HomeMy WebLinkAboutResolutions - 2015.12.09 - 22112FORMAT (PROGRAM/ELEMENT)
SPECIAL REQUIREMENTS
I. Budget and Agreement Requirements - Lists those special funding and agreement requirements
applicable to the program/element as a whole.
II. Grantee Requirements - Lists those special requirements applicable to all agencies
administering the program element.
III. Department Requirements - Lists those special requirements applicable to the Department.
IV. Grantee Specific Requirements - Lists those unique requirements applicable only to the single
Grantee covered by this agreement.
Page 4 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
ADOLESCENT SEXUALLY TRANSMITTED DISEASE (STD) SCREENING
SPECIAL REQUIREMENTS
(OAKLAND COUNTY HEALTH DIVISION)
Grantee Specific Reauirements
Project Summary: Individuals 15-24 years of age will be screened for chlamydia and gonorrhea at
the following Oakland County sites:
1. Oakland County Children's Village Detention
2. Oakland County Children's Village Shelter Care
3. Oakland County Main Jail
4. Oakland County
Utilizing the identified project sites:
1. Test at least 100 adolescents and young adults per month, using NAAT tests for gonorrhea
and chlamydia.
2. Collect race, gender, age, test result, and treatment date for all tests.
3. Refer clients for further health evaluation if indicated.
4. Provide client centered risk reduction plan, promoting abstinence.
5. Treat all positives on site if possible.
6. Contact positive clients that are released prior to treatment with treatment options in
community.
7. Promote self-notification of partners.
8. Analyze and forward data to the Department every quarter.
9. Develop one annual slide set highlighting year end data by demographic variable including
trend data.
10. Continue to promote awareness of prevalence of STDS within adolescent and young
adult populations.
11. Participate in quarterly Michigan Infertility Prevention Project meetings; providing
quarterly screening project data.
BODY ART FACILITY LICENSING
SPECIAL RqQUIREMENTS
Budaet andAareement Reauirements
This agreement is intended to establish a payment schedule to the Grantee, following notification of a
completed inspection and recommendation for issuance of license. The intent is to help offset
costs related to the licensing of a body art facility, when fees are collected from the respective
Grantee's jurisdiction in accordanc6with Section 13101-13111of the Public Health Code, Public Act
149 of 2007, which was updated on December 22, 2010 and is now Public Act 375.
Page 5 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT [II
6/27/15
The Department will reimburse the Grantee on a quarterly basis according to the following criteria:
Initial annual license for a Body Art Facility prior to July 1 $ 261.61
52.32% of state fee
Initial annual license for a Body Art Facility on or after July 1 $130.81
52.32% of state fee
Issue a temporary license for a Body Art Facility $117.72
78.48% of state fee
License renewal prior to December 1 $261.61
52.32% of state fee
License renewal after December 1 $392.42
52.32% of state fee + 52.32% of penalty
Duplicate License $26.16
Payment will be made for those body art facilities that have applied and paid in full to the Department
after the signing of PA 375 (December 22, 2010), following notification of a completed inspection and
recommendation for issuance of license.
Grantee Requirements
The Grantee is authorized to enforce PA 375 and conduct an inspection of all body art facilities under
its jurisdiction, investigate complaints, and enforce licensing regulations and requirements. The
Grantee must complete a Body Art Facility Inspection Report [DCH-1468 (07-09)], as provided by the
Department, or other report form approved by the Department that meets, at minimum, all standards
of the state inspection report. Only body art facilities that have applied for licensure should be
inspected. All body art facilities must be inspected annually. Licenses will only be released from the
Department following notification of a completed inspection and upon recommendation by the
Grantee. Completed inspection reports should be signed by the facility owner and recommendation
for licensure should be forwarded to the Department within two to four weeks following the inspection.
Reports should be entered via the online interface or can be sent to: HIV, Body Art, Tuberculosis and
Viral Hepatitis Section, Division of Communicable Diseases, 201 Townsend Rd, 5th Floor, Lansing,
Michigan 48913. The contact person is Mr. Michael Kucab, who can be reached at 517-335-81685 or
by e-mail at kucabm@michigan.gov .
Department Requirements
The Department will notify the Grantee by email when an applicant has paid for licensure or renewal.
This will serve as the request to the Grantee to perform an inspection. The Department will issue a
license to an applicant upon the recommendation of the Grantee performing the inspection. The
Department will reimburse the Grantee according to this payment schedule to help offset the costs
related to the licensing of the body art facility. Payments will be released quarterly based on the FSR
submitted. The Department will provide a reporting template to be attached to the FSR.
BREAST AND CERVICAL CANCER CONTROL NAVIGATION PROGRAM (BCCCNP)
SPECIAL REQUIREMENTS
Grantee Requirements
The BCCCNP (Breast and Cervical Cancer Control Navigation Program) provides individualized
assistance to low-income women, <250% FPL, in overcoming barriers that may impede their access
Page 6 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
to receiving breast and cervical services. Program services are targeted to women in hard to reach
populations, such as minorities, particularly African American and Native American women, and
women aged 50-64, as well as women who have insurance but do not know how to access the
healthcare system to receive breast or cervical cancer services.
The BCCCNP provides specific services to uninsured, underinsured, and insured women both
within and outside the program.
Breast and/or cervical screening and diagnostic services are provided ONLY to uninsured and
underinsured low-income women enrolled through the program that meet the following criteria:
• Age 21-39; referred from a Family Planning/Title X provider with abnormal Pap test result
requiring diagnostic follow-up to rule out or confirm a cancer diagnosis.
• Age 25-39; referred from a non-BCCCNP provider with a breast abnormality requiring
diagnostic follow-up to rule out or confirm a cancer diagnosis.
• Age 40-64; self-referred, referred from a BCCCNP provider or a non-BCCCNP provider and
requires breast/cervical cancer screening and/or diagnostic services for an identified
abnormality.
The BCCCNP provides navigation services to low-income insured women, not enrolled in the
program, to assist them in accessing the healthcare system so they can receive breast and/or
cervical cancer screening, diagnostic, and/or treatment services through their insurance provider.
For specific BCCCNP requirements, refer to the most current BCCCNP Policies and Procedures
Manual.
BCCCP Make it Your Own (MIY0) Project Funding
The BCCCNP Make It Your Own (MIY0) Project funding has been used by local coordinating
agencies to create individualized education and outreach materials for the agency's BCCCNP
program. These additional funds, approved by the Cancer Prevention and Control Section, will be
allocated during FY16 to the BCCCNP agencies to support printing of education materials from the
MIYO Project. Agencies will distribute to providers and potential program clients.
The BCCCNP MIYO Project funding is NOT subject to the caseload performance requirement.
Therefore, these funds will not be included in the settlement that may be required if screening levels
do not meet budgeted caseload.
The project is overseen by Angela McFall, Contract Manager, who is responsible for reviewing
materials and printing bid costs prior to the agency printing the developed materials.
Page 7 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
CHILDHOOD LEAD POISONING EDUCATION & OUTREACH
SPECIAL REQUIREMENTS
(BERRIEN COUNTY HEALTH DEPARTMENT, DISTRICT HEALTH DEPARTMENT #10, INGHAM
COUNTY HEALTH DEPARTMENT, JACKSON COUNTY HEALTH DEPARTMENT, KENT COUNTY
HEALTH DEPARTMENT, PUBLIC HEALTH, DELTA-MENOMINEE COUNTIES, SAGINAW COUNTY
DEPARTMENT OF PUBLIC HEALTH, ST. CLAIR COUNTY HEALTH DEPARTMENT, WAYNE
COUNTY HEALTH DEPARTMENT)
Purpose
Grantee activities funded by the Department are expected to be focused on educational activities
throughout the prosperity region, with special attention to high risk areas. Continued funding is
contingent on completion of the required activities.
Grantee Requirements
1. Education and training to professionals that serve as distribution channels to families,
especially those living in geographical areas with a higher risk of lead exposure. Training
will include a component on how to engage parents of children at risk for lead poisoning.
Professionals to train must include:
a. WIC staff/consultants
b. Great Start Collaborative partners
c. Great Start Parent Coalition participants
d. Child care providers
2. Distribute, through trainings and other means, an education toolkit developed by the
Department /partners, available through the Department.
3. Participation of at least one representative from each regional project in a learning
community to assess and improve the use of the education toolkit over the course of the
year. Attendance in person is preferred, but participation by conference call/webinar will be
available.
4. A narrative report describing progress made and barriers encountered for each of the
SMART goals and activities outlined in the work plan submitted with the project proposal.
To the extent possible, this narrative should include measurements for each of the SMART
goals and activities. Reports should be submitted to Karen Lishinski:
lishinskik(@snichiqan.qov.
5. Required Reporting due 30 days after the end of each of three quarters
Reporting Time Period Due Date
October 1 — January 31 March 2
February 1— May 31 June 30
June 1 — September 30 October 30
6. Prohibited expenditures
a. These funds may not be used to provide direct health care services such as lead
testing, care coordination, case management, or to provide services such as
environmental investigations or remediation/repair of a dwelling.
b. These funds may not be used to fund other local public health operations.
Page 8 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
CHILDHOOD LEAD POISONING INTERVENTION
SPECIAL REQUIREMENTS
(DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION, KENT COUNTY HEALTH
DEPARTMENT, WAYNE COUNTY HEALTH DEPARTMENT)
Purpose:
Grantee activities funded by the Department are expected to be focused on case management and
intervention activities for children with elevated blood lead levels (above > 2Oug/dL). Continued
funding is contingent on completion of the required activities.
Funding requirements:
1. Funds may be used to provide intervention services in the following locations:
a. Detroit — Detroit
b. Kent County — Grand Rapids
c. Wayne County — Hamtramck and Highland Park
2. Funds may only be used for the following purposes:
a. Administrative support for case management services
b. For children insured by Medicaid, any nursing visits and other case management
services beyond those billable to Medicaid.
c. For children not insured by Medicaid, all nursing visits and other case management
services provided.
Grantee Requirements:
1. Each child in the jurisdiction with a confirmed blood lead level equal to or greater than 20
ug/dL will receive a full complement of case management services. Refer to the most
current "Michigan's Case Management Protocol for Children with a Blood Lead Levels
(venous) Equal to or Greater than 2Oug/dL" for an explanation of required services.
2. Children in the jurisdiction with blood lead levels from 5 to 19 ug/cIL will receive case
management services to the extent that resources allow.
3. Grantee must bill Medicaid for services rendered to Medicaid-insured children, for the
maximum amount possible. For specific information on Medicaid covered services, please
refer to the Medicaid Provider Manual.
4. The Department CLPPP protocol must be followed and standardized case management
forms must be used, for all case management activities.
5. Grantee must participate in quarterly grantee activities as scheduled by the Department
CLPPP.
Required Reporting:
Timely documentation of all case management activities, communications and Medicaid
billing in the Healthy Homes and Lead Poisoning Surveillance System (HHLPSS), in a
manner prescribed by the Department CLPPP.
Prohibited expenditures:
a. Screening or Testing for Blood Lead
b. Billable services for children insured by Medicaid
c. Childhood Lead Poisoning Prevention funds may not be used to fund other local
public health operations.
Page 9 of 96
MDHI-15/G&PD FY 15/16 ATTACHMENT 111
6/27/15
CHILDHOOD LEAD POISONING PREVENTION (CLPPP)
SPECIAL REQUIREMENTS
(DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION, GENESEE COUNTY
HEALTH DEPARTMENT, INGHAM COUNTY HEALTH DEPARTMENT, JACKSON COUNTY
HEALTH DEPARTMENT, KENT COUNTY HEALTH DEPARTMENT, MUSKEGON COUNTY
HEALTH DEPARTMENT„ WAYNE COUNTY HEALTH DEPARTMENT)
Purpose:
Grantee activities funded by the Department are expected to be focused on the prevention of
childhood lead poisoning. The target populations for these activities are children with lead levels 5 to 9
pg/dL, and pregnant women enrolled in Medicaid living in homes built before 1960. The terms of this
contract require funding to be used in high risk communities only (as designated by the Department
CLPPP), and must be used for lead program services only. Continued funding is contingent on
completion of the required activities.
Funding requirements:
Funds may be used to provide prevention services in the following locations:
1. Adrian (Lenawee Co. Health Dept.)
2. Dearborn, Hamtramck and Highland Park (Wayne Co. Health Dept.)
3. Detroit (Detroit Dept. of Health & Wellness Promotion)
4. Flint (Genesee Co. Health Dept.)
5. Grand Rapids, Kentwood and Wyoming (Kent Co. Health Dept.)
6. Jackson and Leoni Township (Jackson Co. Health Dept.)
7. Lansing (Ingham Co. Health Dept.)
8. Muskegon and Muskegon Heights (Muskegon Co. Health Dept.)
Contractor Requirements:
1. (Optional) Expand use of piloted "Rx for Children with Elevated Blood Lead Levels 5 to 14
ug/dL" in provider offices.
2. (Optional) Use Code Enforcement Assessment Tool to continue working with local officials
to improve code enforcement.
3. (Optional) Continue Rental Property Owner education through presentations or other
outreach. Up to 25% of funding can be used to continue activities #1, #2 and #3.
4. (Required) Participate in a Quality Improvement Learning Community organized by
MDHHS CLPPP, to meet quarterly in Lansing. Up to 25% of funding can support this
required activity—i.e., travel and CQI activities developed by the QI Learning Community.
5. (Required) Conduct prevention activities in homes of families with children with blood lead
levels 5 to 9 pg/dL, and in homes of pregnant women enrolled in Medicaid living in homes
built before 1960. Activities may include but are not limited to:
a. Providing information on lead safe cleaning methods
b. Providing lead safe cleaning supplies/equipment
c. Lending HEPA vacuums
d. Creating temporary barriers to possible lead hazards (e.g., window sills, areas of
deteriorating paint
e. Providing direct training and coaching on lead safe cleaning methods
f. Conducting lead safe cleaning in the home
g. Conducting technical clean by trained crew
h. Covering bare soil
Providing help with applications to the Lead Safe Home Program
In carrying out these activities, contractor must coordinate with any care management services
Page 10 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
provided through Medicaid Health Plans.
Contractors are encouraged to involve community partners—e.g., churches, community health
workers, colleges, service organizations, or other community-based agencies—to expand the
scope and reach of these activities.
A minimum of 50% of funds must be used to support these in-home activities.
Required Reporting (due 30 days after the end of each quarter—i.e., due January 30, April 30,
July 30, October 30):
A Lead Prevention Quarterly Report Form will be provided.
1. (If applicable) Provide a log of health care providers to whom the Rx has been distributed,
including provider or clinic name and address, date, and number of pads provided.
2. (If applicable) Provide a narrative description of efforts to bring about best practices.
Attach a copy of the updated Code Enforcement CLP Assessment Tool.
3. (If applicable) Provide the number of presentations to RPOs and the number of attendees,
and/or the number of RPOs reached by mailings or other methods.
4. By 4' quarter, complete at least one CQI project and provide a storyboard per
specifications from MDHHS CLPPP.
5. Use HHLPSS to document prevention activities for children with BLL 5 to 9. Provide a log
of the HHLPSS IDs of those children. Provide a log of prevention activities conducted for
pregnant women, including address, type of activity, date of activity, and who provided the
service.
Prohibited expenditures:
1. Prevention funds may not be used to support Intervention.
2. Screening or Testing for Blood Lead
3. Billable services for children insured by Medicaid
4. Childhood Lead Poisoning Prevention funds may not be used to fund other local public
health operations.
CHILDREN'S SPECIAL HEALTH CARE SERVICES (CSHCS)
SPECIAL REQUIREMENTS
Program Management: Reporting Requirements
The Grantee shall submit:
1. Annual Narrative Progress Report
A brief annual narrative report is due by November 15 following the end of the fiscal year.
The reporting period is October 1 – September 30. The annual report will be submitted to
the Department and shall include:
a. Summary of CSHCS successes and challenges
b. Technical assistance needs the Grantee is requesting the Department to address
c. Brief description of how any local MCH funds allocated to CSHCS were used
(e.g.,CSHCS salaries, outreach materials, mailing costs, etc.) (if applicable)
d. The duplicated number of clients referred for diagnostic evaluations
e. The unduplicated number of CSHCS eligible clients assisted with CSHCS enrollment
f. The unduplicated number of CSHCS clients in the CSHCS renewal process.
Duplicated Number of Clients Referred for Diagnostic Evaluation is defined as:
Number of individuals the Grantee referred for and/or assisted in obtaining a diagnostic
evaluations during the fiscal year. Those eligible for this service must have symptoms and
medical history indicating the information. Individuals currently enrolled in a commercial
Page 11 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
Health Maintenance Organization (HMO), Medicaid Health Plan (MHP) or with other
commercial insurance coverage must seek an evaluation by an appropriate physician sub-
specialist through their respective health insurer.
A diagnostic may be issued for insured persons to cover the cost of the evaluation that is by
policy not covered by the health insurance (e.g. co-pay, deductible).
Unduplicated Number of CSHCS Eligible Clients Assisted with CSHCS Enrollment is
defined as: Number of CSHCS eligible clients the Grantee assisted in the CSHCS enrollment
process during the fiscal year. This assistance includes but is not limited to helping the
family obtain necessary medical reports to determine clinical eligibility, completing the
CSHCS Application for Services, completing the CSHCS financial assessment forms, etc.
"Assisted" refers to help provided either over the telephone or in person with the client.
Unduplicated Number of CSHCS Clients Assisted in the CSHCS Renewal Process is
defined as: Number of CSHCS enrollees the Grantee assisted in the completion and/or
submission of the documents required for the Department to make a determination whether
to continue/renew CSHCS coverage during the fiscal year. "Assisted" refers to help
provided either over the telephone or in person with the client.
2. Quarterly Care Coordination and Case Management Logs
Submit the Care Coordination and Case Management Logs electronically in an encrypted
manner to the Contract Manager. The quarterly logs will be submitted in coordination with
the FSRs no later than thirty (30) days after the close of the quarter.
Quarter Reporting Time Period Quarterly LOCJS Due Date
1 st October 1 — December 31 January 30
2 ' January 1— March 31 April 30
3rd April 1 — June 30 July 30
4th July 1 — September 30 October 30
Unless otherwise stated, all reports and information shall be submitted electronically via the
secure electronic method of communication for sharing of PHI designated by CSHCS
EZ-Link):
Courtney Lawler
Quality & Program Services Section
Children's Special Health Care Services
The Contract Manager shall evaluate the reports submitted as described in A above, for
their completeness and adequacy. The Contract Manager will conduct case management
and care coordination log audits on a quarterly basis.
Relationship between Grantees and Medicaid Health Plans:
The Grantee must establish and maintain care coordination agreements with all Medicaid Health
Plans for CSHCS enrollees in the Grantees service area. Grantees and the Medicaid Health
Plans may share enrollee information to facilitate coordination of care without specific, signed
authorization from the enrollee. The enrollee has given consent to share information for
purposes of payment, treatment and operations as part of the Medicaid Beneficiary Application.
The agreement must address all of the following topics:
a. Data sharing
b. Communication on development of Care Coordination Plan
c. Reporting requirements
d. Quality assurance coordination
e. Grievance and appeal resolution
Page 12 of 96
MDHI-15/G&PD FY 15/16 ATTACHMENT III
6/27/15
f. Dispute resolution
g. Transition planning for youth
Care coordination agreements between Grantees and the Medicaid Health Plans will be available for
review upon request from the MDHHS.
Relationship between Local Public Health Departments and MIChild Health Plans:
The Grantee must establish and maintain care coordination agreements with all MIChild Health
Plans in their jurisdiction. Grantees and the Contractor may share enrollee information to facilitate
coordination of care without specific, signed authorization from the enrollee. The intent of
establishing a written agreement between the M1Child Health Plan and the Grantees is to assure
service coordination and continuity of care for persons receiving services from both
organizations.
The agreement must address all of the following topics:
a. Data sharing
b. Communication on development of Care Coordination Plan
c. Reporting requirements
d. Quality assurance coordination
e. Grievance and appeal resolution
f. Dispute resolution
g. Transition planning for youth
Care coordination agreements between the Grantees and the M1Child Health Plans will be available
for review upon request from the MDHHS.
COMPREHENSIVE CANCER CONTROL (CCC) COMMUNITY
IMPLEMENTATION PROJECT
SPECIAL REQUIREMENTS
(BARRY-EATON DISTRICT HEALTH DEPARTMENT, DISTRICT HEALTH DEPARTMENT #10,
INGHAM COUNTY HEALTH DEPARTMENT)
Program Purpose:
The purpose of this project is to increase local implementation activities for Cancer
Prevention and Control. Projects must include at least one evidence-based strategy.
Strategies should be based upon a recent evaluation of the community's cancer burden and
the community's specific gaps and needs.
Grantee Requirements:
1. Any print or media materials produced by the grant must be reviewed by the Department
prior to products being finalized and distributed.
2. Any print or media materials produced by the grant must include CDC credit language:
"This publication (journal article, etc.) was supported by the Cooperative Agreement
5U58DP003921 from the Centers for Disease Control and Prevention. Its contents are
solely the responsibility of the authors and do not necessarily represent the official views of
the Centers for Disease Control and Prevention."
3. Institutional Review Board approval must be considered for focus groups, surveys and other
similar activities. This should be factored into the project timeline and the Department
should be involved and kept apprised.
Page 13 of 96
M DH HS/G&PD FY 15/16
ATTACHMENT III
6/27/15
4. Quarterly Progress Reports and one Final Report of Results and Program Issues, including
the following information:
Quarter
2'
3rd
4th Final
Report
Reporting Time Period
November 1 — December 31
January 1— March 31
April 1 — June 30
July 1 — September 30
Due Date
no later than January 31
no later than April 30
no later than July 31
no later than October 31
Reports shall be submitted to the Contract Manager at:
Polly A. Hager, MSN RN, Manager
Comprehensive Cancer Control Unit
Cancer Prevention & Control Section
P.O. Box 30195
Lansing, MI 48909
Phone: (517) 335-9729
E-mail: haoerp0,michigan.qov
COUNTY HEALTH RANKINGS & ROADMAPS
SPECIAL REQUIREMENTS
(BENZIE-LEELANAU DISTRICT HEALTH DEPARTMENT, CENTRAL MICHIGAN DISTRICT
HEALTH DEPARTMENT, DISTRICT HEALTH DEPARTMENT #2, DISTRICT HEALTH
DEPARTMENT #10)
March 1 — May 14, 2016
Program Purpose: The purpose of this project is to engage the Local Health Departments to generate
action to improve health within local communities.
Grantee Requirements:
Local Health Departments are asked to identify a project that will focus on increasing awareness
among new stakeholder groups and/or that mobilizes action steps to advance health. Ideally, projects
will serve as a catalyst to actions or new relationships that were not already in process. They should:
• Engage new stakeholders in understanding how they can be partners in improving community
health
• Build or strengthen relationships with partners to identify specific strategies to improve health
• Build local capacity to improve community health
Reporting Requirements:
May 29: Final report of project due to Jon Gonzalez (GonzalezJ6michidan.qov). Note all project
activities must be completed by May 14.
Page 14 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
EAT SAFE FISH
SPECIAL REQUIREMENTS
(BAY COUNTY HEALTH DEPARTMENT)
The Grantee will collaborate with the Department and the EPA Region V Saginaw Community
Information Office to deliver a uniform message for the Saginaw River and connected waters
regarding the fish and wild game consumption advisories within the tri-county area (Midland,
Saginaw, and Bay). Bay County Health Department (BCHD) will develop a plan to distribute that
message using existing health department programs, the medical community, special events, and
community service providers to communicate with the at-risk population. BCHD will get approval from
the Department program manager and for any changes to the Saginaw and Bay County Cooperative
Agreement Scope of Work including budget and budget narratives.
Grantee Reauirements:
The Grantee will provide appropriate staff to fulfill the following objectives and outputs as detailed:
1. Comply with the Saginaw and Bay County Cooperative Agreement budget and
budget narratives as describe in the scopes of work provided to the BCHD program
manager as applicable from October 1 to September 30.
2. Provide 30 hours of health education and community outreach per week.
a. Conduct health education and community outreach in Saginaw, Midland, and Bay
Counties. Activities will include, but not be limited to, internal BCHD distribution,
health care provider outreach, and key event participation.
b. Track hours to comply with cost recovery requirements.
3. Development, Printing, and Distribution of Outreach Materials and implementation of
Display Booth.
a. Identify, track, and record of materials distributed at additional locations within
Midland, Bay, arid Saginaw Counties.
b. Make payment for the replacement of signage on the Tittabawasse and Saginaw
Rivers.
4. Conduct Capacity Building in Saginaw, Midland and Bay Counties
a. Actively seek out new community partners in Saginaw, Midland and Bay Counties.
5. Participate in monthly SBCA teleconference.
6. Track and report output measures.
7. Write and Submit quarterly reports and an annual report to the Department.
a. Submit draft quarterly reports within 15 days after the end of each
quarter.
b. Annual reports upon request.
8. Provide Presentation of display booth at select community events in coordination with EPA
Region V Saginaw Community Information Office.
9. Conduct Outreach though existing BCHD Programs such as WIC, Immunizations, programs
for young mothers, or other programs reaching the target population.
10. Assist the EPA Region V Saginaw Community information Office with community outreach.
11. Outreach to Health Care Providers.
Page 15 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT II
6/27/15
ESSENTIAL. LOCAL PUBLIC HEALTH SERVICES (ELPHS)
SPECIAL REQUIREMENTS (Budget and Aareement Reauirements)
1 State funding for ELPHS shall support and the Grantee shall provide for all of the following
required services in accordance with P.A. 368, of 1978 and P.A. 92 of 2000, as amended, Part
24 and Act No. 336, of 1998 Section 909:
Infectious/Communicable
Disease Control
On-Site Wastewater
Treatment Management
Hearing
Sexually Transmitted
Disease
Drinking Water Supply
Vision
Immunization
Food Service Sanitation
State funding for ELPHS can support administrative cost for the eight required services
including allowable indirect cost, or a Grantee's cost allocation plan.
2. ELPHS funding can also be used to fund other core health functions including: Community
Health Assessment & Improvement, Public Policy Development, Health Services
Administration, Quality Assurance, Creating & Maintaining a Competent Work Force and
Local Public Health Accreditation. These services may be budgeted separately as part of the
Administrative Budget element.
3. Net allowable expenditures are the authorized actual/allowable expenditures (total costs
less specified exclusions). Available funding is also limited by state appropriations.
4. First and second party fees earned in each required service program may be used only in
that required service program.
5. State ELPHS funding is subject to local maintenance of effort compliance distribution of state
ELPHS funds shall only be made to agencies with total local general fund public health
services spending in FY 15116 of at least the amount expended in FY 92/93. To be eligible
for any of the State funding increases from FY 94/95 through FY 15/16, the FY 92/93 Local
Maintenance of Effort Level must be met.
6. A final statewide cost settlement will be performed to assure that all available ELPHS funds
are fully distributed and applied for required services.
Grantee Reauirenients
1. Assure the availability and accessibility of services for the following basic health services:
Prenatal Care; Immunizations; Communicable Disease Control; STD Disease Control;
Tuberculosis Control; Health/Medical Annex of Emergency Preparedness Plan.
2. Fully comply with the Minimum Program Requirements for each of the required services.
3. Grantee will be held to accreditation standards and follow the accreditation process and
schedule established by the Department for the required services to achieve full
accreditation status. Agencies designated as "not accredited" may have their Department
allocations reduced for Departmental costs incurred in the assurance of service delivery.
The accreditation process is based upon the Minimum Program Standards and scheduled
on a three-year cycle. The Minimum Program Standards include the majority of the required
Department reviews. Some additional reviews, as mandated by the funding agency, may
not be included in the Program Standards and may need to be scheduled at other times.
Page 16 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT HI
6/27/15
Department Reauirements
1. Whenever the Department delivers direct services within the Grantee's area, it shall give prior
notification and provide summary reports of those activities upon the request of the Grantee
health officer.
Grantee Specific Reauirements — Food Service Sanitation
fludaet and Agreement Reauirennents
Michigan Department of Agriculture and Rural Development (MDARD) Agrees to:
Food Service Establishment Licensing
1. Furnish pre-printed food service establishment license applications and pre-printed licenses
to the Grantee for each licensing year (May 1 through April 30) using previous year active
license data.
2. Provide a count of all licenses sent to the Grantee titled "Record of Licenses Received."
3. Reprint any licenses requiring correction and send corrected copies to the Grantee.
4. Bill the local health department for state fees upon notification by Grantee that the license
has been approved and issued.
Temporary Food Service Establishment Licensing
1. Furnish blank temporary food service license application forms (forms Fl-231, Fl-231A) and
blank Combined License/Inspection forms (Fl-229) upon request from the local health
department.
a. Furnish a "Record of Licenses Received" with each order of Combined
Licenses/lnspection forms.
b. Periodically reconcile temporary food service establishment licenses sent to the
Grantee with the licenses that have been issued (copy returned to MDARD).
c. Bill the local health department for state fees upon notification by the Grantee
that the license has been approved and issued.
Grantee Reauirements
The Grantee agrees to:
Food Service Establishment Licensing
1. Accept responsibility for all licenses specified in the "Record of Licenses Received."
2. Issue licenses in accordance with the Michigan Food Law 2000, as amended.
3. Provide updates to MDARD on the 1 st and 15th of each month, as necessary to:
a. Provide a list of food service establishments approved for licensure/license issued.
b. Provide a list of food service establishment licenses that have not been approved
for licensure and are considered voided or deleted.
c. Return the actual licenses to MDARD that are to be voided or deleted.
d. Return renewal license applications and licenses that require correction. Mark
the corrections on the renewal application.
Temporary Food Establishment Licensing
1. Upon receipt, sign and return the "Record of Licenses Received" to MDARD.
Page 17 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT Ill
6/27/15
2. Issue licenses in accordance with the Michigan Food Law 2000, as amended.
3. Make every effort to issue temporary food establishment licenses in numerical order.
4. Provide updates to MDARD on the 1 st and 15th of each month, as necessary, to
provide:
a. A copy of each temporary food establishment license issued.
b. A list of lost or voided licenses by license number.
Grantee Specific Reauirements — Private and Type III Drinking Water SUDDIV Reauirements
The Grantee shall perform the following services including but not limited to:
1. Perform water well permitting activities, pre-drilling site reviews, random construction
inspections, and water supply system inspections for code compliance purposes with
qualified individuals classified as sanitarians or equivalent.
2. Assign one individual to be responsible for quarterly reporting of the data and to coordinate
communication with the assigned State staff. Reports shall be submitted no later than fifteen
(15) days following the end of the quarter on forms provided by the State. The report form
EQP 2057( 8/2014) is available on the MDEQ website. All quarterly reports are submitted
directly to the MDEQ address noted on the form.
3. Perform Minimum Program Requirements (MPRs) activities and associated performance
indicators. These are available on the MDEQ website. Guidance regarding the MPRS and
indicators in available in the "Local Health Department Guidance Manual for the Private and
Type ill Drinking Water Supply Program." The guidance manual is available online at
www.michigan.gove/waterwellconstruction
Grantee Specific Reauirements — Private On-Site Wastewater Treatment Management
Proaram Reauirements
The Grantee shall perform the following services for private single- and two-family homes and other
establishments that generate less than 10,000 gallons per day of sanitary sewage:
1. Maintain an up-to-date regulation for on-site wastewater treatment systems (Systems). The
regulation shall be supplemented by established internal policies and procedures. Technical
guidance for staff that defines site suitability requirements, the basis for permit approval
and/or denial, and issues not specifically addressed by the regulation shall be provided.
2. Evaluate all parcels to determine the suitability of the site for the installation of initial
and replacement Systems in accordance with applicable regulation(s). These evaluations
shall be conducted by a trained sanitarian or equivalent and shall consist of a review of the
permit application for the installation of a System and a physical evaluation of the site to
determine suitability.
3. Accurately record on the permit to install the initial or replacement System or on an
attachment to the permit the site conditions for each parcel evaluated including soil profile
data, seasonal high water table, topography, isolation distances, and the available area and
location for initial and replacement Systems. The requirement for identifying a replacement
System applies to issuance of new construction permits only.
4. Issue a permit, prior to construction, in accord with applicable regulation(s) for those sites
that meet the criteria for the installation of a System. The permit shall include a detailed plan
and/or specifications that accurately define the location of the initial or replacement System,
System size, other pertinent construction details, and any documented variances.
Page 18 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
5. Provide and keep on file formal written denials, stating the reason for denial, for those
applications where site conditions are found to be unsuitable.
6. Conduct a construction inspection prior to covering each System to confirm that the
completed System complies with the requirements of the permit that has been issued.
Maintain, on file, an accurate individual record of each inspection conducted during
construction of each system. In limited circumstances where constraints prohibit staff from
completing the required construction inspection in a timely manner, an effective alternate
method to confirm the adequacy of the completed System shall be established. The
effective alternative method shall be utilized for no more than 10 percent of the total number of
final inspections unless specific authorization has been granted by the State for other
percentage. The results of all such inspections or an alternate method shall be clearly
documented.
7. Maintain an organized filing system with retrievable information that includes
documentation regarding all site evaluations, permits issued or denied, final inspection
documentation, and the results of any appeals.
8. Conduct review and approval or rejection of proposed subdivisions, condominiums and also
land divisions under one acre in size for site suitability according to the statutes and
Administrative Rules of the Michigan Department of Environmental Quality (MDEQ).
9. Utilize the State's "Michigan Criteria for Subsurface Sewage Disposal" (Criteria) for Systems
other than private single- and two-family homes that generate less than 10,000 gallons per
day. Systems treating less than 1,000 gallons per day may be approved in accordance with
the Grantee's regulation. Advise the State prior to issuance of a variance from the Criteria.
Variances are only to be issued by the Director of Environmental Health of the Grantee after
consultation with the State. Appeals of any decision of the Grantee pursuant to the Criteria
including systems treating less than 1,000 gallons evaluated in accordance with the
Grantee's regulation shall only be made to the State.
10. Maintain quarterly reports that summarize the total number of parcels evaluated, permits
issued, alternative or engineered plans reviewed, and number of appeals, number of
inspections during construction, number of failed systems evaluated, and number of sewage
complaints received and investigated. The report form EQP 2057a is available on the MDEQ
website. All quarterly reports are to be submitted directly to MDEQ to the address noted on
the form within 15 days following the end of each quarter to the address noted on the form.
11. Review all engineered or alternative System plans. Conduct adequate inspections during
the various phases of construction to ensure proper installation.
12. Collect data at the time of permit issuance when a System has failed to document the
System age, design, site conditions, and other pertinent factors that may have contributed to
the failure of the original System. Evaluations shall record information indicated on the
MDEQ Residential and Non- Residential Failed System Data Collection forms. The results
for all failed Systems evaluated shall be maintained in a retrievable file or database and
summarized in an annual calendar year data report. Annual summaries of failed system
data shall be provided to the MDEQ for input into the state-wide failed system database.
MDEQ Failed System Data Submission Forms (Non Residential and Residential) shall be
provided to the State no later than February 1st of the year following the calendar year for
which the data has been collected.
13. Provide training for staff involved in the Program as necessary to maintain knowledge of
current regulations and internal policies and procedures and to keep staff informed of
Page 19 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT HI
6/27/15
technological improvements and advancements in Systems.
14. Establish and maintain an enforcement process that is utilized to resolve violations of the
Local Entity and/or State's rules and regulations.
15. Maintain complaint forms and a filing system containing results of complaint investigations
and documentation of final resolution. Investigate and respond to all complaints related to
Systems in a timely manner.
FAMILY PLANNING - PREGNANCY PREVENTION
SPECIAL REQUIREMENTS
Grantee Rea u irements
1. The funds appropriated in the current State Public Health Appropriations Act for pregnancy
prevention programs shall not be used to provide abortion counseling, referrals or services,
unless contradicts Title X Federal Law (Title X of the Public Health Service Act).
2. Each delegate grantee must serve a minimum of 95% of proposed Title X users, to access
its total amount of allocated funds. Biannual FPAR data will be used to determine total Title
X users.
3. Title X Family Planning grantees must collect Medicaid. The information must be reported on
the Michigan Table 14, as provided by program, and must be submitted biannually along
with Family Planning Annual Report (FPAR) in an electronic reporting format as prescribed
by the Department.
JReporting Reauirements
The Grantee shall submit Family Planning Annual Reports (FPAR):
Period covered Due to the Department
Mid-Year Report (Jan-June) July 15
Annual Report (Jan-Dec) January 10
FETAL ALCOHOL SPECTRUM DISORDER (FASDI PROJECT1
SPECIAL REQUIREMENTS
(CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT AND PUBLIC HEALTH, DELTA-
MENOMINEE COUNTIES)
Objective: For the project period of October 1 to September 30, the Grantees will collaborate with
the Department to assist local communities with evidence-based activities identified in the FASD
Interagency Strategic Plan, to prevent prenatal alcohol exposure among women of reproductive age
and to refer affected children, birth to 18 years of age, and their families to an FASD Diagnostic
Center for evaluation and intervention for the purpose of improving care and services for women,
infants and families.
Grantee Reau I rements
1. FASD project coordinator (or designee) must participate/attend semi-annual FASD Grantees
Conference Calls provided by the department during FY 15/16.
2. Implement the FASD Interagency Strategic Plan, activities as approved by the department.
3. Produce quarterly and year-end reports using the Uniform Data Collection Tool (UDCT) form
Page 20 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT Ill
6/27/15
provided by the department that provides documentation of the types, numbers and
demographic data including racial data of contacts for screening, motivational interviews
and/or referrals from the grantee's FASD community based program. The UDCT form
is available on the MI E-Grants system. The FASD UDCT quarterly reports are to be
submitted via the MI E-Grants system attached to the FSR. The 4th quarter report, due
October 15, will serve as the year-end report.
Department Reauirements
1. Convene FASD Grantees semi-annual conference calls during FY 15/16 to discuss
progress toward community project goals outlined in the cooperative agreement and provide
technical assistance questions/answers as outlined in the cooperative agreement.
2. Describe and provide resources and updates for the evidence-based interventions required
by this contract.
3. Provide technical assistance for each requirement of this contract.
4. Provide reporting formats for data collection and deliverables.
Reporting Requirements
1. Deliverables are due QUARTERLY and a YEAR-END REPORT will summarize the results of
the contract year. The Grantee shall submit the following reports within 15 days after the
end of each quarter on the following dates:
Quarter End Date Report Due Date
Quarter Reporting Time Period Due Date
1st October 1 — December 31 January 15
2nd January 1— March 31 April 15
3rd April 1 — June 30 July 15
4th July 1 — September 30 October 15
2. The Grantee will collect data using the Uniform Data Collection Tool (UDCT) project
evaluation/data tracking forms to monitor the FASD community program effectiveness.
The Uniform Data Collection Tool (UDCT) is available on MI E-Grants.
3. The Grantee shall submit the following information electronically to the Department FASD
Program via the MI E-Grants system attached to FSR
a, The Grantee must provide documentation that FASD services are tracked for all
individuals referred through the FASD community project program and shall submit a
UDCT Data Tracking Form to be sent at the end of each quarter.
Submit UDCT quarterly & year-end reports via the MI E-Grants system attached to FSR.
Program Contact Information:
Debra Kimball, FASD State Program Coordinator
Michigan Department of Health & Human Services, Division of Family and Community
Health
P.O. Box 30195, Lansing, MI 48909
Phone (517)335-8379 Fax (517)335-8822
Kimballdl@michigan.gov
Page 21 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
FETAL AND INFANT MORTALITY REVIEW TIMM CASE ABSTRACTIONS
SPECIAL REQUIREMENTS
(ALLEGAN COUNTY HEALTH DEPARTMENT, BERRIEN COUNTY HEALTH DEPARTMENT,
CALHOUN COUNTY HEALTH DEPARTMENT, CITY OF DETROIT HEALTH AND WELLNESS,
GENESEE COUNTY HEALTH DEPARTMENT„ INGHAM COUNTY HEALTH DEPARTMENT,
JACKSON COUNTY HEALTH DEPARTMENT, KALAMAZOO COUNTY HEALTH DEPARTMENT,
MACOMB COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY HEALTH DEPARTMENT,
SAGINAW COUNTY HEALTH DEPARTMENT)
Grantee Reauirements
Objective:
To assist local communities to learn from individual cases of fetal and infant death regarding what
factors contribute to poor pregnancy outcome in their community, for the purpose of improving care
and services for women, infants and families.
Key Activities:
Qualified individuals will perform medical record case abstraction for Fetal Infant Mortality Review
to include the following:
1. Review of medical records involved in fetal and infant death to include but not limited to
hospital records, pre-natal records, pediatric records, emergency and medical examiner's
records.
2. Interact with other agencies and service providers involved in infant's death (Ml Department
of Human Services, Child Protective Services, local health department, law enforcement).
3. Develop case summaries from the above abstracted information as well
as the Maternal Interview, using Michigan F1MR Network tools and
guidelines
4. Attend the review team meetings to facilitate the presentation of the cases.
5. Enter cases into access data base and submit cases to MPH for MFIMR data base
Department Requirements
1. Each completed case abstraction will be compensated at $270.00 per case.
2. Department will provide ongoing technical assistance to local FIMR teams for medical
record case abstraction, developing case summaries, maintaining a functioning Case
Review Team, and facilitating moving recommendations to community action.
3. Department provides the statewide F1MR database, administered through MPHI.
Reporting Reauirements
Quarterly progress reports following the template supplied by the FIMR State support program.
Quarterly reports are due the 15th of the month following the end of the quarter and are submitted to
the State coordinator. End of FY final report on cases completed and team findings are submitted to
the State coordinator.
Quarter Reporting Time Period Due Date
1 St
October 1 — December 31 January 15
2nd January 1— March 31 April 15
3rd April 1 — June 30 July 15
4th July 1 — September 30 October 15
Page 22 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
GONOCOCCAL ISOLATE SURVEILLANCE PROJECT (GISP)
SPECIAL REQUIREMENTS
(OAKLAND COUNTY HEALTH DEPARTMENT)
The objectives of this project are:
1. To monitor trends in antimicrobial susceptibilities in N. gonorrhoeae.
2. To characterize male patients with gonorrhea, particularly those infected with N.
gonorrhoeae that are not susceptible to recommended antimicrobials.
3. To phenotypically characterize antimicrobial-resistant isolates to describe the diversity of
antimicrobial resistance in N. gonorrhoeae.
Contractor Requirements
1. Assess each male STD patient for possible gonococcal infection.
2. For each STD clinic male patient suspected of having GC, collect sample using a Modified
Thayer Martin (MTM) plate.
3. For client's with positive isolates, submit specimen to regional lab for susceptibility testing.
4. Assure monthly data reports are completed and submitted to CDC.
J-IIV/STD PARTNER SERVICES PROGRAM
SPECIAL REQUIREMENTS
(CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT)
Grantee Requirements
1. Adhere to all federal and Michigan laws pertaining to HIV/AIDS treatment,
disability accommodations, non-discrimination and confidentiality.
2. Adhere to all federal and state issued guidance and policy for services provided.
3. Adhere to all Michigan Public Health Accreditation Standards
4. Participate in monitoring site visits, if they occur, including review of fiscal and programmatic
compliance with Department's policies and contract requirements.
5. Ensure that records are available for review by the Department auditors, staff and federal
government agencies, if applicable, to monitor performance. Maintain and provide access to
primary source documentation.
6. Establish written procedures for protecting client information kept electronically or in charts or
other paper records. Protection of electronic client-level data will minimally include:
a. Regular back-up of client records with back-up files stored in a secure location;
b. Use of passwords to prevent unauthorized access to the computer or Client Level
Data program;
c. Use of virus protection software to guard against computer viruses; and
d. Provide annual training to staff on security and confidentiality of client level data and
sharing of electronic data files according to the Department policies concerning
Sharing and Secured Electronic Data.
7. Client and service level data is the property of the Department. In the event that services
are no longer delivered under this agreement, electronic data files held outside of the central
HES and/or EvalWeb database must be returned to the Department within 30 days of the
loss of services.
8. Provide immediate notification to the Department, in writing, in the event of any of the
following:
Page 23 of 96
MD1-11-1S/G&PD FY 15/16 ATTACHMENT III
6/27/15
a. Any formal grievance initiated by a service recipient and subsequent resolution of
that grievance.
b. Any event occurring or notice received by the Grantee or subcontractor, that
reasonably suggests that the Grantee or subcontractor may be the subject of, or a
defendant in, legal action. This includes, but is not limited to, events or notices related to
grievances by service recipients or Grantee or subcontractor employees.
c. Provide immediate notification of the Department, in writing, of any staff vacancies that
negatively impact the delivery of services to clients, and/or exceed 30 days.
9. Submit all educational materials (e.g., brochures, posters, pamphlets and videos) used
in conjunction with program activities to the STD/HIV Prevention Program Review Panel for
review and approval prior to their use, if funding is used to purchase these materials.
10. Maintain, for a minimum of four (4) years after the grant period, program, fiscal records,
and client health records including documentation to support program activities
and expenditures, under the terms of this agreement, for clients residing in the State of
Michigan.
Grantee Specific Reauirements
I . Pursuant to a protocol established by the Department, provide positive test notification,
HIV/STD and syphilis partner counseling and referral services, victim notification and
recalcitrant investigation for the following local health departments: Bay County Health
Department, Benzie-Leelanau District Health Department, Central Michigan District Health
Department, Chippewa County Health Department, Dickinson-Iron District Health
Department, District Health Department # 2, District Health Department # 4, District Health
Department #10, Grand Traverse County Health Department, Luce-Mackinac-Alger-
Schoolcraft District Health Department, Marquette County Health Department, Mid-
Michigan District Health Department, Midland County Health Department, Northwest
Michigan Community Health Agency, Public Health, Delta and Menominee Counties, and
Western Upper Peninsula District Health Department.
2. Establish, maintain and document (e.g., via MOU or MOA) linkages with community resources
that are necessary and appropriate to addressing the needs of clients and that are essential
to the success and effectiveness of services supported under this agreement.
3. Provide these services fifty-two weeks a year..
4. The Grantee and its subcontractors are required to use the HIV Event System (HES) and/or
EvalWeb to enter HIV client and service data into the centrally managed database on a secure
server. The collection of all required data variables and the clean-up of any missing data or
service activities should be completed in HES no later than the 15th day after the end of each
calendar quarter.
Department Requirements
1. Provide technical assistance, as requested, .
2. Provide training on HES and/or EvalWeb, Ml E-Grants system and other issues related to
Prevention services.
3. May conduct a site visit, including both fiscal and programmatic review annually, or more
often, if needed. The Department will provide 30 days written notice of the site visit, including
an agenda and the assessment tool.
Page 24 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
)-IIV PREVENTION PROGRAM
SPECIAL REQUIREMENTS
Grantee Reauirements— Cateaorical
1. Grantee will provide HIV counseling, testing and referral and partner services within their
jurisdiction, pursuant to applicable federal and state laws; and policies and program standards
issued by the Department. See "Applicable Laws, Rules, Regulations, Policies, Procedures,
and Manuals."
2. Adhere to all federal and Michigan laws pertaining to HIV/AIDS treatment,
disability accommodations, non-discrimination and confidentiality. See "Applicable Laws,
Rules, Regulations, Policies, Procedures, and Manuals."
3. Adhere to all Michigan Public Health Accreditation Standards. See "Applicable Laws, Rules,
Regulations, Policies, Procedures, and Manuals."
4. Adhere to all federal and state issued guidance(s) and policy(ies) for services provided.
5. Participate in monitoring site visits including review of fiscal and programmatic compliance
with Department policies and contract requirements.
6. Ensure that records are available for review by the Department auditors, staff and federal
government agencies, if applicable, to monitor performance. Maintain and provide access to
primary source documentation.
7. Grantees may enter into subcontracts or vendor agreements to fulfill the service delivery
expectations of this agreement.
a. All subcontracts issued under this funding agreement are subject to the same
requirements as outlined in this agreement and subject to prior approval by the
Department.
b. The Grantee will monitor subcontractors annually to assess compliance with
the subcontract; take primary responsibility to monitor follow-up and remediate in
cases where the subcontracted entity is not in compliance with the contract; report
the results of all contract monitoring activities to the Department.
c. Provide, upon request, a copy of all fully signed subcontracts, memorandums of
understanding (MOUs) or letters of agreement related to the services in this
agreement.
8. Establish written procedures for the confidentiality and security of client information. Per
CDC guidelines, all sub-grantees must adhere to the NCHHSTP data and security
guidelines. Refer to the following link for more details:
http://www.cdc.qovinchhstp/orograminteoration/Data-Security.html .
9. Client and service level data is the property of the Department. In the event that services
are no longer delivered under this agreement, electronic data files held outside of the HES
and/or EvalWeb, must be returned to the Department within 30 days of the loss of services.
10.
Provide immediate notification to the Department, in writing any staff vacancies that negatively
impact the delivery of services to clients, and/or exceed 30 days.
11. Submit all educational materials (e.g., brochures, posters, pamphlets and videos) used
in conjunction with program activities to the HIV Prevention Program Review Panel for review
and approval prior to their use, regardless of the source of funding used to purchase these
materials.
12. Assist the Department in appropriate needs assessment activities.
13. Maintain, for a minimum of four (4) years after the end of the grant period, program, and
Page 25 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
fiscal records, and client health records, including documentation to support program
activities and expenditures, under the terms of this agreement, for clients residing in the State
of Michigan.
Contract Specific Reauirements - Categorical
1. If conducting HIV testing using rapid HIV testing, comply with guidelines and standards issued
by the Department and:
a. Conduct quality assurance activities, guided by written protocol and procedures.
Protocols and procedures, as updated and revised, are to be submitted to the
Department. Quality assurance activities are to be responsive to: Quality Assurance
for Rapid HIV Testing, MDHHS (March 2015, or subsequent revisions).
b. Ensure provision of the local health department's current CLIA certificate.
c. Report discordant test results to the Division of Health, Wellness and Disease
Control.
d. Submit quality control, daily patient logs and test inventory on a monthly basis to the
HIV Care Section Quality Assurance Staff.
e. Ensure that staff performing counseling and/or testing with rapid test technologies
has completed, successfully, rapid test counselor certification course (if applicable), test
device training, and proficiency testing.
f. Ensure that site supervisors have completed, successfully, appropriate laboratory
quality assurance training, blood borne pathogens training and rapid test device
training.
g. Develop, implement and monitor protocol and procedures to ensure that patients
receive confirmatory test results.
2. Grantee must participate in training for new statewide reporting database.
3. The Grantee and its subcontractors are required to use the HIV Event System (HES) and/or
EvalWeb to enter client and service data into the centrally managed database on a secure
server. The collection of all required data variables and the clean-up of any missing data or
th
service activities should be completed in HES and/or EvalWeb no later than the 15 day after
the end of each calendar quarter.
Department Reauirements- Cateaorical
1. The Department will provide rapid HIV test devices and external controls in sufficient quantity
to ensure that HIV testing is provided as a standard of care to clients seeking HIV and STD
prevention and treatment services and to facilitate staff training and proficiency testing. For
FY 15, the quantity of rapid HIV test devices provided by the Department shall not exceed:
Page 26 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
Grantees Maximum # of Rapid
HIV Test Devices
Berrien County Health Department 1,140
Calhoun County Health Department 2,235
Detroit Department of Health and Wellness Promotion 9,020
Genesee County Health Department 3,300
Ingham County Health Department 2,440
Jackson County Health Department 300
Kalamazoo County Health and Community Services 3,340
Kent County Health Department 3,420
Muskegon County Health Department 2,200
Oakland County Health Division 14,420
Saginaw County Health Department 1,620
Washtenaw County Health Department 1,700
Wayne County Health Department 2,200
Van Buren —Cass District Health Department 920
2. Additional quantities of rapid HIV test devices and controls may be made available to Grantee
provided that the Grantee can demonstrate that test devices will be used in a manner
consistent with the general purposes of this agreement and in accordance with approved
program methodologies and predicated upon availability of resources.
3. Provide training and technical assistance in support of implementation of HIV testing as a
standard of care and use of rapid HIV tests.
4. Provide training on HES and/or EvalWeb„ MI E-Grants system and other issues related
to Prevention Services.
5. The Department my conduct a site visit, including both fiscal and programmatic review. The
Department will provide 30 days written notice of the site visit, including an agenda and the
assessment tool.
6. Review on a quarterly basis, HES and/or EvalWeb data. Questions or clarifications,
if any, will be requested within 30 calendar days of submission date.
Grantee Reauirements— Non-Categorical
Grantees that do not receive categorical HIV prevention funds and that elect to conduct HIV testing
may request reimbursement for performing HIV tests. For Grantees that do not receive categorical
AIDS/HIV prevention funds and who elect to conduct HIV testing:
1. Provide HIV Counseling, testing and referral services, pursuant to statute and the
Michigan Public Accreditation Standards.
2. Submit client-level service data to the Department via the HES and/or EvalWeb. The
time line and procedures for submitting these data are to conform to guidelines issued by the
Department.
Page 27 of 96
MDHI-15/G&PD FY 15/16 ATTACHMENT III
6/27/15
Department Reauirements — Non-Categorical
Reimburse Grantees at a rate of $11.00 per test, not to exceed $2,000 for Fiscal Year
15/16.
HIV/AIDS LINKAGE TO CARE
SPECIAL REQUIREMENTS
(BERRIEN COUNTY HEALTH DEPARTMENT)
Grantee Specific Reouirements
1. If funding is available implement annual work plan that describes the objectives, activities,
and measures for work to be performed under this contract. The work plan will include
measurable outcomes for services provided for each funded service.
2. Adhere to all federal and Michigan laws pertaining to HIV/AIDS treatment, disability
accommodations, non-discrimination, and confidentiality.
3. Ryan White is payer of last resort, and as such Grantee must adhere to the Ryan White
HIV/AIDS Treatment Extension Act. See "Applicable Laws, Rules, Regulations, Policies,
Procedures, and Manuals.
4. Adhere to all federal and the Department issued guidance(s) and policy (ies) for services
provided. See "Applicable Laws, Rules, Regulations, Policies, Procedures, and Manuals.
The Department may update and/or add guidance within the contract year. Any new
additions will be supplied to the Grantee by the Department.
5. The Department will monitor Grantee performance throughout the contract year, which may
include a review of financial status reports (FSRs), CAREWare data entries, quarterly
progress reports, and site visits. If a site visit occurs, it will include a review of programmatic,
fiscal, administrative, and client health records to ensure compliance with federal,
Department, and contract requirements. The Department will provide 30 calendar days
written notice of the site visit, including an agenda and the assessment tool to be used. The
Department will provide a written report post-site visit within 45 calendar days. If a plan of
correction is necessary as a result of the site visit, a timeframe for completion will be
provided in the report.
6. Ensure that records are available for review by the Department auditors, staff and federal
government agencies, if applicable, to monitor performance. Maintain and provide access to
primary source documentation.
7. Grantees may enter into subcontracts or vendor agreements to fulfill the service delivery
expectations of this agreement. Grantee must adhere to HRSA Fiscal Monitoring Standard
rules regarding monitoring of subcontracts.
8. Provide notification to the Grants and Contracts Administrator, or designee, of Ryan White-
funded staff vacancies that exceed 30 calendar days.
9. When issuing statements, press releases, requests for proposals, bid solicitations and other
documents describing projects or programs funded in whole or in part with Federal money,
all grantees receiving Federal funds, including but not limited to State and local governments
and recipients of Federal research grants, shall clearly state:
a. The percentage of the total costs of the program or project which will be financed with
Federal money,
b. The dollar amount of Federal funds for the project or program,
c. Percentage and dollar amount of the total costs of the project or program that will be
financed by non-governmental sources.
Page 28 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT HI
6/27/15
10. Participate in the Department needs assessment activities.
11. Maintain, for a minimum of four (4) years after the end of the budget period, program and
-fiscal records and files including documentation to support program activities and
expenditures, under the terms of this agreement.
12. Each employee funded in whole or part with federal funds must record time and effort spent
on the project(s) funded. Policies and procedures must be in place to ensure this occurs.
The staff member must clearly identify the percentage of time devoted to contract activities in
accordance with the approved budget. The percent of effort devoted to the project may vary
from month to month. The percent of effort recorded for Ryan White funds must match the
percentage being claimed on the Ryan White FSR for the same period. In cases where the
percentage of effort of contract staff changes (FTE changes) during the contract period, sub-
recipients must submit a budget modification request to the Department.
13. The grantee and its subcontractors are required to use the HRSA-supported software
CAREWare to enter client and service data into the centrally managed database on a secure
server. Data must include all Part B services delivered to HIV-infected and affected clients.
All data for a particular month must be entered by the 10th of the following month. The
collection of all required data variables and the clean-up of any missing data or service
activities should be completed in CAREWare each month.
14. The grantee will participate in regular grantee meetings which may be: face-to-face,
teleconferences, webinars, etc. The grantee is highly encouraged to participate in other
training offerings and information-sharing opportunities provided by the Department.
Grantee Reporting Requirements
1. To complete the Ryan White Service Report (RSR), a HRSA required annual data report, all
CAREWare data must be complete, cleaned and entered into an online form via the HRSA
Electronic Handbook between March 10 and 20, 2016. The report shall have no more than
5% missing data variables. The report will be closed for any further data entry at end of
business on March 20, 2016.
2. Grantee will submit quarterly progress report, attached to the FSR. Progress reports will
detail progress made on work plan objectives and activities during the reported quarter.
3. If the Grantee provides at least one core medical service, the Grantee will develop a Quality
Management plan and submit it no later than March 31, 2016. Quality Management Plan
guidelines may be obtained from the Department. Quality management activities should
incorporate the principles of continuous quality improvement, including agency leadership
and commitment, staff development and training, participation of staff from all levels and
various disciplines, and systematic selection and ongoing review of performance criteria,
including consumer satisfaction. A contact person shall be designated by the Grantee for
quality management activities and correspondence.
Page 29 of 96
MDH1-15/G&PD FY 15/16
ATTACHMENT III
6/27/15
4. Allocations reports are required three times each year to identify expenses by Ryan White
Service Category. These must be submitted according to the following schedule:
Report How to Submit Due Date
Planned Allocation by Service
Category of FY15/16 Budget
To MDHHS HIV Care Section
Grants and Contracts
Administrator or designee.
October 30
Allocation of Actual Six Month
FYI 5/16 Expenditures by
Service Category
Attached to FSR April 30
Allocation of Actual FY15/16
Year End Expenditures by
Service Category
Attached to FSR October 31
Work plan of funded services
developed in consultation with
HIV Care Section Staff
Attached in Budget tab in
Application
August 17, with
Application
5. Administrative Costs and Program Income must be reported quarterly, attached to the FSR. The
Department will supply these templates to the Grantee.
• 1st Quarter: January 30
• 2nd Quarter: April 30
• 3rd Quarter: July 30
• 4th Quarter: November 15
Department Requirements
1. The Department will provide technical assistance, as requested, on the implementation of
the Ryan White Part B program. This may include technical assistance related to:
CAREWare, Quality Management, Programs, Budget/Fiscal, Grants and Contracts, ADAP,
or other activities related to carrying out Ryan White Part B activities.
2. The Department will monitor Grantee performance throughout the contract year, which may
include a review of financial status reports (FSRs), CAREWare data entries, quarterly
progress reports, and site visits. If a site visit occurs, it will include a review of
programmatic, fiscal, administrative, and client health records. The Department will provide
30 calendar days written notice of the site visit and a written report post-site visit within 45
calendar days.
3. The Department will review quarterly reports. Questions or clarifications, if any, will be
requested within 30 calendar days of submission due date.
HIV RYAN WHITE PART B
SPECIAL REQUIREMENTS
(CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT, INGHAM COUNTY HEALTH DEPARTMENT,
MARQUETTE COUNTY HEALTH DEPARTMENT)
Grantee Specific Requirements
1. If funding is available, implement annual work plan that describes the objectives, activities and
Page 30 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT ill
6/27/15
measures for work to be performed under this agreement. The workplan will include
measurable outcomes for services provided for each funded service.
2. Adhere to all federal and Michigan laws pertaining to I-IIV/AIDS treatment, disability
accommodations, non-discrimination and confidentiality. Ryan White is payer of last resort, as
such, Grantee must adhere to the Ryan White HIV/AIDS Treatment Extension Act. See
"Applicable Laws, Rules, Regulations, Policies, Procedures and Manuals."
3. Adhere to all federal and Department issued guidance(s) and policy(ies) for
services provided. See "Applicable Laws, Rules, Regulations, Policies, Procedures and
Manuals."
4. The Department will monitor Grantee performance throughout the contract year, which may
include a review of financial status reports (FSRs), CAREWare data entries, quarterly progress
reports, and site visits. If a site visit occurs, it will include a review of fiscal, program,
administrative, and client health records to ensure compliance with federal, Department, and
contract requirements. The Department will provide 30 calendar days written notice of the site
visit, including an agenda and the assessment tool to be used. The Department will provide a
written report post-site visit within 45 calendar days. If a plan of correction is necessary as a
result of the site visit, a timeframe for completion will be provided in the report.
5. Ensure that records are available for review by the Department auditors, staff and federal
government agencies, if applicable, to monitor performance. Maintain and provide access to
primary source documentation.
6. Grantees may enter into subcontracts or vendor agreements to fulfill the service delivery
expectations of this agreement. Grantee must adhere to HRSA Fiscal Monitoring Standard
rules regarding monitoring of subcontracts.
7. Provide immediate notification to the Grants and Contracts Administrator, or designee of Ryan
White-funded staff vacancies the exceed 30 calendar days.
8. When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
money, all grantees receiving Federal funds, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state:
a. The percentage of the total costs of the program or project which will be financed with
Federal money.
b. The dollar amount of Federal funds for the project or program.
c. Percentage and dollar amount of the total costs of the project or program that will be
financed by non-governmental sources.
9. Participate in the Department needs assessment activities.
10. Maintain, for a minimum of four (4) after the end of the budget period, program and
fiscal records and files including documentation to support program activities and
expenditures, under the terms of this agreement.
11. Each employee funded in whole or part with federal funds must record time and effort spent
on the project(s) funded. Policies and procedures must be in place to ensure this occurs.
The staff member must clearly identify the percentage of time devoted to contract activities
in accordance with the approved budget. The percent of effort devoted to the project may
vary from month to month. The percent of effort recorded for Ryan White funds must match
the percentage being claimed on the Ryan White voucher for the same period. In cases
where the percentage of effort of contract staff changes (FTE changes) during the contract
period, sub-recipients must submit a budget modification request to the Department.
Page 31 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
12. The Grantee and its subcontractors are required to use the HRSA-supported software
CAREWare to enter client and service data into the centrally managed database on a secure
server. Data must include all all Part B eligible services delivered to HIV-infected or affected
clients. All data of a particular month must be entered by the 10 th of the following month.. The
collection of all required data variables and the clean-up of any missing data or service
activities should be completed in CARE Ware each month.
Grantee Reporting Requirements
1. To complete the Ryan White Service Report (RSR), a HRSA required annual data report,
all CAREWare data must be complete, cleaned and entered into an online form via the
HRSA Electronic Handbook between March 10 and 20, 2016. The report shall have not
more than 5% missing data variables. The report will be closed for any further data entry at
end of business on March 20, 2016.
2. Grantees will submit quarterly progress report, attached to the FSR. Progress reports will
detail progress made on work plan objectives and activities during the reported quarter.
3. If the Grantee provides at least one core medical service, the Grantee will develop a Quality
Management plan and submit it no later than March 31, 2016. Quality Management Plan
guidelines may be obtained from the Department. Quality management activities should
incorporate the principles of continuous quality improvement, including agency leadership and
commitment, staff development and training, participation of staff from all levels and various
disciplines, and systematic selection and ongoing review of performance criteria, including
consumer satisfaction. A contact person shall be designated by the Grantee for quality
management activities and correspondence.
4. Allocations reports are required three times each year to identify expenses by Ryan White
Service Category. These must be submitted according to the following schedule:
Report How to Submit Due Date
Planned Allocation by Service
Category of FYI 5/16 Budget
To MDHHS HIV Care
Section Grants and
Contracts Administrator
or designee
October 30
Allocation of Actual Six Month
FYI 5/16 Expenditures by
Service Category
Attached to FSR April 30
Allocation of Actual FY15/16
Year End Expenditures by
Service Category
Attached to FSR October 31
Work plan of funded services
developed in consulation with
HIV Care Section Staff
Attached in Budget tab
in Application
August 17, with
Application
5. Administrative Costs and Program Income must be reported quarterly, attached to the FSR.
The Department will supply these templates to the Grantee.
• lst Quarter: January 30
• 2" Quarter: April 30
• 3rd Quarter: July 30
• 41h Quarter: November 15
Page 32 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT IL
6/27/15
Department Requirements
The Department will provide technical assistance, as requested, on the implementation of the
Ryan White Part B program. This may include technical assistance related to: CAREWare,
Quality Management, Programs, Budget/Fiscal, Grants and Contracts, ADAP, or other
activities related to carrying out Ryan White Part B activities.
2. The Department will monitor Grantee performance throughout the contract year, which may
include a review of financial status reports (FSRs), CAREWare data entries, quarterly progress
reports, and site visits. If a site visit occurs, it will include a review of programmatic, fiscal,
administrative, and client health records. The Department will provide 30 calendar days
written notice of the site visit and a written report post-site visit within 45 calendar days. The
Department will review quarterly reports. Questions or clarifications, if any, will be requested
within 30 calendar days of submission due date.
RYAN WHITE PART B SPECIAL REQUIREMENTS
COORDINATED STATE PLANNING
(CITY OF DETROIT DEPARTMENT OF HEALTH WELLNESS AND PROMOTION)
The City of Detroit Department of Health Wellness and Promotion will provide program planning,
development and evaluation support to the MDHHS Ryan White Part B program to ensure SE
Michigan representation in state planning efforts.
Grantee Requirements:
This project will promote cost-effective program planning support and ensure integration of SE
Michigan community planning and state Ryan White Planning and Implementation efforts.
1. Provide staff support to MDHHS and SE Michigan in the completion of a Statewide HIV Needs
Assessment and Planning process.
2. Participate in state advisory meetings to integrate planning efforts.
3. Serve as the liaison to SE Michigan agencies to assure adequate representation in completion
of the State Needs Assessment process.
4. Provide education and outreach to SE Michigan agencies to facilitate discussion and
troubleshoot issues, concerns and recommendations from the agency contracted to complete
the Statewide HIV Needs Assessment.
5. Assist in the review and evaluation of the results of the Needs Assessment.
6. Coordinate with MDHHS to update the integrated HIV Care and Prevention Plan.
7. Distribute results of Statewide HIV needs Assessment to SE Michigan funded agencies.
8. Assist MDHHS in distribution of the state HIV Comprehensive Plan.
9. Serve on the State CAREWare Users group to improve data reporting, integration and sharing.
10. .Provide CAREWare assistance to SE Michigan area in the merger of the City CAREWare
database with the State of Michigan CAREWare database.
11. Ensure that records are available for review by MDHHS auditors, staff and federal
government agencies, if applicable, to monitor performance. Maintain and provide access to
primary source documentation.
12. Maintain, for a minimum of f o U r (4 ) , fiscal records and files including source
documentation.
13. Adhere to all federal and the Department issued guidance's and policies for services provided.
See "Applicable Laws, Rules, Regulations, Policies, Procedures and Manual." The
Department may update and/or add guidance within the contract year. Any new additions will
be supplied to you by the Department.
Page 33 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
14. A bi-annual and annual report will be required.Submit reports as an attachment to second and
fourth quarter FSRs.
2' Quarter: April 30'
4th Quarter: November 15th
Department Requirements:
1. The Department will coordinate the merger and development of a State CAREWare database.
2. The Department will review bi-annual reports. Questions or clarifications, if any, will be
requested within 45 calendar days of submission due date.
3. DHWP agrees to sharing and usage of Ryan White Part A in the development,
implementation, and rollout of a merged CAREWare Statewide database.
HIV SURVEILLANCE SUPPORT PROGRAM
SPECIAL REQUIREMENTS
(OAKLAND COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION)
Grantee Requirements:
Provide the resources necessary to house the Department's HIV Surveillance Staff at the South
Oakland Health Center, 27725 Greenfield Road, Southfield, MI 48076. Support includes overhead
costs for the office space and includes costs and technical support for phone and technology lines.
Department Requirements:
Reimburse the Grantee for costs associated with the location of the State KV Office in the South
Oakland Health Center as reflected in the attachment to the Comprehensive Agreement.
HOUSING OPPORTUNITIES FOR PERSONS LIVING WITH HIV/AIDS (HOPWA)
SPECIAL REQUIREMENTS
(MARQUETTE COUNTY HEALTH DEPARTMENT)
pudaet and Aureement Requirements
HOPWA PROGRAM OVERVIEW
The Housing Opportunities for Persons with AIDS (HOPWA) program provides housing assistance
and related supportive services for low-income persons living with HIV/AIDS and their families. The
HOPWA program helps eligible clients improve their health by providing stable housing as a basis
for increased participation in the coordinated delivery of supportive services. These services may
involve support with their daily living activities; case management; substance abuse treatment and
counseling; and other services, to help beneficiaries maintain appropriate housing and access other
needed support. HOPWA clients very often use a range of health and supportive services funded by
HHS through the Ryan White Care Act and other public or private support, which will improve their
ability to participate in health care and access other supportive services.
A. HOPWA Eligibility
An eligible person means a person with acquired immunodeficiency syndrome or
related diseases who is below 80% median income. A family member regardless of
income is eligible to receive housing information services. Any person living in proximity to a
community residence is eligible to participate in that residence's community outreach and
educational activities regarding AIDS or related diseases. Within the population eligible for
this program, nondiscrimination and equal opportunity regulations must be followed, including
Page 34 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
fair housing and affirmative outreach. A project sponsor and all Grantees and subcontractors
must adopt procedures to ensure that all persons who qualify for the assistance, regardless
of their race, color, religion, sex, age, national origin, familial status, or handicap, know of the
availability of the HOPWA program, including facilities and services accessible to persons
with a handicap, and maintain evidence of implementation of the procedures.
HIV Status Determination
HIV status must be documented for each client, subject to confidentiality procedures.
Acceptable forms of documentation include the following:
• Documentation from a health professional qualified to make such a
determination.
• Documentation from an HIV test conducted by a physician, community
health center or HIV counseling center.
Income Determination
Household Income must be determined and verified prior to housing assistance being
provided and annually thereafter. Income determination includes all members of the
household.
Nondiscrimination and eaual opportunity
Within the population eligible for this program, the nondiscrimination and equal opportunity
requirements apply including Fair Housing and Affirmative Outreach. Affirmative outreach
requires that a project sponsor must adopt procedures to ensure that all persons who qualify
for the assistance, regardless of their race, color, religion, sex, age, national origin, familial
status, or handicap, know of the availability of the HOPWA program, including facilities and
services accessible to persons with a handicap, and maintain evidence of implementation of
the procedures.
B. Allowable Use of Funds
Funds may be used to assist all forms of housing designed to prevent homelessness. This
includes emergency housing, shared housing arrangements, apartments, single room
occupancy (SRO) dwellings, and community residences. It includes assistance to remain in
current homes, whether owned or rented, and assistance in relocating to another home if
needed. In the Department's HOPWA program, housing options have been limited by
excluding the construction, purchase or renovation of a structure by HOPWA Sponsors or to
establish a Facility-based housing option.
The following activities may be carried out with HOPWA funds:
a. HOUSING SUBSIDY ASSISTANCE
i. Tenant Based Rental Assistance (TBRA): Subsidy for use on the open rental
market. Tenant holds lease to unit rented at or under Fair Market rent (FMR), is
documented to be Rent Reasonable, and meets Housing Quality Standards
(HQS) or HOPWA Habitability Standards. Calculation of utility allowances as
needed.
ii. Short-Term Rent, Mortgage and Utility (STRMU) payments: Subsidy to
prevent homelessness of mortgagers or renters in their current place of
residence. Persons cannot be homeless and the subsidy is limited to 21-weeks in
any 52-week period.
Page 35 of 96
MDFIFIS/G&PD FY 15/16 ATTACHMENT III
6/27/15
Permanent Housing Placement: Expenditures that help establish a household
in a housing unit. May include application fees, related credit check fees,
reasonable security deposits (limited to amount equal to two months rent), and
one-time utility connection fees. Provide counseling in understanding a
residential lease and its obligations, and mediation of disputes.
b. SUPPORT SERVICES.
Housing Case management: The goal is to establish stable permanent housing
and prevent homelessness. It is expected that many of the services needed by
the client will be provided by other staff or assistance agencies via referral from
the Housing Case Manager. Housing Case management may include directly or
through other agencies: client advocacy; assistance with access to local, State,
and Federal government benefits(SSI/SSDI application using the SOAR model);
assistance completing the housing application and assessment form; assistance
with developing a budget; assuring that all required forms and documents are
completed fully and in a timely manner; Fair housing counseling for eligible
persons who may encounter discrimination on the basis of race, color, religion,
sex, age, national origin, familial status, or handicap.
Other Support Services: Assistance obtaining other support services needed.
HOPWA funded Support Services are limited to categories in the CAPER:
Adult Day Care & personal assistance; Alcohol and Drug abuse services
outreach, Child Care and other child services; Education; life skills
management; education; Legal services; Transportation; Mental Health
services; Meals and nutritional services; Health/medical/intensive care
services if approved by DCH/HUD (conform with 24CFR 574.310) and health
services may only be provided to individuals with acquired immunodeficiency
syndrome or related diseases and not to family members of these
individuals. HOPWA cannot fund services already available through other
agencies or funding sources.
c. HOUSING INFORMATION SERVICES
1. Housing Information Services: Information and referral services to assist
eligible persons and their families with locating, acquiring, financing and
maintaining housing. Activities may include housing counseling, housing
advocacy, housing search assistance, etc.
d. GRANT ADMINISTRATION AND OTHER ACTIVITIES
Resource Identification: Activities to establish, develop, and coordinate
housing assistance resources. This can include attending Continuum of Care
meetings, meeting with landlord associations, etc. Does not include any client
contact activities
Administration: General management, oversight, coordination, evaluation, and
reporting on eligible activities. Such costs do not include costs directly related
to carrying out eligible activities, since those costs are eligible as part of the
activity delivery costs of such activities.
C. DCH will determine the total budget for HOPWA. Sponsors, in consultation with the
HOPWA Specialist will determine the estimated funding amounts for each activity (See
Operating Year Budget and Plan). Deviations in funded amounts of activity categories
are allowed as long as the total contract amount is not exceeded and the DCH HOPWA
Page 36 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
Specialist is notified. Deviations over 5% of the Activity budget must be approved by the
DCH HOPWA Specialist. Expenditures for Administration cannot exceed 7% of the total
budget as it is fixed at 7% by law.
A formal amendment is required to request an increase in the total contractual amount.
Grantee Reauirements
A. The HOPWA OPERATING YEAR PLAN and OPERATING YEAR BUDGET.
The HOPWA Operating Year is July 1st through June 30th. This coincides with the
Reporting Year for HOPWA. The annual report, the Consolidated Annual Performance
and Evaluation Report (CAPER), must report on the funds expended, household
demographics, and answers to narrative questions concerning the households assisted
during this Operating / Reporting Year. DCH is reimbursed by HUD according to the
Operating Year and Budget.
HUD notifies the HOPWA Consolidated Plan Lead Agency Michigan State Housing
Development Authority (MSHDA for the Michigan HOPWA program of the total HOPWA grant
amount available. This notification usually occurs between February and the end of March
(although at times it has been later). DCH administrative staff will review the grant funds
available and the DCH HOPWA Specialist will notify each sponsor of the planned amount of
funding for the HOPWA Operating year for each sponsor. The HOPWA Specialist will send
each Sponsor instructions for completing the Operating Year Narrative Plan and Operating
Year Budget. In consultation with and assistance from the HOPWA Specialist, the Sponsor
will determine the estimated Operating year budget amounts for each allowed HOPWA
Activity and complete the narrative Operating Year Plan covering July 1, through June 30.
This Operating year Budget and Plan is to be submitted to DCH by with the Fiscal Year
contract.
NOTE: The 1st quarter of the HOPWA Operating year (July 1 to September 30) will be the
amount of funds remaining from the previous fiscal year contract with DCH. The amount for
the balance of the Operating Year Budget (October 1 to June 30) will generally be calculated
as 3 quarters of the new Fiscal Year (October 1 to September 30) budget. This plan, along
with an annual report (the CAPER), data from ongoing HMIS (or other) data collection
systems and the Grantees FSR Supplemental Forms, will provide the Department with
information to satisfy most federal reporting requirements, carry out monitoring activities, and
assure that departmental goals for this program can be met. See Operational Plan Details.
The Operating Year Plan and Budget are to be returned to DCH with the new Fiscal Year
contract — generally in August. An electronic copy of the Operating Year Budget in Excel
format must be submitted electronically to: ebys@michigan.gov
B. Fiscal Year Contract and Budget
The Department's Fiscal Year runs from October 1 through September 30. The Fiscal Year
contract from DCH is sent to Health Department Sponsors via the MI E-Grants
system in early July. The contract in the MI E-Grants system needs to be completed
and returned to DCH within 2 weeks of receipt of the MI E-Grants system contract.
Page 37 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
Billing for HOPWA reimbursement will involve completing a DCH FSR form and
attaching the HOPWA FSR Supplemental form (attached). The FSR for HOPWA
will not be reimbursed without the FSR Supplemental form. The pages of the FSR-
Supplemental form must be attached in the MI E-Grants system in an Excel format.
C. GRANTEE SERVICE REQUIREMENTS
Project Sponsors must assure access to HOPWA assistance in their assigned service area.
Qualified households from outside the Sponsor's assigned service area but seeking assistance
from your service area are to be assisted. (See attached 'Service Areas' page).
The Grantee must assure that all persons living with HIV/AIDS (PLWH/A) and seeking housing
assistance must be provided Housing Information Services. To the extent that
HOPWA funds are available, persons seeking housing assistance are to be provided:
a. DIRECT HOUSING ASSITANCE: Tenant Based Rental Assistance (TBRA), Short-
Term Rent, Mortgage and Utility (STRMU), and Permanent Housing Placement
Services. See descriptions above.
b. SUPPORT SERVICES: Housing Case Management and Other Support Services.
See descriptions above.
c. HOUSING INFORMATION SERVICES: Housing Information Services. See
description above.
d. GRANT ADMINISTRATION AND OTHER ACTIVITIES: Resource Identification.
See description above.
D. Reporting and Data Collection
Submission of the FSR and the FSR Supplemental Forms for reimbursement per the billing
instructions, the collection of data used for the annual HOPWA report, the CAPER, and
collection of data required by standards regarding eligibility, HIV status, and documentation of
provision of required/needed services.
In order to submit the Michigan CAPER report, HOPWA Sponsors are required to obtain a
DUNS (Data Universal Numbering System) number and) obtain an account with the System
for Award Management (SAM) https://www.gam.gov/portal/public/SAM/ The SAM Service Desk
is at URL: http://vwmFSD.gov. If you had an active record in CCR, you have an active record in
SAM. You do not need to do anything in SAM at this time, unless a change in your business
circumstances requires updates to your Entity record(s) in order for you to be paid or to receive
an award or you need to renew your Entity(s) prior to its expiration. SAM will send notifications
to the registered user via email 60, 30, and 15 days prior to expiration of the Entity. To update or
renew your Entity records(s) in SAM you will need to create a SAM User Account and link it to
your migrated Entity records. You do not need a user account to search for registered entities in
SAM by typing the DUNS number or business name into the search box.
References: Section 872 of the National Defense Authorization Act, the American Recovery
and Reinvestment Act (ARRA) and the Federal Funding Accountability and Transparency
Act (FFATA).
a. Sponsors must fully implement HUD's Measurement of Performance Outcomes
Reporting Requirements. Data collected must include all data required for the
HOPWA Consolidated Annual Performance and Evaluation Report (CAPER) Exp.
Currently the plan is that the demographic will be collected in the HMIS System and
Page 38 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
use of HMIS must continue until another DCH approved data collection system is
approved. Data not collected in HMIS must be collected and reported by the Sponsor
to the HOPWA Specialist.. Data must be internally consistent and complete per Data
Quality checks and consistent with data obtained via FSRs, FSR Supplemental forms
and any monitoring of records. Data not obtainable from HMIS (Financial data) must
be provided directly from Sponsor records to the DCH HOPWA Specialist. Data and
answers to Narrative questions will be combined and summarized by the HOPWA
Specialist for the Michigan CAPER. Separate CAPER reports for each Sponsor will
be created by the Integrated Disbursement and Information System (I DIS), therefore
all narrative questions applicable to the Sponsor must be complete.
b. Staff are required to attend offered HMIS training to increase skills and use of HMIS or
another approved data collection system that DCH is using. Staff assigned to
complete data entry into HMIS and/or run HMIS reports are to attend the HOPWA HMIS
Webinars.
c. The project sponsor agrees, to Staff assigned to complete data entry into HMIS and/or
run HMIS reports are to attend the HOPWA HMIS Webinars of the HOPWA Financial
Management Online Training
http://www.hudhre.info/index.cfm?do=viewHopwaFinancialTrainino, or to demonstrate
financial management capacity by the use of other credentials related to Federal
requirements at 24 C.F.R. 85.20, as specified in a HUD- approved plan. If the HOPWA
Financial Management trained staff leaves the Sponsor's employment, another staff
must complete the HOPWA Financial Management training within 90 days.
d. Sponsors and staff will work cooperatively with DCH and provide staff time to
develop HUD required Policies and Procedures to be used by all sponsors and to
develop and/or revise required HOPWA forms. The current mandatory forms in use
include but which may be modified during the operating year include:
i. Conflict of Interest Assurances — included with the contract. Must be signed
and returned each year.
ii. Housing Application & Assessment
iii. Client File Documentation-STRMU assistance
iv. Client Budget Worksheet
v. DCH HOPWA Habitability Standards inspection form (TBRA) with Lead based
paint Acknowledgement form when required
vi. Zero Income Affidavit
vii. Client File Contents Checklist — TBRA
viii. Client File Contents Checklist — STRMU
Additional forms and documents that must be used and filed in the client record
include those that are needed to verify:
i. HIV Status.
ii. Status of Disability.
Releases of Information completed.
iv. Household Income and HOPWA financial eligibility (Pay stubs, Benefit letters or
copies of checks, copy of checking and savings account statements, Median
Income documents; etc.).
v. Home ownership or lease responsibility.
vi. Expenditures claimed. For Example: lease/house payment; taxes; payments
Page 39 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
for home/apartment/vehicle/life insurance; vehicle debt & payments; credit
card debt & payments; phone, cable, TV expenses; utilities that are not part of
the lease; other personal debts owed & the payments; etc.
vii. Estimates of Other expenditures. For example: food, out of pocket medical
expenses, gas & vehicle repairs, bus or other transportation costs, Household
supplies, cigarette & entertainment expenses, etc.
viii. Calculation and determination of Household Median Income with published
current HUD/MSHDA Median Incomes for the county of residence.
ix. Calculation of adjusted income.
x. Shared Housing Rent Calculation.
xi. Income and Rent Calculation including current Utility Allowance calculation
with Utility Allowance documents for the county of residence.
xii. Domestic Partnership Declaration.
Ail. Client Housing Plan that includes: Need(s) identified — the reason(s) this
household needs HOPWA housing assistance at this time, what precipitated the
current situation; eligibility status; current type of housing, make-up of
Household; analysis of income, expenditures; a monthly budget; specific goals
with measureable short term tasks to meet the goal(s); responsibility for
completing tasks. Must be regular updates on the Plan (can be a call to check
on status of the completion of a task, questions about any household changes,
etc. The Plan should address immediate needs first then move on to longer
term goals of increasing income, benefits, skills, job training, education, etc.
Also address ways to decrease expenses and/or reduce barriers to housing
stability. All households should be required to apply for all other supported
housing options.
xiv. Current Fair Market rent (FMR) form for county of residence.
xv. Verification of Rent Reasonableness.
xvi. Receipt of Grievance policy form and a Client Termination of Services policy that
includes the involvement of DCH as needed. A copy must be kept in the client
record.
Current Documents and Forms are subject to review and modification with
DCH approval. HOPWA Client forms and documents must be collected/filed
so that they are easily assessable (table of contents, location of document in
file — use of tabs) legible and signed and dated as needed, and renewed
annually as specified in policies and procedures.
Documents may be kept electronically with DCH approval. Grantee must
have a plan to meet concerns for security, confidentiality, ease of use for
monitoring, and data back-up as needed. Sponsors must have a backup of
HMIS client access codes.
e. All forms, policies and procedures are subject to review by the HUD Field Office.
Page 40 of 96
NADHHS/G&PD FY 15/16
ATTACHMENT UI
6/27/15
Grantee Specific Reauirements
1. All Project sponsors using grant funds to provide housing must adhere to the following
standards:
A. Ensure that qualified available, mainstream service providers in the area make
available appropriate supportive services to the individuals assisted with housing
assistance through HOPWA. If services are denied or unavailable, notify the Grantee
in writing specifying denials or unavailability of the support services. Monthly
summary reports are adequate. If available, qualified Sponsor staff may provide these
needed support services as a last resort.
B. For any individual with acquired immunodeficiency syndrome or a related disease
who requires more intensive care than can be provided in housing assisted under
HOPWA, the project sponsor shall provide assistance in locating a care provider who
can appropriately care for the individual and for referring the individual to the care
provider.
C. Ensure that grant funds will not be used to make payments for health services for any
item or service to the extent that payment has been made, or can reasonably be
expected to be made, with respect to that item or service: under any State
compensation program; under an insurance policy; under any Federal or State health
benefits program; or by an entity that provides health services.
D. Operate the program in accordance with the provision of 24 CFR 574 and other
applicable HUD regulations. Prior to dispensing HOPWA direct housing assistance
and at least annually thereafter, document the eligibility of each person receiving
HOPWA benefits: To include documentation of HIV status of the eligible individual
and verification of income of all members of the household (household income to be
less than 80% of area Median income).
E. Keep records and reports which are consistent with the information required by the
current Consolidated Annual Performance and Evaluation Report (CAPER) as
requested by the Department through the operating year Annual reports for HOPWA.
Implement the Uniform Reporting System which includes data regarding HOPWA
eligible persons and information needed for the CAPER. Submit needed financial
data for the CAPER and have HMIS data fully available in HMIS for the operating
year July 1 through June 30.
F. Participate with the Department in facilitating and conducting site visits. Comply with
on-site and/or remote monitoring of their program. Monitoring may include but not
limited to reviews of: Housing Applications and Assessment forms; documentation of
eligibility — documentation of household income, number of persons in the household,
HIV status; housing habitability inspection reports; tracking of TBRA & STRMU
expenditures and the 21 week limit for STRMU; current conflict of interest statement;
use of DCH specified mandatory forms; documentation relating to the annual report
data; tracking of program income (tenant co- pay for TBRA; returned security
deposits); adequate documentation of expenditures, etc.
G. Provide services in accordance with an approved housing plan and comply with
reporting requirements as specified by law, HUD and/or the Department.
H. Retain documentation of the rental subsidy payment calculations, Habitability
inspections, and for repayment of security deposits and other HOPWA records for a
Page 41 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
period of 4 years. Disposal of confidential records must assure confidentiality. Keep
a record of their destruction.
The Department of Housing and Urban Development has insisted that all employee
costs that are to be billed to the HOPWA grant be documented through the use of a
time sheet. All time/costs billed to the HOPWA grant must be documented and
readily available to HUD and the Department staff. This includes calculations of
salaries, fringe benefits, and in-direct costs as allowed. Rather than specify a
particular format, the Department requires only that the tracking document conform to
general accounting principles in the applicable OMB circulars, in acknowledgment of
sponsor accounting system variations.
J. Oversee process and performance of subcontractors for the provision of HIV
related HOPWA services. Ensure a contractual requirement to adhere to all applicable
state and federal laws and regulations for all subcontractors.
K. Conduct an ongoing assessment of the housing assistance and supportive services
required by participants as identified in Individual Housing and Service Plans,
including an annual assessment of their housing situation, a reevaluation of the
appropriateness of rental subsidies or other support, and a report on annual results of
program activities under the HOPWA client outcome goals for achieving stable
housing, reducing risks of homelessness and improving access to healthcare and
other support. Specifically complete and report the results of the Housing
component of the Acuity Scale. Prepare a summary report annually and keep
original assessments on file.
L. Assist the Grantee in completing elements of the Consolidated Plan per 24 CFR part
91.
The HOPWA Consolidated Plan should incorporate the following elements:
a. Consult with other public and private agencies that provide assisted housing,
health services, and social services for persons with HIV/AIDS and their
families;
b. Consider any comments or views expressed on HIV/AIDS housing and
service needs by citizens under their citizen participation plan;
c. Estimate the number and type of family members in need of housing
assistance for persons with HIV/AIDS and their families under the housing and
homeless needs assessment (including needs in their HOPWA service area,
i.e. the size and characteristics of the population with H1V/AIDS in the entire
eligible metropolitan statistical area (EMSA) for a city grantee, or, for a state
grantee, the areas of the state that are outside of any EMSA); in addition to
homeless needs, the plan's assessment of "other special needs" should
include the number of persons with HIV/AIDS;
d. Individuals and their families who are not homeless but require supportive
housing;
e. In providing a housing market analysis, including the supply, demand,
condition and cost of housing and the housing stock available to serve persons
with HIV/AIDS and their families;
f. Address other special needs with components relative to persons with
HIV/AIDS and their families who are not homeless but require supportive
housing that:
Page 42 of 96
MDHHS/GatIDD FY 15/16 ATTACHMENT III
6/27/15
i. Indicate general priorities for allocating HOPWA program funds
geographically within the eligible metropolitan statistical area and among
priority needs;
ii. Describe the basis for assigning the priority given to each category of
priority needs;
iii. Identify any obstacles to meeting underserved needs;
iv. Summarize the priorities and specific objectives, describing how funds
made available will be used to address identified needs; and
V. For each specific objective, identify proposed accomplishments the
jurisdiction hopes to achieve in quantitative terms over a specific time
period (e.g. over two-five years), or in other measurable terms as
identified and defined by the jurisdiction.
9. Provide outcome measures for activities in the action plan consistent with the
HOPWA reporting format;
h. Provide specific one-year goals for the number of households to be provided
housing through the use of HOPWA activities for STRMU assistance
payments to prevent homelessness, as well as TBRA assistance and units
provided in housing facilities that are developed and/or operated with HOPWA
funds;
Identify the method of selecting project sponsors, including providing full
access of HOPWA funds to grassroots, faith-based, and other community
organizations; and
j. In annual reporting compare proposed to actual outcomes for measures in
their plan; explain, if applicable, why progress was not made toward meeting
goals and objectives.
M. Obtaining Certification of Consistency with the Consolidated Plans in your service area
is not required for existing DCH HOPWA programs. They are only required when a
new Sponsor is awarded a HOPWA contract. They would also be required for
establishing a community residence or housing facility which DCH HOPWA does not
do.
Contact with the agencies or units of local government that complete Consolidated
Plans is encouraged. These are the grantees that would establish low income
housing and for them to be aware of the need of low income HIV positive persons
could be beneficial to people needing affordable housing.
N. Defaults and Remedies. A default shall occur when the Sponsor materially fails to
comply with program requirements. A default may consist of using Grant Funds
other than as authorized by this Agreement, noncompliance with statutory,
regulatory, or other requirements applicable to this HOPWA award, any other
material breach of this Agreement, or any material misrepresentation, which, if known
to the Grantee, would have resulted in the Grant Funds not being provided. If the
Sponsor fails to comply with any term of this award, including the prompt submission of
data for reporting, keeping HMIS data up- to-date, fully completing needed documents
and forms, serving only qualified individuals and families, or other Sponsor
requirements, the Grantee may:
a. Temporarily withhold further payments pending corrective action by the
Page 43 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
Project Sponsor;
b. Disallow all or part of the cost of an activity or action not in compliance;
c. Wholly or partly suspend or terminate the current award for the Sponsor's
program;
d. Withhold further awards for the HOPWA program;
e. Reduce or recapture Grant Funds;
f. Require the Sponsor to reimburse program accounts with non-Federal funds for
the amount of ineligible costs; or
g. Take other appropriate action, including, but not limited to, any remedial action
legally available, such as affirmative litigation seeking declaratory judgment,
specific performance, damages, temporary or permanent injunctions and any
other available remedies. Nothing in this paragraph shall limit any remedies
otherwise available to the Grantee in the case of a default by the Sponsor. No
delay or omissions by the Grantee in exercising any right or remedy available
to it under this Agreement shall impair any such right or remedy or constitute a
waiver or acquiescence in any Sponsor default. The Grant may be terminated
for convenience when both parties agree that the continuation of the award
would not produce beneficial results.
Email a copy of all HOPWA required documents to: ebvsmichiqan.gov
With approval, mail a copy to:
Division of Community Living
Michigan Department of Health & Human Services
Lewis Cass Building, 5th Floor North, 320 S. Walnut
Lansing, Michigan 48913
Attention: HOPWA Program
Assure that Grantees and subcontractors have developed and make available to
service recipients both grievance and appeals processes (Termination of Services
Policy).
J. Determine/document the unit cost per service for each funded service. Retain
data supporting the per-unit cost and how it was determined.
K. Assure the confidentiality of the name of any individual assisted and any other
information regarding individuals receiving assistance per HIPAA standards that
apply. The grantee shall agree, and shall ensure that each project sponsor agrees, to
ensure the confidentiality of the name of any individual assisted under this part and
any other information regarding individuals receiving assistance
L. Assure that no fee, except tenant portion of rent, shall be charged to an eligible
person for housing or services.
M. Assure that Grantees and subcontractors have the capacity to effectively carry out
the activity and that they agree to maintain and make available to HUD for inspection
financial records sufficient to ensure proper accounting and disbursing of amounts
received.
N. Ensure that issue statements, press releases, RFP, bid solicitations and other
documents describing projects or programs funded in whole or in part with Federal
funds, clearly state 1) the percentage or total cost of the program or project which will
be funded with Federal funds; 2) the amount of Federal funds for the project or
program; and 3) percentage and dollar amount of the total costs of the project or
Page 44 of 96
MDHI-15/G&PD FY 15/16
ATTACHMENT III
6/27/15
program that will be financed by non- governmental resources. Releases by the
Sponsor need to include copies sent to DCH of statements and press releases issued
by the Grantee. Retain copies of same on file for two (2) years.
0. Ensure all services are available in the entire Grantee catchment's area. If persons
from outside a catchment's area are assisted, communicate with the Sponsor for
that catchment's area to verify that assistance is not duplicated and that STRMU funds
do not exceed the 21 week limit.
P. Ensure that all activities funded under the program will meet urgent needs that are
not being met by available public and private sources.
Provide ongoing monitoring and on-site monitoring as required of all HOPWA
Sponsors. Provide technical assistance where required or seek it through the HUD
Field Office. Provide Policy and procedures governing HOPWA Operations and
supply all Sponsors with needed forms and HOPWA related information provided by
HOPWA/HUD offices.
Grantees Reoortina Reauirements
Sponsors must fully implement HUD's Measurement of Performance Outcomes reporting
requirements. See the HOPWA Consolidated Annual Performance and Evaluation Report (CAPER)
HUD-40110-D (Expires 10/31/2015). Obtain at
http://wwvv.hudhre.info/index.cfm?do=viewResource&ResourcelD=383 . As such demographic data
should be collected from HMIS as possible. Some demographic data, most financial data and all
narrative responses will need to be reported separately to DCH from Sponsor records.
1. Copies of all HOPWA required documentation, a copy of the FSR and FSR Supplemental
HOPWA forms and the CAPER Financial Data must be emailed to Sue Eby
at gbvsf@michiaan.aov. . Materials that cannot be emailed, should be sent to:
HOPWA Program, Division of Community Living
Michigan Department of Health & Human Services
Lewis Cass Building, 5th Floor North
320 S. Walnut
Lansing, MI 48913
2. Reimbursement: Financial Status Reports (FSRs) shall be prepared and submitted to the
Department via the MI E-Grants system. The FSR Supplemental (FSR-S) pages must be
included as an attachment. Follow the instructions provided for use of this automated system
including completing a Fiscal Year (October 1 to September 30) Budget. A copy should be
with the documents in the MI E-Grants system.
Reimbursement for Administration is limited to the 7% of your contract as allowed by law (3%
for agencies providing fiduciary services only). Total expenditures for other Activity categories
can vary from the ones proposed in your budget by 5% with notification of the HOPWA
Specialist, but total expenditures cannot exceed the total amount of the contract. Contact the
HOPWA Program manager prior to changes exceeding 5% of the Activity amount. An Excel
formatted copy of the FSR Supplemental (FSR-S) form has been emailed to all Sponsors.
Page 45 of 96
MDRHS/G&PD FY 15/16
ATTACHMENT 111
6/27/15
Additional copies can be obtained from Housing Services staff. ebysmichiclan.gov .
3. Sponsor will participate in the training for and the continued implementation of the Homeless
Management Information System (HMIS). It is expected that all persons who are recipients of
HOPWA services will be entered into the HMIS system during the current contract year. At the
end of the operating year (June 30) it is expected that service data extracted from the HMIS
system will be consistent with the data submitted in the FSR & FSR Supplemental forms and
internally consistent.
Continue to work with DCH staff to develop a means to collect data on qualified people that cannot
obtain housing assistance — Unmet Need. This would include people, who are turned away for any
reason including a decision that sufficient funds are not available, or the person's financial needs are
too great to be assisted at this time, or there are persons with a higher priority. Or other reasons that
you may be aware of.
OPERATING YEAR NARRATIVE PLAN AND OPERATING YEAR BUDGET - COMPONENTS
The HOPWA Specialist will email you the amount of your budget by May 30. An Excel formatted version will be
emailed to sponsors or you can contact the HOPWA Specialist for a copy. It is recommended that you enter a
minimum amount in every activity, even if it is just $50. That $50 can always be transferred to another Activity at
the end of the year. However, if you do not have any funds entered into an Activity at the beginning of the
year, you cannot bill from that activity without completing an amendment which is a lengthy process. The
HOPWA Specialist will contact each Sponsor to review this budgeting process. This operating year budget
will serve as the basis for reporting financial information for the CAPER.
As mentioned in Grantee Requirements 2A, the completed Operating Year Budget will be used to complete
the Fiscal Year Budget quickly but with forethought.
The Operating Year Plan is a narrative summary of the past Operating Year (July 1 through June 30) and a
narrative of your plans for the upcoming Operating Year (July 1 through June 30).
The summary of the past year will be questions that need to be answered on the upcoming CAPER. Page
references below are to the corrected CAPER. Send a Word document to the attention of the
HOPWA Specialist that contains the following information plus the plan budget:
Begin by reviewing the CAPER (sent to you electronically) to make sure the data for your agency is correct
for Item 2 Project Sponsor Information (pages 3-12). Send corrections if needed.
(A). Grantee and Community Overview. Provide information about your organization, area of
service and an overview of the type of housing provided. See the CAPER. Please add a
description of where clients assisted were/are located (city/county). Note that this
section is to be 1-3 pages and DCH has to combine/summarize 7 sponsor's
information for the Michigan Caper, however individual sponsor CAPWERs will also be
completed so provide all relevant information.
(B). Annual Performance under the action Plan. Questions 1 & 2 it will be difficult to answer the
numeric questions until the 2012 CAPER is compiled in July or August. However you can
provide information from question 2 to describe other steps you want to take with your
Page 46 of 96
MDRHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
program.
(B). Annual Performance under the action Plan. Question 3 Coordination needs to
be addressed by your agency as to coordination with other mainstream housing and
supportive services resources - be sure to name them.
(B). Annual Performance under the action Plan. Question 4 Technical Assistance.
Provide your input as to training that would benefit your agency and the clients assisted. Please
specify by subject: training on utility allowances, developing a Housing Plan, identifying
housing plan tasks, etc. Or you can broaden your scope to a training session between various
community agencies so that you can work more cooperatively.
(C) Barriers and Trends overview Questions 1 through 3.
When describing (1) Barriers, note those barriers that clients face and those barriers that
your agency faces (lack of funds, hard to keep staff, cost of implementing a new accounting
system, lack of agency cooperation, whatever is hampering you and ultimately impacting
service to your clients. What is particularly difficult in your area? High rent in Kalamazoo
due to the college? Has SOAR training been helpful? Check applicable boxes.
For (2) Trends I think we need some mention of people living longer, being older and having
health problems, needing longer term assistance, harder to find jobs, etc. Trends can be
local, state or national. Are fewer people qualifying as disabled? Has bus service been cut?
Inability to get mental health diagnosis (use numbers of people)
For (3) Evaluations, please include a summary of the housing evaluation that is to be done
yearly (See Grantee Requirements — Standards (K) above), plus any satisfaction surveys
or maybe a review of the Acuity scale scores from July 1 until May or June 1. It does not have
to be a HOPWA initiated evaluation. Provide references where possible.
The Plan Narrative and Plan Budget should be emailed to ebvsmichigan.gov when the
Fiscal Year contract and budgets are completed..
References See: 24 CFR574; 24 CRF 5.611; 24 CFR 5.601; 24 CFR 5.609; 24 CFR 21; 24
CFR 35; 24,CFR 87; 24 CFR 100; 24 CFR 107; and 24 CFR 82.306(d); CPD Notices 01-01;
02-09; 03-09; 04-10; 06-06; 06-07; 07-06; 07-07; 08-05; and 94-05; FAQ STRMU updated
8/3/06; OMB Circulars A-110, A-122 and A-133; CPD Monitoring Handbook Chapter 10;
HOPWA Grantee Oversight Resource Guide; CAPER form HUD-40110-D, HOPWA
Financial Management online training guide.
Page 47 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
IMMUNIZATION ACTION PLAN
SPECIAL REQUIREMENTS
Grantee Reauirements
1. Service Delivery: Offer immunization services to the public.
A. Collaborate with public and private sector organizations to promote childhood,
adolescent and adult immunization activities in the county including but not limited to
recall activities.
B. Educate providers about vaccines covered by Medicare and
Medicaid.
C. Provide and implement strategies for addressing the immunization rates of
special populations (i.e., college students, educators, health care workers, detention
centers, homeless, tribal and migrant and child care employees).
D. Develop mechanisms to improve jurisdictional and LHD immunization rates for
children, adolescents and adults.
E. Ensure clinic hours are convenient and accessible to the community, operating both
walk-in and scheduled appointment hours.
F. Coordinate immunization services, including WIC, Family Planning, and STD,
developing plans or memorandums of understanding.
G Collaboratively work with regional MCIR staff to ensure providers are using
MCIR appropriately.
H Develop strategies to identify and target local pocket of need
areas.
2. Adhere to federal and state appropriation laws pertaining to use of programmatic funds.
See Immunization Allowable Expenditures in Attachment I for appropriate use of Federal
Funds.
3. Adhere to requirements set forth in the Omnibus Budget Reconciliation Act of 1993, section
1928 Part IV — Immunizations and the most current CDC Vaccines for Children Operations
Manual, Michigan Resource Book for VFC Providers, and documents that are updated
throughout the year pertaining to the Vaccines For Children (VFC) Program.
4. Ensure that federally procured vaccine is administered to eligible children only and is
properly documented per VFC guidelines.
A. The VFC Program provides VFC vaccine to only eligible children who meet the
following criteria: are Medicaid eligible, have no health insurance, are American Indian
or Alaskan Native, are served at a Federally Qualified Health Center (FQHC), a Rural
Health Center (RHC) or a public health clinic affiliated with a FQHC and are also
under-insured.
B. Ensure state-supplied vaccines provided in the jurisdiction are administered only to
eligible clients as determined by the state. This program allows for the immunization
of select populations who are underinsured and not served at a FQHC, RHC, or a
public health immunization clinic affiliated with a FQHC as defined by current state
program requirements.
C. Ensure that all providers receiving vaccine from the state screen children for VFC
eligibility for children
Page 48 of 96
MDHFIS/G&PD FY 15/16
ATTACHMENT RI
6/27/15
D. Fraud or abuse of federally procured vaccine should be monitored and reported.
5.
Adhere to all Federal and Michigan Laws pertaining to immunization administration and
reporting including reporting to the MCIR, VAERS and schools and daycare reporting
6. Coordinate the submission of immunization data from schools and child care centers in
your jurisdiction and follow-up with programs providing incomplete or inaccurate data.
Assure compliance levels are adequate to protect the public.
7. Provide education to the parents of children seeking a non-medical exemption in your
jurisdiction.
8. Monitor any provider receiving federally procured vaccine including but not limited to VFC/AFIX
site visit.
9. Ensure on-site attendance of at least 1 LHD immunization program staff to two (2)
Immunization Action Plan (IAP) meetings each year.
10. Submit original FSR's to the Department on a quarterly basis.
11. LAP Reports are submitted electronically in accordance with due dates set by the Department.
12. IAP Plan will be submitted electronically using a template provided by the Department,
in accordance with due dates set by the Department.
13. By April 1, of each year provide one copy of the provider enrollment form which includes a
profile for each provider who receives vaccine from the state. These documents must be
postmarked or filed electronically no later than April 1.
14. Implements Perinatal Hepatitis B program activities to prevent the spread of Hepatitis B
Virus (HBV) from mother to newborn.
A. Verify pregnancy status on all hepatitis B surface antigen (HBsAg) positive
pregnant women of childbearing years (10-60 years of age.)
B. Ensure HBsAg positive pregnant women are reported to the Perinatal Hepatitis B
case manager and according to the Public Health Code.
C. Coordinate Perinatal Hepatitis B case management activities between local
health department, provider, and Perinatal Hepatitis B Case Manager to:
1. Ensure that all infants, born to women who are HBsAg positive receive hepatitis B
vaccine and hepatitis B immune globulin (HMG) within 12 hours of life, a complete
hepatitis B vaccine series with post vaccination serology testing and program
support services,.
2. Ensure that all susceptible household and sexual contacts associated with HBsAg
positive women receive appropriate testing, vaccination, and support services.
D. Ensure birthing hospitals are able to offer hepatitis B vaccine to all newborns prior
to hospital discharge by enrolling them in the Universal Hepatitis B Vaccination Program
for Newborns.
15. Surveillance of vaccine preventable disease (VPD) activities:
A. Ensure that all reportable diseases are reported to the Department in the time
specified in the public health code and appropriate case investigation is completed.
B. Conduct active surveillance when indicated (i.e. during an outbreak) and contact
hospitals, laboratories, and/or other providers on a regular basis.
C. Utilize VAERS to report all adverse vaccine reactions.
Department Rea ukements
1. The department will develop templates for submission of lAP reports and the annual 1AP plan,
Page 49 of 96
M DH HS/G&PD FY 15/16 ATTACHMENT 111
6/27/15
and provide feedback to the local health departments.
2. Provide technical assistance in establishing and operating immunization action plans.
3. Provide technical assistance in MCIR activities through regional coordinators.
4. Provide supportive services and resource identification when needed.
5. Provide financial support for LI-ID and Community / Migrant Health Centers for Immunization
in pocket of need (PON) areas.
6. Each LHD will have an annual VFC/AFIX site visit by the Department.
7. Develop pre-formatted tools including training for new initiatives and IAP reports / plan.
IMMUNIZATION ASSESSMENT FEEDBACK INCENTIVE EXCHANGE (AFDC'
FOLLOW-UP SITE VISIT
SPECIAL REQUIREMENTS
Budaet and Aareement Reauirementl
The rate of reimbursement per AFIX follow-up visit is $100 for an on-site personal visit to the
provider office or $50 for a follow-up phone call (with information mailed afterward) to the provider
office.
Grantee Reauirements
1. Conduct AFIX follow-up with all providers receiving an AFIX/VFC site visit with identified
follow-up issues/activities.
2. AFIX follow-up visits are required to occur within 3 — 6 months from date of VFC/AF1X site
visit.
3. Document all AFIX follow-up visit information in the AFIX Online Tool using current
Department AFIX guidelines within 10 days of the AFIX follow-up visit.
Department Reauirements
1. The Department will provide payment quarterly based on the fixed unit rate reimbursement
mechanism upon completion and timely submission of the required documents mentioned
above.
2. The Department will develop pre-formatted tools. The Department will provide support to the
Grantees.
3. The Department will provide AFIX training module upon request by the LHD and will also
provide guidance at IAP meetings and through the Department Immunization field
representatives.
4. The Department will provide written guidance to agencies on annual requirements to
complete AR( site visits.
Page 50 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
IMMUNIZATION BILLING PRACTICE INFRASTRUCTURE ENHANCEMENT
SPECIAL REQUIREMENTS
IBENZIE-LEELANAU DISTRICT HEALTH DEPARTMENT, BERRIEN COUNTY HEALTH DEPARTMENT,
CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT, CITY OF DETROIT DEPARTMENT OF
HEALTH AND WELLNESS, DISTRICT HEALTH DEPARTMENT #2, DISTRICT HEALTH
DEPARTMENT #4, DISTRICT HEALTH DEPARTMENT #10, HEALTH DEPARTMENT OF
NORTHWEST MICHIGAN, HURON COUNTY HEALTH DEPARTMENT, INGHAM COUNTY HEALTH
DEPARTMENT, KENT COUNTY HEALTH DEPARTMENT, MONROE COUNTY HEALTH
DEPARTMENT, OTTAWA COUNTY HEALTH DEPARTMENT, SAGINAW COUNTY HEALTH
DEPARTMENT, ST. CLAIR COUNTY HEALTH DEPARTMENT, SANILAC COUNTY HEALTH
DEPARTMENT, TUSCOLA COUNTY HEALTH DEPARTMENT, WASHTENAW COUNTY HEALTH
DEPARTMENT, WAYNE COUNTY HEALTH DEPARTMENT, WESTERN U.P. DISTRICT HEALTH
DEPARTMENT)
October 1 — June 30, 2016
Grantee Requirements:
The Grantee will apply funding to support the Department's Division of Immunization in generating an
Immunization Billing Best Practice Guide. The Grantee will document the best practice details of
immunization billing based on guidance provided by the Department. The Grantee should utilize the
funding on activities to improve immunization billing infrastructure, including but not limited to:
staffing, software/system upgrades, supplies, training, and travel related to the billing project.
Detailed budgets should be provided that outline allocation of funds. Participate in group conference
calls.
Grantee Reporting:
The Grantee will provide monthly narrative activity reports by the 15 th of the following month detailing
activities performed. The monthly narrative report will be sent to Department via email at
SmithC63michioan.gov (Christopher Smith). A reporting template will be provided by the
Department. Additional monthly calls and technical assistance will be provided to agencies by the
Department as needed.
IMMUNIZATION — FIELD SERVICE REPRESENTATIVES
SPECIAL REQUIREMENTS
(DISTRICT HEALTH DEPARTMENT #10, KENT COUNTY HEALTH DEPARTMENT, LIVINGSTON COUNTY
HEALTH DEPARTMENT, MARQUETTE COUNTY HEALTH DEPARTMENT, MONROE COUNTY
HEALTH DEPARTMENT, ST. CLAIR COUNTY HEALTH DEPARTMENT)
Grantee Requirements (District #10. Marquette and St. Clair Counties)
1. Employ and oversee a full-time Immunization Field Representative for the Immunization
Program who shall be acceptable to the Department and who shall be supported by this
agreement, understanding that their full time is to be devoted for regional immunization
related activities.
2. Provide the Immunization Field Representative with permanent office space and supplies,
including, but not limited to: a telephone, general office supplies, a computer with high speed
internet capabilities, a printer, a cellular telephone and a use of vehicle or reimbursement
mechanism for transportation unless otherwise arranged.
3. Ensure the Immunization Field Representative will be available to all local health
Page 51 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
departments in the assigned regions to provide Immunization Program activities equitable
and at the direction of the Department. Refer to field representative responsibilities as
defined by the Department and distributed to the Grantee.
4. Provide for reimbursement for reasonable telephone charges incurred in the conduct of
business by the Immunization Field Representative unless otherwise arranged.
5. Provide reasonable reimbursement for any travel and subsistence expenses incurred by the
Immunization Field Representative necessary to the conduct of the Immunization Program.
Travel could include the annual National Immunization Conference or other professional
immunization related conferences, attendance at the Department Immunization staff
meetings and trainings, and accreditation visits made in other areas of the state.
Grantee Reauirements — Kent. Livingston and Monroe Counties
1. Provide adequate office space, telephone connections, and high-speed internet access.
Also provide access to fax and photocopiers.
2. Provide feedback to Division Director as needed, on employee work related conduct.
Field Representative Roles and Responsibilities- District #10, Marauette. and St. Clair
Counties
This position serves as a liaison, resource person and as a regional expert for local health
jurisdictions regarding all the Department immunization programs and initiatives.
1. PROGRAM SUPPORT:
A. Assist with the regional MCIR activities and act as a regional resource on MCIR
processes and assessment protocols.
B. Assist with the local implementation and monitoring of all state programs at the
regional level- including IAP implementation, VFC, AFIX, Accreditation, Perinatal
Hepatitis B, School / Childcare reporting, special projects and the INE program.
C.
Participate in planning for regional conferences, IAP Coordinator meetings, and
other the Department programs and initiatives as needed.
D. Assist state, regional and local epidemiologists and communicable disease staff as
needed with VPD surveillance and outbreak control.
2. PROGRAM QUALITY ASSURANCE:
A. Assist in the orientation of new IAP Coordinators.
B. Work with local health departments to assess and increase immunization levels for all
age groups, especially identifying and targeting pockets of need.
C. Identify evidence-based strategies that support improved coverage levels in the
region, including use of recall, coordination of LHD services, and provider and LHD
staff education.
Consult with the local health department on the immunization component of
the accreditation process, including preparation for reviews and conducting a walk
through or mock accreditation review.
E. Consult with local coalitions and private stakeholders to promote immunizations and
ensure consistent messages are relayed to the public.
F. Consult with local health departments on the school and day care assessment
process.
Page 52 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
G. Encourage or provide educational updates and interventions on all immunization
issues with staff at local health departments, healthcare providers, school and
childcare staff and other stakeholders.
3. PROGRAM COMPLIANCE:
A. Monitor compliance with policies/legislation at national/state and local levels such as:
1. VFC program requirements and vaccine distribution
2. VAERS program
3. Public Health Code
4. Administrative Rules
a. School and childcare legislation and reporting requirements
b. MCIR legislation and rules
c. Communicable Disease Rules
4. PROGRAM OVERSIGHT and PROGRAM REVIEW:
A. Perform oversight of the following programs with assigned local health
departments.
B. Accreditation-Conduct reviews, and monitor corrective actions.
C. VFC including orientation to annual VFC site visit process, monitoring of VFC
vaccine losses, submission of mandatory reports, annual LHD VFC site visits and
quality assurance review of all provider public vaccine orders.
D. AFIX—including assuring local feedback with providers, and follow up on
recommendations.
E. Perinatal Hepatitis B-regional birth dose levels and universal vaccine program.
F. Review and summarize LHD LAP Annual Plans and Biannual 1AP Reports.
G. Monitor LHD compliance with Comprehensive agreements and special
requirements relating to the Immunization program.
H. Subrecipient monitoring of funds.
Department Reauirements
1. As financially feasible, provide necessary adjunct clerical services to the Immunization Field
Representatives for the duplicating/printing of materials and the packaging and distribution of
these materials.
2. Provide program direction, responsibilities and definition of Immunization Field Service
Representative responsibilities.
3. Support or solicit the Immunization Field Service Representative input into policy-making
decisions.
IMMUNIZATION MICHIGAN CARE IMPROVEMENT REGISTRY (MCIR) REGIONAL
SPECIAL REQUIREMENTS
(DISTRICT HEALTH DEPARTMENT #10, GENESEE COUNTY HEALTH DEPARTMENT, KALAMAZOO
COUNTY HEALTH & COMMUNITY SERVICES, MID-MICHIGAN DISTRICT HEALTH DEPARTMENT,
PUBLIC HEALTH, DELTA AND MENOMINEE COUNTIES)
Grantee Reauirements
The Grantee shall ensure the performance of the following activities on behalf of the Department to
support the MC1R:
1. Promote and train providers and Health Care Organizations (HC0s) on all features of the
Page 53 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
MGR Web application.
2. Support regional MCIR users by operating the regional help desk in accordance with
Department approved procedures.
3. Monitor and develop strategies to increase private provider and HCO enrollment and
participation in the MCIR which includes development of strategies to encourage all
providers to fully participate with the MCIR, (such as sites of excellence awards).
4.
Process all user/usage agreements, according to the Department's approved procedures, to
create user accounts.
5. Implement and update marketing plans in support of increased provider and parent
acceptance and use of the MCIR.
6. Keep regional users updated on MCIR status and system changes.
7. Conduct ad hoc reporting and querying on behalf of MCIR users.
8. Work with local health departments to establish a mechanism and internal process to assure
persons who have died within their county are appropriately flagged in the MCIR.
9.
Maintain a listing of HCO private and public immunization providers. This listing should be as
comprehensive as possible and should include all providers in the region.
10. Conduct regular de-duplication activities to assure that duplicate records are removed from
the MCIR as quickly as possible.
11. Process user petitions to change MCIR data according to Department approved procedures.
12. Monitor ongoing immunization data submission for all local health departments and
private providers.
13. Conduct training functions as needed to assure that local health department staff can train
and educate providers on how to access and submit data into MCIR.
14. Maintain a policy/procedure manual, approved by the Department.
15. Process and file all "opt out" forms according to the Department approved procedures.
16. Attend regular MCIR regional Grantee/coordinator meeting.
17. Conduct Onboarding activities as required for providers submitting immunization data via 1-IL7
messaging to MCIR.
18. Perform quality assurance checks on the MCIR data for the region as prescribed by
the Department.
A. Assist local health departments and private providers with methodologies to "clean up"
their data.
B. Provide assistance to the Department on User Acceptance Testing (UAT) when
required to verify MCIR system releases of bug fixes and enhancements.
C. Attend all UAT training sessions as required by the Department.
18. The Grantee shall provide to the MCIR Regional Coordinator: a) permanent office space; b)
general office supplies; c) a land based telephone; d) a computer with high speed internet
capabilities; e) a printer; f) a cellular telephone; and g) use of a vehicle or in the alternative
reimbursement mechanism for transportation unless otherwise arranged.
19. When sufficient funding is available, provide to the MCIR Regional Coordinator
reimbursement for travel to attend the National Registry related meetings if approved by the
Department. This includes travel related expenses concerning air fare, lodging, baggage
processing, taxi services, etc.
20. Consult with the Department on any personnel or performance issues that could affect the
above mentioned contract requirements.
21. Facilitate the Department's attendance in the interview process for hiring of a MCIR
Page 54 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
Regional Coordinator / MC1R staff. This process includes consultation with the
Department regarding selection of interview candidates as well as participation in the hiring
determination.
Grantee Perforrnance/Proaress Report Reauirernents
1. Ensure the quarterly submission of status reports on work plan progress. Reports are due
within 30 days of the end of each quarter. (January 31, April 30, July 31, October 31).
2.
Final quarterly report shall be an annual report. The annual report will be distributed to the
Department and shall include:
A. Summary of provider enrollment (breakdown by role);
B. The amount of data submitted to the region during the fiscal year;
C. Summary of staff resources;
D. Sites of excellence award recipients.
3. Any other information as specified in the special requirements shall be developed and
submitted by the Grantee as required by the Department.
Reports and information should be submitted to:
Bea Salada, MCIR Coordinator
Michigan Department of Health & Human Services
Immunization Division
P.O. Box 30195
Lansing, MI 48909
Phone: (517) 335-9340
The Grantee shall permit the Department or its designee to visit and to evaluate on an as- needed
basis.
Department Reauirements
1. Provide support and technical assistance to Regional staff,
2. Provide initial training and support to a MCIR Regional Coordinator
3. The Department shall evaluate submitted reports as described above for their
completeness and adequacy.
IMMUNIZATION — NURSE EDUCATION REIMBURSEMENT
SPECIAL REQUIREMENTS
Budaet and Aareement Reauirements
The rate of reimbursement is $200 per eligible educational session for all modules except Vaccines
Across the Lifespan, which is reimbursed at $250 per eligible educational session to the Grantee,
upon completion and submission of INE Provider Contact and Report Forms. Reimbursement will be
based on a first come-first served basis and also based on most current INE Program Guidelines. . All
requests for reimbursement should be submitted on the quarterly Financial Status Report (FSR) and
should include all sessions conducted during that quarter. The submission should include, as an
attachment to the FSR, detail of the sessions during that quarter using the spreadsheet information
provided by the Department.
Page 55 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
Grantee Requirements
1. Ensure that all Immunization Nurse Educators are trained as required by the Department.
2. Ensure that the INE Provider Contact and Report Form is complete and submitted to the
Department/Immunization Program within 5 days after the presentation.
Department Requirements
1. The Department will provide payment based upon the fixed unit rate reimbursement
mechanism upon completion and submission of the INE Provider Contact and Report Forms
for eligible sessions. Payment will be based on submission of the quarterly FSR that should
include all sessions conducted during that quarter with detail of the sessions documented on
the spreadsheet that is provided by the Department.
2. The Department will provide two (2) sessions per calendar year for Grantee Immunization
Nurse Educators.
IMMUNIZATION — VACCINE QUALITY ASSURANCE PROGRAM
SPECIAL REQUIREMENTS
Grantee Requirements
1. Follow-up on vaccine losses and replacement for compromised vaccines for
immunization providers within the jurisdiction.
2. Monitor and approve all temperature logs, doses administered reports, and ending
inventory reports received from participating VFC providers within the jurisdiction,
3. Monitor and approve vaccine orders for participating VFC providers within the jurisdiction
4. Act as the Primary Point of Contact (PPOC) for VFC providers within the jurisdiction.
5. Provide education and intervention on inappropriate use of publicly purchased vaccine.
6. Follow-up on VFC site visit non-compliance issues.
7. Assist VFC providers within the jurisdiction on issues related to balancing vaccine inventories.
8. Assist with the redistribution of short dated vaccine for providers within the jurisdiction.
9. Assist with the equitable allocation of vaccines to providers in the jurisdiction during a
vaccine shortage.
Department Requirements
1. Monitor and approve all temperature logs, doses administered reports and ending inventory
reports received from Local Health Departments.
2. Monitor and approve vaccine orders for Local Health Departments.
3. Consult with Local Health Departments on vaccine losses and assist as needed.
4. Act as the PPOC to Local Health Departments.
5. Assist Grantees on education and intervention on the inappropriate use of publicly
purchased vaccine.
6. Assist Local Health Departments on issues related to MCIR functionality and operation.
7. Assist Grantees with the redistribution of short dated vaccine.
Page 56 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT 111
6/27/15
IMMUNIZATION VFCIAFIX SITE VISIT
SPECIAL REQUIREMENTS
Grantee Bt_ id et and Agreement Requ i rements.
1. The rate of reimbursement is $150 for a VFC Enrollment or a VFC Only visit, $350 for a
combined VFC/AFIX or birthing hospital visit. An enrollment visit is required for all new VFC
enrolled provider sites. All LHD staff involved with any AF1X site visits must complete the
Department AFIX training module, presented by the Department AF1X Coordinator, prior to
conducting any AFIX visits. Annual VFC/AFIX visit guidance and review will be provided to
each LHD at the 1AP Meetings and consult will be conducted by the Department
Immunization Field Representative for each Grantee.
2. Jurisdictions must visit at least 50 percent of their sites every year. The requirement is that
all enrolled and active VFC providers receive a VFC or VFC/AFIX site visit at least every
other year. This means that one half are visited one year and the other half are visited the
following year. Detroit Department of Health and Wellness Promotion Immunization Program
is required to complete visits annually to 100% of the VFC providers in accordance with the
SEMHA Quality Assurance Specialist (QAS) contractual obligations. Combined VFC/AFIX
site visits will be conducted using registry based AFIX reports and AFIX tools developed by
the Department. Follow-up of outstanding issues must be completed within CDC guidelines.
3. All reimbursement requests should be submitted on the quarterly Comprehensive Financial
Status Report (FSR). The submission should include, as an attachment, detail all of the visits
during the quarter using the spreadsheet information provided by the Department.
The format of the site visit will be based on the complete site visit questionnaire and AFIX
Online Tool reviewed at the most recent Fall IAP meeting and the site visit guidance
documents (VFC and AF1X) provided by the department and the CDC. All site visit
information shall be entered into the appropriate database as required by CDC (PEAR and
AFIX Online Tool) within 10 days of the site visit by the individual who conducted the site
visit.
4. Data from the CDC PAPA/PEAR system regarding the number of site visits will be used to
reconcile the request for reimbursement. For additional detail on the program requirements,
refer to the Resource Book for Vaccine for Children Providers and the AFIX/VFC site visit
guidance documents, as well as other guidance provided by the Department /Immunization
Program in correspondence to Immunization Action Plan (1AP), Immunization Coordinators,
or through health officers.
Department Requirements
1. The Department will provide payment quarterly based upon the fixed unit rate
reimbursement mechanism upon completion and submission of the questionnaires.
2. The Department will develop pre-formatted tools, electronic and/or paper.
3. The Department will provide support to the Grantees.
4. The Department will provide training at IAP meetings, vaccine management calls, and
through field representatives.
Page 57 of 96
MDHHS/G&I'D FY 15/16
ATTACHMENT Ili
6/27/15
INFANT SAFE SLEEP
SPECIAL REQUIREMENTS
(BERRIEN COUNTY HEALTH DEPARTMENT, CALHOUN COUNTY HEALTH DEPARTMENT,
GENESEE COUNTY HEALTH DEPARTMENT, INGHAM COUNTY HEALTH DEPARTMENT,
KENT COUNTY HEALTH DEPARTMENT, MACOMB COUNTY HEALTH DEPARTMENT,
MUSKEGON COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY HEALTH DEPARTMENT,
SAGINAW COUNTY HEALTH DEPARTMENT, ST. CLAIR COMITY HEALTH DEPARTMENT,
WASHTENAW COUNTY HEALTH DEPARTMENT,CITY OF DETROIT HEALTH AND
WELLNESS, KALAMAZOO COUNTY HEALTH DEPARTMENT, WAYNE COUNTY HEALTH
DEPARTMENT)
Objective: Provide funding to select local health departments (LHD) to support promotion and
awareness of infant safe sleep best practices in their communities. Funding must be expended by
September 30.
Grantee Requirements
'I. LHD personnel will provide educational activities, conduct community outreach efforts and/or
expand community awareness of infant safe sleep. These efforts must adhere to the
guidelines for infant safe sleep safety and SIDS risk reduction issued by the American
Academy of Pediatrics in 2011. Activities are to be culturally relevant to at-risk, high-risk
families in the community and reflect diversity in terms of race, ethnicity, language, and
socioeconomic status.
2. LHD will convene and facilitate a local advisory team that focuses on infant safe sleep, a
public/private partnership that coordinates local efforts to promote infant safe sleep and
reduce infant deaths related to unsafe sleep environments. If a similar community based
group or team addressing infant safe sleep already exists, it is not necessary to create a new
one.
3. Funds may be used for the purchase of demonstration and/or educational items.
Additionally, a maximum of 15% of the funding may be used for giveaway items that
are directly related to infant safe sleep such as cribs, pack-and-plays, and/or sleep
sacks.. A maximum of 25% of the funding may be used for advertising, including
billboards, bus signage and the purchase of radio, tv and/or print media.
Department Reauirements
1. Provide technical assistance for infant safe sleep through Infant Safe Sleep Program
Coordinator.
Reoortina Requirements
I. Prior to the submission of the proposed FYI 5/16 workplan, LHD will participate in a group
conference call with all mini-grantees facilitated by the Infant Safe Sleep Program
Coordinator to review current data, discuss infant safe sleep best practices and answer any
questions related to mini grant requirements.
2. LHD will submit a written summary to date on all activities using the template provided in the
mini grant guidance. This summary will be due to the Infant Safe Sleep Program Coordinator
15 days after the end of the 2'd quarter (April 15).
Page 58 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT 111
6/27/15
3. LHD will participate in a TA call with the Infant Safe Sleep Program Coordinator by April 30 to
review progress to date.
4. LHD will submit a final report on all activities, using the template provided in the mini grant
guidance, by October 30 via email to Patti Kelly, MDHHS Infant Safe Sleep Program
Coordinator, at kellyp2@michigan.gov.
INFORMED CONSENT
SPECIAL REQUIREMENTS
Grantee Reauirements
The following requirements apply to all Grantees, whether the Grantee operates a Family Planning
Clinic or not:
1. When a woman states that she is seeking an abortion and is requesting services for that
purpose the Grantee will provide:
A pregnancy test with a determination of the probable gestational stage of a confirmed
pregnancy.
Note: The Grantee must destroy the individual "informed consent" files containing
identifying information (Name, Address, etc.) after 30 days.
2. When a woman seeks a pregnancy test and does not explicitly state that she is doing so for
the purpose of obtaining an abortion, she should be directed to a family planning clinic or to
her primary care provider for a pregnancy test. Services to comply with PA 345 of 2000 should
not be provided to a woman in a Title X funded family planning clinic.
Department Requirements
The Department will provide funding, at the fixed rate of $50 per woman served, for each woman
that expressly states that she is seeking a pregnancy test or confirmation of a pregnancy for the
purpose of obtaining an abortion and is provided the services noted in item 1 above. The number of
services, rate per service and total amount due must be noted as a funding source, under the
element where the staff providing the services are funded, on the Comprehensive FSR through the
MI E-Grants system.
LABORATORY SERVICES
SPECIAL REQUIREMENTS
(KALAMAZOO COUNTY HEALTH AND COMMUNITY SERVICES, KENT COUNTY HEALTH DEPARTMENT,
OAKLAND COUNTY HEALTH DIVISION, SAGINAW COUNTY HEALTH DEPARTMENT)
Grantee Requirements
1. Grantee Specific Requirements - All Grantees
A. Meet established standards of performance and objectives in the following areas:
a. Public Health Emergency Preparedness:
i. Maintain a current list of contact information for local community
hospital laboratories to facilitate communication.
Page 59 of 96
MDHI-15/G&PD FY 15/16 ATTACHMENT ill
6/27/15
Facilitate response with local community hospital laboratories in
preparation for and during public health threats.
iii. Coordinate and facilitate specimen collection and transport with
facilities within jurisdiction. This may include specimen packaging and
shipping and coordination with the courier service.
iv. Provide 24/7 contact information to hospital partners and BOL.
v. Participate in and provide support for Department PHEP exercises with
community hospital laboratories within jurisdiction.
b. Renew yearly a Memorandum of Understanding (MOU) with the
Department BOL.
B. Provide the Bureau of Laboratories records and reports as required. The Grantee will
designate one staff member as a liaison to the Bureau of Laboratories. Each Grantee
must designate appropriate staff to take part in LIMS training activities.
C. Provide information on specimen submission to local health jurisdictions to assure
that specimens are submitted to the BOL LRN laboratory, or other appropriate LRN
laboratory as determined by the Department.
Department Requirements
1. Department Requirements (for All Grantees):
A. The Department will provide notifications and explicit instruction for stop and start
days to Grantee laboratory regarding this contractual arrangement prior to its
implementation.
B. The Department will provide access to LIMS, support for LIMS hardware and
software, user training for LIMS utilized for testing performed under contract,
advanced training for LIMS liaisons for test master and Grantee specific data. The
Department will maintain the sole contract with LIMS vendor. Backups and
maintenance of all module(s)/customization(s) will be performed by the
Department staff.
C. Analyze data from reports submitted from Grantee. Supply timely feedback of
statistical analysis and other data related to ongoing program activities.
D. Assist in technical training of personnel and computer software utilization.
E. Supply Grantee with a copy of the contracts associated with this program.
F. Renew yearly a Memorandum of Understanding (MOU) with Grantees.
1. Department Requirements (for Kalamazoo County Health & Community Services,
Kent County Health Department and Saginaw County Department of Public Health
Only)
A. The Department:
a. Designate and assign personnel who meet the qualifications required as a
high complexity laboratory director in CLIA 1988.
b. Laboratory Directors will:
Sign the appropriate CMS paperwork for CLIA certification for their
region as needed.
Perform annual site visit of the Grantee high complexity laboratory
and assist in CLIA surveys.
Page 60 of 96
MDHH5/G&PD FY 15/16 ATTACHMENT Ul
6/27/15
Be available for consultation to the Grantee laboratory by telephone,
email, and other communication methods.
iv. Provide technical consultation for laboratory guidelines, testing
procedures, quality control methods or quality assurance in
accordance with CLIA requirements.
V. Review Quality Assurance program with attention to effective quality
control activity and corrective action.
vi. Review and sign training records and competency evaluations.
vii. Review and sign external proficiency testing results in a timely manner.
viii. Review and sign procedure manual(s) annually, and any new
procedure prior to its implementation.
Grantee Specific Requirements
. Kalamazoo County Health and Community Services Department
A. Provide laboratory support to investigate all suspect Norovirus outbreaks that occur in
Kalamazoo County.
B. Act as a surge capacity laboratory for the Department to perform Norovirus testing
when the Department has reached maximum testing capacity or if the Department
laboratory resources are required for another purpose. Activation of the Kalamazoo
County laboratory for this purpose will be made by the Bureau of Laboratories (BOL)
Infectious Diseases Division Director. The Department -BOL shall provide $5,000
initially to Kalamazoo County. Kalamazoo will bill the Department -BOL for $100.00
per test that is not covered in the initial amount.
C. Purchase and maintain adequate inventories of any supplies needed for testing and
reporting, not specifically supplied by the Department in this agreement.
D. Provide the Bureau of Epidemiology, and Bureau of Laboratories records and reports
as required. For all testing services performed under contract by the Grantee for
the Department all specimen submission data and reporting data will be entered and
reported using Bureau of Laboratories (BOL) Laboratory Information Management
Systems (LI MS) software. The Grantee will designate one staff member as a liaison
to the Bureau of Laboratories. The Grantee must designate appropriate staff to take
part in LI MS training activities.
E. Meet established standards of performance and objectives in the following areas:
Participate in a Department sponsored proficiency testing program consisting
of two proficiency events per year. Continued funding is based on successful
participation with a minimum passing grade of 80%.
Provide Laboratory support for examination of up to 100 stool specimens
associated with suspect Norovirus disease outbreaks. Specimens are to be
processed within 2 business days of receipt.
Utilize standardized testing procedures, standards of quality assurance and
quality control approved by the Department laboratory director. Assist the
Department in Quality Assurance Assessment semi-annually or as
determined by the Department.
iv. Establish and maintain a personnel training and competency assessment
program. Maintain documentation of training of all testing personnel.
Page 61 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
V. Maintain Clinical Laboratory Improvement Amendments (CLIA) of '1988
certification for high complexity testing.
LHD SERVICE SHARING SUPPORT
SPECIAL REQUIREMENTS
(BENZIE-LEELANAU DISTRICT HEALTH DEPARTMENT)
Local health departments participating in the project will utilize funds to support activities pertinent to
the exploration, preparation, planning, implementing, and improving sharing of local health
department services, programs or personnel.
Requirements:
Local health departments must submit a response to the Request for Proposal (REP) "Local Health
Department Collaboration and Exploration of Shared Approach to Delivery of Services," distributed
March 16 and due April 6
The RFP response or amended response (as negotiated with Local Health Services) will suffice as
the Workplan.
Eligible Activities:
A. Meeting activities, including time and travel costs
B. Cost of research activities
C. Supplies and presentation materials
D. Legal fees and other professional services related to the project
E. IT cost related to service sharing (grant funds may not be used to reimburse equipment
costs)
Deliverables:
Awardees will provide a narrative report at the midpoint (August 1) and at the end of the grant period
(November 1) which describes the activities, performance on objectives, other
accomplishments, and evaluation as performed under the grant.
LOCAL MATERNAL AND CHILD HEALTH (MCH1 PROGRAM
SPECIAL REQUIREMENTS
General PerfDrmance Reauirementl
1. LOCAL MATERNAL AND CHILD HEALTH
A. Local MCH funds are available to support one or more of the Title V Maternal Child
Health Block Grant national and state performance measures. This is a change
from previous years' use of these funds.
B. Grantees are to follow the FY 2016 Local Maternal Child Health Grant Program
Plan Instructions to prepare the agency's Local Maternal Child Health Plan.
Budget and Agreement Requirements
1. Projects to be supported by LMCH in MI E-Grants have been renamed in some budget
Page 62 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
categories.- Refer to the glossary of terms to determine services that fits into each category
as defined in the Title V MCH Block grant. Definitions are included in the Annual Local
Maternal Child Health Grant Program Community Plan — FY 2016 Instructions that are sent
to local health departments under separate cover. The LMCH funding needs to be
budgeted separately instead of being distributed in projects. The budget categories that are
to be used are as follows:
1. Direct Services Children — MCH
2. Enabling Services Children — MCH
3. Direct Services Women — MCH
4. Enabling Services Women - MCH
• Public Hlth Functions & Infrastruct MCH
• Childrens Special Hlth Care Services — MCH
5. Family Planning — Adolescents — MCH
6. Family Planning — Women — MCH
7. Immunizations — Children — MCH
8. Immunization — Women — MCH
9. Maternal Infant Hlth Program (MIHP) Women — MCH
10. Maternal Infant Hlth Program (MIHP) Children — MCH
2. The agency FY 2016 Local Maternal and Child Health Plan is due when the budget
application is due, August 17. The previous year's activity report will be due at the time of
the final FSR submission. The department will provide the instructions and format for the
LMCH Plan and for the LMCH Report.
3. Local MCH funding source cannot be used under the WIC element, except in extreme
circumstances where a waiver is requested in advance of the expenditures and evidence is
provided that the expenditures satisfy all funding requirements. Local MCH funds may not
be used to supplant available/billable program income such as Medicaid or Healthy
Michigan Plan fees or additional funding under the Medicaid Cost-Based Reimbursement
process.
4. Local effort for program elements supported by Local MCH funds must not be reduced in
instances in which added Medicaid has been generated through enhanced collection of
Medicaid fees and/or funding under the Medicaid Cost-Based Reimbursement process.
Page 63 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
LOCAL TOBACCO PREVENTION
SPECIAL REQUIREMENTS
(, BRANCH/HILLDSDALE/ST. JOSEPH HEALTH AGENCY, CHIPPEWA COUNTY HEALTH
DEPARTMENT„ DISTRICT HEALTH DEPARTMENT 410, GENESEE COUNTY HEALTH
DEPARTMENT, HEALTH DEPARTMENT OF NORTHWEST MICHIGAN, INGHAM COUNTY
HEALTH DEPARTMENT, JACKSON COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY
DEPARTMENT OF HEALTH & HUMAN SERVICES/HEALTH DIVISION, PUBLIC HEALTH DEPARTMENT
DELTA & MENOMINEE COUNTIES, WASHTENAW COUNTY HEALTH,)
Budget and Agreement Reguirements
No funds may be expended for lobbying as defined in Act No. 472 of the Public Acts of 1978, being
sections 4.411 to 4.431 of the Michigan Compiled Laws.
Grantee Reauirements
Complete requirements and update information in attached reports:
1 st tri-annual report October 1—January 31 — due February 16
2nd tri-annual report — February 1—May 31 — due June 15
3 rd tri- annual report — June 1—September 30 — due October 31
MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING INITIATIVE (MIECHV)
LOCAL HOME VISITING LEADERSHIP GROUP FUNDING
SPECIAL REQUIREMENTS
(GENESEE COUNTY HEALTH DEPARTMENT, ST. CLAIR COUNTY HEALTH DEPARTMENT)
All Maternal, Infant and Early Childhood Home Visiting Initiative (MIECHV) subcontracting agencies
must follow the program assurances and requirements, as prescribed. Requirements in section I-A
should be reflected in each agency's respective work plan.
1. Program Specific Assurances and Requirements
A. Each Local Leadership Group (LLG) will be required to adhere to Michigan's
MIECHV Program Requirements (PRs), as outlined in the chart. The PRs are
written based on the Federal MIECHV Program Grant Application submitted to the
Health Resources and Services Administration (HRSA).
B. The LLG will work with the MDCH contractor, Early Childhood Investment
Corporation (ECIC), who will provide technical assistance to the LLG as they seek
to carry out the MIECHV activities related to local home visiting system Continuous
quality Improvement (CQI), developing a continuum of models and sustainability
planning.
a. Year Three:
1. Continue efforts started in years one and two.
2. Continue to implement one strategy from the respective community's
local home visiting continuum plan
3. Participate in a state project to increase outreach and enrollment in
evidence-based home visiting.
b. Year Four:
Page 64 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT UI
6/27/15
1. Continue efforts started in years one, two and three.
2. Begin developing a local home visiting funding sustainability plan.
C. The funding can be used to:
a. Enable the LLG to pay for staff support.
b. Financially support LLG members, including parent leaders, to be a part of
the LLG.
c. Carry out the MIECHV activities, as specified in this agreement.
D. The LLG must include representatives from Public Health, Mental
Health/Substance Abuse, DHS/CAN Council, and Head Start. The LLG must also
include two parents, at minimum, who are or have been recipients of evidence
based home visiting services (as defined by P.A. 291 of 2012). Within two years of
receiving funding, the parent representatives must be parents of a child age 5 or
younger.
E. Other LLG representatives strongly encouraged, but not limited to, are: education,
local home visiting programs and from your Great Start Collaborative/Great Start
Parent Coalitions. We also recommend that the local groups include members of
tribal nations whose service areas overlap the community, and members of
community service agencies that represent populations that frequently experience
health disparities.
If a subcontracting agency wishes to print promotional or educational materials,
using contract funds, related to the M1ECHV initiative, they must:
1. Send draft materials electronically to the contract manager, Penny Eisfelder,
at eisfelderomichician.qov.
2. Materials must be approved by MDCH staff and a written approval received
by the subcontracting agency.
3. All materials must include the Michigan Home Visiting Initiative logo, which
can be obtained from the contract manager, upon request.
4. All materials must include the HRSA federal grant disclaimer and grant
number, which can be obtained from the contract manager upon request.
Separate approval must be obtained for each publication an agency wishes
to print.
Reporting Requirements:
1. A budget must be submitted via the Department's electronic MI E-Grants system.
2. Financial Status Reports (FSR's) will need to be submitted quarterly, through the Michigan E-
Grants system. All FSR's must report total actual expenditures, regardless of the source of
funds and must be submitted within 30 days of the required time period outlined in the
contract.
3. A work plan must be submitted to Penny Eisfelder via e-mail or fax by 3:00 p.m. on October
15:
Penny Eisfelder, Program Analyst
Division of Family & Community Health Michigan Department of Health & Human
Services
P.O. Box 30195
Lansing, MI 48909
Phone: 517-373-2039
Fax: 517-373-4294
eisfelderpmichician.00v
Page 65 of 96
M DH I-15/G&PD FY 15/16 ATTACHMENT III
6/27/15
4. Quarterly work plan reports must be submitted to Penny Eisfelder (contact information above)
within 30 days of the end of each quarter; the format for the quarterly reports will be provided
by the Department.
MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING INITIATIVE (MIECHV)
RURAL LOCAL HOME VISITING LEADERSHIP GROUPS FUNDING
SPECIAL REQUIREMENTS
(HEALTH DEPARTMENT of NORTHWEST MI-REGIONS 2 & 3 and
LUCE-MACKINAW-ALGER-SCHOOLCRAFT DISTRICT HEALTH DEPARTMENT)
Purpose:
To provide funding to support the convening of the Local Home Visiting Leadership (LLG) group in the
agency's respective region.
Funding Requirements:
All Grantees must follow the program assurances and requirements, as prescribed. Requirements
should be reflected in each agency's respective work plan (see Reporting Requirements).
1. The LLG will work with the MDHHS contractor, Early Childhood Investment Corporation
(ECIC), who will provide technical assistance to the LLG as they seek to carry out the activities
related to local home visiting system Continuous quality Improvement (CQI), developing a
continuum of models and sustainability planning.
a. Year One:
Integrate parent leaders on the LLG.
Assess LLG membership and participation and take action to increase
membership and increase consistent participation.
b. Year Two:
Continue efforts started in year one.
Establish a local systems-level Continuous Quality Improvement (CQI) team
and process.
Begin to outline a local continuum of home visiting models.
c. Year Three:
Continue efforts started in years one and two.
Continue to implement one strategy from the respective community's local
home visiting continuum plan
Participate in a state project to increase outreach and enrollment in evidence-
based home visiting.
d. Year Four:
Continue efforts started in years one, two and three.
Begin developing a local home visiting funding sustainability plan.
2.. The funding can be used to:
a. Enable the LLG to pay for staff support.
b. Financially support parent leaders to be a part of the LLG.
c. Carry out the Michigan Home Visiting Initiative activities, as specified in this agreement.
d. Send a minimum of 2 people to the annual home visiting conference
e. Send parents to the home visiting conference.
f. Off-set training expenses for Healthy Families America (HFA)-sponsored trainings.
g. Off-set training expenses for Parents as Teachers (PAT) curriculum trainings for new
HFA programs only.
3. The LLG must include representatives from Public Health, Mental Health/Substance Abuse,
DHS/CAN Council, and Head Start. The LLG must also include two parents, at minimum, who
are or have been recipients of evidence based home visiting services (as defined by P.A. 291
Page 66 of 96
MDH1-15/G&PD FY 15/16 ATTACHMENT III
6/27/15
of 2012). Within two years of receiving funding, the parent representatives must be parents of a
child age 5 or younger.
4. Other representatives strongly encouraged, but not limited to, are, education, local home
visiting programs, and from your Great Start Collaborative/Great Start Parent Coalitions. We
also recommend that the local groups include members of tribal nations whose service areas
overlap the community, and members of community services agencies that represent
populations that frequently experience health disparities.
5. If a subcontracting agency wishes to print promotional or educational materials, using contract
funds, related to the Michigan Home Visiting initiative, they must:
a. Send draft materials electronically to the contract manager, Penny Eisfelder, at
eisfelderp@michigan.gov .
b. Materials must be approved by MDHHS staff and a written approval received by
the subcontracting agency.
c. All materials must include the Michigan Home Visiting Initiative logo, which can
be obtained from the contract manager, upon request.
d. Separate approval must be obtained for each publication an agency wishes to print.
Reporting Requirements:
1. A budget must be submitted via the state's electronic MI E-Grants system.
2. Financial Status Reports (FSR's) will need to be submitted quarterly, through the MI E-Grants
system. All FSR's must report total actual expenditures, regardless of the source of funds and
must be submitted within 30 days of the required time period outlined in the contract.
3. A work plan must be submitted to Penny Eisfelder via e-mail or fax by 3:00 p.m. on October
15.
Penny Eisfelder, Program Analyst
Division of Family & Community Health Michigan Department of Health & Human
Services
P.O. Box 30195
Lansing, MI 48909
Phone: 517-373-2039
Fax: 517-373-4294
eisfelderpmichioan.qov
4. Quarterly work plan reports must be submitted to Penny Eisfelder (contact information above)
within 30 days of the end of each quarter; the format for the quarterly reports will be provided by
MDHHS.
MATERNAL INFANT EARLY CHILDHOOD HOME VISITING PROGRAM (MIECHVIDI HEALTHY FAMILIES
AMERICA EXPANSION
SPECIAL REQUIREMENTS
(KALAMAZOO COUNTY HEALTH AND COMMUNITY SERVICES DEPARTMENT, AND
WAYNE COUNTY HEALTH DEPARTMENT)
Grantee Requirements for all Department Funded Projects
Maintain Fidelity to the Model:
1. The Local Implementing Agency (LIA) shall Adhere to the Healthy Families America (HFA)
Best Practice Standards and operate the program with fidelity to the requirements of
Michigan Department of Health and Human Services (MDHHS) and the Best Practice
Standards. Projects must incorporate MDHHS, Michigan Home Visiting Initiative (MHVI) and
HFA requirements as required for fidelity.
Page 67 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
P.A. 291
2. The LIA shall comply with the provisions of Public Act 291 of 2012.
Staffing:
3. The LIA's HFA home visiting staff will reflect the community served. If unable to obtain and
maintain a staff that reflects the population served, the agency must document their good faith,
due diligent effort to comply with this requirement.
Target. Population:
4. The LIA shall serve the target population identified in their community's Needs Assessment,
which was approved by the MDHHS.
a. The Wayne County Babies HFA program will serve an additional 62 families living in
Highland Park, Hamtramck, Redford, Westland, Taylor, Romulus, Van Buren and
Inkster.
b. The Kalamazoo County Health & Community Services Department HFA program will
serve an additional 75 families with children who are at high-risk in the areas of
Comstock Township; City of Kalamazoo- Arcadia, Vine, Eastside Edison
neighborhoods, Richland Township, City of Portage, Texas Township, Oshtemo,
Galesburg.
5. The LIA shall develop an Outreach Plan for HFA that is consistent with the results of the
community needs assessment Exploration and Planning Tool submitted to, and agreed upon
by, MDHHS.
6. The LIA shall ensure that the Outreach Plan results in full caseloads within the pre-determined
mutually agreed upon date with MDHHS.
7. The LIA shall demonstrate that enrollment reflects the use of the outreach plan and shall
submit bi-annual reports on outreach activities and caseload population status.
8. The LIA shall refer clients not eligible for FIFA to another evidence-based Home Visiting
Program(s) designed for at risk families in their community.
Proaram Monitorina. Assessment. Support and Technical Assistance (TAI:
9. Fully participate with the Department arid the Michigan Public Health Institute (MPHI) with regards to
program development and monitoring, training, support and technical assistance services.
Professional Development and Training:
10. All of the LIA's FIFA program staff associated with this funding will participate in professional
development and training activities, as required by HFA. In addition, as required by the
Department, [IA's will participate in home visiting learning communities, other learning
opportunities, and meetings. There must be team representation during three full-day grantee
meetings each year. Work plans and budgets must reflect this activity.
Supervision:
11. The LIA shall adhere to the HFA supervision requirements of weekly 1.5-2 hour individual
supervision per 1.0 FTE and pro-rated as allowed by the Best Practice Standards.
pngaae and Coordinate with Community Stakeholders:
12. The LIA shall assure that there is a broad-based community advisory committee that is
providing oversight for HFA as required by the Best Practice Standards. This will occur
collaboratively with other early childhood committees or advisory bodies, or the Local
Leadership Group established to work with the Michigan Home Visiting Initiative Program.
Coordinate with Aporopriate_Entities/Prog rams;
13. The [IA shall build upon and maintain diverse community and target population collaboration
and support. ,
14. The [IA shall participate in a Local Leadership Group (or if none, at the Great Start
Collaborative) that seeks to effectively align home visiting efforts across the community,
and represent HFA in Continuous Quality Improvement efforts that assess the impact of the
overall home visiting effort in the community.
Page 68 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
Data Collection:
15. The L1A shall comply with all HFA and MDHHS data collection requirements.
16. The LIA shall work with the MHVI Evaluation contractor to develop and implement a plan to
collect and report additional data.
Continuous Quality Improvement (CQI):
17. The LIA shall participate in all HFA quality initiatives including: research, evaluation and
continuous quality improvement.
18. The LIA shall participate in all State and local Home Visiting CQI activities as required by
MDHHS.
Work Plan Requirements
19. Within 30 days of the initiation of the FY16 contract, the LIA must submit a work plan (outlining
all program activities) via e-mail or fax to Rosemary Fournier at fournierrl (michioan.00v or
517-373-4294. A template for the work plan will be provided. The work plan must also include
an outline of:
a. The LIA's strategies for minimizing attrition rates for their respective home visiting
program participants.
b. The LIA's strategies for addressing challenges to maintaining program quality and
fidelity.
Reoortina Reauirements
20. The LIA shall adhere to the HFA National Office program reporting requirements.
21. The LIA shall submit all required reports in accordance with the Department reporting
requirements.
a. Staff Roster: within 30 days of the beginning of each fiscal year and within 30 days of
a staffing change.
b. HFA Community Outreach Plan: within 30 days of the beginning of each fiscal year.
c. Work Plan Reports: within 30 days of the end of each quarter (January 30, April
30, July 30 and October 30). Biannually (April 30 and October 30) the work plan
reports must include information about outreach activities and caseload population
status.
d. Implementation Planning Review and HRSA data collection requirements on the 15 th
of each month.
22. Reports and information shall be submitted either electronically or via fax to: Cynthia Zagar at:
zaoarcmichiqan.qov or 517-373-4294.
Printed Materials
23. If the LIA wishes to print promotional or education materials, using contract funds, related to
the MIECHV initiative, they must:
a. Send draft materials electronically to Rosemary Fournier at zaoarcmichioan.00v.
b. Materials must be approved by MDHHS and a written approval received by the L1A.
c. All materials must include the MHVI logo, which can be obtained from MDHHS, once
approval is granted.
d. All materials must include the HRSA federal grant disclaimer and grant number, which
can be obtained from MDHHS, once approval is granted.
e. Separate approval must be obtained for each publication an agency wishes to print.
Page 69 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
MI HOME VISITING INITIATIVE RURAL EXPANSION GRANT
SPECIAL REQUIREMENTS
(LUCE-MACKINAC-ALGER-SCHOOLCRAFT HEALTH DEPARTMENT, HEALTH DEPARTMENT OF
NORTHWEST MICHIGAN REGION 2 & 3)
Grantee Requirements for all Department Funded Projects
Maintain Fidelity to the Model:
1. The Local Implementing Agency (LIA) shall Adhere to the Healthy Families America (HFA)
Best Practice Standards and operate the program with fidelity to the requirements of
Michigan Department of Health and Human Services (MDHHS) and the Best Practice
Standards. Projects must incorporate MDHHS, Michigan Home Visiting Initiative (MHVI) and
HFA requirements as required for fidelity.
P.A. 291
2. The LIA shall comply with the provisions of Public Act 291 of 2012.
Staffing:
3. The LIA's HFA home visiting staff will reflect the community served. If unable to obtain and
maintain a staff that reflects the population served, the agency must document their good faith,
due diligent effort to comply with this requirement.
Taraet Population:
4. The LIA shall serve the target population identified in their community's Needs Assessment,
which was approved by the MDHHS.
5. The LIA shall develop an Outreach Pian for HFA that is consistent with the results of the
community needs assessment Exploration and Planning Tool submitted to, and agreed upon
by, MDHHS.
6. The LIA shall ensure that the Outreach Plan results in full caseloads within the pre-determined
mutually agreed upon date with MDHHS.
7. The LIA shall demonstrate that enrollment reflects the use of the outreach plan and shall
submit bi-annual reports on outreach activities and caseload population status.
8. The LIA shall refer clients not eligible for HFA to another evidence-based Home Visiting
Program(s) designed for at risk families in their community.
Proararn Monitorina. Assessment. Support and Technical Assistance (TA):
9. Fully participate with the Department and the Michigan Public Health Institute (MPHI) with
regards to program development and monitoring, training, support and technical assistance
services.
Professional Development and Training:
10. All of the LIA's HFA program staff associated with this funding will participate in professional
development and training activities, as required by HFA. In addition, as required by the
Department, LIA's will participate in home visiting learning communities, other learning
opportunities, and meetings. There must be team representation during three full-day grantee
meetings each year. Work plans and budgets must reflect this activity.
Supervision:
11. The LIA shall adhere to the HFA supervision requirements of weekly 1.5-2 hour individual
supervision per 1.0 FTE and pro-rated as allowed by the Best Practice Standards.
Enaaqe and Coordinate with Community Stakeholders:
12. The LIA shall assure that there is a broad-based community advisory committee that is
providing oversight for HFA as required by the Best Practice Standards. This will occur
collaboratively with other early childhood committees or advisory bodies, or the Local
Leadership Group established to work with the Michigan Home Visiting Initiative Program.
Coordinate with Appropriate Entities/Proarams:
13. The LIA shall build upon and maintain diverse community and target population collaboration
and support.
Page 70 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
14. The LIA shall participate in a Local Leadership Group (or if none, at the Great Start
Collaborative) that seeks to effectively align home visiting efforts across the community,
and represent HFA in Continuous Quality Improvement efforts that assess the impact of the
overall home visiting effort in the community.
Data Collection:
15. The LIA shall comply with all HFA and MDHHS data collection requirements.
16. The LIA shall work with the MHV1 Evaluation contractor to develop and implement a plan to
collect and report additional data.
Continuous Quality Imorovement
17. The LIA shall participate in all HFA quality initiatives including: research, evaluation and
continuous quality improvement.
18. The LIA shall participate in all State and local Home Visiting CQ1 activities as required by
MDHHS.
Work Plan Requirements
19. Within 30 days of the initiation of the FY16 contract, the LIA must submit a work plan (outlining
all program activities) via e-mail or fax to Rosemary Fournier at fournierr1rnichician.qov or
517-373-4294. A template for the work plan will be provided. The work plan must also include
an outline of:
a. The LIA's strategies for minimizing attrition rates for their respective home visiting
program participants.
b. The LIA's strategies for addressing challenges to maintaining program quality and
fidelity.
Recortina Reauirements
20. The LIA shall adhere to the HFA National Office program reporting requirements.
21. The LIA shall submit all required reports in accordance with the Department reporting
requirements.
a. Staff Roster: within 30 days of the beginning of each fiscal year and within 30 days of
a staffing change.
b. HFA Community Outreach Plan: within 30 days of the beginning of each fiscal year.
c. Work Plan Reports: within 30 days of the end of each quarter (January 30, April
30, July 30 and October 30). Biannually (April 30 and October 30) the work plan
reports must include information about outreach activities and caseload population
status.
d. Implementation Planning Review and HRSA data collection requirements on the 15th
of each month
22. Reports and information shall be submitted either electronically or via fax to: Cynthia Zagar at:
zaqarcmichigan.00v or 517-373-4294.
MICHIGAN ABSTINENCE PROGRAM (MAP)
SPECIAL REQUIREMENTS
(DISTRICT HEALTH DEPARTMENT #2, DISTRICT HEALTH DEPARTMENT #4, JACKSON COUNTY
HEALTH DEPARTMENT, TUSCOLA COUNTY HEALTH DEPARTMENT)
Grantee Reauirement
1. Provide fourteen (14) or more hours of structured intervention to youth ages 10-15 (up to 21
for special education populations), spread across at least a four week period. Activities that are
solely recreational or social shall not be included.
Page 71 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
2. Develop and/or maintain a coalition/advisory council representative of the diversity of
the community (including teens and parents/guardians) who are instrumental in all phases
of the program planning, implementation and evaluation. The coalition/advisory council must
meet at least quarterly throughout the funding period.
3. If programming will be provided by a subcontractor, a Letter of Understanding (LOU) detailing
the responsibilities to which both parties agree must be completed.
4. Secure local matching funds (either cash or in-kind resources) totaling 50 percent or more of
the amount requested.
5. A minimum of 90% of the proposed users must be served to access the total amount of
allocated funds.
6. I n addition to those mentioned here, the Grantee must adhere to all of the Michigan Abstinence
Program's Minimum Program Requirements (MPRs).
Department Reauirements
1. Provide administrative professional and technical consultation to the program.
2. Provide a minimum of one MAP-sponsored coordinator meetings/trainings per year.
Reporting Requirements
1. The Grantee shall submit program narrative reports on the following dates:
Tvpe of Report and Timetrame Due Date
Quarterly Report (October 1 — December 31) January 30
Quarterly Report (January — March 31) April 30
Quarterly Report (April '1 — June 30)
July 30
Year-End Report (October 1 — September 30) November 30
2. Any such information as specified in the contract requirements and MAP Report Fact Sheet
shall be developed and submitted by the Grantee as required by the Contract Manager.
3. Reports and information shall be submitted to the Contract Manager
at:
Robyn Corey, Teen Pregnancy Prevention Consultant
Michigan Department of Health & Human Services
P.O. Box 30195, 109W. Michigan Ave.8 th Floor
Lansing, MI 48909
4. The Contract Manager shall evaluate the reports submitted for their completeness and adequacy.
5. The Grantee shall permit the Department or its designee to visit and to make an evaluation of
the projects as determined by the Contract Manager.
MICHIGAN ADOLESCENT PREGNANCY & PARENTING PROGRAM (MI-APPP)
SPECIAL REQUIREMENTS
(BERRIEN COUNTY HEALTH DEPARTMENT, AND CALHOUN COUNTY HEALTH DEPARTMENT)
Grantee Requirements
1. Implement approved Adolescent Family Life Project-Positive Youth Development (AFLP-PYD)
case management program for pregnant and parenting teens and fathers 15-'19 years of age.
Activities that are solely recreational or social shall not be included.
2. Develop and/or maintain a local steering committee representative of the diversity of the
Page 72 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
community, including pregnant/parenting mothers and fathers, who are instrumental in all
phases of the program planning, implementation and evaluation. The steering committee
must meet at least quarterly throughout the funding period.
3 If programming will be provided by a subcontractor, a Letter of Understanding (LOU) detailing
the responsibilities to which both parties agree must be completed.
4. Secure local matching funds (either cash or in-kind resources) totaling 20 percent or more of
the amount requested.
5. In addition to those mentioned here, the Grantee must adhere to its approved program work
plan and all of the MI-APPP Minimum Program Requirements (MPRs).
6. A minimum of 90% of the proposed users must be served to access the total amount of
allocated funds.
7. Information provided must be medically accurate, age appropriate, culturally relevant and up to
date.
8. Programs must complete, following the approved implementation guidelines, the MI-APPP
participant tracking database and submit to MPHI quarterly.
9. Programs must administer, following the approved implementation guidelines, the MI-APPP
youth intake and exist forms and enter required information into MI-APPP database and
submit to MPHI quarterly.
10. Pregnancy prevention education must be delivered separate and apart from any religious
education or promotion. MI-APPP funding cannot be used to support inherently religious
activities including but not limited to, religious instruction, worship, prayer or proselytizing (45
CFR Part 87).
11. Family planning drugs and/or devices cannot be prescribed, dispense or otherwise distributed
on school property as part of the pregnancy prevention education funded by MI-APPP as
mandated in the Michigan School Code.
12. Abortion services, counseling and/or referrals for abortion services cannot be provided as part
of the pregnancy prevention education funded under MI-APPP.
13. MI-APPP funding cannot be used to supplant funding for an existing program supported with
another source of funds.
14. All program and financial reports must be submitted by the deadlines specified by the
Department in the report face sheet.
Department Requirements
1. Provide administrative professional and technical consultation to the program.
2. Provide two two-day MI-APPP sponsored learning collaboratives per year.
Reporting Requirements
1. The Grantee shall submit program and evaluation progress reports on the following dates:
Type of Report and Timeframe Due Date
Quarterly Report (October 1 — December 31) January 30
Quarterly Report (January 1 — March 31) April 30
Quarterly Report (April 1— June 30) July 30
Quarterly Report ( July 1 — September 30) October 30
2. Any such information as specified in the contract requirements and MI-APPP Report Fact
Sheet shall be developed and submitted by the Grantee as required by the Contract Manager.
Page 73 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT ill
6/27/15
3. Reports and information shall be submitted to the Contract Manager at:
Hillary Turner, MI-APPP Program Coordinator
Michigan Department of Health & Human Services
109 W. Michigan Ave., 8th Floor
P.O. Box 30195
Lansing, MI 48913
4. The Contract Manager shall evaluate the reports submitted for their completeness and
adequacy.
5. The Grantee shall permit the Department or its designee to visit and to make an evaluation of
the projects as determined by the Contract Manager.
MICHIGAN CARE IMPROVEMENT REGISTRY
SPECIAL REQUIREMENTS
Grantee Reauirements
1. Michigan Care Improvement Registry (MCIR) responsibilities:
A. Ensure that all immunizations administered to persons born after December 31, 1993
by the Grantee, or by any provider with the jurisdiction are reported to the MCIR.
B. Ensure that all immunization providers within the Grantee's jurisdiction are registered
through the MCIR and that all of their activities are coordinated with the regional Grantee
of the Department and operated within their guidelines.
MICHIGAN COLORECTAL CANCER EARLY DETECTION PROGRAM
SPECIAL REQUIREMENTS
(CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT, DISTRICT HEALTH DEPARTMENT #10,
DISTRICT HEALTH DEPARTMENT #4, HEALTH DEPARTMENT OF NORTHWEST MICHIGAN,
HURON COUNTY HEALTH DEPARTMENT)
Grantee Reauirements:
The Michigan Colorectal Cancer Early Detection Program (MCRCEDP) provides colorectal
screening services to program eligible men and women:
1. Aged 50-64 years
2. Average risk for colorectal cancer — screened by Fecal I mmunochemical Test (FIT) or
colonoscopy
3. Increased risk for colorectal cancer— screened by colonoscopy
4. Low income (up to 250% of the Federal poverty level)
5. Who have inadequate or no health insurance
For specific MCRCEDP requirements please refer to the most current MCRCEDP manual available
at http://www.michigancancer.orq/Colorectal/.
Page 74 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT Ill
6/27/15
MILLION HEARTS MICHIGAN LEARNING COLLABORATIVE
SPECIAL REQUIREMENT
(MUSKEGON COUNTY HEALTH DEPARTMENT)
October 1 — January 15, 2016
Grantee Requirements
1 Develop, submit, and implement an approved work plan and budget which will be maintained on
file at MDHHS.
2. Participate and support the evaluation process, as created by MPH I and approved by MDHHS
staff.
3. Maintain an active Collaborative to support the funded project, interventions, and activities.
4. The Grantee will submit a progress report to the project evaluator, MPHI.
Period Covered Report Due Dates
October 1 — January 31 February 16
5. Schedule and attend regular Collaborative meetings.
6. The Grantee shall collaborate with the program consultant to schedule and participate in site
visits.
7. Provide interventions and strategies to support multiple Plan-Do-Study-Act cycles for policy and
systems change to increase monitoring of blood pressure, improve identification of high blood
pressure, and reduce high blood pressure.
8. Performance will be measured based on the progress towards meeting work plan
objectives. Activities in your work plan, the expenditures, reports, site visits, success stories
and evaluation outcomes will also be used to assess progress and level of impact.
9. Failure to comply with these requirements may result in punitive consequences such as denial
of future funding and/or other consequences as appropriate.
NURSE FAMILY PARTNERSHIP (NFP) SERVICES
SPECIAL REQUIREMENTS
(BERRIEN COUNTY HEALTH DEPARTMENT, CALHOUN COUNTY PUBLIC HEALTH DEPARTMENT,
INGHAM COUNTY HEALTH DEPARTMENT, KALAMAZOO COUNTY HEALTH AND COMMUNITY
SERVICES DEPARTMENT, KENT COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY
DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION, AND SAGINAW COUNTY
HEALTH DEPARTMENT)
Grantee Requirements for All Department Funded Projects
Maintain Fidelity to the Model:
1. The Local Implementing Agency (LIA) shall adhere to the Nurse Family Partnership (NFP)
National Service Office program standards and operate the program with fidelity to the
requirements of the Michigan Department of Health and Human Services (MDHSS/the
Department) and the Nurse Family Partnership (NFP) National Service Office (NSO)
Application Review Team approved Implementation Plan. Projects must incorporate
MDHHS, Michigan Home Visiting Initiative (MHVI) and NSO NFP requirements as required for
fidelity.
P.A. 291
2. The LIA shall comply with the provisions of Public Act 291 of 2012.
Page 75 of 96
MDHHS/G&PD Pe 15/16 ATTACHMENT 111
6/27/15
Staffing:
3. The LIA's NFP home visiting nursing staff will reflect the community served. If unable to obtain
and maintain a staff that reflects the population served, the agency must document their good
faith, due diligent effort to comply with this requirement.
Taraet PODU I ati on :
4. Michigan is using NFP as a specialized home visiting service strategy for low income, first
time mothers whose population group contributes to the community's excess infant deaths.
This specialized service strategy is a focused way use limited resources, directing it to the most
at risk populations.
5. The LIA shall develop an Outreach Plan for NFP that is consistent with the risk-based
analysis identified in the Annual Kitagawa analysis community profile, provided by MDHHS.
6. The LIA shall demonstrate that enrollment reflects the use of the outreach plan and shall
submit bi-annual reports on outreach activities and caseload
population status.
7. The LIA shall refer clients not eligible for NFP to another evidence-based Home Visiting
Program(s) designed for at-risk pregnant women in their community.
Program Monitoring. Assessment, Support and Technical Assistance (TA):
8. The LIA shall fully participate with the NFP NSO, the Department and the Michigan Public
Health Institute (MPHI) with regards to program monitoring, assessment, support and technical
assistance services.
Professional Development and Training:
9. All LIA NFP staff associated with this funding will participate in professional
development and training activities, as required by NFP. As required by the Department, LIAs
will participate in home visiting learning communities, other learning opportunities, and
meetings such as grantee meetings.
Supervision
10. The LIA shall adhere to the NFP supervision requirements.
Engage and Coordinate with Comm nity Stakeholders:
11. The LIA shall assure that there is a broad-based community advisory committee that is
providing oversight for NFP. This will occur collaboratively with other early childhood
committees or advisory bodies, or the Local Leadership Group (LLG) established to work with
the Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program as listed.
Coordinate with Appropriate Entities1Proarams:
12. The LIA shall build upon and maintain diverse community and target population collaboration
and support.
13. The L1A shall participate in the Local Leadership Group (LLG) (or, if none, at the Great Start
Collaborative) that seeks to effectively align home visiting efforts across the community,
and represent NFP in Continuous Quality Improvement efforts that assess the impact of the
overall home visiting effort in the community.
Data Collection:
14. The LIA shall comply with all NFP and MDHHS data collection requirements.
15. The LIA shall authorize the Department and the MPHI to receive information from the national
NFP clinical information system known as Efforts to Outcomes (ET0).
16. The LIA shall Work with the II/IIECHV evaluation contractor to develop and implement a plan to
collect and report additional data beyond that required for NFP.
Continuous Quality Improvement
17. The L1A shall participate in all NFP quality initiatives including: research, evaluation and
continuous quality improvement.
18. The LIA shall participate in all State and local Home Visiting CQI activities as required by
IIADH HS .
Page 76 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
Work Plan Requirements
19. Within 30 days of the initiation of the FY16 contract, the LIA must submit a work plan (outlining
all program activities) via e-mail or fax to Rosemary Fournier at fournierr1michigan.gov or
517-373-4294. A template for the work plan will be provided. The work plan must also include
an outline of:
a. The LIA's strategies for minimizing attrition rates for their respective home visiting
program participants.
b. The LIA's strategies for addressing challenges to maintaining program quality and
fidelity.
Reporting Reauirements
20. The LIA shall adhere to the NFP, Inc., National Office program reporting requirements.
21. The LIA shall submit all required reports in accordance with the Department reporting
requirements.
a. Staff Roster: within 30 days of the beginning of each fiscal year and within 30 days
of a staffing change.
b. NFP Community Outreach Plan: within 30 days of the beginning of each fiscal year.
c. Work Plan Reports: within 30 days of the end of each quarter (January 30, April 30,
July 30 and October 30). Biannually (April 30 and October 30) the work plan reports
must include information about outreach activities and caseload population status.
d. Implementation Planning Review (IPR) and the Health Resources & Services
Administration (HRSA) data collection requirements: on the 15 th of each month.
e. Medicaid Outreach Report (Berrien, Calhoun, Kalamazoo and, Kent only): within 30
days of the end of each quarter.
22. Reports and information shall be submitted either via e-mail or fax to: Rosemary Fournier at:
fournierrimichigan.ciov or 517-373-4294.
Printed Materials
23. If the LIA wishes to print promotional or education materials, using contract funds, related to
the MIECHV initiative, they must:
a. Send draft materials electronically to Rosemary Fournier at fournierr1@michigan.gov .
b. Materials must be approved by MDHHS and a written approval received by the [IA.
c. All materials must include the MHVI logo, which can be obtained from MDHHS, once
approval is granted
d. All materials must include the HRSA federal grant disclaimer and grant number which
can be obtained from MDHHS, once approval is granted.
e. Separate approval must be obtained for each publication an agency wishes to print.
PUBLIC HEALTH EMERGENCY PREPAREDNESS (PHEP)
SPECIAL REP UIREMENTS
(INCLUDING CRI FUNDING FOR, DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION,
WAYNE, OAKLAND, LIVINGSTON, LAPEER, MACOMB AND ST. CLAIR COUNTY HEALTH
DEPARTMENTS)
OCTOBER 1, 2015 — JUNE 30, 2016
Grantee Reauirements (Base/ CRI)
The Public Health Emergency Preparedness section of Attachment III is effective from October 1,
2015 through June 30, 2016. Funds are provided by the Department for nine months based on the
Department's fiscal year.
Page 77 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
As a sub-recipient of funding provided through the Centers for Disease Control and Prevention
(CDC) National Bioterrorism Hospital Preparedness Program (HPP) and Public Health Emergency
Preparedness (PHEP) Cooperative Agreement, each local health department (LHD) shall conduct
activities to build preparedness and response capacity and capability. These activities shall be
conducted in accordance with the HPP/PHEP Cooperative Agreement guidance for 2015-2016 plus
any and all related guidance from the CDC and the Department that is issued for the purpose of
clarifying or interpreting overall program requirements. All Grantee activities shall be consistent
with all approved BP4 work plan(s) and budget(s) on file with the Department through the MI E-
Grants system. In addition to these broad requirements, the Grantee will comply with the following:
1. One (1) full time equivalent (FTE) emergency preparedness coordinator (EPC), as a point of
contact. In addition to the Grantee health officer, the EPC shall participate in collaborative
capacity building activities of the HPP/PHEP Cooperative Agreement, all required reporting
and exercise requirements and in regional Healthcare Coalition (HCC) initiatives.
2. Under the alignment of the HPP and PHEP cooperative agreements, LHD's must partner with
the Regional Healthcare Coalition (HOC) and support HCC initiatives to ensure that
healthcare organizations receive resources to meet medical surge demands. Working well
together during a crisis is facilitated by meeting on a regular basis. To this end, EPCs,
supported by CDC PHEP are required to participate in and support regional HCC initiatives. In
addition, the EPC or designee is required to attend regional HCC planning or advisory board
meetings.
3. There are a number of special initiatives, projects, and/or supplemental funding opportunities
(supplementals) that are facilitated under this cooperative agreement. For example, the Cities
Readiness Initiative (CRI) performance and evaluation initiatives. Each Grantee that is
designated to participate in any of these types of supplementals is required to comply with all
CDC and MDHHS — DEPR guidance, and all accompanying work plan and budgeting
requirements implemented for the purpose of subrecipient monitoring and accountability.
Some or all supplementals may require separate recordkeeping of expenditures. If so, this
separate accounting will be identified in separate project budgets in the MI E-Grants system.
These supplementals may also require additional reporting and exercise activities.
4. Grantees are required to submit a 9-month (October 1 to June 30) budget and a 3-month
(July 1 to Sept 30) for both Base PHEP and CR) funding, including the 10 percent (10%)
MATCH for those periods (see #14 below for detail regarding Match). Submitted to
OPHP PHEPmichioangov by May 1, 2016.
5. ALL activities funded through the PHEP cooperative agreement must be completed between
July 1, and June 30, and all BP4 funding must be obligated by June 30, 2016 and completed
by the August 15, 2016 FSR submission deadline.
6. All budget amendments to the Division of Emergency Preparedness and Response (DEPR)
for review prior to submitting them in the MI E-Grants system. Budget amendments that
contain line items deviating more than 15 percent from the original budgeted line item must be
approved by DEPR prior to implementation (15 percent deviation rule) via email to Jolene
Miller at milleri39(@snichician.gov . Note: This change reflects the removal of the $10,000
maximum deviation.
7. The final Financial Status for funding period ending June 30 reports MUST be submitted in the
MI E-Grants system for this funding source no later than August 15, 2016,
8. The ace of supplantation is the replacement of non-federal funds with federal funds to
Page 78 of 96
MDHHS/G&PD FY 15/16 ATTACHMENTI!I
6/27/15
support the same activities. The Public Health Service Act, Title I, Section 319(c) specifically
states, ''SUPPLEMENT NOT SUPPLANT. — Funds appropriated under this section shall be
used to supplement - not supplant - other federal, state, and local public funds provided for
activities under this section." This law strictly and expressly prohibits using cooperative
agreement funds to supplant any current state or local expenditures.
9. Unallowable Costs:
A. Recipients may not use funds for fund raising activities or lobbying.
B. Recipients may not use funds for research.
C. Recipients may not use funds for construction or major renovations.
D. Recipient may not use funds for clinical care.
E. Recipients may not use funds to purchase vehicles to be used as means of
transportation for carrying people or goods, e.g., passenger cars or trucks, electrical
or gas-driven motorized carts.
F. Recipients may not use funds for reimbursement of pre-award costs.
G. Recipients may supplement but not supplant existing state or federal funds for
activities described in the budget.
H. Payment or reimbursement of backfilling costs for staff is not allowed.
I. None of the funds awarded to these programs may be used to pay the salary of
an individual at a rate in excess of Executive Level II or $181,5000 per year.
10. Other funding Notes:
a. Awardee can use funds to support appropriate accreditation activities that meet
the Public Health Accreditation Board's preparedness-related standards.
b. Awardee can use funds to purchase caches of antiviral drugs to help ensure
rapid distribution of medical countermeasures.
c. Awardee can (with prior approval by CDC) use funds to purchase industrial or
warehouse-use trucks to be used to move materials, such as forklifts, lift trucks,
turret trucks, etc. Vehicles must be of a type not licensed to travel on public
roads.
d. Awardee can (with prior approval by CDC) use funds to lease vehicles to be
used as means of transportation for carrying people or goods, e.g., passenger
cars or trucks and electrical or gas-driven motorized carts.
11. Grantees must maintain National Incident Management System (NIMS) compliance as detailed
in the LHD work plan and submit annually to the Department — DEPR per the LHD BP4 work
plan.
12. Each subrecipient Grantee must retain program-related documentation for activities
and expenditures consistent with Title 2 CFR Part 200; Uniform Administrative Requiremtns,
Cost Principles and Audit Requiremths for Federal Awards, to the standards that will pass the
scrutiny of audit.
13. Audit Requirement - A grantee may use its Single Audit to comply with 42 USC 247d —
3a(j)(2) if at least once every two years the awardee obtains an audit in accordance with the
Single Audit Act (31 USC 7501 — 7507) and Title 2 CFR, Part 200 Subpart F; submits that
audit to and has the audit accepted by the Federal Audit Clearinghouse; and ensures that
applicable PREP CFDA number 93.069 are listed on the Schedule of Expenditures of Federal
Awards (SEFA) contained in that audit.
14. LHDs provide the required 10 percent MATCH for July 1,2015 through September 30,
2015 and October 1, 2015 through June 30, 2016. Grantees are required to submit a letter
(on agency letterhead) stating the source, calculation and narrative description of how the
Page 79 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
match was achieved, unless said match is met using Local dollars. This was due with the
narrative budget submission to the Department — DEPR.
15. Administrative preparedness - During BP4, Grantees must strengthen (or develop_ and test
its administrative preparedness plann, to include written policies, procedures, and/or protocols
that address the following:.
a. Expedited procedures for receiving emergency funds during a real incident or
exercise;
b. Expedited processes for reducing the cycle time for contracting and/ or procurement
during a real emergency or exercise;
c. Internal controls related to subrecipient monitoring and any negative audit findings
resulting from suboptimal internal controls; and
d. Emergency authorities and mechanisms to reduce the cycle time for hiring and/ or
reassignment of staff (workforce surge).
All administrative preparedness planning activities should be considered in coordination with
healthcare systems, law enforcement, and other relevant stakeholders as appropriate.
16. The Pandemic and All Hazards Preparedness Reauthorization Act (PAHPRA) of 2013 requires
the withholding of amounts from entities that fail to achieve PHEP benchmarks. The following
PHEP benchmarks have been identified by CDC and MDHHS-DEPR for the Fiscal Year:
a. Demonstrated adherence to all PHEP application and reporting deadlines. Grantees
must submit required PH EP program data and reports by the stated deadlines. This
includes, but is not limited to, progress reports, performance measure data reports,
National Incident Management System (NIMS) compliance reports, updated
emergency plans, budget narratives, Financial Status Reports (FSR), etc. Failure to do
so will constitute a benchmark failure. All deliverables must be submitted by the designated
due date in the LHD BP4 work plan.
b. Demonstrated capability to receive, stage, store, distribute, and dispense medical
countermeasures (MCM) I during a public health emergency, per the PB4 LHD Work
Plan.
c. Pandemic Influenza Preparedness plans:. . Plans should be updated to describe
activities that will be conducted with respect to pandemic influenza as required by
Sections 319C — 1 and 319C — 2 of the PHS Act. Awardees must work with their
immunization programs to complete the CDC pandemic influenza readiness
assessment* designed to identify operational gaps and inform MDHHS — DEPR of
technical assistance and guidance needs for pandemic preparedness planning (*CDC
will release this assessment during BP4).
17. In response to repeated communications from CDC strongly urging states to ensure all
funds are spent each year a threshold has been established to limit the amount of unspent
funds. A maximum of 2% of the LHD allocation or $3,000 (whichever is greater) of unspent
funds is allowable each budget period. Failure to meet this requirement, or misuse of funds,
will affect the amount that is allocated in subsequent budget periods.
18. Benchmark Failure - Awardees are expected to "substantially meet" the PAHPRA
benchmarks. Per the Cooperative Agreement, failure to do so constitutes a benchmark
failure, which carries an allowable penalty withholding of funds. Failure to meet any one of the
two benchmarks and/or the spending threshold is considered a single benchmark failure. Any
awardee (or sub-awardee) that does not meet a benchmark and/or the spending threshold will
have an opportunity to correct the deficiency during a probationary period. If the deficiency is
not corrected during this period the awardee is subject to a 10% withholding of funds the
following budget period. Failure to meet the pandemic influenza plan requirement constitutes
a separate benchmark failure, and is also subject to a 10% withholding. The total potential
Page 80 of 96
MDH1-15/G&PD FY 15/16
ATTACHMENT III
6/27/15
withholding allowable is 20% the first year. If the deficiency is not corrected, the allowable
penalty withholding increases to 30% in year two and 40% in year three.
Regional Epidemiology Support:
1. For those Grantees receiving additional funds to provide workspace for Regional
Epidemiologists, the grantee must provide adequate office space, telephone connections, and
high-speed Internet access. The position must also have access to fax and photocopiers.
PUBLIC HEALTH EMERGENCY PREPAREDNESS (PHEPI
EBOLA VIRUS DISEASE (EVDI PHASE II
SPECIAL REQUIREMENTS
Grantee Requirements
As a sub-recipient of funding provided through the Centers for Disease Control and Prevention
(CDC) National Bioterrorism Hospital Preparedness Program (HPP) and Public Health Emergency
Preparedness (PHEP) Cooperative Agreement/PHEP Supplemental for Ebola Preparedness and
Response Activities, each local health department (LHD) shall conduct activities to support
accelerated Ebola public health preparedness planning and response. These activities shall be
conducted in accordance with the HPP/PHEP Cooperative Agreement guidance for 2015— 2016, plus
any and all related guidance from the CDC and The Office of Public Health Preparedness (OPHP) that
is issued for the purpose of clarifying or interpreting overall program requirements. Grantee
activities shall be consistent with all approved PHEP EVD PHASE II work plan(s) on file with OPHP.
In addition to these broad requirements, the LHD will comply with the following:
This funding is targeted to address public health preparedness capabilities, including, but not limited,
to:
a. Community Preparedness
b. Public Health Surveillance and Epidemiological Investigation
C. Public Health Laboratory Testing
d. Non-Pharmaceutical Interventions
e. Responder (Worker) Safety and Health
f. Emergency Public Information and Warning/Information Sharing
g. Medical Surge
1. No cost sharing or matching is required for this supplement.
2. Maintenance of effort is not required for this supplement.
3. Restrictions, which must be taken into account while writing the budget, are as follows:
a. Recipients may not use funds for research.
b. Recipients may not use funds for clinical care.
c. Recipients may only expend funds for reasonable program purposes, including
personnel, travel, supplies, and services, such as contractual.
d. Grantees may not generally use HHS/CDC/ATSDR funding for the purchase of
furniture or equipment. Any such proposed spending must be identified in the budget.
e. Recipients may not use funds for fund-raising activities or lobbying.
f. Recipients may not use funds for construction or major renovations.
Page 81 of 96
MDH1-15/G&PD FY 15/16 ATTACHMENT III
6/27/15
g. Recipients may not use funds for reimbursement of pre-award costs.
h. Recipients may supplement but not supplant existing state or federal funds for
activities described in the budget.
Payment or reimbursement of backfilling costs for staff is not allowed.
j. None of the funds awarded to these programs may be used to pay the salary of an
individual at a rate in excess of Executive Level II or $181,500 per year
4. Funding is for an 18 month period which runs from 4/1/15 — 9/30116, There will be an
opportunity to roll unspent funds from FY 15 into FY16.
5. All funds and activity need to be complete by 9/30/16.
6. Separate budget narratives will not be required for this supplemental funding. Enter as much
detail as possible into the EGrAMS budget.
7. FINAL FSR —A final FSR for this funding period will be due no later than 11/30/16,
SEAL! MICHIGAN DENTAL SEALANT PROGRAM
SPECIAL REQUIREMENTS
(INGHAM COUNTY HEALTH DEPARTMENT, OTTAWA COUNTY HEALTH DEPARTMENT, AND VAN
BUREN CASS COUNTY HEALTH DEPARMENT)
Grantee ReauIrements
1. Administer screening, fluoride and dental sealant applications to all eligible children with a
signed consent form in the Department Oral Health Program designated schools, to meet
goals of the priority population.
2. Provide oral health promotion of dental sealants through literature and/or presentations
to parents/guardians of children that are culturally and linguistically sensitive.
3. Provide instruction on oral health and sealant placement to children targeted for the SEAL!
Michigan program prior to sealant placement.
4. Measure quality control of the sealant program through SEALS data software and provide
hard copy forms to the Department upon request:
5. Ensure all staff has received training in the SEAL! Michigan Program via on-line training
provided by the Department, which includes SEALS training. Note: even if training has been
completed by grantees in previous years, attendance for the current grant cycles is required.
6. Adhere to CDC, OHSA and MIOSHA Standards and the State of Michigan Administrative Rules.
7. Ensure sealant material is approved by ADA, is non-expired, and applied according
to manufacturer's specifications.
8. Demonstrate activity in establishing a dental home or referral network for children referred
for dental treatment. Grantees must document that personal contact via phone or letter is made
to the parent/guardian of child with urgent dental care needs. (Urgent means care needed
within 24 hours). Grantee must have a mechanism to track the children receiving
emergency dental restorative emergency services within 20 miles of the sealant site and
provide the tracking information to the Department upon request.
9. Provide details on how the program is working toward sustainability beyond the grant.
Grantees must provide documentation on how sustainability is taking place, for example:
Medicaid, 3rd party billing protocols or in-kind contributions.
10. Grantees must utilize experienced and competent staff to accomplish program goals.
11. Grantees must track separately the amount of schools they serve, how many children
Page 82 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT Ill
6/27/15
received dental sealants, and how many dental sealants have been placed separately from
SEALS and be able to provide this information upon request.
12. Retention checks must be performed on 20% of children serviced and achieve 90% or better
retention rates on occlusal surfaces and 65% retention rates on buccal pits. If retention is
found to be less than 90% (meaning more than 10% of dental sealants are falling out) then
40% of students must be checked for sealant retention. Any dental sealants which have fallen
out upon the retention check must be replaced immediately free of charge and then
rechecked for retention.
13. Grantees shall be compliant with sub-recipient grantee meetings quarterly. A minimum of two
on- site visits will be required yearly, remaining two will take place via conference call.
14. To be considered for the non-competitive continuation grant the following must be
completed:
a. Meet and/or exceed all grant requirements and priorities
b. Complete the non-competitive grant application in its entirety (see REP)
c. Have the application postmarked or received by the Department by December 1, for
the second year.
Reo rtinp Requirements
The Grantee shall submit the following reports within 15 days as stated on the following dates:
• End Date Report Due Date
1 st Qtr (December 31)
January 15
2 nd Qtr (March 31)
April 15
3rd Qtr (June 30)
July 15
4th Qtr (September 30) October 15
1. Collect data through SEALS software so as to monitor the program effectiveness, final
reporting due within two (2) weeks of the end of the year fourth quarter grant period.
2.
The Grantee shall submit the following information electronically in an encrypted manner to
the Department Oral Health Program or through the State of Michigan File Transfer system.
a. Complete Sealant Efficiency Assessment for Locals and States (SEALS) software
to include: (Exported Child Level, Exported Event Level and entire software). This
should be updated weekly and sent at the end of grant year in the fourth quarter
and/or upon request by the Department.
b. Electronic copy of Program Level. This should be sent at the end of the 4th quarter
and prepared for each quarterly site visit.
c. Demonstration of retention check of sealants of 90% or greater on occlusal surfaces and
65% on lingual and buccal pits.
i, A sampling of 20% of the teeth sealed by new employees must be checked
for retention within 3-6 weeks following sealant placement. All retention checks
shall be entered into SEALS within each grant year.
3. A work plan should be submitted at the end of every quarter. The work plan should include
an update on all of the Grantee requirements.
4. Provide documentation that emergency dental restorative services are tracked for children
referred through the SEALl Michigan dental sealant program within a 20 mile radius of the
Page 83 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
sealant program.
5. The Grantee shall submit an Evaluation Form to be sent at the end 4th quarter. This will be
provided to grantees by September 1 by Oral Health Coordinator.
Send reports to:
Jill Moore, Dental Sealant Coordinator
Oral Health Program — SEAL! Michigan
Michigan Dept. of Health & Human Services, Division of Chronic Disease and Injury
Control
P.O. Box 30195, Lansing MI 48909
Phone: (517)373-4943 Fax: (517)335-8697 MooreJ14nmichigan.qov
SEXUAL VIOLENCE PREVENTION
SPECIAL REQUIREMENTS
(KENT COUNTY HEALTH DEPARTMENT)
November 1, 2015— September 30, 2016
Grantee Requirements:
1. Strengthen individual knowledge in Kent County (Ongoing).
2. Promote community education in Kent County (Ongoing).
3. Educate Kent County Providers (Ongoing).
4 Foster coalitions and networks in Kent County (Ongoing).
5. Work with local businesses to change organizational practices (Ongoing).
6. Educational local/state policy makers about sexual violence prevention (Ongoing).
7. Restrictions, which must be taken into account while writing the budget, are as follows:
a. Recipients may not use funds for research.
b. Recipients may not use funds for clinical care.
c. Recipients may only expend funds for reasonable program purposes, including
personnel, travel, and supplies.
d. Awardees may not generally use CDC funding for the purchase of furniture or
equipment. Any such proposed spending must be identified in the budget.
e. Recipients may not use funds for fund-raising activities or lobbying.
f. Recipients may not use funds for construction or major renovations.
g. Recipients may not use funds for reimbursement of pre-award costs.
h. Recipients may supplement but not supplant existing state or federal funds for
activities described in the budget.
Recipients may not include indirect costs.
j. Payment or reimbursement of backfilling costs for staff is not allowed.
Reporting Requirements:
The Grantee shall submit the following reports on the following dates:
Deliverable
Project Report 1
Project Report 2
Project Report 3
Project Report 4
Period Covered
10/01 — 12/30
01/01 — 03/31
04/01 — 06/30
07/01 —09/30
Due Date
01/15
04/15
07/15
10/14
Page 84 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT II
6/27/15
Any such other information as specified in the Grantee Requirements section shall be developed and
submitted by the Grantee as required by the Contract Manager.
Reports and information shall be submitted to the Contract Manager at:
drzwaczimichioan.00v.
SEXUALLY TRANSMITTED DISEASE (STD) CONTROL
SPECIAL REQUIREMENTS
(BERRIEN COUNTY HEALTH DEPARTMENT, CALHOUN COUNTY HEALTH DEPARTMENT, CITY OF
DETROIT HEALTH AND WELLNESS, GENESEE COUNTY HEALTH DEPARTMENT, INGHAM
COUNTY HEALTH DEPARTMENT, JACKSON COUNTY HEALTH DEPARTMENT, KALAMAZOO
COUNTY HUMAN SERVICES DEPARTMENT, KENT COUNTY HEALTH DEPARTMENT, MACOMB
COUNTY HEALTH DEPARTMENT, MUSKEGON COUNTY HEALTH DEPARTMENT, OAKLAND
COUNTY HEALTH DEPARTMENT, SAGINAW COUNTY HEALTH DEPARTMENT, ST. CLAIR
COUNTY HEALTH DEPARTMENT, WASHTENAW COUNTY HEALTH DEPARTMENT, WAYNE
COUNTY HEALTH DEPARTMENT)
1. For medical providers that identify 5% or more of the County's gonorrhea, chlamydia, and/or
syphilis morbidity, the local STD program will visit them at least annually to review provider
screening, reporting, treatment, and partner management methods.
2. Quarterly Reports: Grantee shall submit the Quarterly Clinic Activity and Medication Inventory
Reports within 10 calendar days after the end of each quarter.
3. Participate in technical assistance/capacity development, quality assurance and program
evaluation activities as directed by DHWDC/STD.
4. Implement program standards and practices to ensure the delivery of culturally, linguistically,
and developmentally appropriate services. Standards and practices must address sexual
minorities
5. Inform DHWDC/STD at least 2 weeks prior to changes in clinic operation (hours, scope
of service, etc.)
6. Adhere to budgets and staffing plans submitted to and approved by DHWDC.
Deviations outside of allowance must be approved by DHWDC.
7. For gonorrhea and chlamydia cases in the Michigan Disease Surveillance System, 50%
shall be completed within 30 days and 60% within 60 days from the date of specimen
collection.
SUDDEN UNEXPLAINED INFANT DEATH (SUIDI AND OTHER FETAL INFANT DEATH
SPECIAL REQUIREMENTS
Grantee Rea uirements
1. Grantee personnel will maintain current expertise in fetal/infant death research, bereavement
and counseling techniques through educational in-service and/or personal professional
development.
2. The Grantee will update current curriculum and materials for maternal and child health
Page 85 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
programs to incorporate Sudden Unexplained Infant Death (SUID) and other fetal/infant death
risk reduction information and interconception care education and/or counseling.
Interconception care, per the joint program brief issued by the CDC and HRSA in 2008, is
comprised of interventions that aim to identify arid modify biomedical, behavioral, and social
risks to a woman's health or pregnancy outcome through prevention and management,
emphasizing those factors which must be acted on before conception or early in pregnancy to
have maximal impact. Thus, it is more than a single visit and less than all well-woman care. It
includes care before a first pregnancy or between pregnancies.
3. The Grantee will facilitate bereavement support services to families and other caretakers of
infants experiencing a fetal or SUID infant death. In communities with an active Fetal Infant
Mortality Review (FIMR) team, the Grantee will facilitate bereavement support services to
families and other caretakers experiencing any type of infant and perinatal death.
4. The Grantee will encourage all infant deaths to be reviewed in the local Child Death Review
team process and/or Fetal-Infant Mortality Review process (if available) to improve the
consistency of death scene investigation, autopsy, death certificate documentation and
accurate SU ID diagnosis.
Department Requirements
1. Provide payment of $125 for each family support visit. A maximum of 6 visits are reimbursable
per fetal/infant death. One of these visits can be utilized to conduct a FIMR Maternal
Interview.
2. Provide training for certification of family support providers.
3. Provide technical assistance for bereavement support through Tomorrow's Child (Michigan SIDS).
TAKING PRIDE IN PREVENTION (TPIP1
SPECIAL REQUIREMENTS
(CALHOUN COUNTY PUBLIC HEALTH DEPARTMENT, JACKSON COUNTY HEALTH DEPARTMENT)
Grantee Reauirements
1. Implement, with fidelity, the approved evidence-based intervention to youth ages 12-19.
Activities that are solely recreational or social shall not be included.
2. Develop and/or maintain a coalition/advisory council representative of the diversity of the
community (including teens and parents/adults/caregivers) who are instrumental in all phases
of the program planning, implementation and evaluation. The coalition/advisory council must
meet at least quarterly throughout the funding period.
3. If programming will be provided by a subcontractor, a Letter of Understanding (LOU) detailing
the responsibilities to which both parties agree must be completed.
4. Secure local matching funds (either cash or in-kind resources) totaling 35 percent or more of
the amount requested.
5. A minimum of 90% of the proposed users must be served to access the total amount of
allocated funds.
6. Comprehensive pregnancy prevention (abstinence and contraception) education must be
taught using an evidence-based intervention approved by the Department and address the
following three adulthood preparation topics: healthy relationships, adolescent development,
and parent-child communication.
7. Information provided must be medically accurate, age-appropriate, culturally relevant, and up-
Page 86 of 96
MDHHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
to-date.
8. Programs must complete, following the approved implementation guidelines, the TPIP/
program/participant tracking database and submit to MPHI quarterly.
10. Programs must administer, following the approved implementation guidelines, the TPIP/ state
pre/post and federal entryexit youth surveys and subsequent entry of the survey data into
ODE quarterly.
11. Pregnancy prevention education must be delivered separate and apart from any religious
education or promotion. TPIP/ funding cannot not be used to support inherently religious
activities including, but not limited to, religious instruction, worship, prayer, or proselytizing (45
CFR Part 87).
12. Family planning drugs and/or devices cannot be prescribed, dispensed, or otherwise
distributed on school property as part of the pregnancy prevention education funded by TPIP/
as mandated in the Michigan School Code (§380.1507, 388.1766).
13. Abortion services, counseling and/or referrals for abortion services cannot be provided as part
of the pregnancy prevention education funded under TPIP/.
14. TPIP funding cannot be used to supplant funding for an existing program supported with
another source of funds.
15. In addition to those mentioned here, the Grantee must adhere to its approved program work plan
and all of the Taking Pride in Prevention Minimum Program Requirements (MPRs).
Department Reauirements
1. Provide administrative professional and technical consultation to the program.
2. Provide two two-day TPIP-sponsored Institutes per year.
Reporting Reauirements
1. The Grantee shall submit progress reports on the following dates:
Type of Report and Timeframe
Quarterly Report (October 1 — December 31)
Quarterly Report (January 1 — March 31)
Quarterly Report (April 1 — June 30)
Quarterly Report ( July 1 — September 30)
Due Date
January 30
April 30
July 30
October 30
2. Any such information as specified in the contract requirements and TPIP Report Fact
Sheet shall be developed and submitted by the Grantee as required by the Contract Manager.
3. Reports and information shall be submitted to the Contract Manager at:
Kara Anderson
Teen Pregnancy Prevention Coordinator
Michigan Department of Health & Human
Services
109 W. Michigan Ave.,8 th Floor
Lansing, MI 48913
4. The Contract Manager shall evaluate the reports submitted for their completeness and
adequacy.
5. The Grantee shall permit the Department or its designee to visit and to make an evaluation of
the projects as determined by the Contract Manager.
Page 87 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT Ill
6/27/15
TOBACCO REDUCTION IN PEOPLE LIVING WITH HIV/AIDS
SPECIAL REQUIREMENTS
(CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT, AND MARQUETTE COUNTY HEALTH
DEPARTMENT)
Grantee Requirements:
1. Implement work plan; correspondence and budget will be maintained on file at MDHHS.
2. Submit monthly progress reports for the indicated time periods:
Period Covered
October 1-31
November 1-30
December 1-31
January 1-31
February 1-29
March 1-31
April 1-30
May 1-31
June 1-30
July 1-31
August 1-31
September 1-30
Report Due Dates
Friday, November 6
Friday, December 4
Friday, January 8
Friday, February 5
Friday, March 4
Friday, April 8
Friday, May 6
Friday, June 3
Friday, July 8
Friday, August 5
Friday, September 9
Friday, October 7
3. The Grantee will collaborate with the Tobacco Section to accomplish goals through monthly
calls, one annual site visit, and other grant monitoring and technical assistance activities.
4. Performance will be measured on progress toward meeting the overall Tobacco Use
Reduction in PLWH Work Plan objectives.
5. Failure to comply with these requirements may result in punitive consequences such as denial
of future funding or other consequences as appropriate.
Page 88 of 96
MDHHS/G&PC} FY 15/16 ATTACHMENT II!
6/27/15
TUBERCULOSIS (TB) CONTROL 340B PROGRAM
SPECIAL REQUIREMENTS
(BARRY-EATON COUNTY HEALTH DEPARTMENT, BAY COUNTY HEALTH DEPARTMENT,
BERRIEN COUNTY HEALTH DEPARTMENT, BENZIE- LEELANAU DISTRICT HEALTH
DEPARTMENT, CALHOUN COUNTY PUBLIC HEALTH DEPARTMENT, CENTRAL MICHIGAN
DISTRICT HEALTH DEPARTMENT, DICKINSON-IRON DISTRICT HEALTH DEPARTMENT,
KALAMAZOO COUNTY HEALTH AND COMMUNITY SERVICES DEPARTMENT, LIVINGSTON
COUNTY DEPARTMENT OF PUBLIC HEALTH, LUCE- MACKINAC-ALGER-SCHOOLCRAFT
DISTRICT HEALTH DEPARTMENT, MID-MICHIGAN DISTRICT HEALTH DEPARTMENT,
MIDLAND COUNTY HEALTH DEPARTMENT, MONROE COUNTY HEALTH DEPARTMENT,
PUBLIC HEALTH DELTA & MENOMINEE COUNTIES, SAGINAW COUNTY HEALTH
DEPARTMENT, ST. CLAIR COUNTY HEALTH DEPARTMENT, WESTERN UPPER
PENINSULA HEALTH DEPARTMENT)
For those local health departments certified to participate in the 340B program to obtain reduced
pricing for anti-tuberculosis medications, minimal funds are provided to offset expenses for
administrative activities. Disallowed Costs: Federal (CDC) guidelines prohibit the use of these funds
to purchase anti-tuberculosis medications or to pay for inpatient services.
TUBERCULOSIS CONTROL AND ELIMINATION
SPECIAL REQUIREMENTS
(GENESEE COUNTY HEALTH DEPARTMENT, INGHAM COUNTY HEALTH DEPARTMENT, KENT COUNTY
HEALTH DEPARTMENT, MACOMB COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY
DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION, OTTAWA COUNTY
HEALTH DEPARTMENT, WASHTENAW COUNTY HEALTH DEPARTMENT, AND WAYNE COUNTY
HEALTH DEPARTMENT)
General Requirements:
Each local health department as a sub-recipient of the CDC Tuberculosis Elimination Cooperative
Agreement shall conduct activities for the purposes of tuberculosis control and elimination. Funds
may be used support personnel, purchase equipment and supplies, and provide services directly
related to core TB control front-line activities, with a priority emphasis on DOT (Directly Observed
Therapy), case management, completion of treatment and contact investigations. Funds may also be
used to support incentive or enabler offerings to enhance patient adherence to treatment. Disallowed
Costs: Federal (CDC) guidelines prohibit the use of these funds to purchase anti-tuberculosis
medications or to pay for inpatient services. Examples of appropriate incentive/enabler offerings
include retail coupons, public transit tickets, food, non-alcoholic beverages, or other goods/services
that may be desirable or critical to a particular patient. For more information and suggested uses of
incentive/enabler options, refer to CDC's Self-Study Module #9, Enhancing Adherence to
Tuberculosis Treatment at http://www.cdc.qov/tb/education/ssmodules/module9/ss9readinq3.htm.
Contract Specific Requirements:
1, Utilize DOT as the standard of care to achieve at minimum 80% of TB cases enrolled in DOT (Jan
1- Dec 31).
2. Document in MDSS all changes to treatment regimen using the Report of Verified Case of
Tuberculosis (RVCT) comments field (pg. 12), and completion of therapy using RVCT Follow-
Page 89 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
Up 2 (pg. 7).
3. Maintain evidence of monthly DOT logs on site (to be made available if needed).
Monthly submission of DOT logs is no longer required.
4. Achieve at least 94% completion of treatment within 12 months for eligible TB cases. The
determination of treatment completion is based on the total number of doses taken, not solely
on the duration of therapy. Consult the most current ATS document Treatment of Tuberculosis
for guidance in the number of doses needed and the length of treatment required following
any interruptions in therapy.
5. Maintain appropriate documentation on site (to be made available if needed). Document
the appropriate use of expenditures for incentive and enablers for clients to best meet their
needs to complete DOT and appropriate therapy.
6. Ensure >90% completion of RVTC pages 1 - 6 in MDSS within one month of diagnosis.
7. Unallowable Costs per federal guidelines:
A. Funds can not be used for procurement of anti-tuberculosis
medications.
B. Funds can not be used for research.
C. Funds can not be used for inpatient services
8. Ensure that confidential public health data, is maintained and transmitted to the Department, in
compliance with applicable standards defined in the "CDC Data Security and Confidentiality
Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Diseases, and
Tuberculosis Programs"
http://www. cdc.govinch hstp/programi nteq rati on/docs/PCS I DataSecurityGuidelines.pdf
Reporting Requirements:
DOT Logs are maintained on site and available if needed. All other data must be entered into MDSS
as stipulated in contract specific requirements.
VAL_
SPECIAL REQUIREMENTS
Grantee Reauirements
1. Provide for security of Project FRESH coupons and WIC EBT cards stored in the local Grantee
prior to issuance. The Grantee must notify the WIC Division in writing of any lost, stolen,
inappropriately issued or otherwise unaccounted for Project FRESH coupons or EBT
cards, immediately upon recognition of such condition.
2. Comply with the requirements of the WIC program as prescribed in the Code of
Federal Regulations (7 CFR, Part 246) including the following special provisions:
If a local Grantee operates a WIC Program within a hospital or has a cooperative agreement
with one or more hospitals, the hospital is required to advise the potentially eligible individuals
that receive inpatient or outpatient prenatal, maternity, or postpartum services or accompany
a child under age 5 years who receives well-child services, of the availability of WIC benefits
[246.6(F)(1)].
3. Maintain an inventory of all equipment purchased with WIC program funds and maintain
such inventory at each WIC clinic location.
4. Assure each Grantee employee authorized for or requesting access to the automated WIC
system complete and sign a security agreement.
5. The Grantee in accordance with the general purposes and objectives of this agreement, will
Page 90 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
comply with the federal regulations requiring that any individual that embezzles, willfully
misapplies, steals or obtains by fraud, any funds, assets or property provided, whether
received directly or indirectly from the USDA, that are of a value of $100 or more, shall be
subject to a fine of not more than $25,000.
6. The Grantee is responsible for installation and maintenance of WIC hardware according
to guidance provided by the Department WIC Program.
Special Reporting Requirements
Grantees shall (when requested) annually report expenditures related to nutrition education and
breastfeeding promotion and support, on a supplemental form, if needed and required, to be provided
by the Department and attached to the final Financial Status Report (FSR) which is due on November 30
after the end of the fiscal year through the MI E-Grants system. The supplemental form will focus on
expenditures related to Travel, Equipment, Subcontract and Other Expense categories and will not
include expenditures related to salaries, wages and fringe benefits. Additionally, only expenditures
supported by regular WIC funds should be reflected on this supplemental form.
Grantees shall report nutrition education and breastfeeding promotion and support expenditures by
completing the WIC Nutrition Education and Breastfeeding Time Study as required by the
Department.
Breastfeeding Peer Counseling Program expenditures are not to be included. The 116th nutrition
education requirement and breastfeeding target must still be met with regular WIC/NSA funds.
Expenditures incurred that are related to general nutrition education and for the promotion and
support of breastfeeding are to be summarized as:
1. Nutrition Education
2. Breastfeeding
Allowable Nutrition Education (NE) Expenses are:
1. Costs for procuring equipment for NE (as approved by the State WIC Program).
2. Interpreter or translator services to facilitate NE.
3. Evaluation or monitoring of NE.
4. NE material costs.
5. Costs of training nutrition educators, including costs related conducting training sessions
and purchasing & producing training materials.
6. Costs for clinic space devoted to NE activities.
7. Travel and related expenses incurred by WIC staff to conduct any NE activity.
8. Costs of reimbursable agreements with other organizations, public or private, to provide NE to
WIC participates.
Allowable Breasffeedino (BF) Promotion & Support Expenses are:
1. Peer counseling if supported with funds allocated through the WIC funding formula. (Report
as time study data.)
2. Cost of procuring BF educational materials.
3. Interpreter or translator services to facilitate BF promotion and support.
4. Costs of training BF promotion & support educators, including costs related to conducting
Page 91 of 96
MDRHS/G&PD FY 15/16
ATTACHMENT III
6/27/15
training sessions and purchasing and producing training materials.
5. Costs of clinic space devoted to BF promotion & support educational and training
activities, including space set aside for BF WIC infants.
6. BF aids which directly support the initiation and continuation of BF, as purchased with WIC
funds allocated through the funding formula.
7. Costs of documenting, monitoring and/or evaluating BF promotion and support staff,
activities, methods and materials. This includes the cost of collecting, analyzing and
evaluating data concerning WIC participant's opinions on the effectiveness of the BF promotion
and support they received. (Report as time study data.)
8. Travel and related expenses incurred by WIC staff to conduct any BF promotion and
support activity.
9. Costs of reimbursable agreements with other organizations, public or private, to undertake
training and direct service delivery to WIC participants concerning BF promotion and support.
The examples above are not all inclusive. In-kind support can also be included, if other non-WIC
resources are used for those costs. Please note that costs for data processing, communications,
postage, freight, rent and utilities necessary to conduct NE and BF activities must be prorated to the
applicable functional category (NE/ BF promotion and support).
The Grantee is required to complete the NE and BF staff time study survey as instructed by the
Department WIC Program.
arm f W RU r uounseim Pr qm
Funds allocated for the Breastfeeding Peer Counseling Program are exempt from the WIC Nutrition
Education and Breastfeeding Time Study. The Grantee may only charge certain allowed expenses to
the Peer Counselor Grant. Expenses for Breastfeeding education and supplies must be charged to
the normal WIC budget; not the Peer Counselor Grant.
See "Allowable Expenses".
Financial Reporting
A Financial Status Report (FSR) must be submitted to the Department Accounting Office on a quarterly
basis. To meet USDA grant reporting deadlines, the Grantee shall submit program expenditures to the
State
WIC Division using DCH-0386 Attachment B.2 Program Budget— Cost Detail Schedule Attachment
B.2. Send to the attention of the State WIC Breastfeeding Coordinator.
Reports are due by the 15th day of: January, March, July and October.
Allowable Expenses
The primary purpose of these funds is to provide breasffeeding support services through peer
counseling to WIC participants. Expenses may include:
1. Supervisor and/or mentor staff time
2. Materials that educate/advertise to WIC clients about the Peer Counseling Program
3. Educational resources for Peer
4. Voicemail, cell phones or phone-line expenses
5. Equipment or office furniture
Page 92 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
6. Indirect costs
The Grantee, however, must not charge a disproportionate amount of funds for these above
noted items when compared to funds spent on direct service delivery by the Peer Counselor.
Other Reporting
The Grantee shall maintain monthly records for each individual Peer Counselor. Specific
supplemental reporting forms will be provided by the State WIC Office. Reports are due to the State
WIC Office by the 15th day of: January, March, July and October
Training and Education
Designated Grantee staff are required:
1. To attend Supervisory training.
2. To attend a minimum of two program updates.
3. To train the peer counselors per standards set forth by USDA and the State WIC Division.
Designated Peer Counselors are required to attend specific training that includes, but is not limited
to:
1. Breastfeeding Basics Training
2. State WIC Peer Counselor Meetings
3. Annual WIC Conference
Staff Training and Education
Designated Grantee staff are required:
1. To attend Supervisory training.
2. To include designated State Lactation Consultants (LC) as part of the peer counselor
recruitment and applicant interview team.
3. To attend a minimum of two program updates.
a. To train the peer counselors per standards set forth by USDA and the State WIC
Division.
Peer Counselors are required to attend specific training that includes, but is not limited to
Breastfeeding Basics Training, State WIC Peer Counselor meetings and Annual WIC
Conference.
Other Grantee Obligations
The following requirements apply to the Grantee receiving a special allocation for the Breastfeeding
Peer Counseling Program. USDA and MDHHS/WIC require the Grantee to comply with the
following nine components:
1. Hire staff that meet the definition of Peer Counselor.
2. Designate a Breastfeeding Peer Counselor Manager at the local level.
3. Establish job parameters and a description for the peer counselor that is consistent with State
WIC policy.
4. Establish compensation and reimbursement rates for peer counselors.
5. Train appropriate WIC local peer counseling management and clinic staff.
6. Establish standardized breastfeeding peer counseling program procedures at the local level as
part of the Grantee's WIC Nutrition Services Plan.
7. Supervise and monitor the peer counselor(s). Establish community partnerships to enhance
the effectiveness of the WIC peer counseling program.
8. To include designated State Lactation Consultants (LC) as part of the peer counselor
Page 93 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
recruitment and applicant interview team.
9. Provide:
a. timely access to breastfeeding coordinators/lactation experts for assistance outside
the peer counselor scope of practice;
b. regular, systematic contact with the supervisor;
c. participation in clinic staff meetings and breastfeeding in-services as part of the WIC
team opportunities to meet regularly with other peer counselors.
10. Provide training and continuing education of the peer counselor(s).
11. Provide access to Peer Counselor outside of normal business hours via a cell phone or
direct line with voicemail that can be accessed after hours.
nit -INTEGRATED SCREENING AND_EVALUATION FOR Mal ACROSS THE NATION
(WISEWOMAN1 PROJECT SPECIAL REQUIREMENTS
(DISTRICT HEALTH DEPARTMENT #10, DISTRICT HEALTH DEPARTMENT #2, GENESEE COUNTY
HEALTH DEPARTMENT, HEALTH DEPARTMENT OF NORTHWEST MICHIGAN, HURON
COUNTY HEALTH DEPARTMENT, LENAWEE COUNTY HEALTH DEPARTMENT, PUBLIC
HEALTH DEPARTMENT DELTA & MENOMINEE COUNTIES)
Grantee Requirements
WISEWOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation) is a
program designed to screen women for chronic disease risk factors, counsel them about lifestyle
changes to reduce risk factors, and refer them for medical treatment of hypertension, hyperlipidemia,
and/or diabetes mellitus. This program will be based within Michigan's Breast and Cervical Cancer
Control Program.
For specific WISEWOMAN Program requirements, refer to the most current WISEWOMAN
Program Policies and Procedures Manual.
WISEWOMAN COMMUNITY NAVIGATION PILOT
SPECIAL REQUIREMENTS
(DISTRICT HEALTH DEPARTMENT #10, LENAWEE COUNTY HEALTH DEPARTMENT, GENESEE
COUNTY HEALTH DEPARTMENT, PUBLIC HEALTH DELTA-MENOMINEE, HURON COUNTY
HEALTH DEPARTMENT)
The WISEWOMAN Community Navigation Pilot will award Grantees a staffing grant to fund the a
Community Navigator or a Community Health Worker position. The objectives of the pilot are to 1) test
novel recruitment methods to enroll new women into the VVISEWOMAN program, 2) provide additional
one-on-one community-based support to WISEWOMAN participants, and 3) test creative intervention
techniques with participants, and identify techniques that will produce sustainable behavior change
and can be duplicated in other agencies.
The WISEWOMAN Community Navigation Pilot will not be subject to the caseload performance
requirement. Therefore, these funds will not be included in the settlement that may be required if
screening levels do not meet the caseload performance requirement.
Page 94 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
Reporting requirements:
Monthly conference calls with Community Navigator and MDHHS WISEWOMAN staff members to
report on activities, discuss any problems, and brainstorm solutions.
Final Progress Report (October 1-September 30) due: October 23
Reports shall be submitted to the Contract Manager at:
Robin Roberts, Program Director
WISEWOMAN Program
P.O. Box 30195
Lansing, MI 48909
Phone: (517) 335-1178; E-mail:robertsr6@michigan.gov
W1SEWOMAN ENTREPRENEURIAL GARDENING PROJECT
SPECIAL REQUIREMENTS
(DISTRICT HEALTH DEPARTMENT NO. 10, LENAWEE COUNTY HEALTH DEPARTMENT, HEALTH
DEPARTMENT OF NORTHWEST MI, PUBLIC HEALTH DELTA-MENOMINEE)
Grantee Requirements:
The WISEWOMAN Entrepreneurial Gardening Project will work with current entrepreneurial
gardeners to plan for coming year, and recruit new participants into the program. The program will
train participants in gardening skills and garden design, assist in the purchase of garden materials
and supplies based on appropriated project budget, and coordinate trainings that strengthen
participants understanding of sales and marking skills at area farm markets for greatest impact.
The WISEWOMAN Entrepreneurial Gardening Project will be subject to a 100% performance
requirement. MDHHS will only reimburse for clients enrolled and participating in the Gardening
Project. Any unused funds will be returned to MDHHS.
Reporting requirements:
Monthly conference calls to report on activities, discuss any problems, and brainstorm solutions.
Final Progress Report (January 1-September 30) due: October 23
Reports shall be submitted to the Contract Manager at:
Robin Roberts, Program Director
WISEWOMAN Program
P.O. Box 30195
Lansing, MI 48909
Phone: (517) 335-1178; E-mail: robertsr6(&,michiqan.qov
Page 95 of 96
MDHHS/G&PD FY 15/16 ATTACHMENT III
6/27/15
WISEWOMAN SYSTEMS AND ENVIRONMENTAL CHANGE PROJECT
SPECIAL REQUIREMENTS
( DISTRICT HEALTH DEPARTMENT NO. 10)
Contractor Requirements:
Through the WISEWOMAN Systems and Environmental Change project, agencies are required to
conduct one low cost systems or environmental change intervention that will benefit WISEWOMAN
participants and the communities where they live.
The WISEWOMAN Systems and Environmental Change Funding will not be subject to the caseload
performance requirement. Therefore, these funds will not be included in the settlement that may be
required if screening levels do not meet caseload performance requirement.
Reporting requirements:
Final Progress Report (May 1 - September 30)
Due: October 23 (May be submitted sooner if project is completed earlier.)
Reports shall be submitted to the Contract Manager at:
Robin Roberts, Program Director
WISEWOMAN Program
P.O. Box 30195
Lansing, MI 48909
Phone: (517) 335-1178; E-mail: robertsr6@michigan.gov
Page 96 of 96
MDHHS/G&pD Pe 15/16 ATTACHMENT III
6/27/15
FOOTNOTES: FY 2015/2016 (a) Refer to Plan and Budget Framework for element definitions. (b) Refer to master comprehensive agreement and program and budget instructions package for further explanation of applicability of these reimbursement methods. (c) Negotiated starting from the average of the past two complete years' actual number where available. (d) Calculated by multiplying the 'Total Performance Expectation" column by the ratio of the elements total State funding (DCH 0410, Line 24) to "Total Expenditures" DCH 0410, Line 17). Prior to calculation, adjustments will be made for unallowable cost, equipment funded by local funds and MDHHS reimbursement not performance based (I.E., fixed unit rate, staffing). (e) Calculated by multiplying the "State Funded Element Target Performance" column by the "Percent" column. (f) Refer to master comprehensive agreement and budget instructions package for further explanation regarding these designations. (1) CSHCS Care Coordination 1. Case Management A. Maximum of six (6) services per year B. Reimbursement -$201.58 per service provided face-to-face in the home setting. 2. CARE COORDINATION A. LEVEL I PLAN OF CARE 1. Annual Plan of Care in the home or home-like setting that requires the Care Coordinator to travel to a non-LHD site $150 2. Annual Plan of Care over the telephone $100 B. LEVEL II CARE COORDINATION 1. Level 11 Care Coordination is reimbursed at $30.00 per unit 2. A maximum of 10 units per beneficiary per eligibility year will be reimbursed. (2) Reimbursement Chart for Fixed Rates AIDS/HIV Prevention Non- Categorical $11.00 per blood draw for non-categorical health departments. Limited annually to $2,000. Biomonitoring of Toxic Substances in Michigan Urban Fisheaters $500 per clinic date Body Art $261.61/appl. annual license prior to 7/1; $130.81/appl. annual license after 7/1; $117.72/appl. temporary license; $ 261.61/appl. renewal prior to 12/1; $392.42/appl. renewal after 12/1; $26.16/duplicate license FDA Tobacco Retailer (A&L) Inspections - Oakland only $325.20 per inspection. Immunization Assessment Feedback Incentive Exchange (AFIX) Follow-up $100 per personal visit or $50 for a phone call (with information mailed afterward) to the provider office, not to exceed the maximum set for each individual contractor. Immunization Nurse Education $200 per session except Vaccines Across the Lifespan, which is to be reimbursed at $250 per session, upon completion and submission of Provider Contracts and Report Forms. Reimbursement can only be made for one in-service module session per physician clinic site per year. Immunization VFC (only) Provider Site Visits $150 per site visit, not to exceed the maximum set for each individual Contractor. Immunization VFC/AFIX Combined Provider Site Visits $350 per site visit, not to exceed the maximum set for each individual Contractor. Informed Consent $50 per woman served, for each woman that expressly states that she is seeking a pregnancy test or confirmation of a pregnancy for the purpose of obtaining an abortion and is provided the services. Laboratory Services & STD See contract language for gonorrhea and chlamydia testing reimbursement performance requirements, AIDS SIDS $125 for each family support visit. A maximum of six (6) visits per infant death is reimbursable Original Notes FY 15/16 6/29/2015
(3) Allocation to be reflected in individual programs during budgeting process. (4) Funding Source (not a single element). Hearing and Vision are single elements. (5) Subject to Statewide Maintenance of Effort requirement for Title X. (6) State funding is first source (after fees and other earmarked sources). (7) Fixed unit rate subject to actual costs. (8) The performance reimbursement target will be the base target caseload established by MDHHS. (9) Subject to a match requirement (hard or in-kind) of $1 for each $3 of MDHHS agreement funding for Coordination. (10) Fixed rate limited to contract amount (11) Up to six (6) visits per family. (12) Non-categorically funded Health Departments will be reimbursed at $11.00 per HIV test conducted up to a maximum of $2,000 annually. (13) Each delegate agency must serve a minimum percentage of Title X users to access their total allocated funds. Quarterly FPAR data will be used to determine total Title X users and Plan First! Enrollees. (14) Public Health Emergency Preparedness (PHEP) funding must be expended by June 30, 2016 and is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHDs must submit a nine month budget and a quarterly Financial Status Report (FSR) column for this program element. (15) Public Health Emergency Preparedness (PHEP) funding for July1, 2016— September 30, 2016 is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHDs must submit a three-month budget and a quarterly Financial Status Report (FSR) column for this program element. (16) Project meets the Research and Development criteria as defined by Title 2 CFR, Section 200.87. (17) Not Applicable (18) Subject to match requirement as specified in Attachment Ill - Program Assurances and Specific Requirements. NOTE: Some footnotes may not apply to this agency. Original Notes FY 15116 6/29/2015