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Resolutions - 2016.09.22 - 22594
HUMAN RESOURCES COMMITTEE REPORT (MSC #16254) September 22, 2016 BY: Human Resources Committee, Bob Hoffman, Chairperson IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION - 2016/2017 COMPREHENSIVE PLANNING, BUDGETING AND CONTRACTING (CPBC) AGREEMENT ACCEPTANCE To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: The Human Resources Committee, having reviewed the above referenced resolution on September 14, 2016, reports with the recommendation that the resolution be adopted. Chairperson, on behalf of the Human Resources Committee, I move the acceptance of the foregoing report. HUMAN RESOURCES COMMITTEE VOTE: Motion carried unanimously on a roll call vote, MISCELLANEOUS RESOLUTION #1, September 22, 2016 BY: General Government Committee, Christine Long, Chairperson IN RE: DEPARTMENT OF HEALTH AND HUMAN SERV10ES/HEALTH DI V I S I O N - 2 0 1 6 / 2 0 1 7 COMPREHENSIVE PLANNING, BUDGETING AND CONTRACTING (CPBC) AGR E E M E N T A C C E P T A N C E To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: WHEREAS the Michigan Department of Health and Human Services (MDHHS) has awarded t h e O a k l a n d County Health Division funding through the Comprehensive Planning, Budgeting, and Contracting ( C P B C ) Agreement for the period October 1, 2016 through September 30, 2017; and WHEREAS the 2015/2016 CPBC Agreement included total funding of $10,234,461; and WHEREAS the 2016/2017 CPBC Agreement reflects grant funding in the amount of $10,239, 7 8 4 , a n i n c r e a s e of $5,323 from the previous year; and WHEREAS the grant agreement and anticipated fiscal year 2017 contract amendments include s u f f i c i e n t funding for the positions listed in Schedule B; and WHEREAS three (3) General Fund/General Purpose (GF/GP) positions (#1060240-00906 a n d 0 3 4 2 7 , 1060234-03107) will be corrected to reflect Special Revenue (SR) with the FY 20'17 — 2019 A d o p t e d B u d g e t t o reflect actual historical and future grant activity; and WHEREAS two (2) GF/GP positions (#1060240-00752 and 03183) need to be changed to correct th e f u n d i n g source to SR to reflect actual historical and future grant activity; and WHEREAS the budget detail for the various•programs is a matter of negotiation between the Hea l t h D i v i s i o n and MDH HS; amendments will be recommended to the FY 2017 Budget when details are finalized ; a n d WHEREAS the CPBC Agreement has completed the Grant Review Process according to t h e B o a r d o f Commissioners Grant Procedures and is recommended for approval. NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners he r e b y a c c e p t s t h e 2016/2017 Comprehensive Planning, Budgeting, and Contracting (CPBC) agreement for f u n d i n g i n t h e amount of $10,239,784 for the period of October 1, 2016 through September 30, 2017. BE IT FURTHER RESOLVED the grant will continue sixty (60) SR positions included in Sch e d u l e B . BE IT FURTHER RESOLVED to change the funding of two (2) General Fund/General Purp o s e ( G F / G P ) positions (#1060240-00752, and 03183) to SR to accurately reflect that these positions a r e f u n d e d b y t h e CPBC Grant. BE IT FURTHER RESOLVED that the future level of service, including personnel, is contingent upo n t h e l e v e l of funding for this program. BE IT FURTHER RESOLVED that the Board Chairperson is authorized to execute this agr e e m e n t , a n y changes and extensions to the agreement not to exceed fifteen percent (15%), which is consisten t w i t h t h e agreement as originally approved. BE IT FURTHER RESOLVED that the Oakland County Board of Commissioners authorizes its Ch a i r p e r s o n t o execute this Agreement subject to the following additional condition: That the County's approval fo r e n t e r i n g into this Agreement is specifically conditioned and premised upon the acceptance, approval an d e x e c u t i o n o f the Agreement containing Addendum A, by the Michigan Department of Health and Human Services , a n d t h a t the failure of the Michigan Department of Health and Human Services to execute the Agree m e n t a s s p e c i f i e d shall, without any further act of the Oakland County Board of Commissioners, automatically nega t e a n d v o i d the County's approval and/or acceptance of this agreement as provided for in this resolu t i o n . Chairperson, on behalf of the General Government Committee, I move the adoption of t h e f o r e g o i n g resolution. GENERAL GOVERNMENT COMMITTEE GENERAL GOVERNMENT COMMITTEE Motion carried unanimously on a roll call vote. OAKLAND COUNTY, MICHIGAN GRANT AWARD HEALTH DIVISION CPBC GRANT SCHEDULE B FY17 Special Revenue Grant Positions Position it Classification (FIE or P ) Position Title Notes 00674 Full-Time Eligible Auxiliary Health Worker 00752 Full-Time Eligible Public Health Nurselll 00906 Full-Time Eligible Public Health Nurse III 00912 Full-Time Eligible Public Health Nutritionist ll 00958 Full-Time Eligible Office Supervisor I 01234 Full-Time Eligible Office Assistant II Filled with 3 PTNEs 01328 Full-Time Eligible Auxiliary Health Worker 01752 Full-Time Eligible Auxiliary Health Worker Filled with PTNE 01865 Full-Time Eligible Public Health Nutrition Supervisor 02070 Full-Time Eligible Health Program Coordinator 02074 Full-Time Eligible Public Health Nutritionist II 02091 Full-Time Eligible Auxiliary Health Worker Filled with PTNE 02436 Full-Time Eligible Vaccine Supply Coordinator 02509 Full-Time Eligible Nutrition Technician - WIC 02740 Full-Time Eligible Clerk Filled with PTNE 03073 Full-Time Eligible Office Supervisor II 03094 Full-Time Eligible Health Program Coordinator 03107 Full-Time Eligible Public Health Nurse III 03183 Full-Time Eligible Public Health Nurse III 03427 Full-Time Eligible Public Health Nurse III 04736 Full-Time Eligible Health Program Coordinator 04737 Full-Time Eligible Public Health Nurse Ill Filled with PTNE 04771 Full-Time Eligible Auxiliary Health Worker Filled with PTNE 04773 Full-Time Eligible Auxiliary Health Worker 05129 Full-Time Eligible Office Assistant ll 05130 Full-Time Eligible Supervisor Public Health Nursing 05131 Part-time Non-Eligible Public Health Nurse II 05163 Full-Time Eligible Public Health Nurse III Filled with 3 PTNEs 05205 Full-Time Eligible Auxiliary Health Worker 05233 --I Full-Time Eligible Public Health Nutritionist II 05234 Full-Time Eligible Public Health Nutritionist 1 05235 Full-Time Eligible Public Health Nutritionist II 05246 Full-Time Eligible Office Leader 05401 Full-Time Eligible Public Health Nutritionist II 05492 Full-Time Eligible Public Health Nurse III 05526 Full-Time Eligible Office Assistant I Filled with PTNE 05693 Full-Time Eligible Public Health Nutritionist II 06099 Full-Time Eligible Public Health Nurse ill Filled with 2 PTNEs 06100 Full-Time Eligible Public Health Nurse III Filled with PTNE 06426 Full-Time Eligible Health Program Coordinator OAKLAND COUNTY, MICHIGAN GRANT AWARD HEALTH DIVISION CPBC GRANT SCHEDULE B FY17 Special Revenue Grant Positions - Position # Classification (FIE or PINE) Position Title Notes 06538 Full-Time Eligible Office Assistant II 06747 Full-Time Eligible Public Health Nurse III 06824 Full-Time Eligible Auxiliary Health Worker 07346 Full-Time Eligible Public Health Nutritionist II Filled with PTNE 07381 Full-Time Eligible Public Health Nutritionist III 07382 Full-Time Eligible Nutrition Technician - WIC 07384 Full-Time Eligible Auxiliary Health Worker 07413 Full-Time Eligible Public Health Nurse ill 07414 Full-Time Eligible Office Assistant II 07415 Full-Time Eligible Office Assistant II 07416 Full-Time Eligible Public Health Educator III 07557 Full-Time Eligible Public Health Nurse III Filled with 2 PTNEs 07559 Full-Time Eligible Vaccine Supply Coordinator 07562 Full-Time Eligible Nutrition Technician - WIC 07563 Full-Time Eligible Auxiliary Health Worker 07564 Full-Time Eligible Office Assistant I Filled with PTNE 07565 Full-Time Eligible Public Health Nurse III Filled with PTNE 07839 Part-time Non-Eligible Auxiliary Health Worker 09668 Full-Time Eligible Public Health Nurse III 09999 Full-Time Eligible Public Health Preparedness Specialist 10012 Full-Time Eligible Medical Technologist Filled with PTNE 11579 Full-Time Eligible Lactation Specialist GRANT REVIEW SIGN OFF — Health Division GRANT NAME: FY 2017 Comprehensive Planning, Budgeting, and Contracting Agreement FUNDING AGENCY: Michigan Department of Health and Human Services DEPARTMENT CONTACT PERSON: Rachel Shymkiw / 452-2151 STATUS: Grant Acceptance DATE: August 29, 2016 Pursuant to Misc. Resolution #13180, please be advised the captioned grant materials have completed internal grant review. Below are the returned comments. The captioned grant materials and grant acceptance package (which should include the Board of Commissioners' Liaison Committee Resolution, the grant agreement/contract, Finance Committee Fiscal Note, and this Sign Off email containing grant review comments) may be requested to be placed on the appropriate Board of Commissioners' committee(s) for grant acceptance by Board resolution. DEPARTMENT REVIEW Department of Management and Budget: Approved. — Laurie Van Pelt (7120/2016) Department of Human Resources: ER Approved (Needs Committee) Position Funding Change with CPBC Acceptance — Lori Taylor (8/23/2016) Risk Management and Safety: Approved by Risk Management. — Robert Erienbeck (7/20/2016) Corporation Counsel: Approved. — Bradley G. Berm (7/26/2016) From: Van Pelt. Laurie M To: West. Catherine A; lavicir4z1; Davis, Patricia G; ach.U.Lt4e10_1 Cc: Shymidw, Rachel M; Forzlev,KatNeen C; Lemon. Kathleen IA; Pisacreta Antonio S Subject: RE: GRANT REVIEW: Health & Human Services/Health Division - FY 2017 Comprehensive Planning, Budgeting, and Contracting (CPBC) - Grant Acceptance Date: Wednesday, July 20, 2016 11:18:14 AM Approved. From West, Catherine A Sent: Tuesday, July 19, 2016 5:21 PM To: Van Pelt, Laurie M; Taylor, Lori; Davis, Patricia G; Schultz, Dean J Cc: Shymkiw, Rachel M; Forzley, Kathleen C; McLernon, Kathleen M; Pisacreta, Antonio S Subject: GRANT REVIEW: Health & Human Services/Health Division - FY 2017 Comprehensive Planning, Budgeting, and Contracting (CPBC) - Grant Acceptance GRANT REVIEW FORM TO: REVIEW DEPARTMENTS — Laurie Van Pelt — Lori Taylor Dean Schultz — Pat Davis RE: GRANT CONTRACT REVIEW RESPONSE — Health & Human Services/Health Division FY 2017 Comprehensive Planning, Budgeting, and Contracting Agreement/Michigan Department of Health & Human Services Attached to this email please find the grant document(s) to be reviewed. Please provide your review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with supporting comments, via reply (to all) of this email, Time Frame for Returned Comments: July 27, 2016 GRANT INFORMATION Date: 7/19/16 Operating Department: Health & Human Services/Health Division Department Contact: Rachel Shymkiw Contact Phone: 2-2151 Document k:ientification Number: REVIEW STATUS: Acceptance — Resolution Required Funding Period: 10/1/16 through 9/30/17 Original source of funding: State and Federal Will you issue a sub award or contract: The various projects may have contracts New Facility/ Additional Office Space Needs: N/A IT Resources (New Computer Hardware/Software Needs or Purchases): N/A From: To; Cc; Subject: Date: Taylor, Lori West, Catherine A Mason, Heather L Health CPBC Grant Tuesday, August 23, 2016 4:45:04 PM HI Katie: Are you going to send around another email regarding approving th e C P B C G r a n t ? If not then: HR Approved (Needs Committee) Position Funding Change with CPBC Acceptance Lori Taylor Deputy Director Human Resources Department Oakland County Michigan 2100 Pontiac Lake Road Waterford, MI 48328 taylorloPoakgov,corn w_w_w_oalsgov_c_omijob_a Phone: 248-858-0548 Fax: 248-858-8391 From: To: Cc: Subject: Date: Trienbeck, Robert C West, Catherine A; Van Pelt, Laurie M; Taylor, Lori; Davis Patricia G; Schultz Dean J ShvmKivit, Rachel M; forzlev. Kathleen C; Lemon, Kathleen M; plsacreta, Antonio S RE: GRANT REVIEW; Health & Human Services/Health Division - FY 2017 Comprehensiv e P l a n n i n g , B u d g e t i n g , and Contracting (CPBC) - Grant Acceptance Wednesday, July 20, 2016 8:40;16 AM Approved by Risk Management. RE. 7/20/16. From: Easterling, Theresa Sent: Wednesday, July 20, 2016 7:32 AM To: West, Catherine A; Van Pelt, Laurie M; Taylor, Lori; Davis, Patricia G; Schultz, Dean 3 Cc: Shymkiw, Rachel M; Forzley, Kathleen C; McLemon, Kathleen M; Pisacreta, Antonio S Subject: RE: GRANT REVIEW: Health & Human Services/Health Division - FY 2017 Comprehensive Planning, Budgeting, and Contracting (CPBC) - Grant Acceptance Please be advised that your request for Risk Management's assistance has been assigned to Bob Erlenbeck, (ext. 8-1694). If you have not done so already, please forward all re l a t e d information, documentation, and correspondence. Also, please include Risk Manag e m e n t ' s assignment number, RM16-0373, regarding this matter. Thank you. From: West, Catherine A Sent: Tuesday, July 19, 2016 5:21 PM To: Van Pelt, Laurie Ni; Taylor, Lori; Davis, Patricia G; Schultz, Dean J Cc: Shymkiw, Rachel M; Forzley, Kathleen C; McLernon, Kathleen M; Pisacreta, Antonio S Subject: GRANT REVIEW: Health & Human Services/Health Division - FY 2017 Comprehensive Planning, Budgeting, and Contracting (CPBC) - Grant Acceptance GRANT REVIEW FORM TO: REVIEW DEPARTMENTS— Laurie Van Pelt— Lori Taylor — Dean Schultz — Pat Davis RE: GRANT CONTRACT REVIEW RESPONSE Health & Human Services/Health Di v i s i o n Pt 2017 Comprehensive Planning, Budgeting, and Contracting Agreement/Michigan Department of Health & Human Services Attached to this email please find the grant document(s) to be reviewed. Please pro v i d e y o u r review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with supporting comments, via reply (to all) of this email. Time Frame for Returned Comments: July 27, 2016 GRANT INFORMATION Date: 7/19/16 From: Penn, Bradley To: 511411S119-..--RBC11d14; West Catherine A Subject: 2016-0731 FY2017 CPBC (Comprehensive, Planning, Budgeting & Contracting) Grant Acceptan c e & A g r e e m e n t Date: Tuesday, July 26, 2016 9:55:03 AM Approved. Bradley G. Bermn Assistant Corporation Counsel Department of Corporation Counsel 1200 N. Telegraph Road Bldg 14 East Courthouse West Wing Extension, 3rd Floor Pontiac, MI 48341-0419 Phone: (248) 858-0558 Fax: (248) 858-1003 Email: bennbaoakgovcom PRIVILEGED AND CONFIDENTIAL — ATTORNEY CLIENT COMMUNICATION This e-mail is intended only for those persons to whom it is specifically addressed, it is c o n f i d e n t i a l a n d i s protected by the attorney-client privilege and work product doctrine. This privilege belongs to t h e C o u n t y o f Oakland, and individual addressees are not authorized to waive or modify this privilege in any w a y . I n d i v i d u a l s a r e advised that any dissemination, reproduction or unauthorized review of this information b y p e r s o n s o t h e r t h a n those listed above may constitute a waiver of this privilege and is therefore prohibited. If yo u h a v e r e c e i v e d t h i s message in error, please notify the sender immediately. If you have any questions, please co n t a c t t h e D e p a r t m e n t of Corporation Counsel at (248) 858-0550. Thank you for your cooperation. 07/15/20'16 Contract #: Agreement Between Michigan Department of Health and Human hereinafter referred to as the "Department" and County of Oakland hereinafter referred to as the "Local Governing Entity" on Behalf of Health Department Oakland County Department of Health and Human Services/ Health Division 1200 N. Telegraph Rd. 34 East Pontiac Ml 48341 0432 Federal I.D.#: 38-6004876, DUNS #: 136200362 hereinafter referred to as the "Grantee" for The Delivery of Public Health Services under the Comprehensive Agreement Part I 1. Purpose This agreement is entered into for the purpose of setting forth a joint and cooperative Grantee/Department relationship and basis for facilitating the delivery of public health services to the citizens of Michigan under their jurisdiction, as described in the attached Annual Budget, established Minimum Program Requirements, and all other applicable Federal, State and Local laws and regulations pertaining to the Grantee and the Department. Public health services to be delivered under this agreement include Essential Local Public Health Services (ELPHS) and Categorical Programs as specified in the attachments to this agreement. 2. Period of Agreement: This agreement shall commence on October 1,2016 and continue through September 30, 2017. This agreement is full force and effect for the period specified, The Department has the option to assume no responsibility for costs incurred by the Grantee prior to the signing of this agreement. 3. Program Budget and Agreement Amount A. Agreement Amount In accordance with Attachment IV - Funding/Reimbursement Matrix, the total State budget and amount committed for this period for the program elements covered by this agreement is $10,239,784,00. Local Health Department - 2017, Date: 07/15/2016 Page: 1 of 176 07/15/2016 B. Equipment Purchases and Title Any equipment purchases supported in whole or in part by the Department with categorical funding must be specified in an attachment to the Program Budget Summary. Equipment means tangible, non-expendable, personal property having useful life of more than one (1) year and an acquisition cost of $5,000 or more per unit. Title to equipment having a unit acquisition cost of less than $5,000 shall vest with the Grantee upon acquisition. The Department reserves the right to retain or transfer the title to all items of equipment having a unit acquisition cost of $5,000 or more, to the extent that the Department's proportionate interest in such equipment supports such retention or transfer of title. C. Budget Transfers and Adjustments 1. Transfers between categories within any program element budget supported in whole or in part by state/federal categorical sources of funding shall be limited to increases in an expenditure budget category by $10,000 or fifteen percent (15%) whichever is greater. This transfer authority does not authorize purchase of additional equipment items or new subcontracts with state/federal categorical funds without prior written approval of the Department. 2. Any transfers or adjustments involving State/Federal categorical funds, other than those covered by C.1, including any related adjustment to the total state amount of the budget, must be made in writing through a formal amendment executed by all parties to this agreement in accordance with Section VIII. A. of Part II, 3. The C.1 and C.2 provisions authorizing transfers or changes in local funds apply also to the Family Planning program, provided statewide local maintenance of effort is not diminished in total. Any statewide diminishing of total local effort for family planning and/or any related funding penalty experienced by the Department shall be recovered proportionately from each local Grantee that, during the course of the agreement period, chose to reduce or transfer local funds from the Family Planning program, 4. Agreement Attachments A. The following documents are attachments to this Agreement Part I and Part II - General Provisions, which are part of this agreement through reference: 1. Attachment I - Annual Budget 2. Attachment Ill - Program Specific Assurances and Requirements 3, Attachment IV - Funding/Reimbursement Matrix B. The attachments are added into this Agreement as follows: 1. Original Agreement (Part I and Part II) - Attachment I, Ill, IV Local Hea!th Department - 2017, Date: 07115/2016 Page'. 2 of 176 07/15/2016 5. Statement of Work The Grantee agrees to undertake, perform and complete the services described in Attachment III - Program Specific Assurances and Requirements and the other applicable attachments to this agreement which are part of this agreement through reference. 6. Method of Payments and Financial Reports The payment procedures shall be followed as described in Part II and Attachment I - Annual Budget and Attachment IV - Funding/Reimbursement Matrix, which are part of this agreement through reference. 7. Performance/Progress Report Requirements The progress reporting methods, as applicable, shall be followed as described in IV - Funding/Reimbursement Matrix, which are part of this agreement through reference. 8. General Provisions The Grantee agrees to comply with the General Provisions outlined in Part II, which are part of this agreement through reference. 9. Administration of the Agreement The person acting for the Department in administering this agreement (hereinafter referred to as the Contract Consultant) is: Name: Title: Telephone No.: E-Mail Address 10. Special Conditions May Alkhafaji Departmental Analyst 517-241-0176 alkhafajim@michigan.gov Brenda Roys Departmental Analyst 517-373-1207 roysb©michigan.gov A. This agreement is valid upon approval by the State Administrative Board as appropriate and approval and execution by the Department. B. The Department and Grantee, under the terms of this agreement shall, subject to availability of funding and other applicable conditions, provide resources and continuous services throughout the period of this agreement as shown in Attachment I - Annual Budget. C. The Department will not assume any responsibility or liability for costs incurred by the Grantee prior to the signing of this agreement. D. The Grantee is required by PA 533 of 2004 to receive payments by electronic funds transfer. Local Health Department - 2017, Date 07/1512016 Page: 3 of 176 07115/2016 11. Special Certification The individual or officer signing this agreement certifies by his or her signature that he or she is authorized to sign this agreement on behalf of the responsible governing board, official or Grantee. 12. Signature Section For Oakland County Department of Health and Human Services/ Health Division Michael J Gingell Chairperson Name Title For the Michigan Department of Health and Human Services Kim Stephen Kim Stephen, Director Bureau of Purchasing 07/15/2016 Date Local Health Department -2017, Date: 07/15/2016 Page: 4 of 176 07/15/2016 Part II General Provisions Responsibilities - Grantee The Grantee in accordance with the general purposes and objectives of th i s agreement will: A. Publication Rights 1. Where the Grantee exclusively develops books, films, or other such copyrightable materials through activities supported by this agreement, the Grantee may copyright those materials. The materials that the Grantee copyrights cannot include service recipient information or personal identification data. Grantee grants the Department a royalty- free, non-exclusive and irrevocable license to reproduce, publish and use such materials and authorizes others to reproduce and use such materials. 2. Any materials copyrighted by the Grantee or modifications bearing acknowledgment of the Department's name must be approved by the Department before reproduction and use of such materials. The State of Michigan may modify the material copyrighted by the Grantee and may combine it with other copyrightable intellectual property to form a derivative work. The State of Michigan will own and hold all copyright and other intellectual property rights in any such derivative work, excluding any rights or interest granted in this agreement to the Grantee. If the Grantee ceases to conduct business for any reason, or ceases to support the copyrightable materials developed under this agreement, the State of Michigan has the right to convert its licenses into transferable licenses to the extent consistent with any applicable obligations the Grantee has to the federal government. 3. The Grantee shall give recognition to the Department in any and all publications papers and presentations arising from the program and service contract herein; the Department will do likewise, 4. The Grantee must notify the Department's Grants and Purchasing Division 30 days before applying to register a copyright with the U.S, Copyright Office. The Grantee must submit an annual report for all copyrighted materials developed by the Grantee through activities supported by this agreement and must submit a final invention statement and certification within 90 days of the end of the agreement period. B. Fees Make reasonable efforts to collect 1st and 3rd party fees, where applicable, and report these as outlined by the Department's Financial Status Report Instructions. Any underrecoveries of otherwise available fees resulting from Local Health Department- 2017, Date: 07/15/2016 Page: 5 of 176 07/15/2016 failure to bill for eligible services will be excluded from reim b u r s a b l e expenditures. Local Health Department - 2017, Date; 07/15/2016 Page: 6 of 176 07/15/2016 C. Program Operation Provide the necessary administrative, professional, and technical staff for operation of the program. D. Reporting Utilize all report forms and reporting formats required by the Department at the effective date of this agreement, and provide the Department with timely review and commentary on any new report forms and reporting formats proposed for issuance thereafter. E. Record Maintenance/Retention Maintain adequate program and fiscal records and files, including source documentation to support program activities and all expenditures made under the terms of this agreement, as required, Assure that all terms of the agreement will be appropriately adhered to and that records and detailed documentation for the project or program identified in this agreement will be maintained for a period of not less than three (3) years from the date of termination, the date of submission of the final expenditure report or until litigation and audit findings have been resolved. F. Authorized Access Permit upon reasonable notification and at reasonable times, access by authorized representatives of the Department, Federal Grantor Agency, Cornptroller General of the United States and State Auditor General, or any of their duly authorized representatives, to records, files and documentation related to this agreement, to the extent authorized by applicable state or federal law, rule or regulation. G. Audits 1. Single Audit Provide, consistent with the regulations set forth in the Single Audit Act Amendments of 1996, P.L. 104-156, and "Title 2 Code of Federal Regulations (CFR) Part 200, Subpart F Audit Section .320 of the Office of Management and Budget (OMB) Circular A-133, "Audits of States, Local Governments, and Non-Profit Organizations," a copy of the Grantee's annual Single Audit reporting package, including the Corrective Action Plan, and management letter (if one is issued) with a response to the Department. The Grantee must assure that the Schedule of Expenditures of Federal Awards includes expenditures for all federally-funded grants. 2. Other Audits The Department or federal agencies, may also conduct or arrange for "agreed upon procedures" or additional audits to meet their needs. Local Health Department - 2017, Date: 07/15/2016 Page: 7 of 176 07/15/2016 3. Due Date The Single Audit reporting package, management letter (if one is issued) with a response and Corrective Action Plan shall be submitted to the Department within nine months after the end of the Grantee's fiscal year. The Single Audit reporting package, management letter, and Corrective Action Plan shall be filed with the Department even if there are no findings or disclosures reported in the audit pertaining to Department programs. 4. Penalty If the Grantee does not submit the required Single Audit reporting package, management letter (if one is issued) with a response, and Corrective Action Plan within nine months after the end of the Grantee's fiscal year and an extension has not been approved by the cognizant or oversight agency for audit, the Department may withhold from the current funding an amount equal to five percent of the audit year's grant funding (not to exceed $200,000) until the required filing is received by the Department. The Department may retain the amount withheld if the Grantee is more than 120 days delinquent in meeting the filing requirements and an extension has not been approved by the cognizant or oversight agency for audit. The Department may terminate the current grant if the Grantee is more than 180 days delinquent in meeting the filing requirements and an extension has not been approved by the cognizant or oversight agency for audit. 5. Where to Send A copy of the Single Audit reporting package, management letter (if one is issued) with a response, and Corrective Action Plan must be forwarded by e-mail to the Department at MDHHS- AuditReports©michigan.gov . The required materials must be assembled as one document in a PDF file compatible with Adobe Acrobat (read only). The subject line must state the agency name and fiscal year end. The Department reserves the right to request a hard copy of the audit materials if for any reason the electronic submission process is not successful. H. Subrecipient/Contractor Monitoring The Grantee must ensure that each of its subrecipients comply with the Single Audit Act requirements. The Grantee must issue management decisions on audit findings of their subrecipients as required by Title 2 Code of Federal Regulations (CFR) Section 200.501(h), as applicable. The Grantee must also develop a subrecipient monitoring plan that addresses "during the award monitoring" of subrecipients to provide Local Heatth Department - 2017, Date: 0711512016 Page: 8 of 176 07/1512016 reasonable assurance that the subrecipient administers Federal awards in compliance with laws, regulations, and the provisions of contracts, and that performance goals are achieved. The subrecipient monitoring plan should include a risk-based assessment to determine the level of oversight, and monitoring activities such as reviewing financial and performance reports, performing site visits, and maintaining regular contact with subrecipients. The Grantee must establish requirements to ensure compliance by for-profit subrecipients as required by Title 2 CFR Section 200.501(h), as applicable The Grantee must ensure that transactions with contractors comply with laws, regulations and provisions of contracts or grant agreements in compliance with Title 2 CFR Section 200.501(h), as applicable Notification of Modifications Provide timely notification to the Department, in writing, of any action by the Grantee, its governing board or any other funding source which would require or result in significant modification in the provision of services, funding or compliance with operational procedures. J. Software Compliance The Grantee must ensure software compliance and compatibility with the Department's data systems for services provided under this agreement including, but not limited to stored data, databases, and interfaces for the production of work products and reports. All required data under this agreement shall be provided in an accurate and timely manner without interruption, failure or errors due to the inaccuracy of the Grantee's business operations for processing date/time data All information systems, electronic or hard copy that contain State or Federal data must be protected from unauthorized access. K. Human Subjects The Grantee will comply with Protection of Human Subjects Act, 45 CFR, Part 46. The Grantee agrees that prior to the initiation of the research, the Grantee will submit institutional Review Board (IRB) application material for all research involving human subjects, which is conducted in programs sponsored by the Department or in programs which receive funding from or through the State of Michigan, to the Department's IRB for review and approval, or the IRB application and approval materials for acceptance of the review of another IRB. All such research must be approved by a federally assured IRB, but the Department's IRB can only accept the review and approval of another institution's IRB under a formally-approved interdepartmental agreement. The manner of the review will be agreed upon between the Department's IRB Chairperson and the Grantee's IRB Chairperson or Executive Officer(s). L. Terms Local Health Department- 2017, Date: 07/15/2016 Page: 9 of 176 07/15/2016 To abide by the terms of this agreement including all attachments. Local Health Department - 2017, Date: 07/15/2016 Page: 10 of 176 07115/2016 M. Minimum Program Requirements To comply with Minimum Program Requirements established in accordance with Section 2472.3 of 1978 PA 368 as amended, MCI_ 333.2472.3, MSA 14.15 (2472.3), for each applicable program element funded under this agreement. N. Annual Budget and Plan Submission To submit an Annual Budget and Plan request to the Department, in accordance with instructions established by the Department, to serve as the basis for completion of specific details for Attachments I and 1N/ of this agreement via Grantee/Department negotiated amendment(s). Failure to submit a complete Annual Budget and Plan by the due date through MI E- Grants will result in the deferral of Department payments until these documents are submitted. 0. Maintenance of Effort All agencies shall comply with maintenance of effort requirements for ELPHS, as defined in the current Department appropriation act, and Family Planning in accordance with federal requirements, except as noted in Section 3,C.3 of Part P. Accreditation All Grantees shall comply with the local public health accreditation standards and follow the accreditation process and schedule established by the Department to achieve full accreditation status. Grantees that fail to meet all accreditation requirements and/or implement corrective plans of action within the prescribed time period will receive the status of "Not Accredited." Grantees designated as "Not Accredited" may have their Department allocations reduced for costs incurred in the assurance of service delivery. Grantees that disagree with on-site review findings or their accreditation status may request an inquiry through written request to the Department. The request must identify the disagreement and resolution sought. The inquiry participants will be comprised of Grantee staff, Department staff, the Accreditation Commission Chair, and the Accreditation Coordinator as needed. Participants will clarify facts, verify information and seek resolution. 2. Consent Agreements/Administrative Compliance Orders/Administrative Hearings for "Not Accredited'' Grantees: a. Grantees designated as "Not Accredited", will receive a Consent Agreement Package from the Department. Grantees and their local governing entities shall be given 75 days to review the package, meet with the Department, and sign/return the Consent Agreement. Local Health Department - 2017, Date: 07/15/2016 Page: 11 of 176 07/1512016 b. Fulfillment of the terms and conditions of the Consent Agreement will not affect accreditation status, but impacts the Grantees' ability to fulfill its contractual obligations under the Comprehensive Planning, Budgeting and Contracting Agreement. Grantees designated as "Not Accredited", will retain this designation until the subsequent accreditation cycle. c. Grantee failure to fulfill the terms and conditions of the Consent Agreement within the prescribed time period will result in the issuance of an Administrative Compliance Order by the Department. d. VVithin 60 working days after receipt of an Administrative Compliance Order and proposed compliance period, a local governing entity may petition the Department for art administrative hearing. If the local governing entity does not petition the Department for a hearing within 60 days after receipt of an Administrative Compliance Order, the order and proposed compliance date shall be final. After a hearing, the Department may reaffirm, modify, or revoke the order or modify the time permitted for compliance. e. If the local governing entity fails to correct a deficiency for which a final order has been issued within the period permitted for compliance, the Department may petition the appropriate circuit court for a writ of mandamus to compel correction. Q. Medicaid Outreach Activities Reimbursement The Grantee agrees to report allowable costs and request reimbursement for the Medicaid Outreach activities it provides in accordance with 2 CFR, Part 225 (OMB Circular A-87) and the requirements in Medicaid Bulletin number: MSA 05-29, The Grantee agrees to submit a Cost Allocation Plan Certification to the Department to bill for the Medicaid Outreach Activities. The Cost Allocation Plan Certification is valid until a change is made to the cost allocation plan or the Department determines it is invalid. The Grantee will submit quarterly FSRs for the Medicaid Outreach activities and an annual FSR for the Children with Special Health Care Services Medicaid Outreach activities in accordance with the instructions contained in Attachment I. In accordance with the Medicaid Bulletin, MSA 05-29, the Grantee agrees to target their Medicaid outreach effort toward Department established priorities. For FY 15/16, the Department priorities are: lead testing, outreach and enrollment for the Family Planning waiver, and outreach for pregnant women, mothers and infants for the Maternal and Infant Health Program. The Grantee will submit a report using the MDCH Local Health Department Medicaid Local Health Department- 2017, Date: 07115/2016 Page: 12 of 176 07/1512016 Outreach form describing their outreach activities targeting the priori t i e s 3 0 days after the end of a fiscal year quarter and at the same time as the f i n a l COMPREHENSIVE FSR is due into the Department. The Local H e a l t h Department Medicaid Outreach report are to be sent through MI E-Grants a s an attachment report to the Financial Status Report. R. Mandatory Disclosures The Grantee must disclose, in a timely manner, in writing to the Depa r t m e n t a l l violations of Federal and State criminal law involving fraud, bribery, or g r a t u i t y violations potentially affecting the agreement. Responsibilities - Department The Department in accordance with the general purposes and objec t i v e s o f t h i s agreement will A. Payment Provide payment in accordance with the terms and conditions of t h i s agreement based upon appropriate reports, records, and docume n t a t i o n maintained by the Grantee. B. Report Forms Provide any report forms and reporting formats required by the Departm e n t a t the effective date of this agreement, and provide to the Grantee a n y n e w report forms and reporting formats proposed for issuance thereafter at least ninety (90) days prior to their required usage in order to afford the Gra n t e e a n opportunity to review and offer comment. C. Terms Abide by the terms of this agreement including all attachments. D. Notification of Modifications To notify the Grantee in writing of modifications to Federal or State la w s , r u l e s and regulations affecting this agreement. E. Identification of Laws To identify for the Grantee relevant laws, rules, regulations, po l i c i e s , procedures, guidelines and State and Federal manuals, and pr o v i d e t h e Grantee with copies of these documents to the extent they are not oth e r w i s e available to the Grantee. F. Modification of Funding To notify the Grantee in writing within thirty (30) calendar days of bec o m i n g aware of the need for any modifications in agreement funding com m i t m e n t s made necessary by action of the Federal Government, the Governor, t h e Legislature or the Department of Management and Budget on beha l f o f t h e Governor or the Legislature. Implementation of the modifications will b e determined jointly by the Grantee and the Department. G. Monitor Compliance l_ocat Health Department 2017, Date: 07115/2016 Page 13 of 176 07/15/2016 To monitor compliance with all applicable provisions contained in federal grant awards and their attendant rules, regulations and requirements pertaining to program elements covered by this agreement. Local Health Department - 2017, Date: 07/15/2016 Page 14 of 176 07/15/2016 H. Reimbursement To reimburse local agencies for costs based upon timely, accurately completed Financial Status Reports in accordance with Section IV. Technical Assistance To make technical assistance available to the Grantee for the implementation of this agreement. J. Health Insurance Portability and Accountability The Department assures that it will be in compliance with the Health Insurance Portability and Accountability Act. K. Accreditation The Department agrees to adhere to the accreditation requirements including the process for "Not Accredited" Grantees. The process includes developing and monitoring consent agreements, issuing and monitoring administrative compliance orders, participating in administrative hearings and petitioning appropriate circuit courts. L. Medicaid Outreach Activities Reimbursement The Department agrees to reimburse the Grantee for all allowable Medicaid Outreach activities that meet the standards of the Medicaid Bulletin: MSA 05- 29 including the cost allocation plan certification and that are billed in accordance with the requirements in Attachment I. In accordance with the Medicaid Bulletin, MSA 05-29, the Department will identify each fiscal year the Medicaid Outreach priorities and establish a reporting requirement for the Grantee. Ill. Assurances The following assurances are hereby given to the Department: A. Compliance with Applicable Laws The Grantee will comply with applicable federal and state laws, guidelines, rules and regulations in carrying out the terms of this agreement. The Grantee will also comply with all applicable general administrative requirements such as OMB Circulars covering cost principles, grant/agreement principles, and audits in carrying out the terms of this agreement. B. Anti-Lobbying Act The Grantee will comply with the Anti-Lobbying Act, 31 USC 1352 as revised by the Lobbying Disclosure Act of 1995, 2 USC 1601 et seq, and Section 503 of the Departments of Labor, Health and Human Services, and Education, and Related Agencies section of the FY 1997 Omnibus Consolidated Appropriations Act (Public Law 104-208). Further, the Grantee shall require that the language of this assurance be included in the award documents of all subawards at all tiers (including subcontracts, subg rants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. Local Health Department - 2017, Date: 07/15)2016 Page: 15 of 176 C. 07/15/2016 C. Non-Discrimination 1. The Grantee agrees not to discriminate against any employee or applicant for employment or service delivery and access, with respect to their hire, tenure, terms, conditions or privileges of employment, programs and services provided or any matter directly or indirectly related to employment, because of race, color, religion, national origin, ancestry, age, sex, height, weight, marital status, physical or mental disability unrelated to the individual's ability to perform the duties of the particular job or position or to receive services. The Grantee further agrees that every subcontract entered into for the performance of any contract or purchase order resulting herefrom will contain a provision requiring non-discrimination in employment, service delivery and access, as herein specified binding upon each subcontractor. This covenant is required pursuant to the Elliot-Larsen Civil Rights Act, 1976 PA 453, as amended, MCL 37.2201 et seq., and the Persons with Disabilities Civil Rights Act, 1976 PA 220, as amended, MCL 37.1101 et seq., and any breach thereof may be regarded as a material breach of the contract or purchase order. 2. The Grantee will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to a. Title VI of the Civil Rights Act of 1964 (P .L. 88-352) which prohibits discrimination on the basis of race, color or national origin; Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of disabilities; d. the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; e. the Drug Abuse Office and Treatment Act of 1972 (P.L. 92- 255), as amended, relating to nondiscrimination on the basis of drug abuse; f. the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616) as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; g. §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee 3), as amended, relating to Locall-lea* Department - 2017, Date: 07/15/2010 Page: 16 of 176 07/15/2016 confidentiality of alcohol and drug abuse patient records h. any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, the requirements of any other nondiscrimination statute(s) which may apply to the application. 3. Additionally, assurance is given to the Department that proactive efforts will be made to identify and encourage the participation of minority owned and women owned businesses, and businesses owned by persons with disabilities in contract solicitations. The Grantee shall incorporate language in all contracts awarded: (1) prohibiting discrimination against minority owned and women owned businesses and businesses owned by persons with disabilities in subcontracting; and (2) making discrimination a material breach of contract. D. Debarment and Suspension Assurance is hereby given to the Department that the Grantee will comply with Federal Regulation, 2 CFR part 180 and certifies to the best of its knowledge and belief that the Grantee's local health department or an official of the Grantee's local health department and the Grantee's subcontractors: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or Grantee; 2. Have not within a three-year period preceding this agreement been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in section 2, and; 4. Have not within a three-year period preceding this agreement had one or more public transactions (federal, state or local) terminated for cause or default. E. Federal Requirement: Pro-Children Act 1 Assurance is hereby given to the Department that the Grantee will comply with Public Law 103-227, also known as the Pro-Children Act of 1994, 20 USC 6081 et seq, which requires that smoking not be permitted in any portion of any indoor facility owned or leased or Local Health Department - 2017, Date: 07/1512016 Page: 17 of 176 07/15/2016 contracted by and used routinely or regularly for the provision of health, day care, early childhood development services, education or library services to children under the age of 18, if the services are funded by federal programs either directly or through state or local governments, by federal grant, contract, loan or loan guarantee. The law also applies to children's services that are provided in indoor facilities that are constructed, operated, or maintained with such federal funds. The law does not apply to children's services provided in private residences; portions of facilities used for inpatient drug or alcohol treatment; service providers whose sole source of applicable federal funds is Medicare or Medicaid; or facilities where Women, Infants, and Children (WIC) coupons are redeemed. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity. The Grantee also assures that this language will be included in any subawards which contain provisions for children's services. 2. The Grantee also assures, in addition to compliance with Public Law 103-227, any service or activity funded in whole or in part through this agreement will be delivered in a smoke-free facility or environment. Smoking shall not be permitted anywhere in the facility, or those parts of the facility under the control of the Grantee. If activities or services are delivered in facilities or areas that are not under the control of the Grantee (e.g., a mall, restaurant or private work site), the activities or services shall be smoke-free. Hatch Political Activity Act and Intergovernmental Personnel Act The Grantee will comply with the Hatch Political Activity Act, 5 USC 1501-1509 and 7324-7328, and the Intergovernmental Personnel Act of 1970, as amended by Title VI of the Civil Service Reform Act, Public Law 95-454, 42 USC 4728 - 4763. Federal funds cannot be used for partisan political purposes of any kind by any person or organization involved in the administration of federally-assisted programs. G. National Defense Authoriation Act Employee Whistleblower Protections The Grantee will comply with the National Defense Authorization Act "Pilot Program for Enhancement of Grantee Employee Whistleblower Protections". 1. This agreement and employees working on this agreement will be subject to the whistleblower rights and remedies in the pilot program on Grantee employee whistleblower protections established at 41 U.S.C. 4712 by section 828 of the National Defense Authorization Act for Fiscal Year 2012 and FAR 3.908, 2. The Grantee shall inform its employees in writing, in the predominant language of the workforce, of employee whistleblower rights and Local Health Department - 2017, Date; 07/15/2016 Page: 16 of 176 07/15/2016 protections under 41 U.S.C. 4712, as described in section 3 . 9 0 8 o f t h e Federal Acquisition Regulation. 3. The Grantee shall insert the substance of this clause, incl u d i n g t h i s paragraph (3), in all subcontracts over the simplified ac q u i s i t i o n threshold. H. Home Health Services If the Grantee provides Home Health Services (as define d i n M e d i c a r e P a r t B ) , the following requirements apply: 1. The Grantee shall not use State ELPHS or categorica l g r a n t f u n d s provided under this agreement to unfairly compete fo r h o m e h e a l t h services available from private providers of the same t y p e o f s e r v i c e s i n the Grantee's service area. 2. For purposes of this agreement, the term "unfair competi t i o n " s h a l l b e defined as offering of home health services at fees su b s t a n t i a l l y l e s s than those generally charged by private providers of the s a m e t y p e o f services in the Grantee's area, except as allowed u n d e r M e d i c a r e customary charge regulations involving sliding fee scale d i s c o u n t s f o r low-income clients based upon their ability to pay. 3. If the Department finds that the Grantee is not in compl i a n c e w i t h i t s assurance not to use state ELPHS and categorical grant funds to unfairly compete, the Department shall follow the procedure r e q u i r e d f o r failure by local health departments to adequately pr o v i d e r e q u i r e d services set forth in Sections 2497 and 2498 of 1978 P A 3 6 8 a s amended (Public Health Code), MCL 333.2497 and 24 9 8 , M S A 1 4 . 1 5 (2497) and (2498). Subcontracts Assure for any subcontracted service, activity or product: 1. That a written subcontract is executed by all affected pa r t i e s p r i o r t o t h e initiation of any new subcontract activity. Exceptions to t h i s p o l i c y m a y be granted by the Department upon written request. 2. That any executed subcontract shall require the subcont r a c t o r t o c o m p l y with all applicable terms and conditions of this agree m e n t . I n t h e e v e n t of a conflict between this agreement and the prov i s i o n s o f t h e subcontract, the provisions of this agreement shall p r e v a i l . A c o n f l i c t between this agreement and a subcontract, however , s h a l l n o t b e deemed to exist where the subcontract: a. Contains additional non-conflicting provisions not set fo r t h i n this agreement; or b. Restates provisions of this agreement to afford the Gra n t e e t h e same or substantially the same rights and privileges as t h e Department; or Local Health Department - 2017, Date: 0705)2016 Page: 19 of 176 07/15/2016 c. Requires the subcontractor to perform duties and/or services in less time than that afforded the Grantee in this agreement. 3. That the subcontract does not affect the Grantee's accountability to the Department for the subcontracted activity. 4. That any billing or request for reimbursement for subcontract costs is supported by a valid subcontract and adequate source documentation on costs and services. 5. That the Grantee will submit a copy of the executed subcontract if requested by the Department. 6. That subcontracts in support of programs or elements utilizing funds provided by the Department, the State of Michigan or the federal government in excess of $10,000 shall contain provisions or conditions that will: a. Allow the Grantee or Department to seek administrative, contractual or legal remedies in instances in which the Contractor violates or breaches contract terms, and provide for such remedial action as may be appropriate. b. Provide for termination by the Grantee, including the manner by which termination will be effected and the basis for settlement. 7. That all subcontracts in support of programs or elements utilizing funds provided by the Department, the State of Michigan or the federal government of amounts in excess of $100,000 shall contain a provision that requires compliance with all applicable standards, orders or regulations issued pursuant to the Clean Air Act of 1970 (42 USC 1857(h)), Section 508 of the Clean Water Act (33 USC 1368), Executive Order 11738 and Environmental Protection Agency regulations (40 CFR Part 15). 8. That all subcontracts and subgrants in support of programs or elements utilizing funds provided by the Department, the State of Michigan or the federal government in excess of $2,000 for construction or repair, awarded by the Grantee shall include a provision: a. For compliance with the Copeland "Anti-Kickback" Act (18 USC 874) as supplemented in Department of Labor regulations (29 CFR, Part 3). b. For compliance with the Davis-Bacon Act (40 USC 276a to a-7) and as supplemented by Department of Labor regulations (29 CFR, Part 5) (if required by Federal Program Legislation). c. For compliance with Section 103 and 107 of the Contract Work Hours and Safety Standards Act (40 USC 327-330) as supplemented by Department of Labor regulations (29 CFR, Part 5). This provision also applies to all other contracts in Local Health Department- 2017, Date: 0711512016 Pagel 20 of 176 07115/2016 excess of $2,500 that involve the employment of mechanics or laborers. J. Procurement Assure that all purchase transactions, whether negotiated or advertised, shall be conducted openly and competitively in accordance with the principles and requirements of Title 2 Code of Federal Regulations, Part 200, as amended, as applicable and that records sufficient to document the significant history of all purchases are maintained for a minimum of three years after the end of the agreement period. K. Health Insurance Portability and Accountability Act To the extent that this act is pertinent to the services that the Grantee provides to the Department under this agreement, the Grantee assures that it is in compliance with the Health Insurance Portability and Accountability Act (HIPAA) requirements including the following: 1. The Grantee must not share any protected health data and information provided by the Department that falls within HIPAA requirements except as permitted or required by applicable law; or to a subcontractor as appropriate under this agreement. 2. The Grantee will ensure that any subcontractor will have the same obligations as the Grantee not to share any protected health data and information from the Department that falls under HIPAA requirements in the terms and conditions of the subcontract. 3. The Grantee must only use the protected health data and information for the purposes of this agreement. 4. The Grantee must have written policies and procedures addressing the use of protected health data and information that falls under the HIPAA requirements. The policies and procedures must meet all applicable federal and state requirements including the HIPAA regulations. These policies and procedures must include restricting access to the protected health data and information by the Grantee's employees. 5. The Grantee must have a policy and procedure to immediately report to the Department any suspected or confirmed unauthorized use or disclosure of protected health data and information that falls under the HIPAA requirements of which the Grantee becomes aware. The Grantee will work with the Department to mitigate the breach, and will provide assurances to the Department of corrective actions to prevent further unauthorized uses or disclosures. 6. Failure to comply with any of these contractual requirements may result in the termination of this agreement in accordance with Part II, Section V. Agreement Termination. 7 In accordance with HIPAA requirements, the Grantee is liable for any Local Health Department- 2017, Date: 07/1512016 Page: 21 of 176 O7/15)26 claim, loss or damage relating to unauthorized use or disclosure of protected health data and information by the Grantee received from the Department or any other source. 8. The Grantee will enter into a business associate agreement should the Department determine such an agreement is required under HIPAA. Local Health Department - 2017, Date: 0711512016 Page: 22 of '176 l:17/ 5/2016 IV. Payment and Reporting Procedures A. Operating Advance Under the pre-payment reimbursement method, no additional operating advances will be issued. B. Comprehensive Prepayments The Department will make monthly prepayments equal to 1/12th of the agreement amount for each non-fee-for-service program contained in Attachment IV of this agreement. One single payment covering all non-fee- for-service programs will be made within the first week of each month. The Grantee can view their monthly prepayment within the MI E-Grants system. Prepayments for the months of October thru January will be based upon the initial agreement amounts in Attachment IV Subsequent monthly prepayments may be adjusted based upon agreement amendments and/or Grantee adjustment requests per Department approval. C. Prepayment Adjustments If the sum of the prepayments do not equal at least 90% of the Grantee's expenditures for a quarter of the contract period, the Grantee may submit documentation for an adjustment to the monthly prepayment amount via the following process: 1. Submit a written request for the adjustment to the Department's Accounting Division, Expenditure Operations Section. 2. The adjustment request must be itemized by program and must list the amount received from the Department, the expenditure amount reported per the quarterly Financial Status Report (FSR), and the difference. The amount received from the Department and the expenditures must be for the same reporting quarterly FSR period. 3. The Department will review the requests and if an adjustment is approved, it will be included in the next scheduled monthly prepayment. 4. Adjustment requests will not be accepted prior to submission of the FSR for the quarter ending December 31. No adjustments will be made prior to the February monthly prepayment. 5. The ability of the Department to approve adjustments may be limited by the quarterly allotments of spending authority in the Department's appropriation account mandated by the Office of the State Budget Director. The quarterly allotment limits the amount of each account (program) that the Department may expend during each fiscal quarter. D. Financial Status Report Submission A Financial Status Report (FSR) must be submitted for all programs listed on Attachment IV. All FSR's must be prepared in accordance with the Department's FSR instructions and submitted electronically not later than thirty Local Health Department - 2017, Date: 07/1512018 Page: 23 of 176 07/15/2016 (30) days after the close of the fiscal quarters through MI E-Grants. Reports are due 1/30, 4/30, and 7/30. FSR's must report total actual program expenditures regardless of the source of funds. The Department will reimburse the Grantee for expenditures in accordance with the terms and conditions of this agreement. Failure to comply with the reporting due dates will result in the deferral of the Grantee's monthly prepayment. E. Reimbursement Method The Grantee will be reimbursed in accordance with the reimbursement methods for applicable program elements described as follows: 1. Performance Reimbursement - A reimbursement method by which Grantees are reimbursed based upon the understanding that a certain level of performance (measured by outputs) must be met in order to receive full reimbursement of costs (net of program income and other earmarked sources) up to the contracted amount of State funds. Any local funds used to support program elements operated under such provisions of this agreement may be transferred by the Grantee within, among, to or from the affected elements without Department approval, subject to applicable provisions of Sections 3.B. and 3.C.3 of Part I and Section XIV of Part II. If Grantee's performance falls short of the expectation by a factor greater than the allowed minimum performance percentage, the State maximum allocation will be reduced equivalent to actual performance in relation to the minimum performance. 2. Staffing Grant Reimbursement - A reimbursement method by which Grantees are reimbursed based upon the understanding that State dollars will be paid up to total costs in relation to the State's share of the total costs and up to the total State allocation as agreed to in the approved budget. This reimbursement approach is not directly dependent upon whether a specified level of performance is met by the local health department. Department funding under this reimbursement method is allocable as a source before any local funding requirement unless a specific local match condition exists. 3. Fixed Unit Rate Reimbursement - A reimbursement method by which Grantee are reimbursed a specific amount for each output actually delivered and reported. 4. Essential Local Public Health Services (ELPHS) - A reimbursement method by which Grantees are reimbursed a share of reasonable and allowable costs incurred for required services, as noted in the current Appropriations Act. F. Reimbursement Mechanism Local Health Department -2017, Date: 07/15/2016 Page: 24 of 176 07/15/2016 All Grantees must sign up through the on-line vendor registration process to receive all State of Michigan payments as Electronic Funds Transfers (EFT)/Direct Deposits. Vendor registration information is available through the Department of Management and Budget's web site: http://wvvw.cpex press . state. mi. us/ G. Unobligated Funds Any unobligated balance of funds held by the Grantee at the end of the agreement period will be returned to the Department or treated in accordance with instructions provided by the Department. H. Fiscal Year-End Reporting An Obligation Report is based on annual guidelines and due date using the format provided by the Department through MI E-Grants. The Grantee must provide, by program, an estimate of total expenditures for the entire agreement period (October 1 through September 30). This report must represent the Grantee's best estimate of total program expenditures for the agreement period. The information on the report will be used to record the Department's year-end accounts payables and receivables by program for this Agreement. The report assists the Department in reserving sufficient funding to reimburse the final expenditures that will be reported on the Final FSR without materially overstating or understating the year-end obligations for this agreement. The Department compares the total estimated expenditures from this report to the total amount reimbursed to the Grantee in the monthly prepayments and quarterly fee-for-service payments to establish accounts payable and accounts receivable entries at fiscal year-end. The Department recognizes that based upon payment adjustments and timing of agreement amendments, the Grantee may owe the Department funding for overpayment of a program and may be due funds from the Department for underpayment of a program at fiscal year-end. Within 75 days after the agreement fiscal year-end, the Grantee must liquidate any unpaid year-end commitments and obligations. Any obligation remaining unliquidated after 75 days from the end of the agreement period shall revert to the Department for disposition in accordance with applicable state and/or federal requirements, except as specifically authorized in writing by the Department. Final Total Grantee FSR Project Public Health Emergency Preparedness WIC All Remaining Projects Final FSR Due Date 11/15/2016 11/30/2016 12/15/2016 The final total Grantee FSR is due December 15, after the agreement period end date. WIC financial data reporting and final FSR must be received by Local Health Department - 2017, Date: 0711512016 Page: 25 of 176 07/15/2016 November 30. Upon receipt of the final FSR electronically through MI E- Grants, the Department will determine by program, if funds are owed to the Grantee or if the Grantee owes funds to the Department. If funds are owed t o the Grantee, payment will be processed. However, if the Grantee underestimated their year-end obligations in the Obligation Report a s compared to the final FSR and the total reimbursement requested doe s n o t exceed the agreement amount that is due to the Grantee, the Department w i l l make every effort to process full reimbursement to the Grantee per the final FSR. Final payment may be delayed pending final disposition of t h e Department's year-end obligations. If funds are owed to the Department, it will generally not be necess a r y f o r Grantee to send in a payment. Instead the Department will make th e necessary entries to offset other payments and as a result the Gran t e e w i l l receive a net monthly prepayment. When this does occur, clarifyi n g documentation will be provided to the Grantee by the Department's Acco u n t i n g Division. J. Penalties for Reporting Noncompliance For failure to submit the final total Grantee FSR report by December 1 5 , through MI E-Grants after the agreement period end date, the Grantee m a y b e penalized with a one-time reduction in their current ELPHS allocation f o r noncompliance with the fiscal year-end reporting deadlines. Any penalt y f u n d s will be reallocated to other Comprehensive Grantees (local he a l t h departments). Reductions will be one-time only and will not carryfor w a r d t o the next fiscal year as an ongoing reduction to a Grantee's ELPHS allocati o n . Penalties will be assessed based upon the submitted date in MI E-Grants: ELPHS Penalties for Noncompliance with Reporting Requirements: 1. 1% - 1 day to 30 days late; 2. 2% - 31 days to 60 days late; 3. 3% - over 60 days late with a maximum of 3% reduction in the Grantee's ELPHS allocation. K. Indirect Costs and Cost Allocations/Distribution Plans The Grantee is allowed to use approved federal indirect rate, 10% de minim i s indirect rate and/or cost allocation/distribution plans in their bud g e t calculations. 1. Costs must be consistently charged as indirect, direct or cost allocated, but may not be double charged or inconsistently charged. 2. If the Grantee does not have an existing approved federal indirect rate , they may use a 10% de minimis rate in accordance with Title 2 Code of Federal Regulations (CFR) Part 200 to recover their indirect costs. 3. Grantees using the cost allocation/distribution method must develop certified plan in accordance with the requirements described in Title 2 Local Health Department - 2017, Date 07/1512016 Page: 26 of 176 07/15/2010 CFR, Part 200 which includes detailed budget narratives and is retained by the Grantee and subject to Department review. 4. There must be a documented, well-defined rationale and audit trail for any cost distribution or allocation based upon Title 2 CFR, Part 200 Cost Principles and subject to Department review. V. Agreement Termination The Department may cancel this agreement without further liability or penalty to the Department for any of the following reasons: A. This agreement may be terminated by either party by giving thirty (30) days written notice to the other party stating the reasons for termination and the effective date. B. This agreement may also be terminated on thirty (30) days prior written notice upon the failure of either party to carry out the terms and conditions of this agreement, provided the alleged defaulting party is given notice of the alleged breach and fails to cure the default within the thirty (30) day period. C. This agreement may be terminated immediately if the Grantee's local health department, or an official of the Grantee's local health department, is convicted of any activity referenced in Part 11, Section 111.D, of this agreement during the term of this agreement or any extension thereof. VI. Final Reporting upon Termination Should this agreement be terminated by either party, within thirty (30) days after th e termination, the Grantee shall provide the Department with all financial, performance and other reports required as a condition of this agreement. The Department w i l l make payments to the Grantee for allowable reimbursable costs not covered by previous payments or other state or federal programs. The Grantee shall immediatel y refund to the Department any funds not authorized for use and any payments or funds advanced to the Grantee in excess of allowable reimbursable expenditures. Any dispute arising as a result of this agreement shall be resolved in the State of Michigan. VII. Severability If any provision of this agreement or any provision of any document attached to or incorporated by reference is waived or held to be invalid, such waiver or invalidity sh a l l not affect other provisions of this agreement. VIII. Amendments Any changes to this agreement will be valid only if made in writing and accepted by a l l parties to this agreement. A. This agreement, including attachments, may be amended by mutual written consent of the Grantee and the Department. When submitting a proposed agreement/budget amendment, the Grantee must submit copies of the revised sheets and a summary description of the changes. B. In the event that circumstances occur that are not reasonably foreseeable, or are beyond the Grantee's or Department's control, which reduce or otherwise Local Health Department- 2017, Date: 0711512016 Page; 27 of 176 0711512016 interfere with the Grantee's or Department's ability to provide or maintain specified services or operational procedures, immediate written notification must be provided to the other party and an amendment to this agreement negotiated. C. Amendments to this agreement shall be made as follows: 1. Any change proposed by the Grantee which would affect the State funding of any element funded in whole or in part by funds provided by the Department, subject to Part I, Section 3.C, of the agreement, must be submitted in writing to the Department immediately upon determining the need for such change. The proposed change may be implemented upon receipt of written notification from the Department. Within thirty (30) days after receipt of the proposed change, the Department shall advise the Grantee in writing of its determination. Subsequently the Department will initiate any necessary formal amendment to the agreement for execution by all parties to the agreement. Any changes proposed by the Department must be agreed to in writing by the Grantee and upon such written agreement, the Department shall initiate any necessary formal amendment as above. 2. Other amendments of a routine nature including applicable changes in budget categories, modified indirect rates, and similar conditions which do not modify the agreement scope, amount of funding to be provided by the Department or, the total amount of the budget may be submitted by the Grantee at any time prior to June 2nd. The Department will provide a written response within thirty (30) calendar days. All amendments must be submitted to the Department by June 15 through MI E-Grants to assure the amendment can be executed prior to the end of the agreement period. IX. Liability A. All liability to third parties, loss, or damage as a result of claims, demands, costs, or judgments arising out of activities, such as direct service delivery, to be carried out by the Grantee in the performance of this agreement shall be the responsibility of the Grantee, and not the responsibility of the Department, if the liability, loss, or damage is caused by, or arises out of, the actions or failure to act on the part of the Grantee, any subcontractor, anyone directly or indirectly employed by the Grantee, provided that nothing herein shall be construed as a waiver of any governmental immunity that has been provided to the Grantee or its employees by statute or court decisions. B. All liability to third parties, loss, or damage as a result of claims, demands, Local Health Department - 2017, Date: 07/15/2016 Page: 28 of 176 07/15/2016 costs, or judgments arising out of activities, such as the provision of policy and procedural direction, to be carried out by the Department in the performance of this agreement shall be the responsibility of the Department, and not the responsibility of the Grantee, if the liability, loss, or damage is caused by, or arises out of, the action or failure to act on the part of any Department employee or agent, provided that nothing herein shall be construed as a waiver of any governmental immunity by the State, its agencies (the Department) or employees as provided by statute or court decisions. C. In the event that liability to third parties, loss, or damage arises as a result of activities conducted jointly by the Grantee and the Department in fulfillment of their responsibilities under this agreement, such liability, loss, or damage shall be borne by the Grantee and the Department in relation to each party's responsibilities under these joint activities, provided that nothing herein shall be construed as a waiver of any governmental immunity by the Grantee, the State, its agencies (the Department) or their employees, respectively, as provided by statute or court decisions. X. Conflict of Interest The Grantee and the Department are subject to the provisions of 1968 PA 317, as amended, MCL 15.321 et seq, and 1973 PA 196, as amended, MCL 15.341 et seq. and Title 2 Code of Federal Regulations, Section 200.318 (c)(1) and (2). Xl. State of Michigan Agreement This is a State of Michigan Agreement and is governed by the laws of Michigan. Any dispute arising as a result of this agreement shall be resolved in the State of Michigan, X11. Confidentiality Both the Department and the Grantee shall assure that medical services to and information contained in medical records of persons served under this agreement, or other such recorded information required to be held confidential by federal or state law, rule or regulation, in connection with the provision of services or other activity under this agreement shall be privileged communication, shall be held confidential, and shall not be divulged without the written consent of either the patient or a person responsible for the patient, except as may be otherwise permitted or required by applicable state or federal law or regulation. Such information may be disclosed in summary, statistical, or other form, which does not directly or indirectly identify particular individuals. XIII. Waiver Any clause or condition of this agreement found to be an impediment to the intended and effective operation of this agreement may be waived in writing by the Department or the Grantee, upon presentation of written justification by the requesting party. Such waiver may be temporary or for the life of the agreement and may affect any or all program elements covered by this agreement. XIV. Funding Local Health Department -2017, Date'. 07/1512016 Page: 29 of 176 07/15/2016 A, State funding for this agreement shall be provided from the applicab l e a n d available Department appropriations for the current fiscal year. T h e Department provided funds shall be as stated in the approved Annual B u d g e t - Attachment I Instructions for the Annual Budget, Attachment Ill, Progr a m Specific Assurances and Requirements, and as outlined in Attach m e n t I V , Funding/Reimbursement Matrix. B. The funding provided through the Department for this agreemen t s h a l l n o t exceed the amount shown for each federal and state categorical pro g r a m element except as adjusted by amendment. The Grantee must ad v i s e t h e Department in writing by May 1, if the amount of Department funding m a y n o t be used in its entirety or appears to be insufficient for any program e l e m e n t . ELPHS transfer requests between MDCH, MDARD and MDEQ must als o b e requested in writing by May 1. All aLPHS required services m u s t b e maintained throughout the entire period of the agreement. C. The Department may periodically redistribute funds between agencies dur i n g the agreement period in order to ensure that funds are expended to mee t t h e varying needs for services. Such redistributions will be bas e d u p o n projections obtained in consultation with the Grantee. Any redistribution s w i l l be effected through the established amendment process. AA Attachments Al Attachment I - instructions for the Annual Budget Attachment I - Instructions for the Annual Budget Attachment II - FY 15/16 Agreement Addendum A Oakland County FY Agreement Addendum A A2 Attachment III - Program Specific Assurances and Requirements Attachment III - Program Specific Assurances and Requirements Local Health Department 2017, Date: 07115,(2016 Page: 30 of 176 Contract # Date: 0711512016 MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTACHMENT IV - Local Health Department - 2017 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source (a) MOHNS Source Fed/St Funding Amount Reimbursement Method (b) Performance Target Output Measurement Total (c) Perform Expect State (d) Funded Target Perform State Funded Minimum Performance Percent Number (e) Contractor! Subrecepient (f) Adolescent STD Screening Reg. Alloc. F 73,000 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Body Art Fixed Fee Calc, Amt 250.00/Numb Fixed Unit Rate (2) N/A N/A N/A N/A N/A Contractor era Children's Special filth Care Cale, Amt 150.00Nario Fixed Unit Rate (1), NIA N/A N/A N/A N/A Contractor Services (CSHCS) Care us (7) Coordination Children's Special Hlth Care Reg. Alloc. F 142,500 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Services (CSHCS) Outreach & Advocacy Reg. Alioc. S 142,500 Enabling Services Women - MCH Local MCH F 150,028 Local MCH (3), (6) N/A NIA N/A N/A N/A Subrecepient Fetal Infant Mortality Review Reg. Alloc. F 6,840 Staffing (6) . N/A N/A N/A N/A NIA Subrecepient (F1MR) Case Abstraction Food ELPHS ELPHS Food S 859,213 ELPHS (3), (4) N/A N/A N/A NIA N/A Contractor General Communicable Disease ELPHS S 68.4,826 ELPHS (3), (6) N/A NIA N/A N/A N/A Contractor ELPHS MDHHS Other Gonococcal Isolate Surveillance Reg. Alloc. F 10,000 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Project Hearing ELPHS ELPHS S 235,112 ELPHS (3), (6) N/A NIA N/A N/A N/A Subrecepient Hearing HIV ELPHS ELPHS S 164,257 ELPHS (3), (4) N/A N/A N/A N/A N/A Contractor MDHHS Other HIV Prevention Reg. Alloc. F 383,986 Staffing (6) NIA N/A NIA N/A NIA Subrecepient Reg. Alloc. S 134,914 HIV Surveillance Support Reg. Alloc. F 7,000 Staffing (6) N/A N/A N/A N/A NIA Subrecepient Reg, Alloc. F 17,500 Reg. Alloc. F 10,500 Immunization Action Plan (lAP) Reg. Alloc. F 502,314 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Local Health Department 2017, Date- 07115/2016 Page: 31 of 176 Contract # Date. 0711512016 MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTACHMENT IV - Local Health Department -2017 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source (a) WID1-11-1S Source FedISt Funding Amount Reimbursement Method (b) Performance Target Output Measurement Total (c) Perform Expect State (d) Funded Target Perform State Funded Minimum Performance Percent Number (e) Contractor! Subreceplent (f) Immunization ELPHS ELPHS S 1,047,653 ELPHS (3), (6) N/A N/A N/A N/A N/A Contractor MDHHS Other Immunization Fixed Fees Calc. Amt 300.00/Numb Fixed Unit Rate (2), N/A N/A N/A N/A N/A Contractor ers (7) Immunization Vaccine Quality Reg. Alloc. S 111,722 Staffing (6) NIA N/A N/A N/A N/A Contractor Assurance Infant Safe Sleep Reg. Alloc. S 22,500 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Laboratory Services Bic Reg. Ake. F 20,000 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Local Tobacco Reduction Reg. Allot. S 30,000 Staffing (6) N/A N/A N/A NIA N/A Subrecepient MDEQ On-site Wastewater Treatment ELPHS On- site Wastew S 372,426 ELPHS (3), (6) N/A N/A N/A N/A N/A Contractor MDEQ Private and Type III Water ELPHS s 514,301 ELPHS (3), (6) N/A N/A N/A N/A N/A Contractor Supply Private and Ty Nurse Family Partnership -MCH Local MCH F 129,505 Local MCH (3), (6) N/A N/A N/A N/A N/A Subrecepient Nurse Family Partnership Reg. Alloc. F 32,052 Staffing (6) N/A NIA N/A NIA N/A Subrecepient Services Reg. Alloc. S 608,988 Public Health Emergency Preparedness (PHEP) 10/1/16- Reg, Alloc. F 233,063 Staffing (6), (14), (18) N/A N/A NIA N/A N/A Subrecepient 6/30/17 Public Health Emergency Preparedness (PH EP) CRI Reg. Alloc. F 159,225 Staffing (6), (14), (18) N/A N/A N/A N/A N/A Subrecepient 10/1/16 - 6/30/17 Public Health Emergency Reg. Alicia F 92,214 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Preparedness (PHEP) Ebola Virus Disease (EVD) Phase II Public Hlth Functions & I nfratruct - Local MCH F 41,924 Staffing (6) WA NIA N/A N/A N/A Subrecepient MCH Sexually Transmitted Disease Reg, Alloc, F 82,650 Staffing (6) N/A N/A N/A N/A N/A Subrecepient (STD) Control Local Health Department- 2017, Date: 0711512016 Page: 32 of 176 Contract # Date: 0711512016 MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTACHMENT IV - Local Health Department - 2017 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source (a) MDFIFIS Source Fed/St Funding Amount Reimbursement Method (b) Performance Target Output Measurement Total (c) Perform Expect State (d) Funded Target Perform State Funded Minimum Performance Percent Number (e) Contractor! Subrecepient (9 Sexually Transmitted Disease ELPHS S 354,554 ELPHS(3), (6) NIA N/A N/A N/A N/A Contractor (STD-ELPHS) MDFIHS Other Sudden Unexplained Infant Death Cab. Amt. 85.00/Numbe Fixed Unit Rate (2), N/A N/A N/A N/A N/A Contractor rs (11) Tuberculosis (TB) Control Reg. Alloc. F 48,678 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Vision ELPHS ELPHS S 235,112 ELPHS (3), (6) N/A N/A N/A N/A N/A Subrec,epient Vision WIC Breastfeeding Reg. Alloc. F 143,397 Staffing (6) N/A N/A N/A N/A N/A Subrecepient VVIC Resident Services Reg. Alloc. F Z435,330 Performance (8) # Average N/A N/A 97 0 Subrecepient Monthly Participation TOTAL MDHHS FUNDING 10,239,784 *SPECIFIC OUTPUT PERFORMANCE MEASURES WILL BE INCORPORATED VIA AMENDMENT Attachment IV Notes Attachment IV Notes Local Health Department - 2017, Date: 07/15/2016 Page: 33 of 176 Contract* Date. 07/15/2016 1 Program Budget Summary PROGRAM I PROJECT Local Health Department - 2017 / Administration DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT FA Original r Amendment AMENDMENT # o CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category i Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 4,714,607.00 4,714,607,00 2 Fringe Benefits 3,155,209.00 3,155,209.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 142,384.00 142,384.00 5 Supplies and Materials 383,337.00 383,337.00 6 Travel 59,038.00 59,038.00 7 Communication 53,853.00 53,853.00 County-City Central Services 0.00 0.00 9 Space Costs 687,269.00 687,269.00 10 All Others (ADP, Con. Employees, Misc.) 1,115,698.00 1,115,698.00 Total Program Expenses 10,311,395.00 10,311,395.00 TOTAL DIRECT EXPENSES 10,311,395.00 10,311,395.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 650,973.00 650,973.00 2 Other Costs Distributions -8,592,038.00 -8,592,038.00 Total Indirect Costs -7,941,065.00 -7,941,065.00 TOTAL INDIRECT EXPENSES -7,941,065.00 -7,941,065.00 TOTAL EXPENDITURES 2,370,330.00 2,370,330.00 Local Health Department - 2017, Date: 07115/20'16 Page: 34 of 176 Contract # Date: 0711512016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 557,400.00 0.00 557,400,00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non IVIDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0,00 0.00 _ Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHSComprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.40 0,00 0.00 0.00 ELPHS - MDHHS Vision . 0.00 0.00 0.00 0.00 ELPHS - MDHEIS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0,00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds-Other 0.00 1,812,930.00 0.00 1,812,930.00 lnkind Match 0.00 0.00 0,00 0.00 MDHHS Fixed Unit Rate 0.00 0.00 0.00 0.00 Total Source of Funds 0.00 2,370,330.00 0.00 2,370,330.00 Totals 0.00 2,370,330.00 0.00 2,370,330.00 Local Health Departmeat - 2017, Date: 0711512016 Page: 35 of 176 Contract # Date: 07115/2016 3 Program Budget - Cost Detail Line Item Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 4,714,607.00 2 Fringe Benefits 3,155,209.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 142,384.00 5 Supplies and Materials 383,337,00 6 Travel 59,038.00 7 Communication 53,853.00 8 County-City Central Services 9 Space Costs 687,269.00 10 All Others (ADP, Con. Employees, Misc.) 1,115,698.00 Total Program Expenses 10,311,395.00 TOTAL DIRECT EXPENSES 10,311,395.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 650,973.00 2 Other Costs Distributions Other Cost Distributions-Other Inf Disea -1,159,714,00 Other Cost Distributions-Misc Distributi -1,206,930.00 Other Cost Distributions-SIDS fee -2,000.00 Health Adm Distribution -6,223,394,00 Total for Other Costs Distributions -8,592,038.00 Total Indirect Costs -7,941,065.00 TOTAL INDIRECT EXPENSES -7,941,065.00 TOTAL EXPENDITURES 2,370,330.00 Local Health Department- 2017, Date: 07/15/2018 Page: 36 of 176 Contract # Date: 07/15/2016 Program Budget Summary PROGRAM /PROJECT Local Health Department - 2017 / Administration - Environmental DATEPREPARED 72016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGETPERIOD From : 10/1/2016 To; 913012017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 17; Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 4,487,348.00 4,487,348.00 2 Fringe Benefits 2,892,001.00 2,892,001.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 6 Supplies and Materials 68,786.00 58,785.00 6 Travel 261,400.00 261,400.00 7 Communication • 113,726.00 113,726.00 8 County City Central Services 0.00 0.00 9 Space Costs 133,328.00 133,328.00 10 All Others (ADP, Con. Employees, Misc.) 647,742.00 647,742.00 Total Program Expenses 8,594,330.00 8,594,330.00 TOTAL DIRECT EXPENSES 8,594,330.00 8,594,330.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 621,498.00 621,498.00 2 Other Costs Distributions -3,711,362.00 -3,711,362.00 Total Indirect Costs -3,089,864.00 -3,089,864.00 TOTAL INDIRECT EXPENSES -3,089,864.00 -3,089,864.00 TOTAL EXPENDITURES 5,504,466.00 5,504,466.00 Local Health Department - 2017, Data; 07/15/2016 Page: 37 01176 Contract # Date: 07115/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 701,950.00 0.00 701,950,00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 247,282,00 0.00 247,282.00 Federal Cost Based Reimbursement 0,00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0,00 0,00 Required Match - Local 0,00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0,00 Local Non-ELPHS 0.00 0.00 0,00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0,00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0,00 ELPHS - MDHHSHearing 0.00 0.00 0.00 0,00 ELPHS - MDHHS Vision 0.00 0.00 0,00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 4 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0,00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0,00 0.00 0,00 Local Funds - Other 0,00 4,555,234.00 0.00 4,555,234.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate 0.00 0.00 0.00 0.00 Total Source of Funds 0.00 5,504,466.00 0.00 5,504,466.00 Totals 0.00 5,504,466.00 0.00 5,504,466.00 Local Health Department - 2017, Date: 07/1512016 Page: 38 of 176 Contract # Date: 07/1512016 3 Program Budget - Cost Detail !Line Item _ Total DIRECT EXPENSES Program Expenses _ 1 Salary & Wages 4,487,348.00 2 Fringe Benefits 2,892,001.00 3 Cap. Exp. for Equip & Fac. 0.00 4 Contractual 0.00 5 Supplies and Materials 58,785.00 6 _ Travel 261,400.00 7 Communication 113,726.00 8 County-City Central Services 9 Space Costs 133,328.00 10 All Others (ADP, Con. Employees, Misc.) 647,742.00 Total Program Expenses 8,594,330.00 TOTAL DIRECT EXPENSES _. 8,594,330.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 621,498.00 2 Other Costs Distributions _1 EH Adm Distribtions -6,439,726.00 Other Cost Distributions-Body Art Fees -15,000.00 Health Mm Distribution 2,743,363.00 Total for Other Costs Distributions -3,711,362.00 Total Indirect Costs -3,089,864.00 TOTAL INDIRECT EXPENSES -3,089,864.00 TOTAL EXPENDITURES 5,504,466,00 Locai Health Department- 2017, Date: 07115,2016 Page: 39 of 176 Contract # Date: 07/1512016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 /Adolescent STD Screening DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Serv ices/ Health Division BUDGET PERIOD From : 10/1/2016 To: 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. 34 East Telegraph Rd. BUDGET AGREEMENT Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 1 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 39,325.00 39,325,00 2 Fringe Benefits 15,641.00 15,641.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0,00 0.00 5 Supplies and Materials 6,132.00 6,132.00 6 Travel E 675.00 675.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con: Employees, Misc.) 5,780.00 5,780,00 Total Program Expenses 67,553.00 67,553.00 TOTAL DIRECT EXPENSES , 67,553.00 67,563.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 5,447,00 5,447.00 2 Other Costs Distributions 8,490.00 8,490.00 Total Indirect Costs 13,937.00 13,937.00 TOTAL INDIRECT EXPENSES 13,937.00 13,937.00 TOTAL EXPENDITURES 81,490.00 81,490.00 Local Health Department- 2017, Date: 0711512016 Page: 40 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 , 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0,00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0,00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 73,000.00 0.00 0.00 73,000.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0,00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0,00 0.00 0.00 ELPHS - Private / Type Ill Water, Supply _..... 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0,00 Local Funds - Other 0.00 8,490.00 0.00 8,490.00 lnkind Match 0.00 0.00 0.00 0.00 MD1-11-IS Fixed Unit Rate Totals 73,000.00 _ 8,490.00 0.00 81,490.00 Local Health Department - 2017, Date: 07115/2016 Page: 41 of 176 Contract # Date: 07/15/2015 3 Program Budget - Cost Detail Line Item Qtyl Rate Units UOM Total DIRECT EXPENSES Program Expenses -I Salary & Wages , Public Health Nurse Notes : GFGP Position-overtime only 0.0962 101030.000 0.000 FTE 9,719.00 Public Health Nurse Notes : GFGP Position-overtime only 0.0962 82325.000 0.000 FTE 7,920.00 Technician 0.1236 52720.000 0.000 FTE 6,516.00 Public Health Nurse Notes : CV, PT non-eligible 0.0721 56875.000 0.000 FTE 4,101.00 Assistant Notes : Office Assistant 0.2769 39975.000 0.000 FTE 11,069.00 Total for Salary & Wages 39,325.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance - Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 39.774 39325.000 15,641.00 Cap. Exp. for Equip & Fac. 4 Contractual 6 Supplies and Materials Office Supplies 0.0000 0.000 0.000 392.00 Medical Supplies 0.0000 0.000 0.000 1,000,00 Printing 0.0000 0.000 0.000 240.00 Educational Supplies 0.0000 0.000 0.000 4,500.00 Total for Supplies and Materials 6,132.00 Travel Mileage Notes : 1,250 miles @ .54 0.0000 0.000 0.000 675.00 Local Health Department - 2017, Date: 0711512016 Page: 42 of 176 Contract # Date: 07115/2016 Line Item Qty Rate UnitslUOM Total 7 Communication 8 County-City Central Services Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0,0000 0.000 0.000 180.00 Information Technology 0.0000 0.000 0.000 2,800.00 Advertising 0.0000 0.000 0.000 2,800.00 Total for All Others (ADP, Con. Employee 5,780.00 Total Program Expenses 67,553.00 TOTAL DIRECT EXPENSES 67,553.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan {-0.0000 13.850 39325.000 5,447.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 6,390.00 Nursing Adm Distribution 0,0000 0,000 0.000 2,100.00 Total for Other Costs Distributions 8,490.00 Total Indirect Costs 13,937.00 TOTAL INDIRECT EXPENSES 13,937.00 TOTAL EXPENDITURES 81,490.00 Local Health Department- 2017, Date: 07/15/2016 Page: 43 of 176 Contract # Date: 07115/2016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Public Health Emergency Preparedness (P H EP) 10/1/16- 6130/17 DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To: 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT r',F, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 111,069.00 111,069.00 2 Fringe Benefits 89,966.00 89,966.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 324.00 324.00 7 Communication 644.00 644.00 8 County City Central Services 0.00 0.00 9 Space Costs 5,403.00 5,403.00 10 All Others (ADP, Con. Employees, Misc.) 31,060.00 31,060.00 Total Program Expenses 238,466.00 238,466.00 TOTAL DIRECT EXPENSES 238,466.00_ 238,466.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 15,383.00 15,383.00 2 Other Costs Distributions 22,221.00 22,221.00 Total Indirect Costs 37,604.00 37,604.00 TOTAL INDIRECT EXPENSES 37,604.00 37,604.00 TOTAL EXPENDITURES 276,070.00 276,070.00 LocaE Health Department - 2017, Date: 07/15/2016 Page: 44 of 176 Contract # Date: 07/1512016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind , Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0,00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0,00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0,00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0,00 Federal Medicaid Outreach 0,00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0,00 0,00 MDHHS Non Comprehensive 0,00 0,00 0.00 0.00 MDHHS Comprehensive 233,063.00 0.00 0.00 233,063.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0,00 0.00 0.00 0.00 ELPHS - Private/Type III Water. Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 22,221.00 0.00 22,221.00 lnkind Match 0.00 0.00 20,786.00 20,786.00 MDEIHS Fixed Unit Rate Totals 233,063.00 22,221,00 20,786.00 276,070.00 Local Health Department - 2017, Date: 0711512016 Page: 45 of 176 Contract # Date: 0711512016 3 Program Budget - Cost Detail Line Item I Qty I Ratel_ UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Coordinator Notes: EP Coordinator 0.7600 61097.000 0.000 FTE 45,823.00 Specialist Notes: EP Specialist 0.3750 52740.000 0.000 FTE 19,778.00 Health Educator Notes : Public Health Educator It 0,3750 41150.000 0.000 FTE 15,431.00 Assistant Notes : Technical Assistant 0.3750 41942.000 0,000 FTE 15,728.00 Office Manager Notes: Office Leader 0.3750 38158.000 0.000 FTE 14,309.00 Total for Salary & Wages 111,069.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemp Ins Retirement Hospital Ins Life Ins Vision Ins Short/Long Term Disability Dental Ins Work Comp 0.0000 81.000 111069.000 89,966.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 , Travel ,-- Mileage Notes : 600 miles @ .54 0.0000 0.000 0.000 324.00 7 Communication , Telephone Communications 0,0000 0,0001 0.000 644.00 8 County-City Central Services 9 _ Space Costs Building Space Rental Notes : Match 0.0000 0.000 0.000 ._ 5,403.00 10 All Others (ADP, Con. Employees, Misc.) Lent Health Department- 2017, Date: 07115/2018 Page: 46 of 176 Contract # Date: 07/15/2016 Line Item Qty Rate Units UOM Total Insurance 0.0000 0.000 0.000 225.00 Copier 0,0000 0.000 0,000 450.00 IT Operations 0.0000 0.000 0.000 5,178.00 Overage to be Amended 0.0000 0.000 0.000 25,207.00 Total for All Others (ADP, Corn Employee 31,060.00 Total Program Expenses 238,466.00 TOTAL DIRECT EXPENSES 238,466.00 INDIRECT EXPENSES Indirect Costs i Indirect Costs Cost Allocation Plan Notes : Indirect - Match 0.0000 13.850 111069.000 15,383.00 Other Costs Distributions Health Adm Distribution _ 0.0000 H. 0:000 22,221.00 Total Indirect Costs 37,604.00 TOTAL INDIRECT EXPENSES 37,604.00 TOTAL EXPENDITURES 276,070.00 Local Health Department - 2017, Date: 07/15/2016 Page: 47 of 176 Contract 4 Date: 07/15/2016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017/ Body Art Fixed Fee DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p7- Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category r Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac, 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials El 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con, Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0,00 2 Other Costs Distributions 15,000.00 15,000.00 Total Indirect Costs 15,000.00 15,000.00 TOTAL INDIRECT EXPENSES 15,000.00 15,000.00 TOTAL EXPENDITURES 15,000.00 15,000.00 Local Health Department - 2017, Date: 07/1512018 Page: 48 of 176 Contract # Date: 07115/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHI-IS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0,00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0,00 Other Non-ELPHS 0,00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0,00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0,00 Local Funds - Other 0.00 0.00 0.00 0.00 Inkind Match 0,00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Body Art Fee 15,000.00 0,00 0.00 15,000.00 Totals 15,000.00 0.00 0.00 15,000.00 Local Health Department - 2017, Date; 07/1512016 Page: 49 of 176 Contract # Date: 07/1512016 3 Program Budget - Cost Detail 'Line Item Qty Rate _ Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 6 Supplies and Materials 6 Travel Communication County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Cost Distributions for Fees from Environ 0.0000 0.000 0,000 15,000.00 Total Indirect Costs 15,000.00 TOTAL INDIRECT EXPENSES 15,000.00 TOTAL EXPENDITURES 15,000.00 Local Health Department- 2017, Date: 07/15/2016 Page: 50 of 176 Contract # Date: 07/1512016 1 Program Budget Summary PROGRAM I PROJECT Local Health Department - 2017 / Children's Special Hlth Care Services (CSHCS) Care Coordination DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To: 9/3012017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT ri Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category ] Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0,00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 6 Supplies and Materials 0.00 0.00 6 Travel 0.00 0,00 7 Communication 0.00 0,00 8 County City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs "I Indirect Costs 0.00 0.00 2 Other Costs Distributions 245,000.00 245,000.00 Total Indirect Costs 245,000.00 245,000.00 TOTAL INDIRECT EXPENSES 245,000.00 245,000.00 TOTAL EXPENDITURES 245,000.00 245,000.00 Local Health Department- 2017, Date: 07116/2016 Page: 51 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0,00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0,00 Federal Medicaid Outreach 0,00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 -1 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0,00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0,00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0,00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Private/Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 Inkind Match 0,00 0.00 0.00_ 0.00 MDI-IHS Fixed Unit Rate CSHCS Care Coordination 245,000.00 0.00 0.00 245,000.00 Totals 245,000,00 0.00 0.00 245,000.00 Local Health Department- 2017, Date: 0711512016 Page: 52 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail 1Line Item Qtyi Rate Units UOM _ Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Travel Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Cost Distributions for Fees-from CSHCS 0 0.0000 0.000 0.000 245,000.00 Total Indirect Costs 245,000.00 TOTAL INDIRECT EXPENSES 245,000.00 TOTAL EXPENDITURES 246,000.00 Local Health Department - 2017, Date: 07/1512016 Page: 53 of 176 Contract # Date: 07/1512016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / CSHCS Medicaid Outreach DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2016 To : 9130/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT P: Original r Arnendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount 1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0,00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 County City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Mc.) 0.00_ 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Other Costs Distributions 301,955.00 301,955.00 Total Indirect Costs 301,955.00 301,955.00 TOTAL INDIRECT EXPENSES 301,955.00 301,955.00 TOTAL EXPENDITURES 301,955.00 301,965.00 Local Heath Department - 2017, Date: 07/15/2016 Page: 54 or 176 Contract 4 Date. 07/1512016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 95,070.00 0.00 0.00 95,070.00 Required Match - Local 0.00 95,070.00 0.00 95,070.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0,00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 111,815.00 0.00 111,815.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 95,070.00 _ 206,885.00 0.00 301,955.00 Local Health Department- 2017, Date: 07115/2016 Page 55 of 176 Contract # Date: 0711512016 3 Program Budget - Cost Detail Line Item Qty Rate Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Distributions for Medicaid 0.0000 0.000 0.000 1-- 301,955.00 Total Indirect Costs 301,955.00 TOTAL INDIRECT EXPENSES 301,955.00 TOTAL EXPENDITURES 301,955,00 Local Health Department- 2017, Date: 0711512016 Page: 56 of 176 Contract # Date: 0711512016 Program Budget Summary PROGRAM/PROJECT Local Health Department - 2017 / Public Health Emergency Preparedness (PHEp) CR1 10/1/16 - 6130117 DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Dlvision BUDGET PERIOD From : 10/1/2016 To: 9130/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd, 34 East BUDGET AGREEMENT 170; Original r Amendment AMENDMENT # 0 CITY Pontiac STATE M1 ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 73,163.00 73,163.00 2 Fringe Benefits 59,262,00 59,262.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 Supplies and Materials 2,239,00 2,239.00 6 Travel 486.00 486.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 5,346.00 5,346.00 10 All Others (ADP, Con. Employees, Misc.) 24,022.00 24,022.00 Total Program Expenses 164,518.00 164,518.00 TOTAL DIRECT EXPENSES 164,518.00 164,518,00 INDIRECT EXPENSES Indirect Costs _ 1 Indirect Costs 9,037.00 9,037,00 2 Other Costs Distributions 15,193,00 15,193.00 Total Indirect Costs 24,230.00 24,230.00 TOTAL INDIRECT EXPENSES 24,230.00 24,230.00 TOTAL EXPENDITURES 188,748.00 188,748.00 Local Health Department - 2017, Date: 07115/2016 Page. 57 of 176 Contract # Date; 07115/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash' Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0,00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 159,225.00 0.00 0.00 159,225.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision . 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food .4 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0.00 0,00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 15,193.00 0.00 16,193.00 Inkind Match 0.00 0.00 14,330.00 14,330.00 MDI-IHS Fixed Unit Rate Totals _ 159,225.00 15,193.00 14,330.00 188,748.00 Local Health Department - 2017, Date: 07/15/2016 Page: 58 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail !Line Item 1 Qtyl Rate Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Specialist Notes : PH Emer Prep Specialist 0.3750 52740.000 0.000 FTE 19,778.00 Health Educator Notes : PH Educator 1 0.3760 41150.000 0.000 FTE 15,431.00 Assistant Notes : Tech Assistant 0.3750 41942.000 0.000 FTE 15,728.00 Office Manager Notes : Office Leader 0,3750 38158.000 0.000 FTE 14,309.00 Administrator Notes : MATCH SALARIES - 0.0837 94585.000 0,000 FTE 7,917.00 Total for Salary & Wages 73,163.00 2 Fringe Benefits All Composite Rate Notes : MATCH $6,413 FICA Unemp ins Retirement Hospital Insurance Life Insurance Vision Ins. Short/Long Term Disability Dental Insurance Work Comp 0.0006 8 000 73163.000 59,262.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials _ Disaster Supplies 0.0000 0.000 0.000 2,239.00 Travel Mileage Notes : 900 miles @ .54 0.0000 0.000 0.000 r 486.00 7 Communication County-City Central Services 9 Space Costs Space/Rental Costs 0.0000_ 0.000j 0.000 5,346.00 10 All Others (ADP, Con. Employees, Misc.) Local Health Department - 2017, Date: 07115/2010 Page: 59 of 176 Contract # Date: 0711512016 Line Item Qty Rate Units UOM Total Insurance 0.0000 0.000 0.000 297.00 IT Operations 0.0000 0.000 0.000 7,803.00 Overage to be amended 0.0000 0.000 _ 0.000 15,922.00 Total for All Others (ADP, Con. Employee 24,022.00 Total Program Expenses 164,518.00 TOTAL DIRECT EXPENSES , 164,518.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan Notes : Indirect costs figured on total salaries less match portion of salaries 0.0000 13.850 65246.000 9,037.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 15,193.00 Total Indirect Costs 24,230.00 TOTAL INDIRECT EXPENSES 24,230.00 TOTAL EXPENDITURES 188,748.00 Local Health Department - 2017, Date: 0711512016 Page: 60 of 176 Contract # Date: 0711512016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Children's Special Hlth Care Services (CSHCS) Outreach & Advocacy DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To : 9/3012017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p Original f7 Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category Amount Total DIRECT EXPENSES Program Expenses Salary & Wages 283,008.00 283,008.00 Fringe Benefits 122,662.00 122,662.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 6,000.00 6,000.00 6 Travel 777.00 777.00 7 Communication 12,500.00 12,500.00 8 County-City Central Services 0.00 0.00 9 Space Costs 23,591.00 23,591.00 10 All Others (ADP, Con. Employees, Misc.) 42,265.00 42,265.00 Total Program Expenses 490,803.00 490,803.00 TOTAL DIRECT EXPENSES 490,803.00 490,803.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 39,197.00 39,197.00 2 Other Costs Distributions -245,000.00 -245,000.00 Total Indirect Costs -205,803.00 -205,803.00 TOTAL INDIRECT EXPENSES -205,803.00 -205,803.00 TOTAL EXPENDITURES 2853000.00 285,000.00 Local Health Department -2017, Date: 07/15/2016 Page: 61 of 176 Contract # Date: 0711512016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0,00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0,00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0,00 0.00 0.00 MDHHS Comprehensive 285,000,00 0.00 0,00 285,000.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 . ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0,00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 Inkind Match 0.00_ 0.00 0,00 0.00 MDHHS Fixed Unit Rate Totals 285,000.00 , 0.00 , 0.00 285,000.00 Local Health Department- 2017, Date: 07115/2015 Page: 62 of 176 Contract* Date: 07115/2016 3 Program Budget - Cost Detail 'Line Item I Qty Rate' UnitsIUOM Total DIRECT EXPENSES Program Expenses I Salary & Wages Supervisor 1.0000 80905.000 0.000 FTE 80,905.00 Public Health Nurse 0.4808 56857.000 0.000 FTE 27,337.00 Public Health Nurse 0.4808 51175.000 0.000 FTE 24,605.00 Outreach Worker 0.3846 42090.000 0.000 FTE 16,188.00 Assistant 1.0000 34268.000 0.000 FTE 34,268.00 Assistant 1.0000 39972.000 0.000 FTE 39,972.00 Public Health Nurse Notes : in MCH 0.2885 56854.000 0.000 FTE 16,402.00 Public Health Nurse Notes : GFGP 0.1442 56869.000 0.000 FTE 8,201.00 Clerk 0.2885 25245.000 0.000 FTE 7,283.00 Assistant 0.4808 31410.000 0.000 FTE 15,102.00 Assistant 0.3846 33138.000 0.000 FTE 12,745.00 Total for Salary & Wages 283,008.00 Fringe Benefits All Composite Rate H Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 43.342 283008.000 122,662.00 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 2,000.00 Postage 0.0000 0.000 0,000 3,000.00 Printing 0.0000 0.000_ 0.000 1,000.00 Total for Supplies and Materials 6,000.00 Local Health Department - 2017, Date: 07115/2016 Page: 63 of 176 Contract # Date: 0711512016 Line Item I Qty Rate UOM 1 Total 6 Travel Mileage Notes : 380 miles @,.54 0.0000 0.000 0.000 205.00 Conferences 0.0000 0.000 0.000 300.00 client transportation 0.0000 0,000 0.000 272,00 Total for Travel 777.00 7 Communication Telephone 0.0000 0.000 0.000 12,500.00 8 County-City Central Services 9 Space Costs Building Space Rental 0.0000 0.000 0.000 23,591.00 10 All Others (ADP, Con. Employees, Misc.) Convenience Copier 0.0000 0,000 0.000 2,500.00 Insurance 0.0000 0.000 0.000 765.00 IT Operations 0,0000 _ 0.000 0.000 _ 39,000.00 Total for All Others (ADP, Con. Employee 42,265,00 Total Program Expenses 490,803.00 I TOTAL DIRECT EXPENSES 490,803.00 INDIRECT EXPENSES Indirect Costs Indirect Costs Cost Allocation Plan H. H. 0.00001_ 13.850 283008.000 39,197.00 2 Other Costs Distributions Other Cost Distributions-CSHCS Care Coor 0.0000 0,000 0.000 -245,000.00 Health Adm Distribution 0.0000 0.000 0.000 46,395.00 Other Cost Distributions-Nursing Staff 0.0000 0.000 0.000 240,315.00 Nursing Adm Distribution 0.0000 0.000 0.000 15,245.00 Other Cost Distributions-CSHCS - Medical 0.0000 0.000 0.000 -301,955.00 Total for Other Costs Distributions -245,000.00 Total Indirect Costs -205,803.00 TOTAL INDIRECT EXPENSES -205,803.00 TOTAL EXPENDITURES 286,000.00 Local Health Department 2017, Date: 07115,2016 Page: 64 of 176 Contract # Date: 07/15/2016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Enabling Services Women - MCH DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 1011/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 17)7 Original F. Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 77,590,00 77,590.00 2 Fringe Benefits 48,088.00 48,088.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 5,700.00 5,700.00 7 Communication 2,304.00 2,304.00 8 County-City Central Services 0,00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 5,600.00 5,600.00 Total Program Expenses 139,282.00 139,282.00 TOTAL DIRECT EXPENSES 139,282.00 139,282.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 10,746.00 10,746.00 2 Other Costs Distributions 16,996.00 16,996.00 Total Indirect Costs 27,742.00 27,742.00 TOTAL INDIRECT EXPENSES 27,742.00 27,742.00 TOTAL EXPENDITURES 167,024.00 167,024.00 Local Health Department - 2017, Date, 07/1512016 Page: 65 of 176 Contract # Date: 07/15/2016 2 Program Budget Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0,00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 L Local Non-ELPHS 0,00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0,00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0,00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water . Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 150,028.00 0.00 0.00 150,028,00 Local Funds - Other 0.00 16,996.00 0.00 16,996.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 150,028,00 15,996.00 0,00 167,024.00 Local Health Departmeht - 2017, Date: 0711512016 Page: 66 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail Line Item I Qty Rate' Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Nutritionist/Dietician 1.0000 57736.000 0.000 FTE 57,736.00 Nutritionist/Dietician 0.3606 55061.000 0.000 FTE 19,854.00 Total for Salary & Wages 77,590.00 2 Fringe Benefits Composite Rate Notes : FICA, UNEMPLY INS, RETIREMENT, HOSPITAL INS, LIFE INS, VISION, DENTAL, WORK COMP, SHORT/LONG- TERM DISABILITY 0.0000 61.977 77590.000 48,088.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel Mileage Notes : 9913 miles @ .575 0,0000 0.000 _ 0.000 5,700.00 7 Communication Telephone 0.0000 0.000 0.000 2,304.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) IT operations 0.0000 0.000 0.000 5,600.00 Total Program Expenses 139,282.00 TOTAL DIRECT EXPENSES 139,282.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.0000 13.850 77590.000 10,746.00 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 12,800.00 Nursing Adm Distribution 0.0000 0.000 0.000 4,196.00 Total for Other Costs Distributions 16,996.00 Total Indirect Costs 27,742.00 Local Health Department- 2017, Date: 07/1512016 Page: 67 of 176 Contract # Date: 07/1512016 Line Item I Qty Rate' UnitslUOIVI Total TOTAL INDIRECT EXPENSES 27,742.00 TOTAL EXPENDITURES 167,024.00 Lac& Health Department - 2017, Date: 07/15/2016 Page: 68 of 176 Contract # Date: 07/1512016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017/ Fetal Infant Mortality Review (FI MR) Case Abstraction DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT rv7 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount I Total DIRECT EXPENSES Program Expenses Salary & Wages 5,702.00 5,702.00 2 Fringe Benefits 330.00 330.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc..) 18.00 18.00 Total Program Expenses 6,050.00 6,050.00 TOTAL DIRECT EXPENSES 6,050.00 6,050.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 790.00 790.00 2 Other Costs Distributions 796.00 796.00 Total Indirect Costs 1,586.00 1,586.00 TOTAL INDIRECT EXPENSES 1,586.00 1,586.00 TOTAL EXPENDITURES 7,636.00 7,636.00 Local Health Department- 2017, Date: 07/1512016 Page: 69 of 176 Contract # Date: 07115/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0,00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0,00 1, 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0,00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.09 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 6,840.00 0.00 0.00 6,840.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0,00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 796.00 0.00 796.00 Inkind Match 0,00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 6,840.00 796,00_ 0.00 7,636.00 LocaL Health Department - 2017, Date: 07/15/2016 Page: 70 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail 1Line Item Qtyl Rate Units UOM Total DIRECT EXPENSES Program Expenses Salary & Wages Public Health Nurse I 0.0846 67387.000 0,0001FTE 5,702.00 2 Fringe Benefits All Composite Rate Notes : Social Security (FICA) Unemp Ins Retirement Hospital Ins Life Ins Vision Ins Dental Ins Work Comp 0.0000 5.790 5702.000 330.00 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 18.00 Total Program Expenses 6,050.00 TOTAL DIRECT EXPENSES 6,050.00 INDIRECT EXPENSES Indirect Costs i Indirect Costs Cost Allocation Plan _ 0.0000 13.850 5702.000 790.00 Other Costs Distributions , Health Adm Distribution 0.0000 0.000 0.000 599.00 Nursing Adm Distribution 0.0000 0.000 0.000 197.00 Total for Other Costs Distributions 796.00 Total Indirect Costs 1,586.00 TOTAL INDIRECT EXPENSES 1,586.00 TOTAL EXPENDITURES 7,636.00 Local Health Department -2017, Date: 07/15/2016 Page: 71 of 176 Contract # Date: 07)15/2015 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Food ELPHS DATE PREPARED 7/1512016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Neagh Division BUDGET PERIOD From : 10/1/2016 To: 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT w- Original r Amendment AMENDMENT # o CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con, Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES _ Indirect Costs 1 Indirect Costs 0.00 0.00 2 Other Costs Distributions 3,756,598.00 3,756,598.00 Total Indirect Costs 3,756,598.00 3,756,598.00 TOTAL INDIRECT EXPENSES 3,756,598.00 3,756,598.00 TOTAL EXPENDITURES 3,766,598.00 _ 3,756,598.00 Local Health Department - 2017, Date, 0711512016 Page: 72 of 176 Contract # Date; 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind _ Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 1,220,250.00 0.00 1,220,250.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 OM 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0,00 0.00 0.00 Other Non-ELPHS 0,00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 859,213.00 0.00 0.00 859,213.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 1,677,135.00 0.00 1,677,135.00 Inkind Match 0.00 0.00 0.00 0,00 MDHHS Fixed Unit Rate Totals 859,213.00 2,897,385.00 0.00 3,756,598.00 Local Health Department - 2017, Date: 0711512016 Page: 73 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail !Line Item 1 CItyl_. Rate] Units_1UOM , Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Environmental Hlth Adm Distribution 0.0000 0.000 0.000 ._ 3,756,598.00 Total Indirect Costs 3,756,598.00 TOTAL INDIRECT EXPENSES 3,756,598.00 TOTAL EXPENDITURES 3,756,598.00 Local Health Department -2017, Date: 07115/2016 Page: 74 of 176 Contract # Date: 07/15/2016 1 Program Budget Summary PROGRAM I PROJECT Local Health Department - 2017 / General Communicable Disease ELPHS DATE ARE 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT rq Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0,00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 0.00 0.00 2 Other Costs Distributions 3,415,947.00 3,415,947,00 Total Indirect Costs 3,415,947.00 3,415,947.00 TOTAL INDIRECT EXPENSES 3,415,947.00 3,415,947.00 TOTAL EXPENDITURES 3,415,947.00 3,416,947,00 Local Health Department - 2017, Date: 07/1512016 Page: 75 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections -'1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 - 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0,00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0,00 0.00 0.00 MDHHS Comprehensive • . 0.00 0.00 0.00 0.00 ELPHS - MDHFIS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 684,826.00 0.00 0.00 684,826.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0,00 Local Funds-Other 0.00 2,731,121.00 0.00 2,731,121.00 lnkind Match 0.00 0.00 0.00 0.00 IVIDHEIS Fixed Unit Rate Totals I 684,826.00 2,731,121,00 0.00 3,415,947.00 Local Health Department -2017, Date: 07/15/2016 Page: 76 of 176 Contract # Date, 07/15/2016 3 Program Budget - Cost Detail Line Item 1 Qtyl Rate! UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual Supplies and Materials 6 Travel 7 Communication County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs Indirect Costs Other Costs Distributions Other Cost Distributions-CD Unit Staff Notes : 50% of FTE Medical Director's salary and fringes 100% of CD Staff Unit time includes,Epidemiologists, PHN's, PHN Supervisor, Office Assistants 0.0000 0,000 0.000 1,159,714.00 Other Cost Distributions-Misc Cost disti Notes :1% of total Health Division Clinic Expenses (based on a workload management program that tracks Clinic Nursing time) 0.0000 0.000 0.000 1,393.00 Health Adm Distribution Notes : 1.14% of Central Support Unit Staff expenses 0.18% of Lab Support staff expenses Adm O'head distribution 0.0000 0.000 0.000 147,687.00 Other Cost Distributions-Field Nursing D 0.0000 0.000 0.000 2,072,537,00 Nursing Adm Distribution 0.0000 0.000 34,616.00 Local Health Department- 2017, Date: 07115/2016 Page: 77 of 176 Contract # Date; 07115/2016 , !Line item [ Qty Rate! Units'UOM Total Total for Other Costs Distributions 3,415,947.00 Total Indirect Costs 3,415,947.00 TOTAL INDIRECT EXPENSES 3,415,947.00 TOTAL EXPENDITURES 3,415,947.00 Local Health Department - 2017, Date: 07/15/2016 Page 76 of 176 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10,000.00 10,000.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Contract # Date: 07/15/2016 1 Program Budget Summary PROGRAM I PROJECT Local Health Department - 2017 / Gonococcal Isolate Surveillance Project DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From .. 10/1/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT r,F Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category DIRECT EXPENSES Program Expenses Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs Amount I Total 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 Total Program Expenses 10,000.00 10,000.00 TOTAL DIRECT EXPENSES 10,000.00 10,000.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 I Other Costs Distributions 1,163.00 1,163.00 Total Indirect Costs 1,163.00 1,163.00 TOTAL INDIRECT EXPENSES 1,163.00 1,163.00 TOTAL EXPENDITURES 11,163.00 11,163.00 Local Health Department - 2017, Date: 07/16/2016 Page 79 of 176 Contract # Date: 0711512016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total "I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0,00 0.00 0,00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0,00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 10,000.00 0,00 0.00 10,000.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0,00 ELPHS - IVIDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 1,163.00 0.00 - 1,163.00 Inkind Match 0.00 0,00 0.00 0.00 MDHHS Fixed Unit Rate Totals [ 10,000.00. 1,163.00_ 0.00 11,163.00 Local Health Deparimert - 2017, Date: 07/15/2016 Page: 80 of 176 Contract # Date: 07/1512016 3 Program Budget - Cost Detail ILine Item Qty Rate UnitslUOM • Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Laboratory Supplies 0.00001. 0.000 0.000 10,000.00 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses 10,000.00 TOTAL DIRECT EXPENSES 10,000.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 875.00 Nursing Adrn Distribution 0.0000 0.000 0.000 288,00 Total for Other Costs Distributions 1,163.00 Total Indirect Costs 1,163.00 TOTAL INDIRECT EXPENSES 1,163.00 TOTAL EXPENDITURES 11,163.00 Local Health Department - 2017, Date: 07/1512016 Page: 61 of 176 Contract # Date: 07115/2016 1 Program Budget Summary PROGRAM! PROJECT Local Health Department - 2017 / Hearing ELPHS DATE PREPARED 7115/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT P: Original IT Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category 1 Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 253,712.00 253,712.00 2 Fringe Benefits 58,567.00 58,567.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 Supplies and Materials 3,706.00 3,706.00 6 Travel 5,572.00 5,572.00 7 Communication 1,056.00 1,056.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con, Employees, Misc,) 4,237.00 4,237.00 Total Program Expenses. 326,850.00 TOTAL DIRECT EXPENSES 326,850.00 326,850.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 35,139.00 35,139,00 2 Other Costs Distributions 123,970,00 123,970.00 Total Indirect Costs 159,109,00 159,109.00 TOTAL INDIRECT EXPENSES 159,109.00 159,109,00 TOTAL EXPENDITURES 485,959.00 485,959.00 Local Health DepaitmeeL 2017, Date: 0711512016 Page: 82 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total .1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0,00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0,00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 235,112.00 0.00 0.00 235,112.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0,00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0,00 0.00 0.00 Local Funds - Other 0.00 250,847.00 0.00 250,847.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 235,112.00 I 250,847.00 0.00 485,959.00 Local Health Department - 2017, Date: 07115/2016 Page: 83 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail Line Item Qtyl Rate UOM Total DIRECT EXPENSES Program Expenses "I Salary & Wages Supervisor 1.0000 48724.000 0.000 FTE 48,724.00 Technician 0.4808 42087.000 0.000 FTE 20,234.00 Technician 0.4808 32314.000 0.000 FTE 15,537.00 Technician 0.4808 40128.000 0.000 FTE 19,294.00 Technician 0,4808 32314.000 0.000 FTE 15,537.00 Technician 0.4808 32314.000 0.000 FTE 15,537.00 Technician 0.4808 32314.000 0.000 FTE 15,537.00 Technician 0.4808 42087.000 0.000 FTE 20,234.00 Technician 0.4808 34265.000 0.000 FTE 16,475.00 Technician 0.4808 32314,000 0.000 FTE 15,537.00 Technician 0.4808 32314.000 0.000 FTE 15,537.00 Coordinator 0.5000 71058.000 0.000 FTE 35,529.00 Total for Salary & Wages 253,712.00 2 Fringe Benefits All Composite Rate Notes : FICA UNEMPLOYMENT INS RETIREMENT HOSPITAL INS LIFE INS VISION INS HEARING INS DENTAL INS WORK COMP SHORT/LONG TERM DISABILITY 0.0000 23,084 253712.000 58,567.00 3 Cap. Exp. for Equip & Fac, 4 Contractual 5 Supplies and Materials Medical Supplies 0,0000 0.000 0.000 881.00 Office Supplies 0.0000 0.000 0.000 1,037.00 _Printing 0,0000 0,000 0.000 1,788.00 Total for Supplies and Materials 3,706.00 6 Travel , Personal Mileage 0.0000 0.000 0.000 . 5,572.00 Local Health Department - 2017, Date: 0711512016 Page: 84 of 176 Contract # Date: 07/1512016 Line Item Qty I Rate Units UOM Total 7 Communication Telephone 0.0000 0.000 0.000 1,056.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Copier 0.0000 0.000 0.000 260.00 Insurance 0.0000 0.000 0.000 349.00 Equipment Repair 0.0000 0.000 0.000 2,332.00 Staff Training 0.0000 0,000 0.000 1,296.00 Total for All Others (ADP, Con. Employee 4,237.00 Total Program Expenses 326,850.00 TOTAL DIRECT EXPENSES 326,850.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.0000 13.850 253712.000 35,139.00 2 Other Costs Distributions Other Cost Distributions-Misc. 0,0000 0.000 0.000 92,282.00 Health Adm Distribution 0.0000 0.000 0.000 31,688.00 Total for Other Costs Distributions 123,970.00 Total Indirect Costs 159,109.00 TOTAL INDIRECT EXPENSES 159,109.00 TOTAL EXPENDITURES 485,959.00 Local Health Department - 2017, Date: 07/15/2018 Page: 85 of 176 Contract # Date: 07115/2016 1 Program Budget Summary PROGRAM I PROJECT Local Health Department - 2017 / HIV ELPHS DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To' 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT r.; Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0,00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services • 0.00 0.00 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Other Costs Distributions 623,510.00 623,510.00 Total Indirect Costs 623,510.00 623,510.00 TOTAL INDIRECT EXPENSES 623,510.00 623,510.00 TOTAL EXPENDITURES 623,510.00 623,510.00 Local Health Department- 2017, Date: 0711512010 Page: 86 of 176 Contract # Date. 0711512016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total "I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0,00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0,00 0.00 0.00 0.00 MDHHS Comprehensive 0,00 0.00 0,00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 164,257.00 0,00 0,00 164,257.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0,00 0,00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 459,253.00 0.00 459,253.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 164,257,00 459,253.00 0.00 623,510.00 Local Health Department - 2017, Date: 07/15/2016 Page: 87 of '476 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail Line Item Qtyl Rate _ UnitslUOM . Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac, 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Nursing Adm Distribution 0.0000 0.000 0.000 14,926.00 Other Cost Distributions-Miso 0.0000 0.000 0.000 608,584.00 Total for Other Costs Distributions 623,510.00 Total indirect Costs 623,510.00 TOTAL INDIRECT EXPENSES 623,510.00 TOTAL EXPENDITURES 623,510.00 Local Health Department- 2017, Date: 07/15/2016 Page: 88 of 176 Contract # Date: 07/15/2016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / HIV Prevention DATE PREPARED 7/15/2016 CONTRACTOR NAME -Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 170 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses Salary & Wages 283,175,00 283,175.00 2 Fringe Benefits 131,852.00 131,852.00 3 Cap. Exp. for Equip & Fac. 0.00 t. 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 17,425.00 17,425,00 6 Travel 11,769.00 11,769.00 Communication 4,200.00 4,200.00 8 County-City Central Services 0.00 0,00 Space Costs 6,450,00 6,450.00 10 All Others (ADP, Con. Employees, Misc.) 24,809.00 24,809.00 Total Program Expenses 479,680.00 479,680,00 TOTAL DIRECT EXPENSES 479,680.00 479,680.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 39,220.00 39,220.00 2 Other Costs Distributions 45,423.00 45,423.00 Total Indirect Costs 84,643.00 84,643.00 TOTAL INDIRECT EXPENSES 84,643.00 84,643.00 TOTAL EXPENDITURES 564,323.00 564,323A10 , Local Health Department - 2017, Date: 07115/2016 Page: 89 of 176 Contract # Date: 07/1512016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash inkind Total 1 Source of Funds Fees and Collections - let and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0,00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 518,900.00 0.00 0.00 518,900.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0,00 0.00 0.00 ELPHS - IVIDHHS Other 0.00 0.00 0.00 0,00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private! Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0,00 Local Funds - Other 0.00 45,423.00 0.00 45,423.00 lnkind Match 0.00 0,00 0.00 0.00 MDHHS Fixed Unit Rate Totals 518,900.00 45,423.00 0,00 564,323.00 Local Health Department - 2017, Date: 07/15/2016 Page: 90 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail 'Line Item Qty Rate' Units UOM Total DIRECT EXPENSES Program Expenses '1 Salary & Wages Public Health Nurse 0.4808 54906.000 0.000 FTE 26,399.00 Coordinator 1.0000 71058.000 0.000 FTE 71,058.00 Assistant 0.7404 39972.000 0.000 FTE 29,595.00 Public Health Nurse 0.4808 56855.000 0.000 FTE 27,336.00 Public Health Nurse 1.0000 67387.000 0.000 FTE 67,387.00 Overtime 0.1466 52139.000 0.000 FTE 7,644.00 Public Health Nurse 0.4808 58028.000 0.000 FTE 27,900.00 Public Health Nurse 0.4808 53778.000 0.000 FIE 25,856.00 Total for Salary & Wages 283,175.00 2 Fringe Benefits Al] Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 46.562 283175.000 131,852.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 2,000.00 Medical Supplies 0.0000 0.000 0.000 2,625.00 , Postage 0.0000 0.000 0.000 1,000.00 Lab Supplies 0.0000 0.000 0.000 800.00 Printing 0.0000 0.000 0.000 6,000.00 Educational Supplies 0.0000 0.000 0.000 5,000.00 Total for Supplies and Materials 17,425,00 6 Travel Mileage Notes : 10,970 miles @ .54 0.0000 0.000 0.000 5,924.00 Local Health Department - 2017, Date: 0711512016 Page: 91 of 176 Contract # Date: 07/1512016 Line Item Qty Rate Units UOM Total Client Transportation 0.0000 0.000 0.000 345.00 Conferences 0.0000 0.000 0.000 5,500.00 Total for Travel 11,769.00 Communication Telephone 0.0000 0.0001 0.000 4,200.00 8 County-City Central Services 9 Space Costs Building Space Rental 0.00001 0.000 0.000 6,450.00 10 All Others (ADP, Con. Employees, Misc.) IT Operations 0.0000 0.000 0.000 16,000.00 Convenience Copier 0.0000 0.000 0.000 1,200.00 Interpretation 0.0000 0.000 0.000 600.00 Insurance 0.0000 0.000 0.000 1,386.00 Advertising 0.0000 0.000 0.000 5,124.00 Lab Fees 0.0000 •0.000 0.000 1,500.00 Total for All Others (ADP, Con. Employee 24,809.00 Total Program Expenses 479,680.00 TOTAL DIRECT EXPENSES 479,680.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.00001 13.850 283175.000 39,220.00 2 Other Costs Distributions Health Adm Distribution I 0.0000 0.000 0.000 45,423.00 Total Indirect Costs 84,643.00 TOTAL INDIRECT EXPENSES 84,643.00 TOTAL EXPENDITURES 564,323.00 Local Health Department - 2017, Dale: 07115/2016 Page: 92 of 176 Contract # Date: 07/15/2016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017/ HIV Surveillance Support DATE PREPARED 7115/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To: 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT f7 Original r. Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount_ Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 3,068.00 3,068,00 2 Fringe Benefits 177,00 177.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 6,731.00 6,731.00 8 County-City Central Services 0.00 0.00 9 Space Costs 23,939.00 23,939.00 10 All Others (ADP, Con. Employees, Misc.) 660.00 660.00 Total Program Expenses 34,575.00 34,575.00 TOTAL DIRECT EXPENSES — 34,575.00 34,575.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 425.00 425.00 2 Other Costs Distributions 4,071.00 4,071.00 Total Indirect Costs 4,496.00 4,496.00 TOTAL INDIRECT EXPENSES 4,496.00 4,496.00 TOTAL EXPENDITURES 39,071.00 39,071.00 Local Health Department - 2017, Date: 07/15/2016 Page: 93 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind , Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 35,000.00 0.00 0.00 35,000.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 Om 0.00 ELPHS - NIDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 4,071.00 0.00 4,071.00 Inkind Match 0.00 0.00 0.00 0.00 IVIDHHS Fixed Unit Rate Totals 35,000.00 4,071.00 0.00 39,071.00 Local Health Department - 2017, Date: 07/1512016 Page: 94 of 176 Contract # Date: 07115/2016 3 Program Budget - Cost Detail I Line Item I QtYI Rate' UnitsIUOM 1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Medical Technologist I 0.0582 52720.0001 0.000 FTE 3,068.00 2 Fringe Benefits All Composite Rate Notes : FICA, UNEMP INS, RETIREMENT, HOSP INS, LIFE INS, VISION INS, HEARING INS, S/L-TERM DISABILITY, DENTAL INS, WORK COMP 0.0000 5.770 3068.000 177.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication Telephone Communications 0.0000 0.000 0.000 6,731.00 8 County-City Central Services - 9 Space Costs Building Space 0.0000 0.000 0.000 23,939.00 10 All Others (ADP, Con. Employees, Misc.) IT Operations 0.0000 0.000{ 0,000 660.00 Total Program Expenses 34,575.00 TOTAL DIRECT EXPENSES 34,575.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.00001 13.850 3068.0001 425,00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 3,064.00 Nursing Adm Distribution 0.0000 0.000 0.000 1,007,00 Total for Other Costs Distributions 4,071.00 Total Indirect Costs 4,496.00 TOTAL INDIRECT EXPENSES 4,496.00 TOTAL EXPENDITURES 39,071.00 Local Health Department- 2017, Date: 07/15/2016 Page: 95 of 176 Contract # Date: 07/15/2016 • Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Immunization Action Plan (IAP) DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT F.: Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category j Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages = 254,535.00 254,535.00 2 Fringe Benefits 190,825.00 190,825.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 14,750.00 14,750.00 6 Travel H i. 3,690.00 3,690.00 7 Communication HI. . 6,000.00 6,000.00 8 County-City Central Services 0.00 0.00 9 Space Costs 11,781.00 11,781.00 10 All Others (ADP, Con. Employees, Misc.) 20,480.00 20,480.00 Total Program Expenses . 502,061.00 502,061.00 TOTAL DIRECT EXPENSES 502,061.00 502,061.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 35,253.00 35,253.00 2 Other Costs Distributions 27,490.00 27,490.00 Total Indirect Costs 62,743.00 62,743.00 TOTAL INDIRECT EXPENSES 62,743.00 62,743.00 TOTAL EXPENDITURES 564,804.00 564,804.00 Local Health Department - 2017, Date: 07/1512016 Page: 96 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0,00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 502,314.00 0.00 0.00 502,314,00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 62,490.00 0.00 62,490.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 502,314.00 62,490.00 [ 0.00 564,804.00 Local Health Department - 2017, Date: 07/1512016 Page: 97 of 176 Contract* Date: 07/15/2016 3 Program Budget - Cost Detail Line Item Qty Ratet Units UOM Total DIRECT EXPENSES Program Expenses Salary & Wages Coordinator 1.0000 71058.000 0.000 FIE 71,058.00 Vaccine Supply Clerk Notes : Shared Vaccine Quality 0.7500 44202.000 0.000 FTE 33,152.00 Public Health Nurse 1,0000 67387.000 0.000 FTE 67,387.00 Office Leader 1.0000 42275.000 0.000 FTE 42,275,00 Assistant 1.0000 39972.000 0.000 FTE 39,972.00 Overtime 0.0144 47883.000 _ 0.000 FTE 691.00 Total for Salary & Wages 254,535.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 74.970 254535.000 190,825.00 3 Cap. Exp. for Equip & Fac. Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 1,000.00 Postage 0.0000 0.000 0.000 12,000.00 Printing 0.0000 0.000 0.000 1,000.00 Educational Supplies 0.0000 0.000 0.000 750.00 Total for Supplies and Materials 14,750.00 6 Travel Mileage Notes : 4055 miles @ .54 0.0000 0.000 0.000 2,190.00 Conferences 0.0000 0.000 0.000 1,500.00 Total for Travel 3,690.00 7 Communication Telephone 1 0.0000 0.000 0.000 6,000.00 Local Health Department- 2017, Date: 07115/2016 Page. 98 of 176 Contract # Date: 07/15/2016 Line Item I Qty Rate I UnitsFUOM Total 8 County-City Central Services 9 Space Costs Building Space Rental 0.0000 0.000 0.000 11,781.00 10 All Others (ADP, Con. Employees, Misc.) Equipment Repair 0.0000 0.000 0.000 200.00 Convenience Copier 0.0000 0.000 0.000 3,280.00 IT Operation 0.0000 0.000 0.000 16,000.00 Insurance 0.0000 0.000 0.000 1,000.00 Total for All Others (ADP, Con. Employee 20,480.00 Total Program Expenses 502,061.00 TOTAL DIRECT EXPENSES 502,061.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.00001_ 13.850 254535.000 35,253.00 2 Other Costs Distributions Other Cost Distributions-Nurse TrainNFC 0.0000 0.000 0.000 -35,000.00 Health Adm Distribution 0.0000 0.000 0.000 47,035.00 Nursing Adm Distribution 0.0000 0.000 0.000 15,455.00 Total for Other Costs Distributions 27,490.00 Total Indirect Costs 62,743.00 TOTAL INDIRECT EXPENSES 62,743.00 TOTAL EXPENDITURES 564,804.00 Local Health Department 2017, Date: 07115/2016 Page: 99 of 176 Contract # Date: 07/1512016 Program Budget Summary PROGRAM 1 PROJECT Local Health Department - 2017 / Immunization ELPHS DATE PREPARED 7115/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To: 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Ea Telegraph Rd. 34 st BUDGET AGREEMENT p: Original 17 Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount 1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 Supplies and Materials 0.00 0.00 6 Travel 0,00 0.00 7 Communication 0.00 0.00 4 8 County-City Central Services 0.00 0,00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Other Costs Distributions 6,295,634.00 6,295,634,00 Total Indirect Costs 6,295,634.00 6,295,634.00 TOTAL INDIRECT EXPENSES 6,295,634.00 6,295,634.00 , TOTAL EXPENDITURES 6,295,634.00 6,295,634.00 Local Health Department- 2017, Date: 07115/2016 Page: 100 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 2,317,412.00 0.00 2,317,412.00 Federal Medicaid Outreach 0.00 0.00 0,00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 1,047,653.00 0.00 0.00 1,047,653.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0,00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 2,930,569.00 0.00 2,930,569.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 1,047,653.00 5,247,981.00 0.00 6,295,634.00 Local Health Department - 2017, Date: 07/1512016 Page: 101 of 176 Contract # Date: 0711512016 3 Program Budget - Cost Detail Line Item I Qty I Rate Units UOM I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Other Cost Distributions-Clinic 0.0000 0.000 0.000 3,978,222.00 Federally Provided Vaccines Notes : Used 2014-15 budgetary figure/current not available yet. 0.0000 H. 0.000 0.000 2,317,412.00 Total for Other Costs Distributions 6,295,634.00 Total indirect Costs 6,295,634.00 TOTAL INDIRECT EXPENSES 6,295,634.00 TOTAL EXPENDITURES 6,295,634.00 Local Health Department- 2017, Date: 07/15/2916 Page: 102 of 176 Contract # Date: 07/1512016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2017 / Infant Safe Sleep DATE PREPARED 7/1512016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2016 To: 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. 34 E Telegraph Rd. ast BUDGET AGREEMENT Iri Original r- Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category 1 Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 4,146.00 4,146.00 2 Fringe Benefits i 2,935.00 2,935.00 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual E 0.00 0.00 5 Supplies and Materials 9,220.00 9,220.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Empioyees, Misc.) 5,625.00 5,625.00 Total Program Expenses , 21,926.00 21,926.00 TOTAL DIRECT EXPENSES 21,926.00 21,926.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 574.00 574.00 Other Costs Distributions 2,617.00 2,617.00 Total Indirect Costs 3,191.00 3,191.00 TOTAL INDIRECT EXPENSES 3,191.00 3,191.00 TOTAL EXPENDITURES 25,117.00 25,117.00 Local Health Department - 2017, Date: 07/15/2016 Page: 103 of 116 Contract # Date: 07/15/2016 2 Program Budget Source of Funds SOURCE OF FUNDS Category I Amount Cash I lnkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00. 0.00 0.00 0.00 Local Non-ELPHS 0.00 0,00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 IVIDHHS Non Comprehensive 0.00 0.00 0.00 0,00 MDHHS Comprehensive 22,500.00 0.00 0.00 22,500.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0.00 0,00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds-Other 0.00 2,617.00 0.00 2,617.00 lnkind Match 0.00 0.00 0.00 0.00 MDFINS Fixed Unit Rate Totals 22,500.00 2,617.00 0,00 25,117.00 Local Health Department- 2017, Date: 07115/2015 Page. 104 of 176 Contract # Date: 0711512016 3 Program Budget - Cost Detail 'Line Item I Qty Rate] Units ILJOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Health Educator Notes i Step 4 GFGP 0.0601 51086.000 0.000 FTE 3,070.00 Chief Community Health Nursing Notes : Step 5 GFGP 0.0120 89625.000 0.000 FTE 1,076.00 Total for Salary & Wages 4,146.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Ins Retirement Ins Hospital Ins Life Ins Vision Ins Dental Ins Workers Comp Short/Long Terms Disability Ins 0,0000 70,790 4146.000 2,935,00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Printing Notes : "We print a significant quantity of locally developed client education materials and distribute them to 15,000+ WIC clients annually, as well as our other community outreach." 0.0000 0.000 0.000 4,314.00 Educational Supplies 0.0000 0.000 0.000 1,531.00 Client Support Materials 0.0000 0.000 0.000 3,375.00 Total for Supplies and Materials 9,220.00 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Advertising 0.0000 0.000 0.000 5,625.00 Total Program Expenses 21,926.00 Local Health Department - 2017, Date: 07115/2016 Page: 105 of 176 Contract # Date: 07/15/2016 'Line Item I Qtyl Rate' Units! UOM Total TOTAL DIRECT EXPENSES _ 21,926.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan I 0.0000 13.850 4146.0001 I. 574.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 1,970.00 Nursing Acim Distribution 0.0000 0.000 0.000 647.00 Total for Other Costs Distributions 2,617.00 Total Indirect Costs 3,191.00 TOTAL INDIRECT EXPENSES 3,191.00 TOTAL EXPENDITURES 25,117.00 Local Health Department - 2017, Date: 07/15/2016 Page: 106 of 176 Contract # Date: 0711512016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Laboratory Services Bio DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 17 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category , Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 16,670.00 16,670.00 2 Fringe Benefits 964.00 964.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0,00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 57,00 57.00 Total Program Expenses 17,691.00 17,691.00 TOTAL DIRECT EXPENSES 17,691,00 17,691.00 INDIRECT EXPENSES Indirect 'Costs 1 Indirect Costs 2,309.00 2,309.00 2 Other Costs Distributions 1,751.00 1,751.00 Total Indirect Costs 4,060.00 4,060.00 TOTAL INDIRECT EXPENSES 4,060.00 4,060.00 TOTAL EXPENDITURES 21,751.00 21,751.00 Local Health Department - 2017, Date: 07115/2016 Page: 107 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 20,000.00 0.00 0.00 20,000.00 ELPHS - MDHHS Hearing 0.00 0,00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds-Other 0.00 1,751.00 0.00 1,751.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 20,000.00 1 1,751.00 0.00 21,751.00 Local Health Department - 2017, Date: 07115/2016 Page: 108 of 176 Contract # Date: 07/1512016 3 Program Budget - Cost Detail Line Item Qty Rate Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Technician Notes : Medical Technologist 0.2990 66753.000 0.000 FTE 16,670.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0,0000 5.780 16670.000 964.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 57.00 Total Program Expenses 17,691.00 TOTAL DIRECT EXPENSES 17,691.00 INDIRECT EXPENSES Indirect Costs Indirect Costs Cost Allocation Plan 0.0000 13.850 16670.000 2,309.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 1,751.00 Total Indirect Costs 4,060.00 TOTAL INDIRECT EXPENSES 4,060.00 TOTAL EXPENDITURES 21,751.00 Local Health Department- 2017, Date: 07/15/2016 Page' 109 of 176 Contract # Date: 07/1512016 1 Program Budget Summary PROGRAM/PROJECT Local Health Department - 2017 / Nurse Family Partnership - MCH DATE PREPARED 1 E CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To: 9/3012017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 17.i Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 69,665.00 69,665.00 2 Fringe Benefits 46,139.00 46,139.00 3 Cap. Exp. for Equip & Fac, 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 300.00 300.00 7 Communication 1,032.00 1,032.00 8 County City Central Services 0,00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 2,720.00 2,720,00 Total Program Expenses 119,856.00 119,856.00 TOTAL DIRECT EXPENSES 119,856.00 119,856.00 INDIRECT EXPENSES Indirect Casts 1 Indirect Costs 9,649.00 9,649.00 2 Other Costs Distributions 14,671.00 14,671.00 Total Indirect Casts 24,320.00 24,320.00 TOTAL INDIRECT EXPENSES 24,320.00 24,320.00 TOTAL EXPENDITURES 144,176.00 144,176.00 Local Health Department - 2017, Date: 07/1512016 Page. 110 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash I lnkind Total .1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDFIHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0,00 0,00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing ,0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0,00 0.00 0.00 0.00 ELPHS - MDHFIS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private/Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 129,505.00 0.00 0.00 129,505.00 Local Funds-Other 0.00 14,671.00 0.00 14,671.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 129,505.00 14,671.00 0.00 144,176.00 Local Health Department - 2017, Date: 07/15/2016 Page: 111 of 176 Contract # Date: 07115/2016 3 Program Budget - Cost Detail !Line Item QtYl Ratel Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Coordinator 1.0000 69665.000 0.000 FTE 69,665.00 2 Fringe Benefits All Composite Rate Notes : FICA, LIFE INS, DENTAL, UNEMPLOYMENT, VISION, WORK COMP, RETIREMENT, HOSPITALIZATION, SHORT/LONG TERM DISABILITY 0.0000 66.230 69665.000 46,139.00 3 Cap. Exp. for Equip & Fac, 4 Contractual 5 Supplies and Materials 6 Travel Mileage Notes : 522 MILES @ .575 0.0000 0.000 0.000 300.00 7 Communication TELEPHONE - 0.00001 0.000 0.000 , 1,032.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) IT IOPERATIONS 0.0000 0.000 0,000 2,720.00 Total Program Expenses 119,856.00 TOTAL DIRECT EXPENSES 119,856,00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.0000 _ 13.850 69665.000 9,649.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 11,049.00 Nursing Adm Distribution 0.0000 0.000 0.000 3,622.00 Total for Other Costs Distributions 14,671,00 Total Indirect Costs 24,320.00 TOTAL INDIRECT EXPENSES 24,320.00 Local Health Department 2017, Date: 07/15/2016 Page' 112 of 176 Contract # Date: 07/1512016 'Line Item 1 Qty Rate Units UOM Total TOTAL EXPENDITURES 144,176.00 Local Health Department- 2017, Date: 07(1512016 Page: 113 of 176 Contract # Date" 07/1512016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Nurse Family Partnership Services DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 101112016 To : 9/30/2017 MAILING ADDRESS Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT P".; Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category 1 Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 408,029.00 408,029.00 2 Fringe Benefits 266,789.00 266,789.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 16,826.00 16,826.00 5 Supplies and Materials 5,750.00 5,750.00 6 Travel 8,559.00 8,559.00 7 Communication H 4,532.00 4,532.00 8 County-City Central Services 0.00 0.00 9 Space Costs 10,954.00 10,954.00 10 All Others (ADP, Con. Employees, Misc.) 39,457.00 39,457.00 Total Program Expenses 760,896.00 760,896.00 TOTAL DIRECT EXPENSES 760,896.00 760,896.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 9,649.00 9,649.00 2 Other Costs Distributions 86,716.00 86,716.00 Total Indirect Costs 96,365.00 96,365.00 TOTAL INDIRECT EXPENSES 96,365.00 96,365.00 TOTAL EXPENDITURES 857,261.00 857,261.00 Local Health Department - 2017, Date: 07/15/2016 Page: 114 of 176 Contract if Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0,00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Feder* Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0,00 MDHHS Comprehensive 641,040.00 0.00 0.00 641,040.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - rVIDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds-Other 0.00 216,221.00 0.00 216,221.00 Inkind Match 0.00 0.00 0.00 0.00 IVIDHHS Fixed Unit Rate Totals 641,040.00 216,221.00 0.00 857,261.00 Local Heatth Department - 2017, Date: 07/1512016 Page: 115 of 176 Contract # Date: 07/1512016 3 Program Budget - Cost Detail 'Line Item Qtyl Rate' Units UOM Total DIRECT EXPENSES Program Expenses I Salary & Wages Public Health Nurse Notes : Public Health Nurse HI 1.0000 66066.000 0.000 FTE 66,066.00 Public Health Nurse Notes : Public Health Nurse Ill 1.0000 66066.000 0.000 FTE 66,066.00 Public Health Nurse Notes : Public Health Nurse III 0.8173 59950.000 0.000 FTE 48,997.00 Public Health Nurse Notes : Public Health Nurse III 1.0000 66066.000 0.000 FTE 66,066.00 Public Health Nurse Notes : Public Health Nurse II 1.0000 55749.000 0.000 FTE 55,749.00 Assistant Notes : Office Assistant 11 0.4808 39184,000 0.000 FTE 18,840.00 Assistant Notes : Office Assistant 0.3846 39188.000 0.000 FTE 15,072.00 Coordinator Notes : Program Coordinator H 1.0000 H 69665.000 0.000 FTE 69,665.00 Overtime Notes : Overtime (PHNs) 0.0240 62820.000 0.000 FTE 1,508.00 Total for Salary & Wages 408,029.00 Fringe Benefits Composite Rate Notes : Flea Unemp Ins Retirement Hosp Ins Life Ins Vision Ins Dental Ins Work Comp Short/Long Term Disability 0.0000 65.385 408029.000 266,789.00 3 Cap. Exp. for Equip & Fac. 4 Contractual NFP National Office Program Suppo 0.0000 0.000 0.000 7,398.00 NFP Consultation 0.0000 0.000 0,000 8,869,00 NFP materials 0.0000 0.000 0.000 559.00 Total for Contractual 16,826.00 Local Health Department - 2017, Date: 07/15/2016 Page: 116 of 176 Contract # Date: 0711512016 Line Item I Qty Rate I Units I UOM Total 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 2,200.00 Postage 0.0000 0.000 0.000 350.00 Printing 0.0000 0.000 0.000 2,000.00 Client Support Materials 0.0000 0.000 0.000 1,200.00 Total for Supplies and Materials 5,750.00 6 Travel Client Transportation 0.0000 0.000 0.000 394.00 Mileage Notes : 14,200 miles @ .575 0.0000 _ 0.000 0.000 8,165.00 Total for Travel 8,559.00 7 Communication Telephone Communications 0.00001 0.000 0.000 4,532.00 8 County-City Central Services 9 Space Costs Building Space Rental 0.0000 0.000 0.000 10,954.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 1,350.00 Info Tech Operations 0.0000 0.000 0.000 13,920.00 Translation & Interpretation 0.0000 0.000 0.000 500.00 Staff Training 0.0000 0.000 0.000 20,750.00 Copier 0.0000 0.000 0.000 2,237.00 Advertising 0.0000 0.000 0.000 700.00 Total for All Others (ADP, Con. Employee 39,457.00 Total Program Expenses 760,896.00 TOTAL DIRECT EXPENSES 760,896.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan L 0.0000 13.850 69665.000 9,649.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 65,620.00 Nursing Adm Distribution 0.0000 0.000 0.000 21,096.00 Total for Other Costs Distributions 86,716.00 Total Indirect Costs 96,365.00 TOTAL INDIRECT EXPENSES 96,365.00 Local Health Department - 2017, Date: 07/15/2016 Page: 117 Of 176 Contract # Date: 07/15/2016 Line Item Qty Rate, Units UOM Total TOTAL EXPENDITURES 857,261.00 Local Health Department - 2017, Date: 0711512016 Page: 118 of 176 Contract # Date: 07/1512016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Medicaid Outreach DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT ro.. Original T AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 134,572.00 134,572.00 2 Fringe Benefits 86,380.00 86,380.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 County-City Central Services 0.00 0.00 9 Space Costs 6,996.00 6,996.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 Total Program Expenses 227,948.00 227,948.00 TOTAL DIRECT EXPENSES 227,948.00 227,948.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 18,638.00 18,638.00 2 Other Costs Distributions 21,586,00 21,586.00 Total Indirect Costs 40,224.00 40,224.00 TOTAL INDIRECT EXPENSES 40,224.00 40,224.00 TOTAL EXPENDITURES 268,172.00 268,172.00 Local Health Department - 2017, Date: 0711512016 Page' 119 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0,00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 123,293.00 0.00 0.00 123,293.00 Required Match - Local 0.00 123,293.00 0.00 123,293.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 21,586.00 0.00 21,586.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 123,293.00 I 144,879.00 0.00 268,172.00 Local Health Department - 2017, Date, 07/1512016 Page: 120 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail Line Item QtYl Rate Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Multiple positons Notes : Amount determined based on time studies. 1.0000 134572.000 0.000 FTE 134,572.00 2 Fringe Benefits All Composite Rate Notes : FICA UNEMPLOY RETIREMENT HOSPITAL LIFE INSURANCE VISION DENTAL WORKERS COMP SHORT/LONG TERM DISABILITY 0.0000 64.190 134570.000 86,380.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 6 Supplies and Materials 6 Travel 7 Communication County-City Central Services 9 Space Costs Office Space Rental 0.0000 0.0001 0,000 6,996.00 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses 227,948.00 TOTAL DIRECT EXPENSES 227,948.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.0000 13.850 134572.000 18,638.00 2 Other Costs Distributions [Health Adm Distribution 0.0000 0.000 0.000 21,586.00 Total Indirect Costs 40,224.00 TOTAL INDIRECT EXPENSES 40,224.00 TOTAL EXPENDITURES 268,172.00 Local Health Department - 2017, Date: 07/1512016 Page: 121 of 176 Contract # Date 07/15/2016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Public Filth Functions & Infratruct - MCH DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To: 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT FF Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & VVages 22,234.00 22,234.00 ,- 2 Fringe Benefits 1,278.00 1,278.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0,00 0.00 5 Supplies and Materials 5,869.00 5,869.00 6 Travel 2,054.00 2,054.00 7 Communication 336.00 336.00 8 County City Central Services 0.00 0,00 9 Space Costs 0,00 0.00 10 All Others (ADP, Con. Employees, Misc.) 7,074,00 7,074.00 Total Program Expenses 38,845.00 38,845,00 TOTAL DIRECT EXPENSES 38,845.00 38,845.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 3,079.00 3,079.00 2 Other Costs Distributions 3,801,413.00 3,801,413.00 Total Indirect Costs 3,804,492.00 3,804,492.00 TOTAL INDIRECT EXPENSES 3,804,492.00 3,804,492.00 TOTAL EXPENDITURES 3,843,337.00 3,843,337.00 Local Health Department - 2017, Date: 07/15/2018 Page: 122 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount 1 Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0,00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0,00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0,00 Federal Cost Based Reimbursement 0.00 0,00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0,00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0,00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0,00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0,00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0,00 0.00 ELPHS - Food 0.00 0.00 0.00 0,00 ELPHS - Private / Type Ill Water - Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 41,924.00 0.00 0.00 41,924.00 Local Funds - Other 0.00 3,801,413.00 0.00 3,801,413.00 lnkind Match 0.00 0.00 _ 0.00 0.00 MDHHS Fixed Unit Rate , Totals 41,924.00 1 3,801,413.00 0.00 3,843,337.00 Local Health Department - 2017, Date: 07/1612016 Page: 123 of 176 Contract # Date: 0711512016 3 Program Budget - Cost Detail Line Item [ Qty.' Ratel Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Public Health Nurse 0.0962 66040.000 0,000 FTE 6,353.00 Public Health Nurse 0.2404 66066.000 0.000 FTE 15,881.00 Total for Salary & Wages 22,234.00 2 Fringe Benefits All Composite Rate Notes : FICA, LIFE INS, DENTAL, UNEMPLOYMENT, VISION, WORK COMP, RETIREMENT, HOSPITALIZATION, SHORT/LONG TERM DISABILITY 0.0000 5.750 22234.000 1,278.00 3 Cap. Exp. for Equip & Fac 4 Contractual 5 Supplies and Materials Printing 0,0000 0.000 0.000 2,700.00 Educational Supplies 0.0000 0.000 0.000 3,169.00 Total for Supplies and Materials 5,869.00 6 Travel Mileage Notes : 1833 miles @ 575 0.0000 0.000 0.000 1,054.00 Client Transportation 0.0000 0,000 0.000 500.00 Conferences 0.0000 0.000 0.000 500.00 Total for Travel 2,054.00 7 Communication Telephone 0.0000 0.000 0.0001 336.00 8 County-City Central Services 9 Space Casts 10 All Others (ADP, Con. Employees, Misc.) Info Tech Operations 0.0000 0.000 0.000 ... 2,800.00 Insurance 0.0000 0.000 0.000 789.00 Translation & Interpretation 0.0000 0.000 0.000 3,235.00 Periodicals Boods Publ Sub 0.0000 0.000 0.000_ 250,00 Total for All Others (ADP, Con. Employee 7,074.00 Local Health Department - 2017, Date: 0711512018 Page: 124 of 176 Contract # Date 07/1512016 Line Item I Qty Rate Units' UOM Total Total Program Expenses 38,845,00 TOTAL DIRECT EXPENSES 38,845.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan _ 0.00001 13.8501 22234.000 3,079.00 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 3,577.00 Other Cost Distributions-Nursing Notes : This distribution takes total costs of Field Nursing and allocates them back to various cost centers by a time study. The % back to MCH is 76.5%. Health is in the process of updating their time study to "random moment in time" for FY 2014-15 0.0000 0.000 0,000 3,757,863.00 Nursing Adm Distribution 0.0000 0.000 0.000 1,172.00 Other Cost Distributions- Clinic/Educatio Notes : This distribution takes total costs of Clinic & Education and allocates them back to various cost centers by a time study. The % back to MCH for Clinic is 3% and the % back to MCH for Education is 2.855%. Health is in the process of updating their time study to "random moment in time' for FY 2014-15 0,0000 0.000 0.000 38,801.00 Total for Other Costs Distributions 3,801,413.00 Total Indirect Costs 3,804,492.00 TOTAL INDIRECT EXPENSES 3,804,492.00 TOTAL EXPENDITURES 3,843,337.00 Local Health Department - 2017, Date: 07115/2016 Page: 125 of 176 Contract # Date: 07/1512016 1 Program Budget Summary PROGRAM I PROJECT Local Health Department - 2017 1 Public Health Emergency Preparedness (PHEP) Ebola Virus Disease (EVD) Phase II PREPARED DATE 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD Fm: 10/1/2016 To: 9/3012017 MAILING ADDRESS (Number and Street) 1200 N. Ea Telegraph Rd. 34 st BUDGET AGREEMENT 17: Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 45,140.00 45,140.00 2 Fringe Benefits 29,959.00 29,959.00 3 Cap, Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 7,773.00 7,773.00 6 Travel 540.00 540.00 7 Communication 450.00 450.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con, Employees, Misc.) 2,100.00 2,100.00 Total Program Expenses 85,962.00 85,962.00 TOTAL DIRECT EXPENSES 85,962.00 _ 85,962.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 6,252.00 6,252.00 2 Other Costs Distributions 8,072.00 8,072.00 Total Indirect Costs 14,324.00 14,324.00 TOTAL INDIRECT EXPENSES 14,324.00 14,324.00 TOTAL EXPENDITURES 100,286.00 100,286.00 Local Health Department - 2017, Date: 07/15/2916 Page: 126 of 176 Contract if Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0,00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELFHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0,00 mDFIFIS Comprehensive 92,214.00 0.00 0,00 92,214.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0,00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0,00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 8,072.00 0.00 8,072.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 92,214.00 8,072.00 0.00 100,286.00 I Local Health Department - 2017, Date: 07/1512018 Page: 127 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail 'Line Item I Qty I Rate Units I UOIVI Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Health Educator 0.7500 54910.000 0.000 FTE 41,183,00 Health Educator 0.0962 41130.000 0.000 FTE 3,957.00 Total for Salary & Wages 45,140.00 2 Fringe Benefits All Composite Rate Notes : FICA UNEMPLOY RETIREMENT HOSPITAL LIFE INSURANCE VISION DENTAL WORKERS COMP SHORT/LONG TERM DISABILITY 0.0000 66.370 45140.000 29,959.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0,0000 0.000 0.000 150.00 Disaster Supplies 0,0000 0.000 0.000 4,327.00 Printing 0.0000 4.000 0.000 3,296.00 Total for Supplies and Materials 7,773.00 6 Travel Mileage Notes : 1000 miles @ 54 0.0000 0.000 0.000 840.00 7 Communication Telephone 0.0000 0.0001 0,000 450.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) IT Operations 0.00001 0.000 0.000 2,100.00 Total Program Expenses 85,962,00 TOTAL DIRECT EXPENSES 85,962.00 INDIRECT EXPENSES Indirect Costs Local Health Department- 2017, Date: 07/15/2016 Page: 128 of 176 Contract # Date. 07/15/2016 Line Item I Qty l Ratel Units I UONI Total 1 Indirect Costs Cost Allocation Plan _ 0.0000 13.850 45140.000 6,252.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 8,072.00 Total Indirect Costs 14,324.00 TOTAL INDIRECT EXPENSES 14,324.00 TOTAL EXPENDITURES 100,286.00 Local Health Department- 2017, Date; 07/15/2016 Page: 129 of 176 Contract # Date: 0711512016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / MDEQ On-site Wastewater Treatment DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2016 To: 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p.i Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual = 0.00 0.00 5 Supplies and Materials 0.00 0.00 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Other Costs Distributions 1,336,609.00 1,336,609.00 Total Indirect Costs 1,336,609.00 1,336,609.00 TOTAL INDIRECT EXPENSES 1,336,609.00 1,336,609.00 TOTAL EXPENDITURES 1,336,609.00 1,336,609.00 Local Health Department - 2017, Date: 0711512016 Page: 130 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 1 ELPHS - MDHHS Vision H 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 372,426.00 0.00 0.00 372,426.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds-Other 0.00 964,183.00 0.00 964,183.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals .._ 372,426.00 _ 964,183.00 0.00 I 1,336,609.00 Local Health Department -2017, Date: 07/15/2016 Page: 131 of 176 Contract # Date 07/15/2016 3 Program Budget - Cost Detail 'Line Item 1 QtY1 Rate Units UOM 1 Total DIRECT EXPENSES Program Expenses Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Environmental Hlth Adm Distribution 0.0000 0.000 0.000 1,336,609.00 Total Indirect Costs 1,336,609.00 TOTAL INDIRECT EXPENSES 1,336,609.00 TOTAL EXPENDITURES 1,336,609.00 Local HeaLth Department - 2017, Date: 07/15/2010 Page: 132 of 176 Contract # Date: 07/15/2016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2017 / Sudden Unexplained Infant Death DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To : 9/30/2017 MAILING ADDRESS Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p: Original r-- Amendment AMENDMENT # 0 CITY Pontiac ,— STATE NU ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount I_ Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 County-City Central Services 0.00 0.00 Space Costs 1 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Other Costs Distributions 2,000.00 2,000.00 Total Indirect Costs 2,000.00 2,000.00 TOTAL INDIRECT EXPENSES 2,000.00 2,000.00 TOTAL EXPENDITURES 2,000.00 2,000.00 Local Health Department- 2017, Date: 0711512016 Page 133 of 176 Contract # Date: 07115/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash I lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 .. Local Non-ELPHS 0.00. 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 H 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water . Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 lnkind Match ._ 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Sudden Infant Death Syndrome Fees 2,000.00 0.00 0.00 2,000.00 Totals 2,000.00 0.00 0.00 2,000.00 Local Health Department - 2017, Date' 07/15/2016 Page 134 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail ILine Item Qty}_ Ratel Units_UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Health Adm Distribution Notes : Cost Distributions for SIDS Fees from Health Adminstration 0.0000 0.000 0.000 2,000.00 Total Indirect Costs 2,000.00 TOTAL INDIRECT EXPENSES 2,000.00 TOTAL EXPENDITURES 2,000.00 Local Health Department - 2017, Date: 07/1512010 Page 135 of 176 Contract # Date, 07/15/2016 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Sexually Transmitted Disease (STD) Control DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 1011/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street} 1200 N. Ea Telegraph Rd. 34 st BUDGET AGREEMENT F.T, Original 17 Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 47,640.00 47,640.00 2 Fringe Benefits 35,010.00 35,010.00 3 Cap. Exp. for Equip & Fac, 0.00 0.00 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 Total Program Expenses 82,650.00 82,650.00 TOTAL DIRECT EXPENSES 82,650,00 82,650.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Other Costs Distributions 7,235.00 7,235.00 Total Indirect Costs 7,235.00 7,235.00 TOTAL INDIRECT EXPENSES 7,235.00 7,235.00 TOTAL EXPENDITURES 89,885.00 89,885.00 Local Health Department - 2017, Date: 07/15/2016 Page: 136 of 176 Contract # Date 07/1512016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash , lnkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0,00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0,00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 82,650.00 0.00 0.00 82,650.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0,00 Local Funds - Other 0.00 7,235.00 0.00 7,235.00 Inkind Match 0.00 0.00 0.00 0.00 MDHI-IS Fixed Unit Rate Totals 82,650,00 7,235.00 0.00 89,885.00 Local Health Department - 2017, Date: 07115/2016 Page: 137 of 176 Contract # Date: 0711512016 3 Program Budget - Cost Detail 1Line Item Qty1 Rate' Units1UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Medical Technologist 0.7356 64764.000 _ 0.000 FTE 47,640.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 73.489 47640.000 35,010.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses 82,650.00 TOTAL DIRECT EXPENSES 82,650.00 INDIRECT EXPENSES Indirect Costs I Indirect Costs 2 Other Costs Distributions Health Adm Distribution _ 0.00001 0.000 0.000 7,235.00 Total Indirect Costs 7,235.00 TOTAL INDIRECT EXPENSES 7,235.00 TOTAL EXPENDITURES 89,885.00 Local Health Department -2017, Date: 07115/2016 Page: 138 of 176 Contract # Date: 07/15/2016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Sexually Transmitted Disease (STD-ELPHS) DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2016 To: 9130/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT P: Original r -.-. Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Other Costs Distributions 1,350,378.00 1,350,378.00 Total Indirect Costs 1,350,378.00 1,350,378.00 TOTAL INDIRECT EXPENSES 1,350,378.00 1,350,378.00 TOTAL EXPENDITURES 1,350,378.00 1,350,378.00 Local Health Department - 2017, Date: 07/15/2016 Page: 139 of 176 Contract * Date: 07/1512016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non IVIDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0,00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0:00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 354,554.00 0.00 0.00 354,554.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 995,824.00 0.00 995,824.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 354,554.00 995,824.00 0.00 1,350,378.00 Local Health Department - 2017, Date: 07/15/2016 Page: 140 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail ILine Item Qty[ Rate' UnitsIUOM Total DIRECT EXPENSES Program Expenses Salary & Wages 2 Fringe Benefits 3 Cap, Exp. for Equip & Fac. 4 Contractual 6 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Nursing Adm Distribution 0.0000 0.000 0.000 15,417.00 Other Cost Distributions-Clinic & Lab di H 0.0000 0.000 0.000 1,334,961.00 Total for Other Costs Distributions 1,350,378.00 Total Indirect Costs 1,350,378.00 TOTAL INDIRECT EXPENSES 1,350,378.00 TOTAL EXPENDITURES 1,350,378.00 Local Health Department - 2017, Date: 07/15/2016 Pane' 141 of 176 Contract// Date: 07/15/2016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Tuberculosis (TB) Control DATE PREPARED 7/1512016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p:-. Original ri Amendment AMENDMENT # 0 CITY Pontiac STATE Mt ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category 1 Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 13,180.00 13,180.00 2 Fringe Benefits 762.00 762.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 44,100.00 44,100.00 6 Travel 13,140.00 13,140.00 7 Communication 721.00 721.00 8 County-City Central Services 0.00 0.00 9 Space Costs 2,100.00 2,100.00 10 All Others (ADP, Con. Employees, Misc.) 51,141.00 51,141.00 Total Program Expenses 125,144.00 125,144.00 TOTAL DIRECT EXPENSES 125,144.00 125,144.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 1,825.00 1,825.00 Other Costs Distributions 906,759.00 906,759.00 Total Indirect Costs 908,584.00 908,584.00 TOTAL INDIRECT EXPENSES 908,584.00 908,584.00 TOTAL EXPENDITURES 1,033,728,00 1,033,728.00 Local Health Department - 2017, Date: 07115/2016 Page: 142 of 176 Contract # Date: 07115/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash 1 Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0,00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 000 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0,00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0,00 MDHHS Comprehensive 48,678.00 0.00 0.00 48,678.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private I Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 985,050.00 0.00 985,050,00 lnkind Match 0.00 0.00 0.00 0.00 NIDHNS Fixed Unit Rate Totals 48,678.00 _ 985,050.00 0.00 1,033,728.00 Local Health Department - 2017, Date: 07/1612016 Page' 143 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail LLine Item I Qty Rate UnitsjUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Outreach Worker 0.3846 34270.000 0.000IFTE 13,180.00 Fringe Benefits All Composite Rate Notes : Social Security Unemployment ins Retirement Hospital Ins Life Ins Vision Ins Dental Ins Work Comp 0.0000 5.780 13180.000 762.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Medical Supplies Notes : TB budget 0.0000 0.000 0.000 1,000.00 Office Supplies Notes : TB budget 0,0000 0.000 0.000 200.00 Client Support Materials Notes : TB budget 0.0000 0.000 0.000 750.00 Postage Notes : TB budget 0.0000 0.000 0.000 250.00 Drugs/Pharm - COUNTY BUDGET 0.0000 0.000 0.000 41,600.00 Printing - COUNTY BUDGET 0.0000 0,000 0.000 300.00 Total for Supplies and Materials 44,100.00 6 Travel Mileage Notes : 16,000 miles @ .54 TB budget 0.0000 0.000 0.000 8,640.00 Conferences Notes : TB budget 0.0000 0.000 0.000 4,000.00 Client Transporation Notes : TB budget 0,0000 0.000 0.000 500.00 Total for Travel 13,140.00 7 Communication Local Health Department - 2017, Dale: 07/15/2016 Page: 144 of 176 Contract # Date: 07115/2016 Line Item Qty Rate Units UOM Total Telephone Communications Notes : TB budget 0.0000 0.000 0.000 600.00 Telephone Comm - COUNTY BUDGET 0.0000 0.000 0.000 121.00 Total for Communication 721.00 8 County-City Central Services 9 Space Costs Bldg Space Costs - COUNTY BUDGET 0.0000 0.000 0.000 2,100.00 10 All Others (ADP, Con. Employees, Misc.) Insurance Notes : TB budget 0.0000 0,000 0.000 180,00 Lab Fees Notes : TB budget 0.0000 0.000 0.000 15,304.00 Translation/Interpretation Notes : TB budget 0.0000 0.000 0.000 817.00 Copier Notes : TB budget 0.0000 0.000 0.000 420.00 Equipment Repair Notes : TB budget 0.0000 0.000 0.000 250.00 Lab Fees, Membership-COUNTY BUDGET 0.0000 0.000 0.000 1,800.00 Prof Svcs, Copier-COUNTY BUDGET 0.0000 0.000 0.000 12,192.00 TB Cases/Outside - COUNTY BUDGET 0.0000 0.000 0.000 20,178.00 Total for All Others (ADP, Con. Employee 51,141.00 Total Program Expenses 125,144.00 TOTAL DIRECT EXPENSES 125,144.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.0000 13.850 13180.000 1,825.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 11,115.00 Other Cost Distributions-Field Nursing d 0.0000 0.000 0.000 21,330.00 Nursing Adm Distribution 0.0000 0.000 0.000 9,780.00 Other Cost Distributions-Misc 0.0000 0.000 0.000 864,534.00 Lee& Hearth Department- 2017, Date: 07/151201e Page: 145 of 176 Contract # Date: 07/1512016 Line Item 1 Qty Rate' Units UOM Total Total for Other Costs Distributions 906,759.00 Total indirect Costs 9080584.00 TOTAL INDIRECT EXPENSES 908,584.00 TOTAL EXPENDITURES 1,033,728.00 Local Health Department - 2017, Date: 07/1512016 Page: 146 of 176 Contract # Date: 07/15/2016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Local Tobacco Reduction DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From: 10/1/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East , BUDGET AGREEMENT F.7 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount 1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 21,788.00 21,788.00 2 Fringe Benefits H 1,259.00 1,259.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 2,149.00 2,149.00 6 Travel 1,150.00 1,160.00 Communication 550.00 550.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 86.00 86.00 Total Program Expenses 26,982.00 26,982.00 TOTAL DIRECT EXPENSES 26,982.00 26,982.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 3,018.00 3,018.00 2 Other Costs Distributions 2,626.00 2,626.00 Total Indirect Costs 5,644.00 5,644.00 TOTAL INDIRECT EXPENSES 5,644.00 5,644.00 TOTAL EXPENDITURES 32,626.00 32,626.00 Local Health Department - 2017, Date: 07116/2016 Page: 147 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0,00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0,00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELP HS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 30,000.00 0.00 0.00 30,000.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0,00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 2,626.00 0.00 2,626.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 30,000.00 2,626.00 0.00 32,626.00 Local Health Department - 2017, Date: 07115/2016 Page: 148 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail Line Item L Qty1 Ratel UnitslUOM Total DIRECT EXPENSES Program Expenses Salary & Wages Health Educator 0.3365 64750.000 0.000 FTE 21,788.00 2 Fringe Benefits All Composite Rate 0.0000 5.780 21788.000 1,259.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0,000 0.000 100.00 Postage 0.0000 0.000 0.000 649.00 Printing 0.0000 0.000 0.000 1,400.00 Total for Supplies and Materials 2,149,00 6 Travel Mileage Notes : 2130 @ .54 0.0000 0.000 0,000 1,150.00 7 Communication Telephone Communications 0.0000 0.000 0.000 550.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.00001 0.000 0.000 86.00 Total Program Expenses 26,982.00 TOTAL DIRECT EXPENSES 26,982.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.0000_ 13.850 21788.000 3,018.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 2,626.00 Total Indirect Costs 5,644.00 TOTAL INDIRECT EXPENSES 5,644.00 TOTAL EXPENDITURES 32,626.00 Local Health Department 2017, Date: 07/15/2016 Page: 149 of 176 Contract # Date: 07/1512016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / Immunization Fixed Fees DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT F. Original r Amendment AMENDMENT # 0 CITY Pontiac STATE IVIt ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category I Amount]. Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 0.00 0.00 2 Other Costs Distributions 35,000.00 35,000.00 Total Indirect Costs 35,000.00 35,000.00 TOTAL INDIRECT EXPENSES 35,000.00 35,000.00 TOTAL EXPENDITURES 35,000.00 35,000.00 Local Health Department - 2017, Date: 07/1512016 Page: 150 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total "I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0,00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.001 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0,00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private/Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate 1MM: VFC - AFIX Visits 35,000.00 0.00 0.00 35,000.00 Totals 35,000.00 0.00 0.00 35,000.00 Local Health Department - 2017, Date: 07/15/2016 Pagel 151 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail Line Item I Qty Ratel Units UOIVI Total DIRECT EXPENSES Program Expenses Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Cost Distributions for Fees-from IAP 0.0000 0.000 0.000 35,000.00 Total Indirect Costs 35,000.00 TOTAL INDIRECT EXPENSES 35,000.00 TOTAL EXPENDITURES 35,000.00 Local Health Department - 2017, Date: 0711512016 Page: 152 of 176 Contract # Date: 07115/2016 Program Budget Summary PROGRAM / PROJECT Local Health Department -2017 / Vision ELPHS DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 1011/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT ro- Original r• Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 308,099.00 308,099.00 Fringe Benefits 97,162.00 97,162.00 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 6 Supplies and Materials 3,444.00 3,444.00 6 Travel 5,178.00 5,178.00 7 Communication 982.00 982.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 3,937.00 3,937.00 Total Program Expenses 418,802.00 418,802.00 TOTAL DIRECT EXPENSES 418,802.00 418,802.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 42,672.00 42,672.00 2 Other Costs Distributions 132,678.00 132,678.00 Total Indirect Costs 175,350.00 175,350.00 TOTAL INDIRECT EXPENSES 175,350.00 175,350.00 TOTAL EXPENDITURES 594,152.00 594,152.00 Local Health Department - 2017, Date: 0711512016 Page: 153 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 _ 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0,00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - moHHs Vision 235,112.00 0.00 0.00 235,112.00 ELPHS - MDHHS Other 1 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0,00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 359,040.00 0.00 359,040.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 235,112.00 359,040.00 0.00 594,152.00 Local Health Department - 2017, Date: 07115/2016 Page: 154 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail Line Item Qty Ratel Units DOM Total DIRECT EXPENSES Program Expenses I Salary & Wages Supervisor 1.0000 46465.000 0.000 FTE 46,465.00 Technician 0,4808 34265.000 0,000 FTE 16,475.00 Technician 0.4808 34265,000 0.000 FTE 16,475.00 Technician 0.4808 32314.000 0.000 FIE 15,537.00 Technician 0.4808 32314.000 0.000 FTE 15,537.00 Technician 0.4808 32314.000 0.000 FTE 15,537.00 Technician 0.4808 32314,000 0.000 PTE 15,537,00 Technician 0.4808 32314.000 0.000 FTE 15,537.00 Technician 0.4808 32314.000 10.000 FTE 15,537.00 Technician 0.4808 32314.000 0,000 FTE 15,537.00 Technician 0.4808 32314.000 0.000 FIE 15,537.00 Technician 0.6000 42087.000 0.000 FTE 25,252.00 Technician 0.4808 H 38176.000 0.000 FTE 18,355.00 Coordinator 0,5000 71058.000 0,000 FTE 35,529.00 Technician 0.6000 42087.000 0.000 FTE 25,252.00 Total for Salary & Wages 308,099.00 2 Fringe Benefits All Composite Rate Notes : FICA UNEMPLOYMENT INS RETIREMENT HOSPITAL INS LIFE INS VISION INS HEARING INS DENTAL INS WORK COMP SHORT/LONG TERM DISABILITY 0.0000 .. 31.536 308099,000 97,162.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 963.00 Medical Supplies 0.0000 0.000 0.000 819.00 Printing 0.0000 0.000 0.000 1,662.00 Local Health Department - 2017, Date: 0711512016 Page: 155 of 176 Contract Date: 07/15/2016 Line Item Qty Rate I Units I UOM Total Total for Supplies and Materials 3,444.00 6 Travel Personal Mileage 0.0000 0.000 0.000 I 5,178.00 7 Communication Telephone 0.0000 0.000 0.000 982.00 8 County-City Central Services 9 Space Costs 10 Al! Others (ADP, Con. Employees, Misc.) Staff Training 0.0000 0.000 0.000 1,204.00 Equipment Repair 0.0000 0.000 0.000 2,168.00 Copier 0.0000 0.000 0.000 241.00 Insurance 0.0000 0.000 0.000 324.00 Total for All Others (ADP, Con. Employee 3,937.00 Total Program Expenses 418,802.00 TOTAL DIRECT EXPENSES 418,802.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.0000 13.850 308099.000 42,672.00 2 Other Costs Distributions Other Cost Distributions-Misc Distributi = 0.0000 0.000 0.000 92,282.00 Health Adm Distribution 0.0000 0.000 0.000 40,396.00 Total for Other Costs Distributions 132,678.00 Total indirect Costs 175,350.00 TOTAL INDIRECT EXPENSES 175,350.00 TOTAL EXPENDITURES 594,152.00 Local Health Department - 2017, Date: 07115/2016 Page: 156 of 176 Contract # Date: 07/15/2016 1 Program Budget Summary PROGRAM/PROJECT Local Health Department - 2017 / Immunization Vaccine Quality Assurance DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To: 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N, Telegraph Rd. 34 East BUDGET AGREEMENT F Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 1,877,435.00 1,877,435.00 2 Fringe Benefits 1,207,233.00 1,207,233.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 1,278,860.00 1,278,860.00 6 Travel 6,684.00 6,684.00 7 Communication 34,272,00 34,272.00 8 County-City Central Services 0.00 0.00 9 Space Costs 175,466,00 175,466.00 10 All Others (ADP, Con. Employees, Misc.) 272,956.00 272,956.00 Total Program Expenses 4,852,906.00 4,852,906.00 TOTAL DIRECT EXPENSES 4,852,906.00 4,852,906.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 260,025.00 260,025.00 2 Other Costs Distributions -3,508,197.00 -3,508,197.00 Total Indirect Costs -3,248,172.00 -3,248,172.00 TOTAL INDIRECT EXPENSES -3,248,172.00 -3,248,172.00 TOTAL EXPENDITURES 1,604,734.00 1,604,734.00 Local Health Department- 2017, Date: 07/16/2016 Page: 157 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 1,163,012.00 0.00 1,163,012.00 Fees and Collections - 3rd Party 0.00 330,000.00 0.00 330,000.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 1 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive E 11 ,722.00 0.00 0.00 111,722.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - moHHs Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals I 111,722.00 1,493,012.00 I 0.00 1,604,734.00 Local Health Department -2017, Date: 07/15/2016 Page: 158 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail Line Item I QtYI Ratel Unitst.10M Total DIRECT EXPENSES Program Expenses I Salary & Wages Vaccine Supply Coordinator 1.0000 39678.000 0.000 FTE 39,678.00 Vaccine Supply Coordinator Notes : Shared IAP 0.2500 44202.000 0.000 FTE 11,051.00 Overtime 0.0962 41928.000 0.000 FTE 4,033.00 PH Clinic Nurses-COUNTY BUDGET 1.0000 1822673.000 0.000 FTE 1,822,673.00 Total for Salary & Wages 1,877,435.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 80.477 54762.000 44,071.00 Composite Rate - COUNTY BUDGET Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 100.000 1163162.00 0 1,163,162.00 Total for Fringe Benefits 1,207,233.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Materials & Supplies Notes : VQA budget 0.0000 0.000 0.000 3,000.00 Local Health Department - 2017, Date: 0711512016 Page: 159 of 176 Contract # Date: 07/15/2016 Line item Qty Rate Units UOM Total Printing-COUNTY BUDGET 0.0000 0.000 0.000 3,500.00 Drugs/Vaccines-COUNTY BUDGET 0.0000 0.000 0.000 1,187,285.00 Medical Supply-COUNTY BUDGET 0,0000 0.000 0.000 77,675.00 Office Supply-COUNTY BUDGET 0.0000 0.000 0.000 7,200.00 Postage-COUNTY BUDGET 0.0000 0.000 0.000 200,00 Total for Supplies and Materials 1,278,860.00 6 Travel Mileage Notes : 930 miles @ .54 VCtA budget 0.0000 0.000 0.000 502.00 Mileage Notes : COUNTY BUDGET 0.0000 0.000 0.000 5,700.00 Conferences Notes : COUNTY BUDGET 0.0000 _ 0.000 0.000 482.00 Total for Travel 6,684.00 7 Communication Telephone COUNTY BUDGET 0.00001 0.000 0.000 34,272.00 8 County-City Central Services 9 Space Costs Bldg Space Cost-COUNTY BUDGET 0.0000 0.000 0,000 175,466.00 10 All Others (ADP, Con. Employees, Misc.) Insurance Notes : VQA budget 0.0000 0.000 0.000 302.00 Insurance Notes : COUNTY BUDGET 0.0000 0.000 0.000 2,213.00 Prof Svcs - Smart Temps 0.0000 0.000 0.000 1,500.00 IT Oper-COUNTY BUDGET 0.0000 0.000 0.000 207,883.00 Copier $1818, Equip Rental $840 Notes : COUNTY BUDGET 0.0000 0.000 0.000 2,658.00 Staff Training Notes : COUNTY BUDGET 0.0000 0.000 0.000 1,000.00 Supporting Services Notes : Software support COUNTY BUDGET 0.0000 0.000 0.000 28,500.00 Prof Svcs-COUNTY BUDGET 0.0000 0.000 0.000 26,000.00 Laundry-COUNTY BUDGET 0.0000 0.000 0.000 2,900.00 Local Health Department - 2017, Date: 0711512016 Page: 160 of 176 Contract # Date: 07/15/2016 Line Item i Qty Rate Units UOM Total Total for All Others (ADP, Con. Employee 272,956.00 Total Program Expenses 4,852,906.00 TOTAL DIRECT EXPENSES 4,852,906.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan Notes : VQA budget 0.0000 13.850 . 54762.000 7,585.00 Cost Allocation Plan Notes : COUNTY BUDGET 0.0000 13,850 1822673.00 0 252,440.00 Total for Indirect Costs 260,025.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 2,355,855.00 Nursing Adm Distribution 0.0000 0.000 0.000 197,538.00 Other Cost Distributions-misc 0.0000 0.000 0.000 -6,061,590.00 Total for Other Costs Distributions -3,508,197.00 Total Indirect Costs -3,248,172.00 TOTAL INDIRECT EXPENSES -3,248,172.00 TOTAL EXPENDITURES 1,604,734.00 Local Health Department - 2017, Date: 07/15/2016 Page: 161 of 176 Contract # Date: 07/15/2016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017/WIC Breastfeeding DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/112016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT re Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category Amount Total DIRECT EXPENSES Program Expenses Salary & Wages 28,408.00 28,408.00 2 Fringe Benefits 35,578.00 35,578.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 73,397.00 73,397.00 5 Supplies and Materials 316.00 316.00 6 Travel 508.00 508.00 7 Communication 870.00 870.00 8 County-City Central Services 0.00 0.00 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 385.00 385.00 Total Program Expenses 139,462.00 139,462.00 TOTAL DIRECT EXPENSES 139,462.00 139,462.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 3,935.00 3,935.00 2 Other Costs Distributions 12,553.00 12,553,00 Total Indirect Costs 16,488.00 16,488.00 TOTAL INDIRECT EXPENSES 16,488.00 16,488.00 TOTAL EXPENDITURES 155,950.00 155,950.00 Local Health Department - 2017, Date: 07115/2016 Page: 162 of 176 Contract # Date: 07115/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0,00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0,00 0.00 0.00 0.00 MDHHS Comprehensive 143,397.00 0.00 0.00 143,397.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0,00 Local Funds - Other 0.00 12,553.00 0.00 12,553.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 143,397.00 12,553.00 0,00 155,950.00 Local Health Department 2017, Date: 07/15/2016 Page: 163 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail Line Item I Qty Rate UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Lactation Specialist 1.0000 28408.0001 0.000 FTE 28,408.00 2 Fringe Benefits All Composite Rate Notes : FICA UNEMP INS RETIREMENT HOSPITAL INS LIFE INS VISION INS DENTAL INS WORK COMP SHORT/LONG TERM DISABILITY 0.0000 125.240 28408.000 35,578.00 3 Cap. Exp. for Equip & Fac. 4 Contractual Subcontracting Agency-OLSHA 0,0000 0.000 0.000 73,397.00 5 Supplies and Materials Medical Supplies 0.0000 0.000 0.000 316.00 6 Travel Mileage Notes : 200 miles @ .54 0.0000 0.000 _ 0.000 108.00 Conferences 0.0000 0.000_ 0.000 400.00 Total for Travel 508.00 7 Communication Telephone Communications 0.0000 0.000 0.000 870.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000_ 385.00 Total Program Expenses 139,462.00 TOTAL DIRECT EXPENSES 139,462.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.0000, 13.850 28408.000 3,935.00 Local Health Department - 2017, Date: 0711512016 Page: 164 of 176 Contract # Date: 07/15/2016 Line Item [ Qty l Rate UnitslUOM Total 2 Other Costs Distributions Health Adm Distribution 0.0000i 0.0001 0.000 12,553.00 Total Indirect Costs 16,488.00 TOTAL INDIRECT EXPENSES 16,488.00 TOTAL EXPENDITURES 155,950.00 Local Health Department - 2017, Date: 07/15/2016 Page: 165 of 176 Contract /I Date: 07115/2016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2017 /WIC Resident Services DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 To: 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT F. Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 1 Category Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 939,874.00 939,874.00 2 Fringe Benefits 673,664.00 673,664.00 3 Cap. Exp. for Equip & Fac. 1. 0.00 0.00 4 Contractual 1 431,550.00 431,550.00 5 Supplies and Materials 43,521.00 43,521.00 6 Travel 5,645.00 5,645.00 7 Communication 16,860.00 16,860,00 8 County-City Central Services 0.00 0.00 9 Space Costs 90,644.00 90,644.00 10 All Others (ADP, Con. Employees, Misc.) 103,399.00 103,399.00 Total Program Expenses I. 2,305,157.00 2,305,157.00 TOTAL DIRECT EXPENSES 2,305,157.00 2,305,157.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 130,173.00 130,173.00 2 Other Costs Distributions 305,466.00 305,466.00 Total Indirect Costs 436,639.00 435,639.00 TOTAL INDIRECT EXPENSES 435,639.00 435,639.00 TOTAL EXPENDITURES 2,740,796.00 2,740,796.00 Local Health Department - 2017, Date: 07h5/2016 Page: 166 of 176 Contract # Date: 07/15/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total "I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0,00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0,00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 2,435,330.00 0.00 0.00 2,435,330.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0,00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 . 0.00 Local Funds - Other 0.00 305,466.00 0.00 305,466.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 2,435,330.00 305,466.00 0.00 2,740,796.00 Local Health Department - 2017, Dale: 07/15/2016 Page: 167 of 176 Contract # Date: 07115/2016 3 Program Budget - Cost Detail Line Item I QtYl RateL Units UOIY1 Total DIRECT EXPENSES Program Expenses I Salary & Wages Supervisor 1.0000 68917.000 0.000 FTE 68,917.00 Supervisor 1.0000 48724.000 0.000 FIE 48,724.00 Supervisor 1.0000 53436.000 0.000 FTE 53,436.00 Outreach Worker 1.0000 38179.000 0.000 FTE 38,179.00 Outreach Worker 1.0000 40131.000 0.000 FTE 40,131.00 Outreach Worker 1.0000 36224.000 0.000 FTE 36,224.00 Outreach Worker 1.0000 31746.000 0.000 FTE 31,746.00 Outreach Worker 1.0000 34268.000 0.000 FTE 34,268.00 Outreach Worker 1.0000 31746.000, 0.000 FTE 31,746.00 Nutritionist/Dietician 1.0000 44330.000 0,000 FTE 44,330.00 Nutritionist/Dietician 1.0000 36099.000 0.000 FTE 36,099.00 Nutritionist/Dietician 1.0000 44330.000 0.000 FTE 44,330.00 Nutritionist/Dietician 1.0000 44330.000 0.000 FTE 44,330.00 Nutritionist/Dietician 1.0000 44330.000 0.000 FTE 44,330.00 Nutritionist/Dietician 1,0000 44330.000 0.000 FTE 44,330.00 Nutritionist/Dietician 1.0000 58891.000 0.000 FTE 58,891.00 Nutritionist/Dietician 1.0000 58891.000 0.000 FTE 58,891,00 Nutritionist/Dietician 1.0000 58891.000 0.000 FTE 58,891.00 Nutritionist/Dietician 1.0000 64740.000 0.000 FTE 64,740.00 Assistant 0.4808 29591.000 0.000 FTE 14,227.00 Outreach Worker 0,4808 34266.000 0.000 FTE 16,475.00 Outreach Worker 0.4808 34266.000 0.000 FTE 16,475.00 Overtime , 0.2404 42283.000 0.000 FTE 10,164.00 Total for Salary & Wages 939,874.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Ins. Retirement Hospital Ins. Life Ins. Vision Ins. Hearing Ins. Dental Ins. 0.0000 71.675 939874.000 673,664.00 Local Health Department - 2017, Date: 0711512016 Page: 168 of 176 Contract # Date: 07/15/2016 Line Item Qty Rate Units UOM Total Work Comp Short/Long Term Disability 3 Cap. Exp. for Equip & Fac. 4 Contractual Subcontracting Agency-OLSHA- WIC svcs in 0.0000 0.000 0.000 431,550,00 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 10,071.00 Medical Supplies 0.0000 0.000 0.000 13,000.00 Educational Supplies 0.0000 0.000 0.000 10,000.00 computer supplies 0.0000 0,000 0.000 100.00 Postage 0.0000 0,000 0.000 2,100,00 Printing 0.0000 0.000 0.000 6,000.00 Materials & Supplies 0.0000 0.000 0.000 2,250.00 Total for Supplies and Materials 43,521.00 6 Travel Mileage Notes : 6,750 miles @ .54 0.0000 0.000 0.000 3,645.00 Conferences 0.0000 0.000 0.000 2,000.00 Total for Travel 5,645.00 7 Communication Telephone 0.0000 0.000 0.000 16,860.00 8 County-City Central Services Space Costs Space/Rental Costs 0.0000 0.000 0.000 90,644.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 6,690.00 Equipment Repair 0.0000 0.000 0.000 1,000.00 Convenience Copier 0.0000 0.000 0.000 4,500.00 IT Operatons 0.0000 0.000 0.000 69,270.00 Advertising 0.0000 0.000 0.000 16,739.00 Staff Training 0.0000 0.000 0.000 2,500.00 Prof svcs, interpretation, laundry 0.0000 0.000 0.000 2,200.00 Expendable Equipment 0.0000 0.000 0.000 500.00 Total for All Others (ADP, Con. Employee 103,399.00 Total Program Expenses 2,305,157.00 Local Health Department - 2017, Date: 07/1512016 Page: 169 of 176 Contract # Date: 07/15/2016 'Line Item I Qty Rate I Units 1 UOM Total TOTAL DIRECT EXPENSES 2,305,157.00 INDIRECT EXPENSES Indirect Costs I Indirect Costs Cost Allocation Plan _ 0.0000 13.850 939874.000 130,173.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 213,184.00 Other Cost Distributions-Health Educatio 0.0000 0.000 0.000 92,282.00 Total for Other Costs Distributions 305,466.00 Total Indirect Costs 435,639.00 TOTAL INDIRECT EXPENSES 435,639.00 TOTAL EXPENDITURES H 2,740,796.00 Local Health Department - 2017, Date: 07/1612016 Page: 170 of 176 Contract # Date: 07/15/2016 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2017 / MDEQ Private and Type III Water Supply DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :1011/2016 To : 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT W Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0,00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Coats 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Other Costs Distributions 1,480,355.00 1,480,355.00 Total Indirect Costs 1,480,355.00 1,480,355.00 TOTAL INDIRECT EXPENSES 1,480,355.00 1,480,355.00 TOTAL EXPENDITURES 1,480,355.00 1,480,355.00 Local Health Department - 20•t7, Date: 07/15/2016 Page: 171 of 176 Contract # Date: 07115/2016 2 Program Budget - Source of Funds SOURCE OF FUNDS Category 1 Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0,00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 514,301.00 0.00 0.00 514,301.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 966,054.00 0.00 966,054.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 514,301.00 966,054.00 0.00 1,480,355.00 Local Health Department -2017, Date: 07/15/2016 Page: 172 of 176 Contract # Date: 07/15/2016 3 Program Budget - Cost Detail Line Item 1 Qty _ Rate Units' UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services c 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Environmental Hlth Adrn Distribution 0,0000 0,000 0.000 1,346,518.00 Other Cost Distributions-Misc. Distribut 0.0000 . 0.000 0.000 133,837.00 Total for Other Costs Distributions 1,480,355.00 Total Indirect Costs 1,480,355.00 TOTAL INDIRECT EXPENSES 1,480,355.00 TOTAL EXPENDITURES 1,480,355.00 Local Health Department - 2017, Date: 07/15/2016 Page: 173 of 176 Contract # Date: 07/15/2016 Summary of Budget PROGRAM / PROJECT Local Health Department - 2017 / Local Health Department - 2017 DATE PREPARED 7/15/2016 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2016 T0. 9/30/2017 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT P Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 4834' 0432 1- FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 14,523,182.00 14,523,182.00 2 Fringe Benefits 9,249,692.00 9,249,692.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 664,157.00 664,157.00 5 Supplies and Materials 1,903,376.00 1,903,376.00 6 Travel 393,189.00 393,189.00 7 Communication 261,619.00 261,619.00 8 Space Costs 1,183,267.00 1,183,267.00 9 All Others (ADP, Con. Employees, Misc.) 2,411,308.00 2,411,308.00 Total Program Expenses 30,589,790.00 30,589,790.00 TOTAL DIRECT EXPENSES 30,589,790.00 30,589,790.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 1,954,906.00 1,954,906.00 2 Other Costs Distributions 8,371,345.00 8,371,345.00 Total Indirect Costs 10,326,251.00 10,326,251.00 TOTAL INDIRECT EXPENSES 10,326,251.00 10,326,251.00 TOTAL EXPENDITURES 40,916,041.00 40,916,041.00 SOURCE OF FUNDS Local Health Department - 2017, Date: 07115/2016 Page: 174 of 176 Contract # Date: 0711512016 Category Amount Cash lnkind Total 1 Fees and Collections - 1st and 2nd Party 0.00 3,642,612.00 0.00 3,642,612.00 2 Fees and Collections - 3rd Party 0.00 330,000.00 0.00 330,000.00 3 Federal or State (Non MDCH) 0.00 247,282.00 0.00 247,282.00 4 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 5 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 6 Federally Provided Vaccines 0.00 2,317,412.00 0.00 2,317,412.00 7 Federal Medicaid Outreach 218,363.00 0.00 0.00 218,363.00 8 Required Match - Local 0.00 218,363.00 0.00 218,363.00 9 Local Non-ELPHS 0.00 0.00 0.00 0.00 10 Local Non-ELPHS 0.00 0.00 0.00 0.00 11 Local Non-ELPHS 0.00 0.00 0.00 0.00 12 Other Non-ELPHS 0.00 0.00 0.00 0.00 13 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 14 MDHHS Comprehensive 5,450,873.0 0 0.00 0.00 5,450,873.00 15 ELPHS - MDHHS Hearing 235,112.00 0.00 0.00 235,112.00 16 ELPHS - MDHHS Vision 235,112.00 0.00 0.00 235,112.00 17 ELPHS - MDHHS Other 2,251,290,0 0 0.00 0.00 2,251,290.00 18 ELPHS - Food 859,213.00 0.00 0.00 859,213.00 19 ELPHS - Private/Type III Water Supply 514,301,00 0.00 0.00 514,301.00 20 ELPHS - On-Site Wastewater Treatment 372,426.00 0.00 0.00 372,426.00 21 MCH Funding 321,457.00 0.00 0.00 321,457.00 22 Local Funds - Other 0.00 23,370,109.0 0 0.00 23,370,109.0 0 23 Inkind Match 0.00 0.00 35,116.00 35,116.00 24 MDHHS Fixed Unit Rate 297,000.00 0.00 _ 0.00 297,000.00 Local Health Department -2017, Data: 07/1512016 Page: 175 of 176 Contract # Date: 07/1512016 TOTAL 10,755,147. 00 30,125,778.0 0_ 35,116.00 40,916,041.0 0 Local Health Department - 2017, Date: 07115/2016 Page: 176 of 176 Version: Comprehensive. MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES FY 16117 AGREEMENT ADDENDUM A 1. This addendum adds the following section to Part I and Renumbers existing 11 Special Certification to 12 and existing 12 Signature Section to 13: Part I 11. Agreement Exceptions and Limitations Notwithstanding any other term or condition in this Agreement including, but not limited to, any provisions related to any services as described in the Annual Action Plan, any Contractor (Oakland County) services provided pursuant to this Agreement, or any limitations upon any Department funding obligations herein, the Parties specifically intend and agree that the Contractor may discontinue, without any penalty or liability whatsoever, any Contractor services or performance obligations under this Agreement when and if it becomes apparent that State or Department funds for any such services will be no longer available. Notwithstanding any other term or condition in this Agreement, the Parties specifically understand and agree that no provision in this Agreement shall operate as a waiver, bar or limitation of any kind, on any legal claim or right the Contractor may have at any time under any Michigan constitutional provision or other legal basis (e.g., any Headlee Amendment limitations) to challenge any State or Department program funding obligations; and, the parties further agree that no term or condition in this Agreement is intended and no such provision shall be argued to state or imply that the Contractor voluntarily assumed or undertook to provide any services as described in the Annual Action Plan, and thereby, waived any rights the Contractor may have had under any legal theory, in law or equity, without regard to whether or not the Contractor continued to perform any services herein after any State or Department funding ends. 2. This addendum modifies the following sections of Part II, General Provisions: Part II I. Responsibilities-Contractor J. Software Compliance. This section will be deleted in its entirety and replaced with the following language: Version: Comprehensive The Michigan Department of Health and Human Services and the County of Oakland will work together to identify and overcome potential data incompatibility problems. Ill. Assurances A. Compliance with Applicable Laws. This first sentence of this paragraph will be stricken in its entirety and replace with the following language: The Contractor will comply with applicable Federal and State laws, and lawfully enacted administrative rules or regulations, in carrying out the terms of this agreement. I. Health Insurance Portability and Accountability Act. The provisions in this section shall be deleted in their entirety and replaced with the following language: Contractor agrees that it will comply with the Health insurance Portability and Accountability Act of 1996, and the lawfully enacted and applicable Regulations promulgated there under. IX. Liability. Paragraph A. will be deleted in its entirety and replaced with the following language. Except as otherwise provided by law neither Party shall be obligated to the other, or indemnify the other for any third party claims, demands, costs, or judgments arising out of activities to be carried out pursuant to the obligations of either party under this Contract, nothing herein shall be construed as a waiver of any governmental immunity for either party or its agencies, or officers and employees as provided by statute or modified by court decisions. 2 ATTACHMENT I MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES Local Health Department Agreement October 1, 2016- September 30, 2017 Fiscal Year 2017 INSTRUCTIONS FOR THE ANNUAL BUDGET MDHHS/CO-2017 06/21/2016 INSTRUCTIONS FOR THE ANNUAL BUDGET FOR LOCAL HEALTH DEPARTMENT SERVICES TABLE OF CONTENTS Page I. INTRODUCTION 2 II. MINIMUM BUDGETING REQUIREMENTS 2 III. REIMBURSEMENT CHART 3 IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION PROCEDURES 4 V. FORM PREPARATION - GENERAL 4 VI. FORM PREPARATION - EXPENDITURE CATEGORIES 4 VII. FORM PREPARATION - SOURCE OF FUNDS 6 VIII. SPECIAL BUDGET INSTRUCTIONS A. Public Health Emergency Preparedness (PHEP) 9 B. WIC 10 C. Family Planning 11 D. Breast and Cervical Cancer 12 E. CSHCS Outreach and Advocacy 13 F. Program Budget Detail- Cost Detail Schedule Preparation 15 Annual Budget Forms 15 G. Medicaid Outreach Activities Reimbursement Procedures 20 Example 1-Medicaid Outreach Activities Cost Allocation Plan Certification 25 Example 2 -Medicaid Outreach Cost Allocation Methodology Certification 26 Example 3-Medicaid Outreach Activities Cost Allocation Plan Sample 27 H. Michigan Colorectal Cancer-Screening Program 30 I. Immunization 317 and VFC Allowable Expenditures 31 MDHHS/C0-2017 06/21/2016 Pagel of 37 INSTRUCTIONS FOR THE ANNUAL BUDGET FOR LOCAL HEALTH SERVICES I. INTRODUCTION The Annual Budget for Local Health Services is completed on a state fiscal year basis, and is used to establish budgets for many Department programs. In the Annual Budget, the Department consolidates many of its categorical programs' funding and Essential Local Public Health Services (ELPHS) (formerly known as the local public health operation's funding) into a single, Comprehensive Agreement for local health departments. The Department's Plan and Budget Framework serves as a principal reference point for budget development. The Annual Budget for Local Health Services must be completed in accordance with and adhere to the established requirements as specified in these instructions and submitted to the Department as required by the agreement. II. MINIMUM BUDGETING REQUIREMENTS A. Cost Principles - Types or items of cost which will be considered for reimbursement are generally consistent with definitions contained in Title 2 Code of Federal Regulations CFR, Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. B. Federal Block Grant Funds - Maternal & Child Health and Preventive Health Block Grant funds may not be used to: provide inpatient services; make cash payments to intended recipients of health services; purchase or improve land; purchase, contract or permanently improve (other than minor remodeling defined as work required to change the interior arrangements or other physical characteristics of any existing facility or installed equipment when the cost of the remodeling incident does not exceed $2,000) any building or other facility; or purchase major medical equipment (any item of medical equipment having a unit cost of over $10,000 and used in the diagnosis or treatment of patients, excluding equipment typically used in a laboratory); satisfy any requirement for the expenditure of non-federal funds as a condition for the receipt of Federal funds; or provide financial assistance to any entity other than a public or nonprofit private entity. C. Expenditure and Funding Source Breakdown - For purposes of development, analysis and negotiation activities must be budgeted at the individual expenditure and funding source category level on the Annual Budget for Local Health Services, D. Special Budget Requirements for Certain Categorical Program Elements - The Annual Budget for Local Health Services is completed in the MI E-Grants System through the application budget to include details for all program elements (excluding Administration and Grantee Support), MDHHS1C0-2017 06/21/2016 Page 2 of 37 E Local MCH - Local MCH funds can be used for general Maternal Child Health (MCH) activity. These funds are to be budgeted as a funding source under any of the appropriate program element(s) listed or a locally defined program which is defined in the LMCH Plan. The Local MCH projects need to be budgeted separately: 1 Public Health Functions & Infrastructure-MCH 2. Direct Services Children-MCH 3. Direct Services Women- MCH 4. Enabling Services Children -MCH 5. Enabling Services Women -MCH These funding sources cannot be used under the WIC element except in extreme circumstances where a waiver is requested in advance of expenditures, and evidence is provided that the expenditures satisfy all funding requirements. The MCH activities and strategies should address one or more of the Title V Maternal Child Health Block Grant national/state performance measures and/or a local MCH priority need identified in the community. HI. REIMBURSEMENT CHART A. Program ElementlFunding Source The Program Element/Funding Source column has been moved to Attachment Ill and provides the listing of all currently funded MDHHS programs that are included in the Comprehensive Local Health Department Agreement. B. Type of Project The type of project designation is indicated by footnote and is used if the project meets the Research and Development Project criteria. Research and Development Projects are defined by Title 2 CFR, Section 200.87, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. Research and development (R&D) means all research activities, both basic and applied, and all development activities that are performed by non-Federal entities. Research is defined as a systematic study directed toward fuller scientific knowledge or understanding of the subject studied. The term research also includes activities involving the training of individuals in research techniques where such activities utilize the same facilities as other research and development activities and where such activities are not included in the instruction function. Development is the systematic use of knowledge and understanding gained from research directed toward the production of useful materials, devices, systems, or methods, including design and development of prototypes and processes. C. Reimbursement Chart The Reimbursement Chart notes elements/funding sources, applicable payment methods, target levels, output measures for each program/element having a performance reimbursement option. In addition, the chart also provides the subrecipient, contractor, or recipient designations, as in prior years: IVIDI-11-1S/C0-2017 06/21/2016 Page 3 or 37 IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION PROCEDURES As in past years, no additional accounting system detail is being required beyond local uniform accounting procedures prescribed by the Michigan Department of Treasury, Local Financial Management System requirements, documentation requirements of categorical program funding sources and any local requirements. Some agencies may already have separate cost centers in their accounting system to directly identify costs and related funding of required services, but such breakdowns are not essential to being able to meet minimum reporting requirements if proper allocation procedures are used and adequate documentation is maintained. All allocations must have clearly measurable bases that directly apply to the amounts being allocated, must be documented with work papers that will provide an adequate audit trail and must result in a representative reporting of costs and funding for affected programs. More specific guidance can be found in Title 2 CFR, Part 200 Appendix V State/Local Government and Indian Tribe- Wide Central Service Cost Allocation Plans and the brochure published by the Department of Health and Human Services entitled "A Guide for State, Local and Indian Tribal Governments: Cost Principles and Procedures for Developing Cost Allocation Plans and Indirect Cost Rates for Agreements with the Federal Government. V. FORM PREPARATION - GENERAL The MI E-Grants System on-line application, including the budget entry forms, are utilized to develop a budget summary for each program element administered by the local Grantee. The system is designed to accommodate any number of local program elements including those unique to a particular local Grantee. Applications, including budget forms, are completed for all program elements, regardless of the reimbursement mechanism, including Agency administration(s) fee for service program elements, categorical program elements, performance based program elements and Medicaid Outreach associated program elements. Budget entry is required for each major expenditure and source of fund categories for which costs/funds are identified. VI. FORM PREPARATION - EXPENDITURE CATEGORIES Budgeted expenditures are to be entered for each program element, project or group of services by applicable major category. A. Salaries and Wages- This category includes the compensation budgeted for all permanent and part- time employees on the payroll of the Grantee and assigned directly to the program. This does not include contractual services, professional fees or personnel hired on a private contract basis. Consulting services, vendor services, professional fees or personnel hired on a private contracting basis should be included in "Other Expenses." Contracts with secondary recipient organizations such as cooperating service delivery institutions or delegate agencies should be included in Contractual (Sub-contract) Expenses. B. Fringe Benefits - This category is to include, for at least the specified elements, all Grantee costs for social security, retirement, insurance and other similar benefits for all permanent and part-time employees assigned to the specified elements. C. Cap Exp for Equip & Fac - This category includes expenditures for budgeted stationary and movable equipment used in carrying out the objectives of each program element, project or service group. The cost of a single unit or piece of equipment includes necessary accessories, installation costs, freight and other applicable expenses associated with the purchase of the equipment. Only budgeted equipment items costing $5,000 or more may be reported under this category. Small equipment items costing less than $5,000 are properly classified as Supplies and Materials or Other Expenses. This category also includes capital outlay for purchase or renovation of facilities. 114DFIHS/C0-2017 06/21/2016 Page 4 of 37 D. Contractual (Subcontracts/Subrecipient) - Use for expenditures applicable to written contracts or agreements with secondary recipient organizations such as cooperating service delivery institutions or delegate agencies. Payments to individuals for consulting or contractual services, or for vendor services are to be included under Other Expenses. Specify subcontractor(s) address, amount by subcontractor and total of all subcontractors. E. Supplies and Materials - Use for all consumable items and materials including equipment-type items costing less than $5,000 each. This includes office, printing, janitorial, postage and educational supplies; medical supplies; contraceptives and vaccines; tape and gauze; prescriptions and other appropriate drugs and chemicals. Federal Provided Vaccine Value should be reported and identified on in Other Cost Distributions category. Do not combine with supplies. F. Travel -Travel costs of permanent and part-time employees assigned to each program element. This includes costs of mileage, per diem, lodging, meals, registration fees and other approved travel costs incurred by the employee. Travel of private, non-employee consultants should be reported under Other Expenses. G. Communication Costs -These are costs for telephone, Internet, telegraph, data lines, websites, fax, email, etc., when related directly to the operation of the program element. H. County/City Central Services - These are costs associated with central support activities of the local governing unit allocated to the local health department in accordance with Title 2 CFR, part 200. I. Space Costs - These are costs of building space necessary for the operation of the program. J. All Others (Line 11) - These are costs for all other items purchased exclusively for the operation of the program element and not appropriately included in any of the other categories including items such as repairs, janitorial services, consultant services, vendor services, equipment rental, insurance, Automated Data Processing (ADP) systems, etc. K. Total Direct Expenditures— The MI E-Grants System sums the direct expenditures budgeted for each program element, project or service grouping and records in the Total Direct Expenditure line of the Budget Summary, L. Indirect Cost — These cost categories are used to distribute costs of general administrative operations that have not been directly charged to individual subrecipient programs. The Indirect Cost expenditures distribute administrative overhead costs to each program element, project or service grouping. Two separate local rates may apply to the agreement period (i.e., one for each local fiscal year). Use Calendar Rate 1 to reflect the rate applicable to the first part of the agreement period and Calendar Rate 2 for the rate applicable to the latter part. Indirect costs are not allowed on programs elements designated as vendor relationship An indirect rate proposal and related supporting documentation must be retained for audit in accordance with records retention requirements. In addition, these documents are reviewed as part of the Single Audit, subrecipient monitoring visit, or other State of Michigan reviews. Following is further clarification regarding indirect rate and/or cost allocation approval requirements to distribute administrative overhead costs, in accordance with Title 2 CFR Part 200 (formerly Circular A- 87 2 CFR Part 225, Appendix E), for Local Health Departments budgeting indirect costs: 1. Local Health Departments receiving more than $35 million in direct Federal awards are required to have an approved indirect cost rate from a Federal Cognizant Agency. If your Local Health Department has received an approved indirect rate from a Federal Cognizant agency, attach the Federal approval letter to your ML E-Grants Grantee Profile. 2. Local Health Departments receiving $35 million or less in direct Federal awards are required to prepare indirect cost rate proposals in accordance with Title 2 CFR and maintain the documentation on file subject to review. MDHHS/C0-2017 06/21/2016 Page 5 of 37 3. Local Health Departments that received approved indirect cost rates from another State of Michigan Department should attach their State approval letter to their MI E-Grants Grantee Profile. 4. Local Health Departments with cost allocation plans should reflect these allocations in the Other Cost Distributions budget category. See Section M. Other Cost Distribution for budgeting guidance. 5. As a Subrecipient of federal funds from MDHHS, a Local Health Department that has never received a negotiated indirect cost rate, your Local Health Department may elect to charge a de minimis rate of 10% of modified total direct costs (MTDC) based on Title 2 CFR part 200 requirements. MTDC includes all direct salaries and wages, fringe benefits, supplies and materials, travel, services, and contractual expenses up to the first $25,000 of each contract. MTDC excludes all equipment, capital expenditures, charges for patient care, rental costs, tuition remission, scholarships and fellowships, participant support costs, and portions subcontractual/subaward expenses in excess of $25,000 per contract. Attach a current copy of the letter stating the applicable indirect costs rate or calculation information justifying the de minimis rate calculation to you MI E-Grants Grantee profile, Detail on how the indirect costs was calculated must be shown on the Budget Detail Schedule. The amount of Indirect Cost should be allocated to all appropriate program elements with the total equivalent amount reflected as a credit or minus in the Administration projects. M. Other Cost Distributions — Use to distribute various contributing activity costs to appropriate program areas based upon activity counts, time study supporting data or other reasonable and equitable means. An example of Other Cost Distributions is nursing supervision. The distribution process permits costs reflected in a single program element to be subsequently distributed, perhaps only in part, to other programs or projects as appropriate. If an allocation is made, the charges must be reflected in the appropriate program element and the offsetting credit reflected in the program element being distributed. There must be a documented, well-defined rationale and audit trail for any cost distribution or allocation based upon Title 2 CFR, Part 200 Cost Principles Local Health Departments using the cost distribution or cost allocation must develop the plan in accordance with the requirements described in Title 2 CFR, Part 200. Local Health Departments should maintain supporting documentation for audit in accordance with record retention requirements. The plan should include a Certification of Cost Allocation plan in accordance with Title 2 CFR, Part 200 Appendix V. The cost allocation plan documentation is not required to be submitted unless specifically requested. Cost associated with the Essential Local Public Health Services (ELPHS), Maternal and Child Health (MCH) Block Grant and Fixed Fee may be budgeted in the associated program element and distributed to the associated projects. Federal Provided Vaccine Value should be reported on a separate line and clearly identified. N. Total Direct & Admin. Expenditures — The MI E-Grants System sums the indirect expenditures program element and records in the Total Indirect Expenditure line of the Budget Summary. 0. Total Expenditures — The MI E-Grants System sums the direct and indirect expenditures and records in the Total Expenditure line of the Budget Summary. MDHHS/C0-2017 06/21/2016 Page 6 of 37 VII. FORM PREPARATION - SOURCE OF FUNDS Source of Funds are to be entered for each program element, project or group of services by applicable major category as follows: A. Fees & Collections - Fees 1 8t & 2nd Party- 1st party funds projected to be received from private payers, including patients, source users and any member of the general population receiving services. i . 2nd party funds received from organizations, private or public, who might reimburse services for a group or under a special plan. iii. Any Other Collections B. Fees & Collections _ 3rd Party — 3rd Party Fees - Funds projected to be received from private insurance, Medicaid, Medicare or other applicable titles of the Social Security Act directly related to the cost of providing patient care or other services (e.g., includes Early Periodic Screening, Detection and Treatment [EPSDT] Screening, Family Planning.) C. Federal/State Funding (Non-MDHHS) - Funds received directly from the federal government and from any state Contractor other than MDHHS, such as the Department of Natural Resources and Environment (MDNRE). This line should also be used to exclude state aid funds such as those provided through the Michigan Department of Treasury under P.A. 264 of 1987 (cigarette tax). D. Federal Cost Based Reimbursement — Funds received for Federal Cost Based Reimbursement which should be budgeted in the program in which they were earned. E. Federally Provided Vaccines — The projected value of federally provided vaccine. F. Federal Medicaid Outreach — (Please note: to be used only for Medicaid Outreach, CSHCS Medicaid Outreach or Nurse Family Partnership Medicaid Outreach program elements.) Funds projected to be received from the federal government for allowable Medicaid Outreach activities. This amount represents the anticipated 50% federal administrative match of local contributions. G. Required Match - Local — Funds projected to be local contribution for programs that have a match contribution requirement (Please note: for Medicaid Outreach, CSHCS Medicaid Outreach, or Nurse Family Partnership Medicaid Outreach, this amount represents the 50% matching local contribution for allocable Medicaid Outreach Activities. Federal Medicaid Outreach and Required Local match amounts should equal each other.) H. Local Non-ELPHS - Local funds budgeted for the following expenditures: 1. Expenditures for services not designated as required and allowable for ELPHS funding (e.g., medical examiner and inpatient maternity services); expenditures determined not to be reasonable; and, expenditures in excess of the maximum state share of funds available. 2. Any losses arising from uncollectible accounts and other related claims. Under-recovery of reimbursable expenditures from, or failure to bill, available funding sources that would otherwise result in exclusions from ELPHS funding, if recovered. However, no exclusion is required where the local jurisdiction has made and documented a decision to have local funds underwrite: a. The cost of uncollectible accounts or bad debts incurred in support of providing required or allowable health services. An example of this condition would be for services provided to indigents who are billed as a matter of procedure with little chance for receipt of payment. b. Potential recoveries or under-recoveries from other sources for the principal purpose of MDHHS/C0-2017 06121/2016 Page 7 of 37 providing required and allowable health services at free or reduced cost to the public served by the Grantee. An example would be keeping fees for services at a reduced level for the benefit of the people served by the Grantee while recognizing that to do so limits recovery from third parties for the same types of services. 3. Contributions to a contingency reserve or any similar provisions for unforeseen events. 4. Charitable contributions and donations. 5. Salaries and other incidental expenditures of the chief executive of a political subdivision (i.e., county executive and mayor). 6. Legislative expenditures; such as, salaries and other incidental expenditures of local governing bodies (i.e., county commissioners and city councils). Do not enter board of health expenses. 7. Expenditures for amusements, social activities and other incidental expenditures related thereto; such as, meals, beverages, lodging, rentals, transportation and gratuities. 8. Fines, penalties and interest on borrowings. 9. Capital Expenditures - Local capital outlay for purchase of facilities and equipment (assets) are excluded from ELPHS funding. I. Other Non- ELPHS - Funds budgeted from sources other than state, federal and local appropriations to the extent that they are not eligible for ELPHS (e.g., funding from local substance abuse coordinating grantee, local area on aging grantees). J. MDHHS - NON-COMPREHENSIVE - Funds budgeted for services provided under separate MDHHS agreements. Examples include: funding provided directly by the Community Services for Substance Abuse for community grants, etc. K. MDHHS - COMPREHENSIVE - This section includes all funding projected to be due under the Comprehensive Agreement from categorical programs and needs to equal the allocation. L. ELPHS - MDHHS Hearing — This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS MDHHS Hearing program and has to equal the MDHHS ELPHS Hearing allocation. Additional ELPHS to be budgeted for the Hearing Program must be entered into ELPHS — MDHHS Other. Hearing allocations may only be spent on the Hearing Program. M. ELPHS MDHHS Vision — This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS MDHHS Vision program and has to equal the ELPHS MDHHS Vision allocation. Additional ELPHS to be budgeted for the Vision Program must be entered into ELPHS — MDHHS Other. Vision allocations may only be spent on the Vision Program. N. ELPHS MDHHS Other— This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS MDH HS Other program for eligible program elements. Please note: The MI E-Grants System validates the ELPHS MDHHS Other budgeted funds across the applicable program elements to assure the agreement does exceed the ELPHS — MDHHS Other allocation. 0. ELPHS — Food This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS Food program and has to equal the ELPHS Food allocation. P. ELPHS — Drinking Water - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS Drinking Water program and has to equal the ELPHS Drinking Water allocation. Q. ELPHS — On-site Sewage - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS On-site Sewage program and has to equal the ELPHS On-site Sewage allocation, MDHHS/CO-2017 06/21/2016 Page 8 of 37 R. MCH Funding - This section includes all funding projected to be due under Comprehensive Agreement specific to the MCH eligible program elements. Please note: The MI E-Grants System validates the MCH budgeted funds across applicable program elements to assure the agreement does exceed the MCH allocation. S. Local Funds - Other - Enter all local support in the appropriate element, project or service group column. This may include local property tax, and other local revenues (does not include fees). T. Inkind Match — Enter Local Support from donated time or services. U. MDHHS Fixed Unit Rate — Select the type of fee-for-services from the lookup to correspond with the program element. VIII. SPECIAL BUDGET INSTRUCTIONS Certain elements are supported by federal or other categorical program funds for which special budgeting requirements are placed upon grantees and subgrantees. These include: Element Federal or Other Funding Contractor Public Health Emergency Preparedness U.S. Department of Health & Human Services, Centers for Disease Control WIC US. Department of Agriculture, Food & Nutrition Service Family Planning U.S. Department of Health & Human Services, Public Health Service Breast and Cervical Cancer U.S. Department of Health & Human Services, Centers for Disease Control CSHCS Outreach & Advocacy Michigan Department of Health & Human Services Medicaid Outreach Activities Centers for Medicare and Medicaid Services In general, subgrantee budgets must provide sufficient budget detail to support grantee budget requests and be in a format consistent with grantor Contractor requirements. Certain types of costs must receive approval of the federal grantor Contractor and/or the grantee prior to being incurred. A. Public Health Emergency Preparedness (PHEP) Special Budget Requirements Local Health Departments will receive the initial FY 16/17 allocation of the CDC Public Health Emergency Preparedness (PHEP) funds in nine equal prepayments for the period October 1, 2016 through June 30, 2017. LHDs must submit a nine-month budget and a quarterly Financial Status Report (FSR) for each of the following COMPREHENSIVE Local Health Department program elements: 1. Public Health Emergency Preparedness (PHEP) (October 1, 2016 — June 30, 2017) 2. Public Health Emergency Preparedness (PHEP)— Cities of Readiness (October 1, 2016—June 30, 2017) 3. Laboratory Services - Bioterrorism (October 1, 2016 — September 30, 2017) MDHHS/C0-2017 06/21/2016 Page 9 of 37 B. WIC Special Budget Requirements 1. Cost/Funding Categories - The following local budget breakdowns are required to fulfill WIC grant application budget requirements each fiscal year: Salaries & Fringe Benefits Automated Management Systems Space Utilization Costs Equipment Supplies Communications & Travel All Other Direct Costs Indirect Costs All Funding Sources by Type The WIC cost/funding categories and supporting budget detail requirements are satisfied by completion of an application budget form in the MI E-Grants System. General instructions for these forms are contained at the end of this section. Agencies receiving WIC-USDA Infrastructure grants must budget these funds as a separate element. Agencies must track and report expenditures separately on the FSR. Agencies receiving WIC-USDA Breastfeeding Peer Counselor funds must budget these funds as a separate element. Agencies must track and report expenditures separately on the FSR. And comply with special reporting requirements. 2. Costs Allowable Only With Prior Approval - The following costs are allowable only with prior review/approval of the Michigan Department of Health & Human Services as specified by the U.S. Department of Agriculture, Food and Nutrition Service (Ref.: 7 CFR Part 246, and USDA- WIC Administrative Cost Handbook 3/86). Prior approval is accomplished by providing appropriate detail in the budget request approved by MDHHS or subsequently in a written request approved in writing by MDHHS. A. Automated Information Systems -which are required by a local Grantees except for those used in general management and payroll, including acquisition of automated data processing hardware or software whether by outright purchase or rental-purchase agreement or other method of acquisition. B. Capital Expenditures of $2,500 or More - such as the cost of facilities, equipment, including medical equipment, other capital assets and any repairs that materially increase the value or useful life of capital assets. C. Management Studies - performed by agencies or departments other than the local Grantee or those performed by outside consultants under contract with the local Grantee. D. Accounting and Auditing Services - performed by private sector firms under professional service contracts for purposes of preparation or audit of program and financial records/reports. E. Other Professional Services - rendered by individuals or organizations, not a part of the local Grantee, such as: 1. Contractual private physician providing certification data. 2. Contractual organization providing laboratory data. 3. Contractual translators and interpreters at the local Grantee level. MD-HS/CO-2017 06/21/2016 Page 10 of 37 F. Training and Education - provided for employee development, which directly or indirectly benefits the grant program, to the extent that such training is contracted for or involves out-of-service training over extended periods of time. G. Building Space and Related Facilities - the cost to buy, lease or rent space in privately or publicly owned buildings for the benefit of the program. H. Non-Fringe Insurance and Indemnification Costs All charges to WIC must be necessary, reasonable, allowable and allocable for the proper and efficient administration of the program. Further information and cost standards are provided in federal instructions including Title 2 CFR, Part 200 and 7 CFR Part 3015. C. Family Planning Special Budget Requirements 1. Cost/Funding Categories - The following local budget breakdowns are required to fulfill Family Planning grant application budget requirements each fiscal year: Salaries & Wages Fringe Benefits Travel Equipment Supplies Contractual Construction All Other Direct Costs Indirect Costs All Funding Sources by Type The Family Planning cost/funding categories and supporting budget detail requirements are satisfied by completion of an application budget in the MI E-Grants System. General instructions for these forms are contained at the end of this section. 2. Costs Allowable Only With Prior Approval - The following costs are allowable only with prior review/approval of MDHHS. Prior approval is accomplished by providing appropriate detail in the budget request approved by MDHHS or subsequently in a written request approved in writing by MDH HS. A. Alterations and Renovations - to change the interior arrangements or other physical characteristics of existing facilities or installed equipment, to the extent that such changes cost more than $1,000 each. B. Audiovisual Materials and Activities - acquired, produced, presented, or disseminated to the general public. C. Consultant Contracts for General Support Services - including equipment and supplies, that will cost in excess of $25,000 or 10% of the total direct cost budget (whichever is greater). D. Equipment - including general purpose and special equipment (e.g., air conditioning) costing $5,000 or more m- unit. E. Insurance - contributions to a reserve for a self-insurance program, F. Public information Service Costs — for the cost of providing public information services. G. Publication and PrintinckCosts - for the cost of publications. H. Capital Expenditures - for land or buildings. I. Indemnification Against Third Parties Costs - insurance against potential liabilities. MDHHS/C0-2017 06/21/2016 Page 11 01 37 J. Mass Severance Pay - involving grant-supported personnel. K. Organization/Reorganization Costs - allocable to the program. L. Overtime Premium - involving grant-supported personnel. M. Patient Care Costs - rebudgeting out of or reduction in patient care costs (considered a change in scope). N. Professional Services - in connection with Patent/Copyright Infringement Litigation. 0. Trailers or Modular Units — for costs of trailers and modular units. P. Transfers Between Construction and Nonconstruction - for approved construction funds. Q. Transfers Between Indirect and Direct Costs - for amounts awarded for indirect costs to absorb increases in direct costs. R. Transfers for Substantive Programmatic Work - to a third party, by contracting, or any other means used for the actual performance of substantive programmatic work. All charges to Family Planning must be necessary, reasonable, allowable, and allocable, for the proper and efficient administration of the program. Further information and cost standards are provided in federal instructions including 2 CFR, Part 225 (OMB Circular A-87), A-102 Common Rule and 2 CFR, Part 215 (OMB Circular A-110) D. Breast and Cervical Cancer Control Coordination Program Special Budget Requirements 1. The Breast and Cervical Cancer Control Navigation Program (BCCCNP) budget is to be developed in the following way: BCCCNP Coordination should be used to budget costs associated with coordination of the program in assuring implementation of all minimum program requirements and policies and procedures. . Only coordination expenses will be reimbursed through the Comprehensive Agreement. All Direct Service claims, including MTA Navigation Services and Navigation- Only Services, must be billed to the MDHHS Cancer Prevention and Control Section for claim processing. The Local Coordinating Agency (LCA) and/or direct service providers with contracts or letters of agreement with the LCA will be responsible for billing Direct Service claims to the MDHHS Cancer Prevention and Control Section. No Direct Services or MTA Navigation or Navigation-Only Service expenses will be reimbursed through the Comprehensive Agreement. The Coordination amount $175 per woman based on a target caseload established by MDHHS. Performance reimbursement will be based upon the understanding that a certain level of performance (measured by adherence to program minimum performance requirements) must be met. There is a 97% performance requirement for this program. There is no longer a match requirement. Match is recorded by the program and reported to MDHHS. For specific billing requirements refer to the most recent BCCCNP Billing Manual. For specific program requirements, including current fiscal year Direct Service Reimbursement Rates and documentation related to the match requirement, refer to the current fiscal year Special Budgeting and Other Program Instructions for the BCCCNP issued in August of each fiscal year. The above referenced documents are available at www.michioancancer.orq/BCCCNP. MDHHS/C0-2017 06/2112016 Page 12 of 37 2. The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) budget is to be developed in the following way: WISEWOMAN Coordination and Screening should be used to budget costs associated with coordination of the program and delivery of the initial screening and risk reduction counseling to WISEWOMAN participants. This includes administration and interpretation of health risk instrument, WISEWOMAN screening services (height, weight, body mass index, 2 blood pressure readings, total cholesterol, HDL cholesterol, and glucose or Al C), and delivery of risk reduction counseling. All Direct Service claims must be billed to the MDHHS Cancer Prevention and Control Section for claim processing. The Local Coordinating Agency (LCA) and/or direct service providers with contracts or letters of agreements with the LCA will be responsible for billing Direct Service claims to the MDHHS Cancer Prevention and Control Section. This includes follow-up fasting lipid panel, fasting glucose, Al c, and one diagnostic exam. No Direct Services expenses will be reimbursed through the Comprehensive Agreement. The Coordination and Screening amount is $150 per woman based on a target caseload established by MDHHS. Performance reimbursement will be based upon the understanding that a certain level of performance (measured by outputs) must be met. There is a 95% caseload performance requirement for this project. For specific billing requirements refer to the most recent Billing Manual. For specific program requirements, including current fiscal year Direct Service Reimbursement rates and documentation related to the match requirement, refer to the current fiscal year Special Budgeting and other Program instructions for the WlSEWOMAN Program issued in August of each fiscal year. The above referenced documents are available at www.michigan.goy/cancer. E. Children's Special Health Care Services (CSHCS) Outreach and Advocacy - The program element, titled CSHCS Outreach and Advocacy should be used to budget costs associated with this program. I. Program Budget - Online Detail Budget Application Entry Complete the appropriate budget forms contained within the MI E-Grants System for each program element. An example of this form is attached (see Attachment 1 for reference). 1. Salary and Wages - a. Position Description - Select from the expenditure row look-up all position titles or job descriptions required to staff the program. If the position is missing from the list, please use Other and type in the position in the drop down field provided. b. Positions Required - Enter the number of positions required for the program corresponding to the specific position title or description. This entry may be expressed as a decimal (e.g., Full-Time Equivalent — FTE) when necessary. If other than a full-time position is budgeted, it is necessary to have a basis in terms of time reports to support time charged to the program. MDHHS/CO-2017 06/21/2016 Page 13 of 37 c. Amount — The MI E-Grants System calculates the salary for the position required and records it on the Budget Detail. Enter this amount in the Amount column. d. Total Salary —The MI E-Grants System totals the amount of all positions required and records it on the Budget Summary. e. Notes - Enter any explanatory information that is necessary for the position description. Include an explanation of the computation of Total Salary in those instances when the computation is not straightforward (i.e., if the employee is limited term and/or does not receive fringe benefits). 2. Fringe Benefits — Select from the expenditure row look-up applicable fringe benefits for staff working in this program. Enter the percentage for each. The MI E-Grants system updates the total amount for salary and wages in the unit field and calculates the fringe benefit amount. If the "Composite Rate" fringe benefit item is selected from the expenditure row look up, record the applicable fringe benefit items (i.e. FICA, Life insurance, etc.) in the "Notes" tab. 3. Equipment - Enter a description of the equipment being purchased (including number of units and the unit value), the total by type of equipment and total of all equipment purchases. 4. Contractual - Specify subcontractor(s)/subrecipient(s) working on this program, including the subcontractor's/subrecipient's address, amount by subcontractor/subrecipient and total of all subcontractor(s)/subrecipient(s). Multiple small subcontracts can be grouped (e.g., various worksite subcontracts), 5. Supplies and Materials - Enter amount by category. A description is required if the budget category exceeds 10% of total expenditures. 6. Travel - Enter amount by category. A description is required if the budget category exceeds 10% of total expenditures. 7. Communication - Enter amount by category. A description is required if the budget category exceeds 10% of total expenditures. 8. County-City Central Services - Enter amount by category and total for all categories. 9. Space Costs - Enter amount by category and total for all categories. 10. Other Expenses - Enter amount by category and total for all categories. A description is required if the budget category exceeds 10% of total expenditures. 11. Indirect Cost Calculation - Enter the base(s), rate(s) and amount(s). 12. Other Cost Distributions - Enter a description of the cost, percent distributed to this program and the amount distributed. 13. Total Exp. - Ml E-grants totals the amount of all positions required and records it on the Budget Summary, MDHHS/C0-2017 06/21/2016 Page 14 of 37 F. Program Budget-Cost Detail Schedule Preparation B1 Attachment B1-Program Budget Summary 5 Application :&fl ABC Health Denetinnera , I I Apelinattsi Ferrily Planning Services SAMPLE Fat., s',10(1. • . i it141.i.cm • • fluilga I • ,ittnf.6 tp4u a • .7 :1 171E:22_..Hj 102,7. rt,a1 (gififri IffiT9, 'Budget Summary &low Documents 7X. Close 0 Program Eases Salary & Wegee Fringe Benefits Cop. Exp. itiv Eqoip & For. Cootraclual Sapplies and Materials Tta,vel Communication County-City Central Services Space Usts Alt Others (ADO:. Con.„Employeea_ rOltd !).1•14...r -Exf..T! • • wroct costs mfirect Costs 10tI•er Costs Distributions h-titatit41.1:6Ct Gists : I 7070k INDiREC.r EY, PeggS. 83A19,00 23275 GU!: ..11 -11-11 tat,' 16.6.5-23.00i 232.75.0li 3340.00I 7,262.00! o3o; anail coq 29,445,00; 2,6850311 31,06601 . . - . ........... 196,613.00 29,405-.U0 1,68 6.00 0,00: • • 30 ba: 6.66!1 a GO Xr.• • • M01-11-1S/C0-2017 06/2112016 Page 15 of 37 Agency AOC Health Department 400c3li00 Family Planning Sao/ices arolioLE Rowell Comprehensive AgreOrnenl - FY 20)0< Show Documents II nsnr.f:.:-.01110151100..s... • . Bodont. mitc:#9-..*0.p. 44634; am: 0.00• Fl 60.oil fq 0.00:1 0 !0.00000.-1 :0•.- .F1; Fl 6.641 j .j'ef •Eg .0=Er r j cops/ 132271_,„law Tr, op I -spotd prFOcis. 1161AL EXPEIllatRIFIEt 6,61 NUMISTSEIMI Sourrg of onds Feria. and C.011ecilons lot and Znd P.Ortir Fees and Collections - 3o1 Early Federal oiStote (Nen-MOGI-0 . Federal C.oxt Has e d Reimbursement redertalty.PravidedVcc-inos edejal It 00010 Ourseach fieged - Lecl Local NOWELPHS • 0.50 0.01:1; 0.00: aGG 0.00 000: 0061: . 01 6:ad 6.7o6ji 'Dia; 0.00: G661 H • "6.&! [1: 1 --- 60 r: i-J:66! 4400000! 44,000.00'd PI 0.00!! 00 Goe 000 6.0d; SI b:ool Source of Funds Laval Non-ELPHS. Othsc-CLPH MUCH Non CompronenOrve Mocil Camprerienalv. ELPHS— RON Hearing ELP.HS ELPHS —7c4DCH Other ELPFiS —DrInIOng Water ELPHO.:— Orii:Site'etoiage rOCH Fi1e000 Local fonds.- thOr Unkind Match MUCH Fixed lodE!ate MDHHS/C0-2017 06/21/2016 Page 16 of 37 f rri i i I --"TrTiiTI 117.07F,P-11 Bridget Detail . . :Category: :prep.i'afp:Eiinemea Cap. OP UK Eglifp ,i Far Tor.- :ELiNiiiiiill.the . .. .. ...... ... „...... zia-Peiecatio 6elll...:. . I i .• SO TA-. is; :flirett. • . -- .......... ..- Inoiuditms.:' ;E41.e.,.qtrrNI Is defeedaa the teat of • sidOs ?tete valued al esme- it more and eth a usefu l life of mere alma are year Coale should kande the dem ade soy MI' ea* a-remises a uch as installatun costa maintenance fete, stc, items es atm c less Oen 55,0de snout!" he entered Into the supplies and materials fee 1 El OL 1K. '5how treat Bodget DetA% _ . . Category iProgrefn 5,1p Type: :011 hnriltur Ctaetifrcatioo geq.: 3012 type 1. Narrative .: EGrAMS Application 'AMMtelMTgagaglifflEiMEN4-ad [ : Menai A3C Heath Department : Mak:aeon : F am Ily PI annIng 9 e Mces SAMPLE aqq-itn::: cenqtleayona. i Budget 1 ta*.ag!,!.: o grarn : Comprehensive Agreement - 03 )c< !mac 5,are 1,01 ValidaM LE piEj [RI 1314get Detail . r'81reitOri: 1..0.grir'PPen•F• Sal &eedilcs Ciasa•ietation Secp: 51" .... . _ .. . .. Type : ExpendRure ... . Sae Type - J:irPet 1.'4 show Tref? j () (i) Narrative: teetuctiorre Ms. Saintly Iterate as Iterate opal per Frr 411..,itorsepracilficiriF O It pubticHealimihrse gig00 000tIFTE 1=le32.430i!FTE 6.4/ 5103.5 000!IFTE i.Oej .202a.:24c1FTE ley?-si pc: oci[ Ott ODD: a] g0.e2,00: 210,02:j.0• 0 MI Type : ;Expencillpre .......-... ......... Sub Type: !Direct Narrative :, ST,1 B2 Attachment B2-Program Budget Cost Detail Piailuctierie Contractual aefers.te seco.ieary reCipeS n rsontiodun a only. Pleas-t 'a:flier Me rade a:t R.fl rnellue CanairheiltS arid se pod rliny ser,ce soleoltraels ancold he tudoot.-tt under dm ether exam. fine. immErre 1-i-rvaikaat9:1ET-777:1 fp-7pi-71—0114-T3iiril 1 •...euptett.elai , . .. : ] C.atuUOY ' 1:1'1..P.9fPti!...P.F.Rq.F...7...!!.P1!?./.!0P....r. l'°.1.0a18: . 1 Classification Sel-.7 Ii el ; Lev :: CT) Line tern ()Category : I IniirOcuons -. ':Itemis that cost -lose Chao a-S,010.. i • • loa.acq101.00:1 '7.00.66 70000 971 ti •CON h MDHHS/C0-2017 06/21/2016 Page 17 of 37 a. El It ',Printing in Saved .13ttriget 14etall Category ilicaOn Seq:1 loStniction; 1111=113111110101111111111001111111.1 !a: 3.0.064 31.100.0e !;13: '&40.03 5 x :Waage 'type : Ibrperrditure +.tA Type ". LPfie'ri goregXern'EXpenses -TreVel -Level : tine Itern 0 Category 1. *.t it valtdo7d .PetegOi.: dasSfrloation Sag ;Pi--eorti, bp p Egvoll (§,;-}iJne Item 0 Category ',Expenditure Sirb Imo • 'Direct Inrcilens : t phones and IT lines Validate PDF Copy EStegory: 1Prograrn Expenses -rouet CoyCnnynI cr ass Itiogron -g eq. 1 Leve: Line Hem ØCnegnin Sub Type: :13$rt — . . • —77:7=7'177.7—:77-M.T7=7.7.7.7=1-f===t',7: tristructiene I ell.S.g ra...t. TA. Vailt-Uala titud5tet Delelt dateglby. F:,ro,gram Expensee -41 COyflOd (ADP, Con: Finployeas, Mis4 gla-seltioation aeg. Lewel r.;..) Li ne Item °Category ingructiong.: 101111 I3upporling SerAces 0 X El X 1.112Lave.r>, ffg validaloj L.LL Budfjet Data , Category I In-v1i;G nla-IndirectCest0 Lab Fees 2,-270.15;' 0.€10 0.00i 3110.00:' 0.00! I0 I -Inn no! ..n tp r!r:rft 1_51,15=,1 ry.pe lExpenditure Sitti Toe tirtiOrect Nanative :. lype . Expenditure Sub Type Direct MOM Rent tOther MDHHS/CO-2017 06/21/2016 Page 18 of 37 .*iroe 11!Isfj. Lr irrr. o l poF : EraOgatarilall: rCelerierY:irnir t usOther Coralabiertaltiritraria Eh' Show 'tree (1) Dee:: tam 'Claestackan Irreauctionsi Sub Type: Wired Narrative : 111111=111111111=111011111MIMI11111=1 ,a1.;,-sing.Adrnoistributcr, : 1111=11==.1111== 1,685.W11,•85.00; a6} Tot MDHFIS/C0-2017 06/21/2016 Page 19 of 37 G. Medicaid Outreach Activities Reimbursement Procedures Medicaid Outreach Activities that are funded by local dollars and meet federal requirements are eligible for reimbursement at a 50% federal administrative match rate. Local Health Departments must maintain proper documentation of the activities performed and those activities must conform with the activities outlined in MSA Bulletin 05-29. Medicaid Outreach Activities funding is a subrecipient relationship. I. Budget Preparation A. Medicaid Outreach Activities Complete the MI E-Grants application and budget forms for the application Medicaid Outreach Activities that occur during the fiscal year: 10/1/xx-09/30/xx. Reimbursable activities included in the budget must conform to the requirements as specified in the MSA Bulletin 05-29. Complete the MI E-Grants application and budget forms for this program. 1 Expenditure Category Tab Enter the expenditures budgeted for the fiscal year: 10/01/xx-09130/xx, Expenses budgeted for each of the listed expenditure categories are allowable and must be specific to the Medicaid program as described in MSA Bulletin 05-29. Outreach activities must not be part of direct service. Expenditures must be reflected in the cost allocation plan. 2. Source of Funds Tab Budget the amount expected from the federal government for allowable Medicaid Outreach Activities. Federal Medicaid Outreach represents the anticipated 50% federal administrative match of local contributions. Budget the local contribution. Required Match - Local represents the 50% matching local contribution for Medicaid Outreach activities. These two amounts must match. 3. Sources of Local Funds Types Local Health Departments may utilize their county appropriation, funds received from local or private foundations, local contributors or donators, and from other non- state/non-federal grant agreements that are specific to Medicaid outreach or are to be used at the discretion of the Health Department as a source for matching funds. Other state and/or federal grant awards for Medicaid Outreach must be recorded on the appropriate line as indicated in the Comprehensive Budget Instructions - Attachment I. (Please specify the source of funds as shown in the example.) B. Nurse-Family Partnership Outreach (applicable only for Berrien, Calhoun, Ingham, Kalamazoo, Kent, Oakland, and Saginaw) Complete the MI E-Grants application and budget forms for the application titled Nurse- Family Partnership Medicaid Outreach for the timeframe: 10/01/xx-09/30/xx. Complete the MI E-Grants application and budget forms for this program. Expenditures related to Nurse-Family Partnership Medicaid Outreach should be reflected under one program element and adhere to Section VIII, Special Budget Instructions section found in the Comprehensive Budget Instructions - Attachment I, The budget should reflect the entire fiscal year period: 10/1/xx-09/30hoc. MDHHS/CO-2017 06121/2016 Page 20 of 37 1. Federal Medicaid Outreach Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the LHD Nurse-Family Partnership program has been applied. The formula for calculating the federal funding is as follows: Federal funding = (Local funds x % of Medicaid Participation Rate) x 50% Federal Administrative Match rate) 2. Required Match - Local Represents the 50% match of local contributions. Budget the local match contribution in Required Match — Local. Federal Medicaid Outreach and Required Match — Local must equal each other. Additional local contribution related to service provision for non-Medicaid eligible participants which are not eligible for the 50% federal match should be reported in Local Funds — Other. 3. Sources of Local Fund Types Local Health Departments may utilize their county appropriation, funds received from local or private foundations, local contributors or donators, and from other non- state/non-federal grant agreements that are specific to Medicaid Outreach or are to be used at the discretion of the Health Department as a source for matching funds. C. CSHCS Medicaid Outreach Complete the MI E-Grants application and budget forms for the application titled CSHCS Medicaid Outreach for the timeframe: 10/01/xx-09/30/xx, Expenditures related to CSHCS Medicaid Outreach should be reflected under one program element and adhere to Section IV, Special Instruction Section found in the Comprehensive Budget Instructions - Attachment I. The budget should reflect the entire fiscal year period: 10/1 /xx-091301xoc 1. Federal Medicaid Outreach Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the LHD CSHCS program has been applied. A table containing each health jurisdiction Medicaid Participation Rate is located in the MI E-Grants site. The formula for calculating the federal funding is as follows: Federal funding = (Local funds x % of Medicaid Participation Rate) x 50% Federal Administrative Match rate) 2. Required Match - Local Represents the 50% match of local contributions. Budget the local match contribution. Federal Medicaid Outreach and Required Match — Local must equal each other. Additional local contribution that is not eligible for the 50% federal match should be reported on the Local Funds — Other line. 3. Sources of Local Fund Types Local Health Departments may utilize their county appropriation, funds received from local or private foundations, local contributors or donators, and from other non- state/non-federal grant agreements that are specific to Medicaid Outreach or are to be used at the discretion of the health department as a source for matching funds. MDHHS/C0-2017 06/21/2016 Page 21 of 37 4. Comprehensive CSHCS Outreach and Advocacy and Case Manaqement/Care Coordination Funds Should be reported in a separate program element. D. Cost Distributions Record costs distributions in the Indirect Costs — Other Costs Distribution on the Application budget if costs associated with allowable Medicaid Outreach activities conducted in other Comprehensive programs (i.e., WIC, Family Planning, Immunization, etc.) are to be distributed. This may require a budget modification in the related program(s) to reflect the cost distribution movement. E. Cost Allocation Certification This certification remains on file with the Department until no longer valid (see Sample 2). Any changes in the Cost Allocation Plan (See Sample 3) requires the Cost Allocation certification to be updated. F. Cost Allocation Plan for Medicaid Outreach Activities A cost allocation plan is a way to identify costs associated with providing Medicaid Outreach, The plan includes both direct and indirect costs. The plan should describe how costs are determined and allocated or distributed to assure the costs are being assigned to the correct program. The cost allocation plan should also identify any non-reimbursable costs. Cost allocation plans are a requirement for receiving federal awards. The agency must retain a copy on file and make available for review upon request. (Sample 2) For FY 2017, LHDs must submit a copy of their cost allocation plan with the budget request only if there is a change from the previous year. The allocation plan is to be attached to an expenditure line on the Medicaid Outreach budget. Financial Status Report (FSR) — LHDs seeking 50% federal administrative match should request reimbursement by submitting their actual expenses for allowable Medicaid Outreach activities on their quarterly FSRs through Ml E-Grants. A. Medicaid Outreach Activities For Quarters 1-3, LHDs must reflect the actual Medicaid Outreach expenses incurred in a separate program element titled Medicaid Outreach. Actual expenses incurred for each of the listed expenditure categories are allowable, but must be specific to Medicaid Outreach as defined by the MSA Bulletin 05-29 and not part of a direct service. Expenses should be supported by an approved methodology and appropriate support documentation. 1. Federal Medicaid Outreach Should be used to request the 50% federal administrative match for Medicaid Outreach. 2. Required Match - Local Should be used to report the remaining portion of the local contribution of the Medicaid Outreach Match. Both amounts should equal. MDHHS/C0-2017 06/21/2016 Page 22 of 37 3. Source of Funds Category Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDHHS grants, etc.) should be reported on the appropriate line has indicated in the Comprehensive Budget Instructions - Attachment I (e.g., Local non-ELPHS or Local Funds — Other). Total Source of Funds must equal Total Expenditures. B. Nurse-Family Partnership Medicaid Outreach — Quarterly and Final FSRs For Quarters 1-3, LHDs must reflect the actual Medicaid Outreach expenses incurred in a separate program element titled Medicaid Outreach. Actual expenses incurred for each of the listed expenditure categories are allowable, but must be specific to Medicaid Outreach as defined by MSA Bulletin 05-29 and not part of a direct service. Expenses should be supported by a time study or other federally approved methodology. 1. Federal Medicaid Outreach Should be used to request the 50% federal administrative match. Match is determined by multiplying local contribution for the program by the percentage of Medicaid enrollees. This product is then multiplied by 50% in order to determine the eligible federal administrative match. 2. Required Match - Local Should be used to report the remaining portion of the local contribution for the Medicaid Outreach Match. Both lines should equal. Additional local contribution related to service provision for non-Medicaid eligible participants which are not eligible for the 50% federal match should be reported in Local Funds • Other. 3. Source of Funds Category Other source of funds that are non-reimbursable for Medicaid Outreach (i,e., other federal grants, other MDHHS grants, etc.) should be reported on the appropriate line has indicated in the Comprehensive Budget Instructions - Attachment I (e.g., Local non-ELPHS or Local Funds — Other), C. CSHCS Medicaid Outreach — Final FSR CSHCS Medicaid Outreach billing should occur on the final FSR through the MI E-Grants system after Comprehensive Agreement CSHCS Outreach and Advocacy funds have been expended. 1. Federal Medicaid Outreach Should be used to request the 50% federal administrative match. Match is determined by multiplying local contribution for the program by the percentage of Medicaid enrollees. This product is then multiplied by 50% in order to determine the eligible federal administrative match. 2. Required Match - Local Should be used to report the remaining portion of the local contribution for the Medicaid Outreach Match. Additional local contribution that is not eligible for the 50% federal match should be reported in Local Funds - Other, MDHHS1C0-2017 06/21/2016 Page 23 of 37 3. Source of Funds Category Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDHHS grants, etc.) should be reported on the appropriate line has indicated in the Comprehensive Budget Instructions - Attachment 1. 4, Comprehensive CSHCS Outreach and Advocacy and Care Coordination Should be billed as separate program element. III. Comprehensive Local Health Department Agreement Obligation Report — filed in September 20xx. The Obligation report is used to estimate the payable amount due to Local Health Departments from MDHHS for each program element. A. In the Estimate Column, enter the maximum projected federal administrative match earnings for allowable Medicaid Outreach Activities to be earned from Medicaid Outreach on the Federal Medicaid Outreach row. B. In the Estimate Column, enter the maximum projected federal administrative match earnings for allowable Medicaid Outreach activities to be earned from CSHSC — Medicaid Outreach. This should reflect the local contribution multiplied by the Medicaid enrollment participation rate x 50% federal match rate. C. In the Estimate Column, enter the maximum projected federal administrative match earnings for allowable Medicaid Outreach activities to be earned from Nurse Family Partnership Outreach. This should reflect the local contribution multiplied by the Medicaid enrollment participation rate x 50% federal match rate. Note: CSHCS Outreach and Advocacy and CSHCS Care Coordination activities funded through the Comprehensive Agreement are recorded as separate program elements. MDFIHS/C0-2017 06/21/2016 Page 24 of 37 Example 1 Medicaid Outreach Cost Allocation Plan Orange County Health Department Cost Allocation Methodology For Medicaid Outreach Activities Orange County Health Department allocated costs for Medicaid Ovtreach as follows: Salaries & Fringes: Distributed based on the actual amount oftime'eachemployee spends in each program for which they work. Vacation/sick/holiday pay ia allocated in the\aarna "mariner. Supplies and Materials: Directly expensed to thq-speCffit,prOgram(S).,identifi,ed" by the employee as needed. Costs that benefit all programs will be'allocaled baeci P6 -perOentaqe ,staff in each program. , \ Travel: All travel costs are charged direi:tl.tolheprogram for ,which the travel was incurred. Communications: Distribvted base'd..oh.i i.h.e,,. OtothItage`bf time staff worked in each program. program All Others: (Translation ServiO.& Miscellaneous services, insurances, dues, etc...) Costs are charged directly to the program for wt.lic h -the erVice occurred. Indirect costs: distributed across all programs based on the salaries and fringes of staff in each program . „ Space Costs: , istribUtd bas'qd,..oriA.he,..s to:e 'foOtage used by the FTE and the percentage of time they worked in each prOg-raiii. COmn* apa --sq'Ua're'footage is allocated based on percentage staff in each .._._.,.._...... - MDHHSIC0-2017 06/21/2016 Page 25 of 37 Example 2 Orange County Health Department Medicaid Outreach Cost Allocation Methodology Certification This is to certify that I have reviewed the cost allocation plan and to the best of my knowledge and belief that: 1. All costs contained in this proposal to establish cost allocations or billings for Medicaid Outreach Activities are allowable in accordance with the requirements of Title 2 CFR Part 200, "Uniform Administrative Requirements, Cost Priindpies and Audit Requirements for Federal Awards," and the federal and state awardECto wnich they apply. Unallowable costs have been adjusted for in allocating costs,indicatQd n-the Cost allocation plan. 2. All costs included in this proposal .)re propCtiialiocable tOlhe Medicaid Outreach Activities Administration award on a hasis. of'a 6e,p6ficial bpuSari-efratio!Iship between the expenses incurred and the MeciiCai'd,Outi'eabh'Admirtis'tratiOn award to which they are allocated in accordance with" applicab16,r0cluir4ments, Further, the same costs that have been treated as indirect costs havb--not.-.bean,clairrieddirOct costs. Similar types of costs have been accounted for cOoster' • 3. Thcprtificati*.w1-11,. be 'resubmitted if a significant change occurs that impacts the Medicaid Pi'itrei'lchCWities or upon a Department review that results in a finding of non- compliance.'-,„it-fteither of these conditions exists, the certification remains valid in subsequent fiscal years. I declare that the foregoing is true and correct: Health Department: Signature: Name of Official: Title: Date: An authorized official of the organization must certify that the plan h a s b e e n p r e p a r e d in accordance with authorizing legislation and regulations, and state o r o t h e r applicable requirements. Every cost allocation plan must include a certifica t i o n . MDHHS/CO-2017 06/21/2016 Page 26 of 37 Example 3 SAMPLE 3 ORANGE COUNTY HEALTH DEPARTMENT Budgeted Costs tor Medicaid Outreach Activities Proglarn BudgerSurnmary PROGRAM / PROJECT Comprehensive Agreement - 2016 1 Medicaid Outreach DATE PREPARED 08417/2015 CONTRACTOR NAME Orange County Health Department BUDGET PERIOD From : 10)112015 To .-. W30/2016 MAILING ADDRESS (Number and Street) 123 Acme Rd, BUDGET AGREEMENT - , Original Arnendthent A ENDMENT # CITY Orangegrove STATE MI ZIP CODE 49555 FEDERAL ID NUMBER 38-5555555' . \ , !Category Amount _. Cash la*ind . - Total , , DIRECT EXPENSES .. Program Expenses 1 Salary & Wagea , 153,556..00,, .00 0.00 153,556.00 2 Fringe Benefits ''..71,20:1.00 . ,. 0.00 0.00 71,204.00 3 Cap. Exp. tor Equip & Far," ' - OM 0 00 0,00 0.00 4 Contractual . , ,.—.. - 0.00 0.00 0.00 5 Supplies and Materials '-, - 500.00 600 0.00 2,500 ,00 6 ., Travel , 5,90.00 0..00 DM 501100 7 Comm unicaticii,,,, --,---.n -.- • – 8,000.00 0.00 0.00 5,000.00 ..4 8 County City Central Seolces 0..00 0,00 0.00 0.00 Space Costa 6,000.00 0,00 0.00 6,000.00 10 All Others (ADP, Con. EmPleyees, Misc.) 4.5.00.00 0.00 0.00 4,500.00 Tots Program Expenses 245260.00 0,00 0,00 245,260.00 TOTAL DIRECT EXPENSES 245,260.00 0.00 0.00 245,260.00 INDIRECT EXPENSES Indirect Costs 1 Indireci Costs 37.220,00 0.00 0.00 27,610.00 2 Other Costs Distributions 35,000.,00 0.00 0.00 35,000.00 Tots Indirect Costs 72,220.00 0.40 0.00 72,22010 TOTAL INDIRECT EXPENSES 72,220.00 0.00 0,00 72,220.00 TOTAL EXPENDITURES 317;480.00 0,00 0,00 317,400.00 MDFIHS/C0-2017 06/21/2016 Page 27 of 37 2 Program Budget-- SOCJIME of Funds Source of Ftmth Category Amowt Cash Inkind Total Fees and Collection - 1st and 2nd Party . 0.00 .00 0.00 Fees and Collections - 3rd Party 0,00 0,00 , 0.00 0.00 Federal or State Non MDCH) 0.00 . ' 0.00 0.00 II Federal Cost Based Reimbursement 0.00 ow, Alm 0.00 Federally Provided Vaccines 0.00 ----- ,.-' `,, 0.00 " 0.00 0.00 1111 Federal Medicaid Outreach 158,740.00 '... 000 0.1)0 - ' - 158140,00 Required Match - Local :' 0.00 1&8 740.00 0.00 . 158,740.00 .11 Local Non-ELPHS - 000 '. :- ', t .4:10. ' - 1,n0 0.00 Local Non-ELPHS -: 0,043 - 0.00, ' 0.00 0.00 MI Local 11111 Non-ELPHS ,„ 000 000 0.00 Other Non-ELPHS 0 000 0_00 0.00 MDCH Non ConnorehensiVe %, '--., -, -,"' -- 0..O0 ,.. 2., 0.00 0.00 0,00 1111 1111 DCH CoUlprehe..asiye ', '., '.. "- , '\ ', ,too 0.00 0,00 0.00 ELPHS - MDCH "Heating '--., ', ' 0.00 0.00 0.00 0.00 ELPHS - MDtil !.../Slari- , ',, •., 0.00 0,06 000 0.06 1111 ELPHS - MDCH Other- ', '' 0.00 0.00 0.00 0.00 - Food 0.00 0,00 0,00 0.00 E HS - Drinking Water (LOU .0 0,00 0.00 ELP HS - On-Site Sewage 0.00 0.00 0.00 0.00 II ELPHS CH Funding 0.00 0. 0.00 0.00 Local Funds - Other 0,00 0,00 0.00 0.00 Inkind Match 0.00 0.00 0.00 0.00 DCH Fixed Unit Rate Totals 158,740.00 i58740.00 000 317,460.00 Page 28 of 37 MDHHS/CO-2017 06/21/2016 3 Program 01.orige.t- Cost D.raif Rine Ile Qty Rate UOM matin Cosh Inkind Tot k DIRECT EXP EN SF S Program Ex cnses Salary & Wages P h lc Nakh NO5e 'L0370 54,54 . 0 FTE 55,553:17 _00 55.56-3 S c al Worker 0.2500 L8TB.08 FTE r 14,52528 0.00 14,525 Technician 0.5650 4 ,650.00 FTE 23,7t13.25 0.08 0.00 ..,...._.- 23.780 Health E accitor 0.5550 5095500 25,285 ,3 0.0e a on 25,2813 C/erical 0.4650 34,071.80 ' FTE f 0,524,44 .. 0.00 . . 0.00 18,524 Supervisor 0.2200 63. i02,00 FTE 13,862.4'4 '- 0. 0 ' 0.00 13, n , Total for Salary & Wages , '1.53,555.6p ,, 0 00 0_00 _ 153,559 rings. Baneflta All Composite ale"Notesip.0000 " FICA, FUTA, I...WE, HEALTH„ DENTAUVISION, - , PENSION, UNEMPLOYMENT, WORKMANS COMP. ' -, 45_3/0 ' ', T. 71,203.73 0.00 0.80 71,204 Cap, Exp. for Equip& Fac. 4 Cootraft1 Supplies and MatenaIS Printing 750.001 0.00 0.00 750. Office Sup it e 1,250,00 0,00 0.00 1,250.00 PoStage 500.00 0,00 0.00 500.00 Travel Mil age sm.0431 0.00 atm 500,00 Communication Telephone, Cell 5,4I 0.0 0.001 0.00 5.000.00 County-City Central Serves Space Costs Space Coet e,coo.00 o.u0 0.00 5,000.08 0 NI Others (ADP, Con. Ereplayess, sc.) Ttansintion Services 4,000 0-0 0.00 0.00 4,000.0 Miacellatheotial 500.00 0.00 0.00 500_00 Total Program Expenses 245,260.0 0 .00 245.260.00 TOTAL DIRECT EXPENSES 245,260.00 00D 0.00 245,260.00 INDIRECT EXPENSES indirect Costs CM Indirect Costs MI Fiscal Year Rate 0,0000 15,560 --' I 'i, 37,270.15/ 11001 0.00 37,220 Eill Other C sts shilatrtions ..,--- El taming Admen Distribution , ,-. f: . DO 35,000.00 0,00 0,00 35,000 Total indireet Cos s , 72,220.15 0,00 0.00 72,220 TOTAL INDIRECT EXPENSES 72,220.15 0.00 0.00 72,220 TOTAL EXPENDITURES 347.481115 8.0 0.00 $317,480 Page 29 of 37 MDHHS/CO-2017 06/21/2016 H. Michigan Colorectal Cancer Screening Program — The Michigan Colorectal Cancer Early Detection program (MCRCEDP) budget is to be developed in the following ways: 1. This budget is intended to cover all staffing and coordination for the program. All allowable expenses will be reimbursed through the Comprehensive Agreement. 2. All direct service claims must be billed through the MDHHS Cancer Prevention and Control Section. The LHD and/or direct service providers with contracts or letters of agreement with the LHD will be responsible for billing. 3. The staffing, coordination and direct service total amount is $255 per woman or man based on a target caseload established by MDHHS. Performance reimbursement will be based upon the understanding that a certain level of performance (measured by outputs) must be met. There is a 90% performance requirement for this program. The performance target output measure is the number of women and men that complete a screening test for colorectal cancer. 4. For specific program requirements, including current direct service reimbursement rates and other documentation refer to the most current MCRCEDP manual. Page 30 of 37 MDHMS/C0-2017 06/21/2016 mtsationtfringe bonefit,s Travel StatencfcaliRegional conference trave Local inectippkteferences (Ad hoc) (excludip_g rnmils) Allowable Uses or 317 and VFC FA Operations Funds POB devekrped the following table to astiit awardees in preparing budgets that are in compliance with federal grants policies and CDC award requirements, The table as desreloped using a combination of OMB Circular A47, PUS GralitS Pohc- y SI:4MM 9505, ad P013- identified prow= ptiorities. Object Class Category/Evenses Allowable with 317 operations Allowable ABowable with WC j with WC opentions ordering fun& fonds Allowable with VFC/AFEK funds Allowable Allowable with with Pan We Disitibuton Flu funds funds (where applicable) Personnel. ht ate. travel oasts Otr (If suit travel coSts (o„& MC. Hop B Coordinator's Meeting, Program Martagers/PHA. Meeting, ACIP meetings, Vre trainings, Program Manger Orientation, and diet CDC-sponsored onization PrO aralEt amain '11.case refer to Operatio Fimding Categories. pg,10 – J 1 for as1ditiortal Ontation. site visits YIX-orily• site visits .41 FC-pwlareil)11 Orpzrefiaera- rgared) 7/1712014 Seodbill—TheBasiosn,20 P013.1 2015 'Class Ottewn Allowable with VFC orderbtg funds He Allowable with with. Pan WC Distailiudon - funds funds . ceppiiathie) Allowable with STFC/AFIX funds Coin Perinatal hovital record reviews eurf:rexior Pae:lifsv) *Equipment: an ankle of tangible nonexpendable personal property having eisefie hfr of mom than eine )-var and an a ClaiSitieln CrO5t eitSlor more per unit. Supplies Vacetne administration supplies (including, but not limited to, nasal pharyngeal swabs, syringas for emergency vaocination clinics> Office supplies-comp-aters, general office (ptns, paper,. paper clips, etc.), ink earaidges, caleciamrs Personal_ets Pink Rooks, Red Books, Yellow Boo Laboratory supplies (influenza cid PCRs, cultures and molecular, lab media serorypi Digital data lona with valid'rtificate o: ealilyrationivalidationttes4g r Vaccine shipping supplies' (storage ou toe packs, bubble wrap, atc„) 711712014 Sec on ask! 1POM 2015 - 11111111111111=1111111111111111111111M111111111•1111111111M Co Stare/local conferences expenses (conference I sate, nuitenals primes, hotel acoorrunotiations evenses, 8ptak-a- fm) Food is nor allowable_ General contractual services (eg,„ IAPs, /coal health deparunertm, comagrual staff arivismy me Cha,mt.prider taining.$) COndlactual seni ces Other IIS contractual agreerne =bane pgaCICS FA N -CD Cov vacciu rt. Mite tin.- service Advertising (resticted to recruitment of staff or I tries. pencaretnent of goods and services, 1 disposal Of scrzo or wafts- materials) !Audit Fee,,s YAMS Survey Object Class CategorylEN:peases Allowable with 317 operations foods „Allowable 1 Allowable with VFC with WC operations orderft KOnds funds knowable Allowable with with Pan Ift/AFEN Flu funds Allowable with VFC 'Distribution fonds (whero applicable) direct Indixtet oosts ,Committee rnethi uip rental% Communiettion (eiectreniekozuputer 7/17.12014 Section I The Basics p.22 IPON1 2015 LE 10 e abed Allowable Allowable Allowable with 317 -with VFC 1 with VFC operations eTerations ordering funds 1 fonds Allowable with VFC/AF1X fonds Allowable Allowable with with Paa VW Distribution Flu fonds Twads twere qpplicabie) Object aass CategoryfE swam, postage, loc dim= to!ephone) CQDS'anw inforrn4ori activities Consumer I provider baud partici rent' tharsesnent) -and long (travel Laboratory services (tests conducted for rouniz•:ior; vs:pans) ServitC activif.es Maintenance Veratitaircpair Malpractice instil-an- ce for volunteers-MernbersitimsesubscOptions Pagers/cell phones Priatiro, of vaccine accountability forms Professional service costs directly related to irnmilnizadon actves (limited terra staff), Attorney General Office services Publiewionipritting costs (an o )ization relared puhlication and printing I Rent (regaires ex.pianation of why these oasts we rtot included in the indirect cost rate I airreeTzent or con allocation plan) Shispin Other that v-acci'ne` Shipping( fro* Tweira efistriki Adky) 7/17t20-14 Sezdea I—The 132:3!, . p-23 IPOM 2015 L£ Jo -17C a62c1 Page 36 of 37 MDHHS/CO-2017 06/21/2016 mt. Non-Allowable Expenses with Federal Immunization Funds R lawn — NOT oltowahlt With federal innintothtation frauds lioneiTivia .r.r . _..... , . .._......, Advertising ciA.Stg (ak, con venthms,, dpks rr1c, MeetiMkt Plowmen :Oil, giftN, xpowoir,v) A1coholi-c bvertiges Buildi•urchases, etYntruetio ea t irttpt9yeanents _ 1.-an< ou ,hase _ _ vi i */ Leo§itgiverifibl?yittg activities Bonding . — — 1.) t Fior1 0.11 me cla-rzes v." c8eareli I Izundraisinz .1 I Interest on loans for the acquisition andior •modernizatica of an xistiu banal , .,....„ „ _ :Jul ica l core ptiot-itorritolitAtior '..sViVic,V,39 ye EnteEtainrnent v` Paymont Oiland debt 'Val leic lurch Prniaioild Materials- (c.g,, piarives,, darning enui edoEmirmwative R..dre2h 121 pr IbidrwrabliON, lanyard& Cillea7V71Ce rtVg49 Punht of food (toadess pan' of aquired travq 1.1,01- diem rtosI8L I , „ - Other restrictions whieh rrnist betaken into account whilt writing the budf,kn:-. Funda may he spent only for EttiiVitit'S nd I.WSOF11101 COSI& Itaii are, directly relatcd to the Immuni2ntion and Vueitteft for Children CoopetWive Ag.wrnent, Funding recittests not directly (dated to irOttlliniz,ation mtiVitlo$ WV- outside the ReciN of this cooperative agreement program and wilt not be funded, Pre-award costsw11 IRA 711 I2014 Setaion11---Thel3usies, p,25 I.POM 2015 Page 36 of 37 MDHHS/C0-2017 06/21/2016 ATTACHMENT HI MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES LOCAL HEALTH DEPARTMENT AGREEMENT October 1, 2016 - September 30, 2017 Fiscal Year 2017 PROGRAM SPECIFIC ASSURANCES AND REQUIREMENTS Local health service program elements funded under this agreement will be administered by the Grantee and the Department in accordance with the Public Health Code (P.A. 368 of 1978, as amended), rules promulgated under the Code, minimum program requirements and all other applicable Federal, State and Local laws, rules and regulations. These requirements are fulfilled through the following approach: A. Development and issuance of minimum program requirements, further describing the objective criteria for meeting requirements of law, rule, regulation, or professionally accepted methods or practices for the purpose of ensuring the quality, availability and effectiveness of services and activities. B. Utilization of a Minimum Reporting Requirements Notebook listing specific reporting formats, source documentation, timeframes and utilization needs for required local data compilation and transmission on program elements funded under this agreement. C. Utilization of annual program and budget instructions describing special program performance and funding policies and requirements unique to each State fiscal year. D. Execution of an agreement setting forth the basic terms and conditions for administration and local service delivery of the program elements. E. Emphasis and reliance upon service definitions, minimum program requirements, local budgets and projected output measures reports, State/local agreements, and periodic department on-site program management evaluation and audits, while minimizing local program plan detail beyond that needed for input on the State budget process. Many program specific assurances and other requirements are defined within the referenced documents including Minimum Program Requirements established for the following program elements as of October 1, 2006: A. Breast and Cervical Cancer Control B. Clinical Laboratory C. Family Planning D. Food Service Sanitation E. General Communicable Disease Control F. Healthy Homes and Lead Poisoning G. Hearing H. HIV/STD Prevention & Treatment I. Immunization (Essential Local Public Health Services & Categorical) J. LHD/CSHCS K. Michigan Care Improvement Registry L. On-Site Wastewater Treatment Management M. Private and Type III Water Supply N. Vision 0. WIC MDHHS/CO-2017 ATTACHMENT III Page 1 of 175 6/23/16 For Fiscal Year 2017, special requirements are applicable for the remaining program elements listed in the attached pages. EGrAMS Code Program Element Title ADOLSTD Adolescent Sexually Transmitted Disease (STD) Screenin_g BODY-FIX Body Art Facility Licensing BCCCP Breast and Cervical Cancer Control Navigation Program BHCH Building Healthy Communities — Getting to the Heart of the Matter CLPEO Childhood Lead Poisoning Education & Outreach CLPEO3 Childhood Lead Poisoning Education & Outreach Region 3 Childhood Lead Poisoning Intervention CLPI CLPP Childhood Lead Poisoning Prevention CC-FIX Children's Special Health Care Services (CSHCS) Care Coordination CSHCS Children's Special Health Care Services (CSHCS) Outreach & Advocacy CUSP Communities Uniting for Suicide Prevention CCC1P Comprehensive Cancer Control Community Implementation Project CC-MED CSHCS Medicaid Outreach EATFISH Eat Safe Fish FP Family Planning Services-Pregnancy Prevention FASD Fetal Alcohol Spectrum Disorder FIMR Fetal Infant Mortality Review (FIMR) Case Abstractions GISP Goriococcal Isolate Surveillance Project (GISP) HIVSTD HIV/STD Partner Services HIVPREV HIV Prevention Services HIV-FIX HIV Prevention Non Categorical HIVMH1 HIV Ryan White Part B HIVSURV HIV Surveillance Support HALCP H1V/AIDS Linkage to Care HOPWA Housing Opportunities for Persons Living with HIV/AIDS 1AP Immunization Action Plan IMMFSR Immunization - Field Service Representatives VFCA-FIX Immunization Fixed Fees 1) Immunization Assessment Feedback Incentive Exchange (AFIX) Follow- up Site Visit 2) Immunization - Nurse Education Reimbursement 3) Immunization - VFC/AFIX Site Visit MCIR Immunizations Michigan Care Improvement Registry (MCIR) Regional Michigan Care Improvement Registry VQA Immunization - Vaccine Quality Assurance Program 1SS Infant Safe Sleep INCON-FIX Informed Consent LABBIO Laboratory Services LACT Lactation Consultant TOBACCO Local Tobacco Reduction Local Maternal and Child Health (MCH) OTHER-MCH Direct Services Children — MCH OTHERMCHW Direct Services Women — MCH MLA-INS/CO-2017 ATTACHMENT Ul Page 2 of 1.75 6/23/16 ESCMCH Enabling Services Children - MCH ESWMCH Enabling Services Women - MCH NFP-MCH Nurse Family Partnership -MCH OTHERMCHV Public Hlth Functions & lnfratruct - MCH MIECHVLLG Maternal Infant Early Childhood Home Visiting Initiative (MIECHV) Local Home Visiting Leadership Group MHVRLH Maternal Infant Early Childhood Home Visiting Initiative (MIECHV) Rural Local Home Visiting Leadership Group MHVRLH3 Maternal Infant Erly Chd Home Visiting Initiative Rural Local Home Visiting Grp3 MHVIRE MI Home Visiting Initiative Rural Expansion Grant MHVIRE3 MI Home Visiting Initiative Rural Expansion Grant Region 3 OR-MED Medicaid Outreach MAP Michigan Abstinence Program MIAPPP Michigan Adolescent Pregnancy & Parenting Program MCRCSP Michigan Colorectal Cancer Early Detection Program BMHFAE MIECHVP Healthy Famalies America Expansion NFP-MED Nurse Family Partnership Medicaid Outreach NFP-SEV Nurse Family Partnership (NFP) Services Public Health Emergency Preparedness (PHEP) BIONINE Public Health Emergency Preparedness (PHEP) 10/1/16- 6/30/17 CRININE Public Health Emergency Preparedness (PHEP) 10/1/16 - 6/30/17 PREPEVD Public Health Emergency Preparedness (PHEP) Ebola Virus Disease (EVD) Phase II RPCS Regional Perinatal Care System SEAL SEAL! Michigan Dental Sealant RAPEPRE Sexual Violence Prevention (Rape Prey Ed) STD Sexually Transmitted Disease (STD) Control SIDS-FIX Sudden Unexplained Infant Death (SUID) and Other Fetal Infant Death TRIP Taking Pride in Prevention TDT Tobacco Dependence Treatment TOBHIV Tobacco Reduction in People with H1V/AIDS TB Tuberculosis (TB) Control 340B Tuberculosis (TB) Control and Elimination Women and Infant Children WIC) WICBRST WIC Breastfeeding Peer Counseling WICMIG WIC Migrant WICRES WIC Resident Services WISEC Wise Choices W1SEW Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) WWHM Worksite Wellness - Getting to the Heart of the Matter MDHHS/C0-2017 ATTACHMENT ill Page 3 of 175 6/23/16 Essential Local Public Health Services (ELPHS) OTHER-MCH Administration —ELPHS FOOD-ELPHS Food ELPHS GCD-ELPHS General Communicable Disease ELPHS HEAR-ELPHS Hearing ELPHS 1-11V-ELPIS HIV ELPHS DlIV-ELPHS HIV & STD Testing and Prevention IMM-ELPHS Immunization ELPHS SEW-ELPHS MDEQ On-site Wastewater Treatment WTR-ELPHS MDEQ Private and Type III Water Supply VIS-ELPHS Vision ELPHS MDH HS/CO-2017 ATTACHMENT III Page 4 of 175 6/23/16 FORMAT (PROGRAMIELEMENT1 SPECIAL REQUIREMENTS I. Reimbursement Chart — a, Program Element: The Program Element indicates currently funded MDHHS programs that are included in the Comprehensive Local Health Department Agreement. b. Reimbursement Methods: The Reimbursement Methods specifies the type of method used for each of the program element/funding sources. Funding under the Comprehensive Local Health Department Agreement Agreement can generally be grouped under four (4) different methods of reimbursement. These methods are defined as follows: 1. Performance Reimbursement - A reimbursement method by which local agencies are reimbursed based upon the understanding that a certain level of performance (measured by outputs) must be met in order to receive full reimbursement of costs (net of program income and other earmarked sources) up to the contracted amount of state funds prior to any utilization of local funds. Performance targets are negotiated starting from the last year's negotiated target and the most recent year's actual numbers except for programs in which caseload targets are directly tied to funding formulas/annual allocations. Other considerations in setting performance targets include changes in state allocations from past years, local fiscal and programmatic factors requiring adjustment of caseloads, etc. Once total performance targets are negotiated, a minimum state funded performance target percentage is applied (typically 90% unless otherwise specified). If local Grantee actual performance falls short of the expectation by a factor greater than the allowed minimum performance percentage, the state maximum allocation for cost reimbursement will be reduced equivalent to actual performance in relation to the minimum performance. 2. Fixed Unit Rate Reimbursement - A reimbursement method by which local health departments are reimbursed a specific amount for each output actually delivered and reported. 3. ELPHS - A reimbursement method by which local health departments are reimbursed a share of reasonable and allowable costs incurred for required Essential Local Public Health Services (ELPHS), as noted in the current Appropriations Act. 4. Staffing Grant Reimbursement - A reimbursement method by which local health departments are reimbursed based upon the understanding that State dollars will be paid up to total costs in relation to the State's share of the total costs and up to the total state allocation as agreed to in the approved budget. This reimbursement approach is not directly dependent upon whether a specified level of performance is met by the local health department. Department funding under this reimbursement method is allocable and a source before any local funding requirements unless a special local match condition exists. MDHHS/C0-2017 ATTACHMENT III Page 5 of 175 6/23/16 C. Performance Level If Applicable The Performance Level column specifies the minimum state funded performance target percentage for all program elements/funding sources utilizing the performance reimbursement method (see above). If the program elements/funding source utilizes a reimbursement method other than performance or if a target is not specified, N/A (not- available) appears in the space provided, D. Performance Target Output Measures Performance Target Output Measure column specifies the output indicator that is applicable for the program elements/ funding source utilizing the performance reimbursement method. Output measures are based upon counts of services delivered. E. Relationship Designation The Subrecipient, Contractor, or Recipient Designation column identifies the type of relationship that exists between the Department and grantee on a program-by-program basis. Federal awards expended as a subrecipient are subject to audit or other requirements of OMB Circular A-133 and Title 2 Code of Federal Regulations (CFR). Payments made to or received as a Contractor are not considered Federal awards and are, therefore, not subject to such requirements. 1. Su brecipient A subrecipient is a non-Federal entity that expends Federal awards received from a pass-through entity to carry out a Federal program, but does not include an individual that is a beneficiary of such a program; or is a recipient of other Federal awards directly from a Federal Awarding agency. Therefore, a pass-through entity must make case-by-case determinations whether each agreement it makes for the disbursement of Federal program funds casts the party receiving the funds in the role of a subrecipient or a contractor. Subrecipient characteristics include: a. Determines who is eligible to receive what Federal assistance; b. Has its performance measured in relation to whether the objectives of a Federal program were met; c. Has responsibility for programmatic decision making; d. Is responsibility for adherence to applicable Federal program requirements specified in the Federal award; and e. In accordance with its agreements uses the Federal funds to carry out a program for a public purpose specified in authorizing status as opposed to providing goods or services for the benefit of the pass-through entity. 2. Contractor A Contractor is for the purpose of obtaining goods and services for the non- Federal entity's own user and creates a procurement relationship with the Grantee. Contractor characteristics include: a. Provides the goods and services within normal business operations; b. Provides similar goods or services to many different purchasers; M DH HS/CO-2017 ATTACHMENT II It Page 6 of 175 6/23/16 c. Normally operates in a competitive environment; d. Provides goods or services that are ancillary to the operation of the Federal program; and Is not subject to compliance requirements of the Federal program as a result of the agreement, though similar requirements may apply for other reasons. In determining whether an agreement between a pass-through entity and another non-Federal entity casts the latter as a subrecipient or a contractor, the substance of the relationship is more important than the form of the agreement. All of the characteristics listed above may not be present in all cases, and the pass-through entity must use judgment in classifying each agreement as a subaward or a procurement contract. 3. Recipient A Recipient is for grant agreement with no federal funding. I L. 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. MDHHS/CO-2017 ATTACHMENT 111 Page 7 of 175 6/23/16 Reimbursement Method Footnotes key: (1) Program element or funding source as applicable. (2) Refer to the master Local Health Department agreement and the program and budget in s t r u c t i o n s package for further explanation of applicability of these reimbursement methods. (3) Allocation to be reflected in individual programs during budgeting process. (4) Not Applicable. (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 th e Department. (9) Subject to a match requirement (hard or in-kind) of $1 for each $3 of the Department agr e e m e n t funding for coordination. (10) Fixed rate limited to contract amount. (11) Up to 6 visits per family. (12) Non-categorically funded Health Departments will be reimbursed at $11.00 per HIV test condu c t e d u p to a maximum of $2,000 annually. (13) Each delegate agency must serve a minimum percentage of Title X users to access their t o t a l a l l o c a t e d funds. Quarterly FPAR data will be used to determine total Title X users and Plan First! e n r o l l e e s . (14) Public Health Emergency Preparedness funding must be expended by June 30, 2015 and is s u b j e c t t o a 10% match requirement as specified in the Public Health Emergency Preparedness ( P R E P ) Cooperative Agreement Guidance. LHDs must submit a nine-month budget and a quarterly F i n a n c i a l Status Report (FSR) column for this program element. (15) Public Health Emergency Preparedness funding for July 1,2015- September 30, 2015 i s s u b j e c t t o a 10% match requirement as specified in the Public Health Emergency Preparedn e s s ( P R E P ) Cooperative Agreement Guidance. LHD's must submit a three-month budget and a quar t e r l y F i n a n c i a l Status Report (FSR) column for this program element. (16) Project meets the Research and Development Criteria as defined by Title 2 CFR Section 20 0 . 8 7 . (17) Not Applicable. (18) Subject to match requirement as specified in Attachment III — Program Assurance s a n d S p e c i f i c Requirements. MDHHS/CO-2017 ATTACHMENT M Page 8 of 175 6/23/16 Performance Target Output Measure N/A , Performance Leve N/A ' (if Applicable) Grant Start Date Grant Contract Administrator Contact Info (phone & email) 10/1/2016 Kris Judd-Tuinier pra.ntEnd Date H 9/30/2017 313-456-4426, judd-tuinierk©michigan,gov Reimbursement Method TSu' brecipient, Recipient (non federal) Designation I Subrecipient Staffing (6) ADOLESCENT SEXUALLY TRANSMITTED DISEASE (STD) SCREENING SPe ements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS Project Summary: individuals 15-24 years of age will be screened for chlanwdia and gonorrhea at the following Oakland County sites: 1. Oakland County Main Jail 2. Oakland County Work Release 3. Oakland County Community Sites where Target Population Gathers 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. MOHHS/C0-2017 ATTACHMENT III Page 9 of 175 6/23/16 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. REPORTING REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT III Page 10 of 175 6/23/16 Grant Start Date 10/1/2016 " Grant Erid Date I Kathryn Macomber MacomberK@michigan.gov 517-335-9807 Grant Contract:: Administrator • Contact Info (phone & email) Reimbursement Method 1 Performance Level I (if. Applicable) Fixed Unit Rate (2) Subrecipient, Contractor, or Recipient (non federal) Designation • • Recipient -I 9/30/2017 • Performance Target N/A Output Measure N/A BODY ART FACILITY LICENSING II Special Requirements BUDGET AND AGREEMENT REQUIREMENTS This agreement is intended to establish a payment schedule to the Grantee, following notification of a completed inspection and recommendation for issuance of license. The intent is to help offset costs related to the licensing of a body art facility, when fees are collected from the respective Grantee's jurisdiction in accordance with Section 13101-13111of the Public Health Code, Public Act 149 of 2007, which was updated on December 22, 2010 and is now Public Act 375. 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 $255.33 50% of state fee Initial annual license for a Body Art Facility on or after July 1 $127.67 50% of state fee Issue a temporary license for a Body Art Facility $114.89 75% of state fee License renewal prior to December 1 $261.61 52.32% of state fee License renewal after December 1 $383.00 50% of state fee + 50% of penalty Duplicate License $25.53 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 MDHHS/CO-2017 ATTACHMENT II Page 11 of 175 6/23/16 Grantee must complete a Body Art Facility Inspection Report [DCH-1468 (07-09)], as p r o v i d e d b y t h e Department, or other report form approved by the Department that meets, at minimum, all s t a n d a r d s of the state inspection report. Only body art facilities that have applied for licensure sho u l d b e inspected. All body art facilities must be inspected annually. Licenses will only be rele a s e d f r o m t h e Department following notification of a completed inspection and upon recommendation by th e Grantee. Completed inspection reports should be signed by the facility owner and recommendation fo r licensure should be forwarded to the Department within two to four weeks following the in s p e c t i o n . 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 - m a i l a t kucabm@michigan.gov . DEPARTMENT REQUIREMENTS The Department will notify the Grantee by email when an applicant has paid for licensure o r r e n e w a l . This will serve as the request to the Grantee to perform an inspection. The Department wil l i s s u e a license to an applicant upon the recommendation of the Grantee performing the inspection . T h e Department will reimburse the Grantee according to this payment schedule to help offset th e c o s t s related to the licensing of the body art facility. Payments will be released quarterly based on t h e F S R submitted. The Department will provide a reporting template to be attached to the FSR, GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDI-4HS/C0-2O17 ATTACHMENT ill Page 12 of 175 6/23/16 10/1/2016 EJ Siegl Grant End Date 1 9/30/2017 Grant Start Date Grant Contract Administrator Contact Info (phone & email) 517-335-8814 siegle@michigan.gov Reimbursement Method Performance (8) Su brecipient, Contractor, or Recipient (non federal Designation 1 Subrecipient Performance Level (if Applicable) Performance Targe Output Measure .1 # Women screened • for Breast & Cervical .i.1 Cancer 97% BREAST AND CERVICAL CANCER CONTROL NAVIGATION PROGRAM (BCCCNP) II Special H.04:lik•omerits BUDGET AND AGREEMENT REQUIREMENTS N/A 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 a c c e s s to receiving breast and cervical cancer services. Program services are targeted to women in h a r d to reach populations, such as minorities, particularly. African American, Hispanic, 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 either a BCCCNP or non-BCCCNP provider with an abnormal Pap test result or an abnormal clinical breast exam 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. MDHHS/C0-2017 ATTACHMENT iii Page 13 of 175 6/23/16 The BCCCNP provides navigation services to low-income insured women, no t e n r o l l e d i n t h e program, to assist them in accessing the healthcare system so they can receiv e b r e a s t a n d / o r cervical cancer screening, diagnostic, and/or treatment services through t h e i r i n s u r a n c e p r o v i d e r . For specific BCCCNP requirements, refer to the most current BCCCNP Pol i c i e s a n d P r o c e d u r e s Manual. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A M DHHS/CO-2017 ATTACHMENT tl I Page 14 of 175 6/23/16 - T Grant Start Date 10/1/2016 Grant Contract Tracy Liichow Administrator Grant End Dath 9/30/2017 Contact Info (phone 8, email) 517-373-3267 Iiichowt@michigan.gov Performance Level (if Applicable) BUDGET AND AGREEMENT REQUIREMENTS N/A N/A Reimbursement Method Staffing (6) BUILDING HEALTHY COMMUNITIES - GETTING TO THE HEART OF THE MATTER II Special Requirements Subreci Went, Contractor, or Recipient Mon fedora Designation I Subrecipient Performance Target N/A Output Measure GRANTEE REQUIREMENTS 1 Collaborate/engage with partners to assess, implement, evaluate, and sustain the Department recommended healthy food service guidelines in community settings regionally. 2. Develop, submit and implement an approved work plan and budget to the Department. 3. Acknowledge receipt of support from the Department with logo or name in all programs and produced materials, events, articles or publications that result from the grant. 4. Distribute any Department "Getting to the Heart of the Matter in Michigan" resources or promotional materials relevant to the BliC project and community settings. 5. Complete Building Healthy Communities program and Getting to the Heart of the Matter initiative evaluation requirements, which may include periodic data collection and submission. 6. Maintain adequate program and fiscal records and files including source documentation to support program activities and all expenditures made under the terms of the grant. 7. Provide progress and final reports to the Contract Manager on specified dates by emailing nickelhmichician.dov . Progress Report Period Covered Report Due Dates January 1 - March 31 April 15 April 1 - June 30 July 15 July 1 - September 30 October 15 Year End Report — Total Grant Period October 30 8. Participate in grant conference calls/meetings, scheduled site visits, and training provided/supported by the Department. 9. Reimbursements occur based on actual expenditures reported on Financial Status Reports (FSR) using the reporting format and deadlines as required by the Department through the MI E-Grants system. MDHH5/C0-2017 ATTACHMENT UI Page 15 of 175 6/23/16 10. Performance will be measured based on the progress towards meeting work plan objectives, work plan activities, expenditures, reports, site visits, success stories and evaluation outcomes. 11. Failure to comply with these requirements may result in punitive consequences including but not limited to reimbursement of activities that were not performed or denial of future funding. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT HI Page 16 of 175 6/23/16 Grant Start Date Grant Contract Administrator Contact Info (phone & email) i Reimbursement Method 10/1/2016 Karen Lishinski (517)241-3599 lishinskik@michigan.gov I Staffing (6) y Performance Level (if Applicable) N/A Subrecipient, : Subreciplent Contractor, or Recipient (non federal) Designation Performance Target N/A Output Measure CHILDHOOD LEAD POISONING EDUCATION & OUTREACH CHILDHOOD LEAD POISONING EDUCATION & OUTREACH REGION 3 II Special Requirements BUDGET AND AGREEMENT REQUIREMENTS 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 MDHHS/C0-2017 ATTACHMENT HI Page 17 of 175 6/23/16 goals and activities. Reports should be submitted to Karen Lishinski: lishinskikmichiqan.gov. 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. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT lil Page 18 of 175 6/23/16 Grant Start Date 10/1/2016 (517)241-3599 lishinskik©michigan.gov Subrecipient Staffing (6) Contact Info (phone & email) Reimbursement Method N/A N/A Subrecipient, Contractor, or Recipient (non federal) Designation Performance Target Output Measure I Performance Level I (if Applicable) CHILDHOOD LEAD POISONING INTERVENTION II Special Requirements Grant End Date ' 9/30/2017 Grant Contract Administrator Karen Lishinski BUDGET AND AGREEMENT REQUIREMENTS Purpose: Grantee activities funded by the Department are expected to be focused on case manage m e n t a n d intervention activities for children with elevated blood lead levels (above > 5ug/dL). Continued f u n d i n g is contingent on completion of the required activities. GRANTEE REQUIREMENTS 1. Grantee must bill Medicaid for services rendered to Medicaid-insured children, for the maximum amount possible. For specific information on Medicaid covered services, ple a s e refer to the Medicaid Provider Manual. 2. Each child in the jurisdiction with a confirmed blood lead level equal to or greater tha n 5ug/dL will receive a full complement of case management services. Refer to the Med i c a i d policy for an explanation of required services. 3. 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. 4. Standardized forms are recommended for all case management activities. 5. Grantee must participate in quarterly grantee activities as scheduled by the Department CLPPP, DEPARTMENT REQUIREMENTS Funding_requirements: 1. 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. MDHHS/CO-2017 ATTACHMENT III Page 19 of 175 6/23/16 c. For children not insured by Medicaid, all nursing visits and other case management services provided. 2. 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 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. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 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. MDHHS/CO-2017 ATTACHMENT III Page 20 of 175 6/23/16 Grant Start Date • Grant Contract Administrator 10/1/2016 Karen Lishinski Grant End Date 90/30/2016 Subrecipient Reimbursement Method Staffing (6) Subrecipient, Contractor, or Recipient (non federal) Designation Contact Info (phone & email) (517)241-3599 lishinskik@michigan.gov Performance Level N/A (if Applicable) Performance Target I N/A Output Measure CHILDHOOD LEAD POISONING PREVENTION (CLPPP) c 0 Requirements BUDGET AND AGREEMENT REQUIREMENTS Purpose: Grantee activities funded by the Department are expected to be focused on the p r e v e n t i o n o f childhood lead poisoning. The target populations for these activities are children w i t h l e a d l e v e l s 5 t o 14 pg/dL, and pregnant women enrolled in Medicaid living in homes built before 1960 . T h e t e r m s o f this contract require funding to be used in high risk communities only (as desig n a t e d b y t h e Department CLPPP), and must be used for lead program services only. Continue d f u n d i n g i s contingent on completion of the required activities. GRANTEE REQUIREMENTS 1, (Optional) Expand use of piloted "Rx for Children with Elevated Blood Lead Leve l s 5 t o 1 4 ug/dL" in provider offices. 2. (Optional) Use Code Enforcement Assessment Tool to continue working with l o c a l o f f i c i a l s to improve code enforcement, 3. (Optional) Continue Rental Property Owner education through presentations o r o t h e r 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 organiz e d b y t h e Department Childhood Lead Poisoning Prevention Program (CLPPP), to meet quarte r l y i n Lansing. Up to 25% of funding can support this required activity—i.e., travel and CQI activities developed by the Ql Learning Community. 5. (Required) Conduct prevention activities in homes of families with children with blood l e a d levels 5 to 14 pg/dL, and in homes of pregnant women enrolled in Medicaid living in h o m e s 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 MDHHS/C0-2017 ATTACHMENT UI Page 21 of 175 6/23/16 d. Creating temporary barriers to possible lead hazards (e.g., window sills, ar e a s o f 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 (does not include removal or replacement) i. Providing help with applications to the Lead Safe Home Program In carrying out these activities, Grantee must coordinate with any care m a n a g e m e n t s e r v i c e s provided through Medicaid Health Plans. Grantees are encouraged to involve community partners—e.g., church e s , c o m m u n i t y h e a l t h workers, colleges, service organizations, or other community-based age n c i e s — t o e x p a n d t h e scope and reach of these activities. A minimum of 50% of funds must be used to support these in-home activit i e s . DEPARTMENT REQUIREMENTS Funding requirements: Funds may be used to provide prevention services in the following loca t i o n s : 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 Leon' Township (Jackson Co. Health Dept.) 7. Lansing (Ingham Co. Health Dept.) 8. Muskegon and Muskegon Heights (Muskegon Co. Health Dept.) 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 othe r l o c a l p u b l i c health operations. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Required Reporting (due 30 days after the end of each quarter—le, d u e J a n u a r y 3 0 , A p r i l 3 0 , 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 be e n d i s t r i b u t e d , including provider or clinic name and address, date, and number of pads pr o v i d e d . 2. (If applicable) Provide a narrative description of efforts to bring about best p r a c t i c e s . Attach a copy of the updated Code Enforcement CLP Assessment Tool. MOHHS/CO-2017 ATTACHMENT Ill Page 22 of 175 6/23/16 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 4th quarter, complete at least one CQI project and provide a storyboard per specifications from the Department CLPPP. 5. Use HHLPSS to document prevention activities for children with BLL 5 to 14. Provide a l o g 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. MDHHS/C0-2017 ATTACHMENT III Page 23 of 175 6/23/16 N/A Performance Level N/A (if Applicable) Grant Start Da e 10/1/2016 Grant End Date 9/30/2017 Grant Contract Administrator I Rebecca Start Contact Info (phone & email) (517) 241-7198; startr@michigan.gov Reimbursement Method Staffing (6) Subrecipient, Contractor, or Recipient (non federal) Designation Subrecipient • Performance Target Output Measure CHILDREN'S SPECIAL HEALTH CARE SERVICES (CSHCS) OUTREACH AND ADVOCACY II Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 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 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 Department. DEPARTMENT REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT III Page 24 of 175 6/23/16 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Program Management: Reporting Requirements The Grantee shall submit: 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 1. 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 commerci a l 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 enrollmen t process during the fiscal year. This assistance includes but is not limited to helping the famil y 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 Pro c e s s 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 via the Children's Healthcare Automated Support Services (CHASS) Billing Module to the Contract Manager. The quarterly logs will be submitted no later than thirty (30) days after the close of the quarter. Quartet: Repotting Time Period Quarterly Logs Due Date 1st October 1 — December 31 January 30 2nd January 1— March 31 April 30 3rd April 1 — June 30 July 30 MDHHS/C0-2017 ATTACHMENT 141 Page 25 of 175 6/23/16 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 Protected Health Information (PHI) designated by CSHCS: Courtney Adams Quality Management and Improvement Analyst 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 manageme n t and care coordination log audits on a quarterly basis. MDHHS/C0-2017 ATTACHMENT III Page 26 of 175 6/23/16 N/A N/A Performance Target Output Measure Performance Level (if Applicable) 1-G—ra—nt End Date 9/30/2017 Subrecipient Contact Info , (phone & email) Reimbursement 1 Staffing (6) • Method • 517-0335-9703; smithp40@michigan.gov Subrecipient, Contractor, or • Recipient (non federal Designation 10/1/2016 Patricia K. Smith Grant Start Date _ Grant -Contract 1 Administrator COMMUNITIES UNITING FOR SUICIDE PREVENTION (CUSP) II sP quire BUDGET AND AGREEMENT REQUIREMENTS Purpose: To develop a replicable model for a comprehensive rural youth suicide prevention community, as presented in the plan submitted to the Department. GRANTEE REQUIREMENTS In project year two, the grantee will 1. Finalize a plan for implementation of activities identified through the year 1 nee d s a s s e s s m e n t to determine current practices and referral networks related to youth and young a d u l t s u i c i d e prevention/continuity of care including screening, evaluation, treatment, and r e f e r r a l s . 2. Conduct a comprehensive community suicide prevention programs in two high - r i s k M a r q u e t t e County communities with school-based health clinics, Gwinn and Ishpeming. 3. Continue the development and implementation of a seamless system of care for M a r q u e t t e County youth and young adults identified at risk of suicide and those otherw i s e i m p a c t e d b y suicide. 4. Continue implementation of the Zero Suicide model in all Marquette County Health Department clinics, as well as one hospital and 25% of the county's outpatien t p r i m a r y c a r e clinics, 5. Continue expansion of Dial Help's Suicide Risk Follow-Up Program to all '15 Uppe r P e n i n s u l a counties. 6. Continue implementation of Dial Help's Bereavement Support Follow-up Progra m f o r a l l 1 5 U P counties. 7. Conduct 3 Applied Suicide Intervention Skills (ASIST) Training, one in each i n t h e w e s t e r n , central and eastern U.P. 8. Introduce a youth focused suicide prevention app to youth and young adults in t h e Communities That Care catchment areas. 9. Begin or enhance suicide prevention work in 10 Communities That Care acros s t h e U P . MC/NHS/CO-2017 ATTACHMENT III Page 27 of 175 6/23/16 10. Conduct awareness and education activities in Marquette County, including one Out of Darkness Community Walk, media education, dissemination of education/awareness media messages, social media initiatives, two community forums. 11. Continue expansion of the Marquette County Suicide Prevention Coalition membership. 12. Send at least one representative to the the state Suicide Prevention Community Technical Assistance Meeting. 13. Work with the Department's Project Officer and the state's youth suicide prevention Transforming Youth Suicide Prevention in Michigan, Phase 2 (TYSP-Mi2) Program Evaluator to develop and carry out an evaluation of the CUSP program and fulfill all of the SAMHSA national cross-site evaluation requirements. Submit all reports as required. DEPARTMENT REQUIREMENTS 1. Provide technical as requested and as needed for program development, implementation, and evaluation. 2. Conduct at least one site visit at the beginning of the program and one at the end of the fiscal year. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS In addition to the quarterly and year-end progress reports submitted through the MI-E-grants system, submit additional quarterly and year-end information using the reporting forms supplied by the Department's Project Officer, Patricia Smith. These reports can be faxed to her attention at 517-335- 9397 or emailed to smithp40Amichigan.qov. The reports are due no later than 15 days after the end of each quarter. MDH HS/CO-2017 ATTACHMENT II! Page 28 of 175 6/23/16 Grant Start Date 10/1/2016 Grant Contract Administrator Polly Hager Contact Info (phone & email) • Reimbursement Method Performance Level j N/A (if Applicable) Grant End Date 1 9/30/2017 Subrecipient, I Subrecipient Contractor, or Recipient (non federal) Designation Performance Target 1 N/A Output Measure 1 Staffing (6) 517-335-9729 hagerp©michigan.gov COMPREHENSIVE CANCER CONTROL (CCC) COMMUNITY IMPLEMENTATION PROJECT Requirements BUDGET AND AGREEMENT REQUIREMENTS 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 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 NU58DP003921from 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. DEPARTMENT REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT III Page 29 of 175 6/23/16 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Quarterly Progress Reports and one Final Report of Results and Program Issues, including the following information: !Quarter 1st 2nd 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 no later than no later than no later than January 31 April 30 July 31 November 15 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: harierpamichioan.00v MDHHS/C0-2017 ATTACHMENT Ili Page 30 of 175 6/23/16 Grant Start Date i 101112016 Grant Contract Administrator 1 Rebecca Start Contact Info (phone & email) Reimbursement Method Performance Level (if Applicable) I (517) 241-7198; startr@michigan.gov Staffing (6) I N/A Grant End Date 'i 9/30/2017 Subeeciplent, Contractor, or Recipient (non federal) :Designation : Performance Target N/A : Output:Measure I Subrecipient CSHCS MEDICAID OUTREACH II Special Requirements BUDGET AND AGREEMENT REQUIREMENTS See Attachment I for details regarding Budgeting requirements. GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT III Page 31 of 175 6/23/16 Performance Level N/A (if Applicable) 10/1/2016 Grant End Date Jennifer Gray Staffing (6) 517-373-7672 grayj@michigan.gov Grant Start Date:: Grant Contract Administrator Contact Info (phone & email) Reimbursement Method Performance Target N/A Output Measure Subrecipient, Contractor, or Recipient (non federal) Designation Subrecipient EAT SAFE FISH II Special Requirements BUDGET AND AGREEMENT REQUIREMENTS The Grantee will collaborate with the Department and the EPA Region V Saginaw C o m m u n i t y Information Office to deliver a uniform message for the Saginaw River and connected w a t e r s regarding the fish and wild game consumption advisories within the tri-county area (Midla n d , Saginaw, and Bay). Bay County Health Department (BCHD) will develop a plan to d i s t r i b u t e t h a t message using existing health department programs, the medical community, special e v e n t s , a n d community service providers to communicate with the at-risk population. BCHD will get a p p r o v a l f r o m the Department program manager and for any changes to the Saginaw and Bay C o u n t y C o o p e r a t i v e Agreement Scope of Work including budget and budget narratives. GRANTEE REQUIREMENTS The Grantee will provide appropriate staff to fulfill the following objectives and outpu t s a s d e t a i l e d : 1. Comply with the Saginaw and Bay County Cooperative Agreement budget and budget narratives as describe in the scopes of work provided to the BCHD program manager as applicable from October 1 to September 30. 2. Provide 30 hours of health education and community outreach per week. a. Conduct health education and community outreach in Saginaw, Midland, and Bay Counties. Activities will include, but not be limited to, internal BCHD distribution, health care provider outreach, and key event participation. b. Track hours to comply with cost recovery requirements. 3. Development, Printing, and Distribution of Outreach Materials and implementation of Display Booth. a. Identify, track, and record of materials distributed at additional locations within Midland, Bay, and Saginaw Counties. b. Make payment for the replacement of signage on the Tittabawasse and Saginaw Rivers. MDHHS/C0-2017 ATTACHMENT III Page 32 of 175 6/23/16 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. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT III Page 33 of 175 6/23/16 i.Reimbursement Staffing (6) .Met.11.o01.:• Performance N/A Level (if Applicable) Subreciplent, Contractor, or Recipient (non federal) Designation Recipient N/A ESSENTIAL LOCAL PUBLIC HEALTH SERVICES (ELPHS) II Special -meats G.tant.-Start Date 10/1/2016 Grant End Date I 9/30/2017 _ Michigan Department of Health and Human Services (MDHHS) ELPHS Other Grant Contract • Administrator Robin Ors born I 517-335-8976 orsbornr©michigan.gov Michigan Department of Health and Human Services (MDHHS) Hearing Program Grant Contract Jennifer Dakers • Contact Info I 517-335-8353 Administrator (phone & email) dakersj@michigan.gov Reimbursement Staffing (6) -..•KOlhod • Performance N/A Level (if Applicable) Su larecipient, Contractor, or Recipient (non federal) Designation Perfeern.dhte: ::.Target Output .' Measure Recipient N/A MDHHS/C0-2017 ATTACHMENT III Page 34 of 175 6/23/16 N/A Performance Target Output Measure N/A Performance Level (if Applicable) Michigan Department of Health and Human Services (MDHHS) Vision Program Grant Contract Administrator Rachel Schumann Contact info (phone & email) I 517-335-6596 schumannr@michigan.gov Staffing (6) Subrecipient, Contractor, or Recipient (non federal) Designation Recipient Michigan Department of Agriculture and Rural Development (MDARD) Food Grant Contract Administrator Marsha Wiegman Contact Info (phone & email) 517-284-5706 WiegmanM@michigan.gov Reimbursement Method I Reimbursement 1 Method l Performance Subrecipient, Contractor, or Recipient (non federal) Designation Performance Target Output Measure Performance • Level (if ' Applicable) ' 75% Staffing (6) Reimbursement Method N/A Performance Level (if Applicable) Michigan Department of Agriculture and Rural Development (MDARD) Food and Water Lead Safety Inspections Subrecipient, Contractor, or Recipient (non federal) Designation Recipient .Performance Target Output Measure • I N/A .1 Recipient % of Food Service Licensees received required inspections MDHHS/C0-21317 ATTACHMENT III Page 35 of 175 6/23/16 Grant Contract Administrator • Reimbursement Method Performance i Level (if Applicable) Recipient N/A Carrie Monosmith Contact Info (phone & email) 517-290-2601 monosmithc@michigan.gov Staffing (6) Subrecipient, Contractor, or Recipient (non federal) Designation Performance Target Output Measure N/A Michigan Department of Envornmental Quality (MDEQ) Private & Type 111 Water Supply On-site Wastewater Treatment BUDGET AND AGREEMENT REQUIREMENTS 1. State funding for ELPHS shall support and the Grantee shall provide for al l o f t h e f o l l o w i n g required services in accordance with RA. 368, of 1978 and P.A. 92 of 2000, a s a m e n d e d , Part 24 and Act No. 336, of 1998 Section 909: Infectious/Communicable Disease Control Sexually Transmitted Disease Immunization On-Site Wastewater Treatment Management Drinking Water Supply Food Service Sanitation Hearing Vision State funding for ELPHS can support administrative cost for the eight require d s e r v i c e s including allowable indirect cost, or a Grantee's cost allocation plan. 2. ELPHS funding can also be used to fund other core health functions inc l u d i n g : C o m m u n i t y Health Assessment & Improvement, Public Policy Development, Health Se r v i c e s Administration, Quality Assurance, Creating & Maintaining a Compete n t W o r k F o r c e a n d Local Public Health Accreditation, These services may be budgeted se p a r a t e l y a s p a r t o f t h e Administrative Budget element, 3. Net allowable expenditures are the authorized actual/allowable expenditu r e s ( t o t a l c o s t s less specified exclusions). Available funding is also limited by state ap p r o p r i a t i o n s . 4. First and second party fees earned in each required service program m a y b e u s e d o n l y i n that required service program. 5. State ELPHS funding is subject to local maintenance of effort complian c e . D i s t r i b u t i o n o f state ELPHS funds shall only be made to agencies with total local gen e r a l f u n d p u b l i c h e a l t h services spending in FY 16117 of at least the amount expended in FY 92/93 . T o b e e l i g i b l e MDHHS/CO-2017 ATTACHMENT III Page 36 of 175 6/23/15 for any of the State funding increases from FY 94/95 through FY 16/17, the FY 92/ 9 3 L o c a l Maintenance of Effort Level must be met. 6. A final statewide cost settlement will be performed to assure that all available ELPHS fu n d s are fully distributed and applied for required services. GRANTEE REQUIREMENTS 1. Assure the availability and accessibility of services for the following basic health servic e s : Prenatal Care; Immunizations; Communicable Disease Control; Sexually Transmitted Disease (STD) 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 proces s a n d schedule established by the Department for the required services to achieve full accreditation status. Agencies designated as not accredited" may have their Departme n t allocations reduced for Departmental costs incurred in the assurance of service delivery. The accreditation process is based upon the Minimum Program Standards and sch e d u l e d on a three-year cycle. The Minimum Program Standards include the majority of the r e q u i r e d Department reviews. Some additional reviews, as mandated by the funding agency, ma y not be included in the Program Standards and may need to be scheduled at other times. DEPARTMENT REQUIREMENTS Whenever the Department delivers direct services within the Grantee's area, it shall give p r i o r notification and provide summary reports of those activities upon the request of th e G r a n t e e h e a l t h officer. GRANTEE SPECIFIC REQUIREMENTS Grantee Specific Reauirements — Food Service Sanitation Budget and Aareement Reauirements 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 licen s e s to the Grantee for each licensing year (May 1 through April 30) using previous yea r a c t i v e 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 Grante e . 4. Bill the local health department for state fees upon notification by Grantee that the lice n s e has been approved and issued. Temporary Food Service Establishment Licensinq 1. Furnish blank temporary food service license application forms (forms F1-231, Fl-231A) and blank Combined License/Inspection forms (FI-229) upon request from the local health department. MDHHS/C0-2017 ATTACHMENT III Page 37 of 175 6/23/16 a. Furnish a "Record of Licenses Received" with each order of Combined Licenses/Inspection forms. b. Periodically reconcile temporary food service establishment licenses s e n t t o t h e Grantee with the licenses that have been issued (copy returned to MD A R D ) . c. Bill the local health department for state fees upon notification b y t h e G r a n t e e that the license has been approved and issued. Grantee Specific Reauirements The Grantee agrees to: Food Service Establishment Licensing 1. Accept responsibility for all licenses specified in the "Record of License s R e c e i v e d . " 2. Issue licenses in accordance with the Michigan Food Law 2000, as a m e n d e d . 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/lic e n s e i s s u e d , b. Provide a list of food service establishment licenses that have not be e n a p p r o v e d 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 corre c t i o n . M a r k the corrections on the renewal application. Temporary Food Establishment Licensing 1. Upon receipt, sign and return the "Record of Licenses Received" to MD A R D . 2. Issue licenses in accordance with the Michigan Food Law 2000, as ame n d e d . 3. Make every effort to issue temporary food establishment licenses in nume r i c a l o r d e r . 4. Provide updates to MDARD on the l 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. czantee_Soecific Reauirements— Private_and Tvoe llt Drinkina Water S u p p l y R e a u i r e m e n t s The Grantee shall perform the following services including but not lim i t e d t o : 1. Perform water well permitting activities, pre-drilling site reviews, r a n d o m c o n s t r u c t i o n inspections, and water supply system inspections for code compliance p u r p o s e s w i t h qualified individuals classified as sanitarians or equivalent. 2. Assign one individual to be responsible for quarterly reporting of the d a t a a n d t o c o o r d i n a t e communication with the assigned State staff. Reports shall be submitte d n o l a t e r t h a n f i f t e e n (15) days following the end of the quarter on forms provided by the State . T h e r e p o r t f o r m EQP 2057(8/2014) is available on the MDEQ website. All quarterly r e p o r t s a r e s u b m i t t e d directly to the MDEQ address noted on the form. 3, Perform Minimum Program Requirements (MPRs) activities and assoc i a t e d p e r f o r m a n c e indicators. These are available on the MDEQ website. Guidance r e g a r d i n g t h e M P R S a n d indicators in available in the "Local Health Department Guidance Ma n u a l f o r t h e P r i v a t e a n d Type 111 Drinking Water Supply Program." The guidance manual is avai l a b l e o n l i n e a t www.michigan.gove/waterwellconstruction MDHHS/C0-2017 ATTACHMENT III Page 38 of 175 6/23/16 Grantee Saecific Reauirernents — Private On-Site Wastewater Treatment Manaem e n t Prearam Reauirements The Grantee shall perform the following services for private single- and two-family homes an d o t h e r 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. Technica l 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 a n d location for initial and replacement Systems. The requirement for identifying a replacement System applies to issuance of new construction permits only. 4. Issue a permit, prior to construction, in accord with applicable regulation(s) for those sites that meet the criteria for the installation of a System. The permit shall include a detailed plan and/or specifications that accurately define the location of the initial or replacement System, System size, other pertinent construction details, and any documented variances. 5. Provide and keep on file formal written denials, stating the reason for denial, for those applications where site conditions are found to be unsuitable. 6. Conduct a construction inspection prior to covering each System to confirm that the completed System complies with the requirements of the permit that has been issued. Maintain, on file, an accurate individual record of each inspection conducted during construction of each system. In limited circumstances where constraints prohibit staff from completing the required construction inspection in a timely manner, an effective alternate method to confirm the adequacy of the completed System shall be established. The effective alternative method shall be utilized for no more than 10 percent of the total number of final inspections unless specific authorization has been granted by the State for other percentage. The results of all such inspections or an alternate method shall be clearly documented. 7. Maintain 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 a l s o 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. MDRHS/C0-2017 ATTACHMENT III Page 39 of 175 6/23/16 Variances are only to be issued by the Director of Environmental Health of the Grantee after consultation with the State. Appeals of any decision of the Grantee pursuant to the Criteria including systems treating less than 1,000 gallons evaluated in accordance with the Grantee's regulation shall only be made to the State. 10, Maintain quarterly reports that summarize the total number of parcels evaluated, permits issued, alternative or engineered plans reviewed, and number of appeals, number of inspections during construction, number of failed systems evaluated, and number of sewage complaints received and investigated. The report form EQP 2057a is available on the MDEQ website. All quarterly reports are to be submitted directly to MDEQ to the address noted on the form within 15 days following the end of each quarter to the address noted on the form. 11. Review all engineered or alternative System plans. Conduct adequate inspections during the various phases of construction to ensure proper installation. 12. Collect data at the time of permit issuance when a System has failed to document the System age, design, site conditions, and other pertinent factors that may have contributed to the failure of the original System. Evaluations shall record information indicated on the MDEQ Residential and Non- Residential Failed System Data Collection forms. The results for all failed Systems evaluated shall be maintained in a retrievable file or database and summarized in an annual calendar year data report. Annual summaries of failed system data shall be provided to the MDEQ for input into the state-wide failed system database. MDEQ Failed System Data Submission Forms (Non Residential and Residential) shall be provided to the State no later than February 1st of the year following the calendar year for which the data has been collected. 13. Provide training for staff involved in the Program as necessary to maintain knowledge of current regulations and internal policies and procedures and to keep staff informed of technological improvements and advancements in Systems. 14. Establish and maintain an enforcement process that is utilized to resolve violations of the Local Entity and/or State's rules and regulations. 15. Maintain complaint forms and a filing system containing results of complaint investigations and documentation of final resolution. Investigate and respond to all complaints related to Systems in a timely manner. Grantee Requirements - School Based Hearing & Vision Special Requirements Grantees must adhere to established Minimum Program Requirements for School Based Hearing 8, Vision Services as outlined in the Michigan Local Public Health Accreditation Program 2017 MPR Indicator Guide. Work Plan Requirements: 1. Upon initiation of the FYI 7 contract, grantees must submit a School Based Hearing and Vision Screening work plan to MDCHHearinqVisionmichiqan.qov The work plan must include: a. One SMART goal, with corresponding objectives and activities that describe the proposed plan for providing school based hearing screenings in the LHD region, MDHHS/C0-2017 ATTACHMENT lil Page 40 of 175 6/23/16 b. One SMART goal, with corresponding objectives and activities that describe the proposed plan for providing school based vision screenings in the LHD region, 2. Work plans must be approved by the Department Hearing & Vision Coordin a t o r f o r t h e i r respective program. 3. All activities, as specified in the final approved work plan, shall be implemen t e d a n d a s i x month and final narrative report submitted by the grantee to the Department. Th e r e p o r t s a r e due 30 days after the six month and year end, and include the following timefram e s : a. Six month report, covering the reporting period of October 1 — March 31, is due A p r i l 300, b. Final year-end report, covering the reporting period of April 1-September 30, is d u e October 30th. 4. The Department will provide specific instructions and a template for reporting o n t h e w o r k p l a n objectives and activities. 5. Changes to the work plan throughout the year can occur with prior approva l f r o m t h e Department Hearing and Vision State Coordinators. 6. The Department staff shall evaluate the reports for their completeness and adequ a c y . Grantee Specific Requirements - Food and Water Lead Safety Inspec t i o n s Purpose Grantee activities funded by the Department are: $150,000 GF/GP for increased fund i n g t o G e n e s e e County Health Department Food Safety Division for inspections of food service e s t a b l i s h m e n t s f o r water sampling and safety, including restaurants, schools, hospitals, etc. The pu r p o s e i s t o a s s u r e safe water is being used in Flint food service establishments throughout the City of F l i n t , w i t h s p e c i a l attention to areas identified with a medium to high lead in water risk. Continued fundin g i s c o n t i n g e n t on completion of the required activities. Grantee Requirements 1. Maintain the FY16 increase in food safety supervision and food safety field staff, up to $150,000 for FY17. This will be specifically to provide for portions of an Environmenta l H e a l t h Director, Food Program Supervisor and one additional food safety Field Inspector. 2. Continue to conduct increased numbers of inspections, compliance assistance visits, w a t e r sampling and enforcement, as needed to assure Flint food service establishments a r e providing safe water to customers per Michigan Department of Agriculture and R u r a l Development (MDARD) requirements document date 1/13116, or any subseque n t u p d a t e s . 3. Proactively provide information and respond to inquiries from public regarding t h e s a f e t y o f t h e water in Flint food service establishments. 4. Train professional staff, as needed, in general food safety and in the specifics of add r e s s i n g Flint lead in water compliance assistance for food service establishments. 5. Coordinate with MDARD and Michigan Department of Environmental Quality to a s s u r e seamless coordination of ongoing response and recovery efforts for both MDARD r e t a i l a n d food processing establishments and local health inspected food service establish m e n t s . 6. Required reporting due 30 days after the end of each six months: Reporting Time Period Due Date 10/1-3/31 5/1 4/1-9/30 11/1 Reports shall include number of inspections, compliance visits, samples collected and f i e l d and administrative hours spent. MDHHS/C0-2017 ATTACHMENT III Page 41 of 175 6/23/16 7. Prohibited expenditures a. These funds may not be used to fund other local public health operations. REPORTING REQUIREMENTS N/A MCHHS/C0-2017 ATTACHMENT III Page 42 of 175 6/23/16 Grant Start Date Grant Contract Administrator Contact Info (phone & email) 10/1/2016 Steve Utter 517-241-0114 utters@michigan.gov Grant End Date 9/30/2017 Reimbursement Method Performance Level (if Applicable) FAMILY PLANNING SERVICES- PREGNANCY PREVENTION paci al Rquirerrif .trIts Performance (5) (8) Subrecipient, (13) Contractor, or Recipient (non federal) Designation 95% Performance large r:Output meqsure. • Subre-cipient 1 # Unduplicated Clinic I Users Served BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. The funds appropriated in the current State Public Health Appropriations Act for pregnancy prevention programs shall not be used to provide abortion counseling, referrals or services, unless contradicts Title X Federal Law (Title X of the Public Health Service Act). 2. Each delegate grantee must serve a minimum of 95% of proposed Title X users, to access its total amount of allocated funds. Biannual FPAR data will be used to determine total Title X users. 3. Title X Family Planning grantees must collect Medicaid. The information must be reported on the Michigan Table 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. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS The Grantee shall submit Family Planning Annual Reports (FPAR): Period covered Due to the Department Mid-Year Report (Jan-June) July 15 Annual Report (Jan-Dec) January 10 REPORTING REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT III Page 43 of 175 6/23/16 Staffing (6) N/A Performance Target N/A Output Measure Performance Level • 1 (if Applicable) 10/1/2016 LLi:rant.-Endpate... • 1 9/30/2017 Debra Kimball 517-335-8379 kimbalid1@michigan.gov Subrecipient, .1 Subrecipient Contractor, or Recipient (non federal) Designation ; Grant Start Date Grant Contract Administrator Contact Info (phone & email) Reimbursement Method FETAL ALCHOHOL SPECTRUM DISORDER (FASO) PROJECTS Special Requirements BUDGET AND AGREEMENT REQUIREMENTS Objective: For the project period of October 1 to September 30, the Grantees will collabo r a t e w i t h the Department to assist local communities with evidence-based activities i d e n t i f i e d i n t h e F A S D Interagency Strategic Plan, to implement alcohol screening and prevent prena t a l a l c o h o l e x p o s u r e among women of reproductive age and to refer affected children, birth to 1 8 y e a r s o f a g e , a n d t h e i r families to an FASD Diagnostic Center for evaluation and intervention for the p u r p o s e o f i m p r o v i n g care and services for women, infants and families. GRANTEE REQUIREMENTS 1, FASD project coordinator (or designee) must participate/attend semi-annual F A S D G r a n t e e Conference Calls provided by the department during FY 16/17. 2. Implement the FASD Interagency Strategic Plan, activities as approved by t h e d e p a r t m e n t . 3. Produce quarterly and year-end reports using the Uniform Data Collection E v a l u a t i o n T o o l (UDCT) form provided by the department that provides documentation of t h e t y p e s , n u m b e r s and demographic data including racial data of contacts for screening, motiv a t i o n a l i n t e r v i e w s and/or referrals from the grantee's FASD community based program. Th e U D C T f o r m is available on the MI E.-Grants system. The FASD UDCT quarterly reports a r e t o b e submitted via the MI E-Grants system attached to the FSR. The 4th quarte r r e p o r t , d u e October 15, will serve as the year-end report, DEPARTMENT REQUIREMENTS 1. Convene FASO Grantees semi-annual conference calls during FY 16/17 t o d i s c u s s progress toward community project goals outlined in the cooperative agreemen t a n d p r o v i d e technical assistance questions/answers as outlined in the cooperative agreeme n t . 2. Describe and provide resources and updates for the evidence-based inter v e n t i o n s r e q u i r e d by this contract. MDHHS/C0-2017 ATTACHMENT RI Page 44 of 175 6/23/16 3. Provide technical assistance for each requirement of this contract. 4 . Provide reporting formats for data collection and deliverables. GRANTEE SPECIFIC REQUIREMENTS N/A 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 2' 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 Ml 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 Work Plan and UDCT Evaluation Form quarterly & year-end reports via the MI E-Grants system. Program Contact information: Debra Kimball, FASD State Program Coordinator MDHHS, Division of Family and Community Health P.O. Box 30195, Lansing, Nil 48909 Phone (517)335-8379 Fax (517)335-8822 Kimballd1@michigan.gov iVIDHI-IS/C0-2017 ATTACHMENT III Page 45 of 175 6/23/16 I 1011/2016 517-335-8131 spitzleyj2@miohigan.gov Performance Level (if Applicable) Staffing (6) N/A Subrecipient, Contractor, or Recipient (non federa Designation FETAL AND INFANT MORTALITY REVIEW (FIMR) CASE ABSTRACTIONS II Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 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. Kev 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 (MI Department of Human Services, Child Protective Services, local health department, law enforcement). 3. Develop case summaries from the above abstracted information as well as the Maternal Interview, using Michigan FIMR Network tools and guidelines 4. Attend the review team meetings to facilitate the presentation of the cases. 5. Enter cases into access data base and submit cases to MPHI for MFIMR data base DEPARTMENT REQUIREMENTS 1. Each completed case abstraction will be compensated at $270.00 per case. MDH HS/CO-2017 ATTACHMENT III Page 46 of 175 6/23/16 2. Department will provide ongoing technical assistance to local FIMR teams for me d i c a l record case abstraction, developing case summaries, maintaining a functioning Case Review Team, and facilitating moving recommendations to community action. 3. Department provides the statewide FIMR database, administered through MPHI. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Quarterly progress reports following the template supplied by the FIMR State support p r o g r a m . Quarterly reports are due the 15th of the month following the end of the quarter and are su b m i t t e d t o the State coordinator. End of FY final report on cases completed and team findings a r e s u b m i t t e d t o the State coordinator. Quarter Reporting Time Period Due Date ist October 1 — December 31 January 15 2nd January 1— March 31 April 15 3rcl April 1 June 30 July 15 4th July 1 — September 30 October 15 MDHHS/C0-2017 ATTACHMENT III Page 47 of 175 5/23/16 10/1/2016 Contact Info 1 (phone & email) 1 Reimbursement 1 Method Performance Level (if Applicable) 313-456-4426, judd-tuinierk@michigan.gov Subrecipient, Contractor, or Recipient (non federa Designation Performance Target Output Measure Staffing (6) N/A N/A GONOCOCCAL ISOLATE SURVEILLANCE PROJECT (GISP) Remimmenn BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Grantee Requirements 1. Assess each male STD patient for possible gonococcal infection. 2. For each STD clinic male patient suspected of having gonorrhea (GC), collect sample using a Modified Thayer Martin (MTM) plate. 3. For clients with positive isolates, submit specimen to regional lab for susceptibility testing. 4. Assure monthly data reports are completed and submitted to CDC. DEPARTMENT REQUIREMENTS N/AGRANTEE SPECIFIC REQUIREMENTS 1. Monitor trends in antimicrobial susceptibilities in N. gonorrhoea°. 2. Characterize male patients with gonorrhea (GC), particularly those infected with N. gonorrhoeae that are not susceptible to recommended antimicrobials. 3. Phenotypically characterize antimicrobial-resistant isolates to describe the diversity of antimicrobial resistance in N. gonorrhoeae. REPORTING REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT III Page 48 of 175 6/23/16 , (phone & email) Reimbursement Method Staffing (6) 10/1/2016 Hope McElhone 517-241-8563; mcelhoneh@michigan.gov Contractor, or Recipient (non federal) Designation Performance Target Output Measure HIV/STD PARTNER SERVICES PROGRAM II Sp:':?c; Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Central Michigan District Health Department will provide STD and HIV partner services (PS) for select low morbidity health departments within the State of Michigan in accordance with program standards and Department oversight. 2. The Grantee will adhere to applicable federal and state laws, as well as policies and program standards issued by the Department. See "Applicable Laws, Rules, Regulations, Policies, Procedures, and Manuals," especially those related to STD and HIV Prevention. The Department may update and/or add guidance within the contract year. The Department will supply any new additions to the organization/agency. LHD should adhere to: a. All federal and Michigan laws pertaining to H1V/AIDS treatment, disability accommodations, non-discrimination, and confidentiality. b. All Michigan Public Health Accreditation Standards. c. Procedures for the confidentiality and security of client information d. All federal and state issued guidance(s) and policy(ies) for services provided. 3. The Grantee will 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. 4. 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; MDH HS/CO-2017 ATTACHMENT III Page 49 of 175 6/23/16 c. Use of virus protection software to guard against computer viruses; and d. 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. 5. The Grantee is required to use Evaluation Web (EvalWeb) and Partner Services Web (PSWeb) to enter HIV client and service data into the centrally managed database on a secure server. 6. The Grantee will have each employee, funded in whole or in part with federal funds, record time and effort spent on the project(s) funded. The Grantee must: a. Have policies and procedures to ensure time and effort reporting. b. Assure the staff member clearly identifies the percentage of time devoted to contract activities in accordance with the approved budget. c. Denote accurately the percent of effort to the project. The percent of effort may vary from month to month, and the effort recorded for funds must match the percentage claimed on the FSR submitted for the same period. d. Submit a budget modification to the Department in instances where the percentage of effort of contract staff changes (FTE changes) during the contract period. 7. The Grantee will provide immediate notification to the Department, in writing, in the event of any of the following: a. Any formal grievance initiated by a service recipient and subsequent resolution of that grievance. b. Any event occurring or notice received by the Grantee or subcontractor, that reasonably suggests that the Grantee or subcontractor may be the subject of, or a defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or Grantee or subcontractor employees. c. Provide immediate notification to the Department, in writing, of any staff vacancies funded for this project and/or that exceed 30 days. 8. The Grantee will submit all educational materials (e.g., brochures, posters, pamphlets, and videos) used in conjunction with program activities to the Department for review and approval prior to their use, regardless of the source of funding used to purchase these materials. 9. The Grantee will maintain, for a minimum of four (4) years after the end of 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. 10. The Grantee will participate in monitoring site visits including review of fiscal and programmatic compliance with Department policies and contract requirements. 11. The Grantee will participate in the Department needs assessment and planning activities, as requested. 12. 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. DEPARTMENT REQUIREMENTS 1. The Department will provide technical assistance (TA), as requested. TA requests may include issues related to: EvalWeb, PSWeb, MDSS, Quality Assurance, Programs, Budget/Fiscal, Grants and Contracts, or other activities related to carrying out HIV Prevention activities. MDHHS/CO-2017 ATTACHMENT 111 Page 50 of 175 6/23/16 2, The Department will monitor Grantee performance throughout the contract year, which may include a review of financial status reports (FSRs), EvalWeb, PSWeb, MOSS data entries, and site visits. For site visits: a. Monitoring will include a review of fiscal, program, and administrative records to ensure compliance with federal, Department, and contract requirements. b. The Department will provide 30 calendar days written notice of the site visit, including an agenda and the assessment tool to be used. c. The Department will provide a written report post-site visit, including a Corrective Action Plan (CAP) template, if warranted, within 45 calendar days. d. The Grantee must complete the CAP template and submit to the Department within 30 calendar days of receipt of the report. e. The Department will monitor Grantee's completion of the CAP items and provide written documentation when all CAP items have been successfully fulfilled. The Department will review quarterly reports and provide written feedback within 30 calendar days of submission due date. 3. The Department will review EvalWeb, PSWeb, and/or MOSS database entries on a quarterly basis, at minimum. Questions or clarifications, if any, will be requested within thirty (30) calendar days of submission due date. GRANTEE SPECIFIC REQUIREMENTS 1. Pursuant to a protocol established by the Department, the Grantee will 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, The Grantee will 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. The Grantee will provide these services fifty-two weeks a year. 4. The Grantee will adhere to reporting deadlines for all contractual Grantee Reporting requirements. 5. The Grantee is required to use the following data systems to enter HIV and Syphilis case investigation data: EvalWeb, PSWeb, Michigan Disease Surveillance System (MDSS) a. All reactive results must be entered into EvalWeb within 48 hours b. All non-reactive results must be entered into EvalWeb within seven days c. All EvalWeb/PSWeb must be entered and missing variables entered by the 10th day after the end of each calendar month. REPORTING REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT III Page 51 of 175 6/23/16 10/1/2016 'Grant End.Date- • • 9/3012017 Hope McElhone 517-241-8563; mcelhoneh©michigan.gov Grant Start. pop Grant Contract Administrator Contact Info (phone & email) Reimbursement Staffing (6) Method Performance Level (if Applicable) N/A Reimbursement ; Method Non-Categorical -,--y---•-..••-.- Fixed Unit Rate (7) (12) Categorical r Subrecipient, Contractor, or Recipient (non federal Designation Performance Target Output Measure Subrecipient Subrecipient, Contractor, or Recipient (non federal) Designation Contractor Performance Target Output Measure N/A I N/A HIV PREVENTION PROGRAM II Spfecial Requirements Performance Level (if Applicable) BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Grantee Reauirements— Cateaorical '1. Local health departments (LHD) will provide HIV counseling, testing, and referral (CTR) and partner services (PS) 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. The Grantee will adhere to applicable federal and state laws, as well as policies and program standards issued by the Department. See "Applicable Laws, Rules, Regulations, Policies, Procedures, and Manuals." The Department may update and/or add guidance within the contract year. The Department will supply any new additions to the organization/agency. LHD should adhere to: a. All federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination, and confidentiality. MDH HS/CO-2017 ATTACHMENT III Page 52 of 175 6/23/16 b. All Michigan Public Health Accreditation Standards. c. Procedures for the confidentiality and security of client information. d. All federal and state issued guidance(s) and policy(ies) for services provided. 3. The Grantee will ensure that records are available for review by the Department au d i t o r s , s t a f f a n d federal government agencies, if applicable, to monitor performance. Maintain and pro v i d e a c c e s s to primary source documentation. 4. The Grantee may enter into subcontracts or vendor agreements to fulfill the serv i c e d e l i v e r y expectations of this agreement. a. The Grantee will assure that all subcontracts issued under this funding agreement are sub j e c t to the same requirements as outlined in this agreement and subject to prior approval b y t h e Department. b. The Grantee will monitor subcontractors annually to assess compliance with the subcontr a c t ; 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 con t r a c t monitoring activities to the Department. c. The Grantee will provide, upon request, a copy of all fully signed subcontracts, mem o r a n d u m s of understanding (MOUs) or letters of agreement related to the services in this agree m e n t . 5. The Grantee and its subcontractors are required to use Evaluation Web (EvalWeb ) a n d , i f applicable, Partner Services Web (PSWeb) to enter HIV client and service data into th e c e n t r a l l y managed database on a secure server. 6. The Grantee will receive a condom and lubrication allowance. The Grantee must: a. Distribute condoms and lubrication b. Place orders for condoms/lubrication between January — September 10 c. Order condoms/lubrication by emalling ctrsupplies@michigan.gov d. Report its condom distribution monthly using EvalWeb. 7. The Grantee will have each employee funded in whole or in part with federal funds mu s t r e c o r d time and effort spent on the project(s) funded. The Grantee must: a. Have policies and procedures to ensure time and effort reporting. b. Assure the staff member clearly identifies the percentage of time devoted to cont r a c t a c t i v i t i e s in accordance with the approved budget. c. Denote accurately the percent of effort to the project. The percent of effort may vary fr o m month to month, and the effort recorded for funds must match the percentage claimed on t h e FSR submitted for the same period. d. Submit a budget modification to the Department in instances where the percentage o f e f f o r t o f contract staff changes (FTE changes) during the contract period. 8. The Grantee will provide immediate notification to the Department, in writing, in the e v e n t o f a n y o f the following: a. Any formal grievance initiated by a service recipient and subsequent resolution of that grievance. b. Any event occurring or notice received by the Grantee or subcontractor, that reason a b l y suggests that the Grantee or subcontractor may be the subject of, or a defendant in, leg a l action. This includes, but is not limited to, events or notices related to grievances by s e r v i c e recipients or Grantee or subcontractor employees. c. Provide immediate notification to the Department, in writing, of any staff vacancies funde d f o r this project and/or that exceed 30 days. • MDHHS/C0-2017 ATTACHMENT III Page 53 of 175 6/23/16 9. The Grantee will submit all educational materials (e.g., brochures, posters, pamphlets, and videos) used in conjunction with program activities to the Department for review and approval prior to their use, regardless of the source of funding used to purchase these materials. 10. The Grantee will maintain, for a minimum of 4 years after the end of 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. 11. The Grantee will participate in monitoring site visits including review of fiscal and programmatic compliance with Department policies and contract requirements. 12. The Grantee will participate in the Department needs assessment and planning activities, as requested. 13. 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. 14. The Grantee must use the Department's standardized Technical Assistance (TA) Request Form when requesting TA. See Department website (www.michioan.gov/hivstd) to download the form. Grantee Reauirements— Non-Catenorical Grantees that do not receive categorical HIV prevention funds and that elect to conduct HIV testing may request reimbursement for performing HIV tests. 1. The Grantee will provide HIV CTR services pursuant to statute and the Michigan Public Health Accreditation Standards. 2. The Grantee will submit client-level service data to the Department via EvalWeb. The time line and procedures for submitting these data are to conform to guidelines issued by the Department. 3. The Grantee will receive a condom and lubrication allowance. The Grantee must: a. Distribute condoms and lubrication b. Place orders for condoms/lubrication between January — September 10 c. Order condoms/lubrication by emailing ctrsupplies@michigan.gov d. Report its condom distribution monthly using EvalWeb. DEPARTMENT REQUIREMENTS Peoartment Reauirements - Categorical 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 testing. 2. The Department will provide training and technical assistance (TA) in support of implementation of HIV testing as a standard of care and use of rapid HIV tests. 3. The Department will provide Grantee with a condoms and lubrication allowance. The Department will: a. Notify the LHD of its condom/lubrication allowance by Jan. 1. b. Place all orders for condom and lubrication between Jan.1 and Sept. 10. c. Track the Grantees' allowance. peoartment Reauirements Non-Cateaorical MDHHS/C0-2017 ATTACHMENT III Page 54 of 175 6/23/16 1. The Department will reimburse Grantees at a rate of $11.00 per test, not to exceed $2,000 for Fiscal Year 16/17, 4. The Department will provide Grantee with a condoms and lubrication allowance. The Department will: a. Notify the LHD of its condom/lubrication allowance by Jan. 1. b. Place all orders for condom and lubrication between Jan.1 and Sept. 10. C. Track the Grantees' allowance. GRANTEE SPECIFIC REQUIREMENTS Contract Specific Reauirements Cateaorical 1. 1. If conducting HIV testing using rapid HIV testing, the Grantee will 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 Quality assurance activities are to be responsive to: Quality Assurance for Rapid HIV Testing, MDHHS. See "Applicable Laws, Rules, Regulations, Policies, Procedures, and Manuals." b. Ensure provision of the LHD's current Clinical Laboratory Improvement Amendments (CLIA) certificate. c. Report discordant test results to the Division of HIV & STD Programs. d. Submit quality control, daily client logs, and test inventory on a monthly basis to the HIV Care and Prevention 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 or Information Based Training (as 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. If conducting PS, the Grantee will comply with guidelines and standards issued by the Department. See "Applicable Laws, Rules, Regulations, Policies, Procedures, and Manuals." The Grantee must: a. Confidentially provide PS follow-up to infected clients and their at-risk partners to ensure disease management and education is offered to reduce transmission. b. Effectively link infected clients and/or at-risk partners to HIV care and other support services. c. Work with Early Intervention Specialist to ensure infected clients are retained in HIV care. 3. Order condoms and lubrication through CTR Supplies; ctrsuppliesamichioan.orq. REPORTING REQUIREMENTS Grantee Reporting-Categorical 1. The Grantee will adhere to reporting deadlines for all contractual Grantee Reporting requirements, 2. The Grantee will submit quality control, daily client logs, and test inventory monthly. These are due by the 10th of the following month to Department staff. 3. The Grantee will submit EvalWeb and, if applicable, PS Web data according to the following schedule: MORNS/CO-2017 ATTACHMENT II Page 55 of 175 6/23/16 a. Enter all reactive results into EvalWeb/PSWeb within 48 hours b. Enter all non-reactive results into EvalWeb/PSWeb within seven days c. Clean-up missing data by the 10th day after the end of each calendar month. 4. The Grantee will enter condom distribution data in EvalWeb within 7 days and enter all missing data variables by the 10th day after the end of each calendar month. Grantee Reporitng-Non-Categorical 1. The Grantee will adhere to reporting deadlines for all contractual Grantee Reporting requirements. 2. The Grantee will submit EvalWeb data according to the following schedule: a. Enter all reactive results into EvalWeb within 48 hours b. Enter all non-reactive results into Eval Web within seven days c. Clean-up missing data by the 10th day after the end of each calendar month. The Grantee will enter condom distribution data in EvalWeb within 7 days and enter missing variables by the 10th day after the end of each calendar month. IVIDHHS/C0-2017 ATTACHMENT III Page 56 of 175 6/23/16 517-241-8563; mcelhoneh@michigan.gov Performance Level N/A (if Applicable) Subrecipient, Subrecipient Contractor, or Recipient (non federal) Designation Performance Target 1 N/A Output Measure _ HIV RYAN WHITE PART B 1D( rnents Grant 9/3012017 I Hope McElhone BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 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. Ryan White is payer of last resort; as such, the Grantee must adhere to the Ryan White H1V/AIDS Treatment Extension Act. 3. The Grantee will adhere to applicable federal and state laws, as well as policies and program standards issued by the Department. See "Applicable Laws, Rules, Regulations, Policies, Procedures, and Manuals." The Department may update and/or add guidance within the contract year. The Department will supply any new additions to the organization/agency. The Grantee should adhere to: a. All federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination, and confidentiality. b. Procedures for the confidentiality and security of client information. C. All federal and state issued guidance(s) and policy(ies) for services provided. 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. For site visits: a. Monitoring will include a review of fiscal, program, administrative, quality management, and client health records to ensure compliance with federal, Department, and contract requirements. MDHHS/CO-2017 ATTACHMENT III Page 57 of 175 6/23/16 b. The Department will provide 30 calendar days written notice of the site visit, including a n agenda and the assessment tool to be used. c. The Department will provide a written report post-site visit, including a Corrective Ac t i o n P l a n (CAP) template, if warranted, within 45 calendar days. d. The Grantee must complete the CAP template and submit to the Department within 3 0 calendar days of receipt of the report. 5. The Grantee will ensure that records are available for review by the Department aud i t o r s , s t a f f a n d federal government agencies, if applicable, to monitor performance. Maintain an d p r o v i d e a c c e s s to primary source documentation. 6. The Grantee may enter into subcontracts or vendor agreements to fulfill the se r v i c e d e l i v e r y expectations of this agreement. a. The Grantee will assure that all subcontracts issued under this funding agreemen t a r e s u b j e c t to the same requirements as outlined in this agreement and subject to prior approv a l b y t h e Department. b. The Grantee will monitor subcontractors annually to assess compliance with the subcontra c t ; 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 con t r a c t monitoring activities to the Department. c. The Grantee will provide, upon request, a copy of all fully signed subcontracts, me m o r a n d u m s of understanding (MOUs) or letters of agreement related to the services in this agre e m e n t . 7. The Grantee will provide immediate notification to the Department, in writing, in th e e v e n t o f a n y o f the following: a. Any formal grievance initiated by a client and subsequent resolution of that grievance. b. Any event occurring or notice received by the Grantee or subcontractor, that reasona b l y suggests that the Grantee or subcontractor may be the subject of, or a defendant in , l e g a l action, This includes, but is not limited to, events or notices related to grievances b y s e r v i c e recipients or Grantee or subcontractor employees. c. Any staff vacancies funded for this project that exceed 30 days. 8. When issuing statements, press releases, requests for proposals, bid solicitations a n d o t h e r documents describing projects or programs funded in whole or in part with Feder a l m o n e y , t h e Grantee receiving Federal funds, including but not limited to State and local gove r n m e n t s a n d recipients of Federal research grants, shall clearly state: a. The percentage of the total costs of the program or project that will be financed with F e d e r a l 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 b e f i n a n c e d by non-governmental sources. 9. The Grantee will participate in the Department needs assessment and planning activ i t i e s , a s requested. 10. The Grantee will maintain, for a minimum of four years after the end of the budg e t p e r i o d , p r o g r a m 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 in part with federal funds must record time an d e f f o r t s p e n t o n the project(s) funded. The Grantee must: MDRHS/C0-2017 ATTACHMENT 1;1 Page 58 of 175 6/23/16 a. Have policies and procedures to ensure time and effort reporting. b. Assure the staff member clearly identifies the percentage of time devoted to contract activities in accordance with the approved budget. c. Denote accurately the percent of effort to the project. The percent of effort may vary from month to month, and the effort recorded for Ryan White funds must match the percentage claimed on the Ryan White FSR for the same period. d. Submit a budget modification to the Department in instances where the percentage of effort of contract staff changes (FTE changes) during the contract period. 12. The Grantee and its subcontractors are required to use the HRSA-supported software CA R E W a r e to enter client and service data into the centrally managed database on a secure server. T h e Grantee must: a. Enter all Ryan White services delivered to HIV-infected and affected clients. b. Enter all data by the 10th of the following month. c. Complete collection of all required data variables and the clean-up of any missing data o r service activities by the 10th of the following month. 13. 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 tr a i n i n g offerings and information-sharing opportunities provided by the Department. 14. The Grantee must use the Department's standardized Technical Assistance (TA) Reque s t F o r m when requesting TA. See Department website (wvvw.michidan.00v/hivstd) to download th e f o r m . DEPARTMENT REQUIREMENTS 1. The Department will provide TA, as requested, on the implementation of the Ryan White p r o g r a m . This may include issues related to: CAREWare, Quality Management, Programs, Budget/Fiscal, Grants and Contracts, ADAP, or other activities related to carrying out Ryan White activities. Please see Grantee Specific Requirements, item 14 for information on how to request TA. 2. The Department will monitor Grantee performance throughout the contract year, whic h m a y include a review of FSRs, CAREWare data entries, quarterly progress reports, and site visits. F o r site visits, the Department will: a. Include a review of fiscal, program, administrative, quality management, and client health records to ensure compliance with federal, Department, and contract requirements. b. Provide 30 calendar days written notice of the site visit, including an agenda and the assessment tool to be used. c. Provide a written report post-site visit, including a CAP template, if warranted, within 45 calendar days. d. Verify that the Grantee completed a response to the CAP template and submitted it to the Department within 30 calendar days of receipt of the report. e. Monitor Grantee's completion of the CAP items and provide written documentation when a l l CAP items have been successfully fulfilled. 3. The Department will review quarterly reports and provide written feedback within 30 calendar d a y s of submission due date. MDHHS/CO-2017 ATTACHMENT II Page 59 of 175 6/23/15 REPORTING REQUIREMENTS 1. The Grantee must adhere to reporting deadlines for all contractual Grantee Reporting requirements. 2. To complete the Ryan White Service Report (RSR), a HRSA required annual data report, the Grantee must assure that all CAREWare data is complete, cleaned, and entered into an online form via the HRSA Electronic Handbook. RSR submission requirements include: a. The report shall have no more than 5% missing data variables. b. Exact dates for Grantee submission will be provided by the Department each reporting year. I. Generally, Grantee submission will open on or around March 1. ii. Generally, Grantee submission will close on or around March 20. c. The Department submits RSR data on behalf of the Grantee. 3. The Grantee will submit quarterly progress report and must provide the following: a. Detail progress made on work plan objectives and activities during the reported quarter. b. Respond to any questions or clarifications of the quarterly progress report that the Department requests, 4. If the Grantee provides at least one core medical service, the Grantee will develop a Quality Management (QM) Plan and submit no later than December 31, 2016. a. QM Plans must contain the eleven required components: 1) Quality statement, 2) Quality infrastructure, 3) Annual quality goals, 4) Capacity building, 5) Performance measurement, 6) Quality improvement, 7) Engagement of stakeholders, 8) Procedures for updating the QM plan, 9) Communication, 10) Evaluation, and 11) Work plan. b. Quality Management Plan guidelines may be obtained from Department Quality Coordinators. C. Grantee 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. d. In accordance with continuous quality improvement principles, the Grantee shall conduct at least one quality improvement project throughout the year, using the Plan-Do-Study-Act method to document progress. e. The Grantee must designate at least one person to attend and actively participate in all Department quality management activities and meetings, as well as be responsible for all quality management correspondence with Department. MDHHS/C0-2017 ATTACHMENT UI Page 60 of 175 6/23/16 5. Allocations reports are required three times each year to identify expenses by Ryan White Service Category. The Grantee must submit an Allocation Report according to the following schedule: Report How to Submit Ryan White Part B Planned Allocation by Service To Grants and Contracts October 30 Category of FY16-17 Budget Administrator or designee. Allocation of Actual FY FY16-17 Attached to FSR April 30 Expenditures by Service Category Allocation of Actual FY16-17 Attached to FSR October 30 Year End Expenditures by Service Category 6. Administrative Costs and Program Income must be reported quarterly. The Grantee must attach the report to the FSR. The Department will supply these templates to the Grantee. The deadline for submission are on or before: a. 1st Quarter: January 30 b. 2nd Quarter: April 30 c. 3rd Quarter: July 30 d. 4th Quarter: November 30 GRANTEE SPECIFIC REQUIREMENTS DATA TO CARE The City of Detroit Department of Health Wellness and Promotion. Grantee Requirements: 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. The Grantee will adhere to applicable federal and state laws, as well as policies and program standards issued by the Department. See "Applicable Laws, Rules, Regulations, Policies, Procedures, and Manuals." The Department may update and/or add guidance within the contract year. The Department will supply any new additions to the organization/agency. The Grantee should adhere to: a. All federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination, and confidentiality. b. Michigan Public Health Accreditation Standards c. Procedures for the confidentiality and security of client information d. All federal and state issued guidance(s) and policy(ies) for services provided. 3. Ryan White is payer of last resort; as such, the Grantee must adhere to the Ryan White HIV/AIDS Treatment Extension Act. 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. MIDHHS/CO-2017 ATTACHMENT III Page 61 of 175 6/23/16 5, The Grantee will 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, The Grantee may enter into subcontracts or vendor agreements to fulfill the service delivery expectations of this agreement. a. The Grantee will assure that 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. The Grantee will provide, upon request, a copy of all fully signed subcontracts, memorandums , of understanding (MOW) or letters of agreement related to the services in this agreement. 7. The Grantee will provide immediate notification to the Department, in writing, in the event of any of the following: a. Any formal grievance initiated by a client 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. Any staff vacancies funded for this project that exceed 30 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, the Grantee 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 that 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. The Grantee will participate in the Department needs assessment and planning activities, as requested. 10. The Grantee will maintain, for a minimum of four 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. 11. Each employee funded in whole or in part with federal funds must record time and effort spent on the project(s) funded. The Grantee must: a. Have policies and procedures to ensure time and effort reporting. b. Assure the staff member clearly identifies the percentage of time devoted to contract activities in accordance with the approved budget. c. Denote accurately the percent of effort to the project. The percent of effort may vary from month to month, and the effort recorded for Ryan White funds must match the percentage claimed on the Ryan White FSR for the same period. MDHHS/C0-2017 ATTACHMENT hl Page 62 of 175 6/23/16 d. Submit a budget modification to the Department in instances where the percentage of effort of contract staff changes (FTE changes) during the contract period. 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. The Grantee must: a. Enter all Ryan White services delivered to HIV-infected and affected clients. b. Enter all data by the 10th of the following month. c. Complete collection of all required data variables and the clean-up of any missing data or service activities by the 10th of the following month. 13. 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. 14. The Grantee must use the Department's standardized Technical Assistance (TA) Request Form when requesting TA. See Department website (www.michioan.00v/hivstd) to download the form. Department Requirements 1, The Department will provide TA, as requested, on the implementation of the Ryan White program. This may include issues related to: CAREWare, Quality Management, Programs, Budget/Fiscal, Grants and Contracts, ADAP, or other activities related to carrying out Ryan White Part 13 activities. Please see Grantee Specific Requirements, item 15 for information on how to request TA. 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. 3. The Department will review quarterly reports and provide written feedback within 30 calendar days of submission due date. Grantee Reporting Requirements 1. The Grantee will adhere to reporting deadlines for all contractual Grantee Reporting requirements. 2. The Grantee will submit a quarterly progress report that details progress made on work plan objectives and activities during the reported quarter. 3. The Grantee must respond to any questions or clarifications of the quarterly progress report that the Department requests. MDHHS/CO-2017 ATTACHMENT III Page 63 of 175 6/23/16 Grant Start Date 10/1/2016 Kathryn Macomber Grant End Date I 9/3012017 Contact Info (phone & email) Reimbursement Method Performance Level (if Applicable) Macomberk@michigan.gov 517-335-9807 Staffing (6) Subrecipient••Subrecipient Contractor, or .Recipient (non federal) :Designation N/A Performance Target N/A Output Measure HIV SURVEILLANCE SUPPORT PROGRAM H Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Provide the resources necessary to house the Department's HIV Surveillance Staff at the South Oakland Health Center, 27725 Greenfield Road, Southfield, MI 48076. Support includes overhead costs for the office space and includes costs and technical support for phone and technology lines. DEPARTMENT REQUIREMENTS Reimburse the Grantee for costs associated with the location of the State HIV Office in the South Oakland Health Center as reflected in the attachment to the Comprehensive Agreement. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT RI Page 64 of 175 6/23/16 10/1/2016 Grant End .Date:: .1 9/3012017 Mary Kay Thelen 517-284-8016 thelenm11 ©michigan.gov Staffing (6) N/A (if Applicable) Performance Target 1 N/A Output Measure Subrecipient, Contractor, or Recipient (non federal) Designation Subrecipient HOUSING OPPORTUNITIES FOR PERSONS LIVING WITH HIV/AIDS (HOP WA) v Si.1,ect'ul Requirements BUDGET AND AGREEMENT REQUIREMENTS HOPWA PROGRAM OVERVIEW The Housing Opportunities for Persons with AIDS (HOPWA) program provides housing assistance and related supportive services for low-income persons living with HIV/AIDS and their families. The HOPWA program helps eligible clients improve their health by providing stable housing as a basis for increased participation in the coordinated delivery of supportive services. These services may involve support with their daily living activities; case management; substance abuse treatment and counseling; and other services, to help beneficiaries maintain appropriate housing and access other needed support. HOPWA clients very often use a range of health and supportive services funded by HHS through the Ryan White Care Act and other public or private support, which will improve their ability to participate in health care and access other supportive services. A. HOPWA Eligibility An eligible person means a person with acquired immunodeficiency syndrome or related diseases who is below 80% median income. A family member regardless of income is eligible to receive housing information services. Any person living in proximity to a community residence is eligible to participate in that residence's community outreach and educational activities regarding AIDS or related diseases. Within the population eligible for this program, nondiscrimination and equal opportunity regulations must be followed, including fair housing and affirmative outreach. A project sponsor and all Grantees and subcontractors must adopt procedures to ensure that all 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 HOPVVA program, including facilities and services accessible to persons with a handicap, and maintain evidence of implementation of the procedures. HIV Status Determination MDH HS/CO-2017 ATTACHMENT III Page 65 of 175 6/23/16 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 el:mail: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. 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 HOP WA funds: a. HOUSING SUBSIDY ASSISTANCE Tenant Based Rental Assistance (TBRA): Subsidy for use on the open rental market. Tenant holds lease to unit rented at or under Fair Market rent (FMR), is documented to be Rent Reasonable, and meets Housing Quality Standards (HOS) or HOPWA Habitability Standards. Calculation of utility allowances as needed. 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. 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. MDHHS/CO-2017 ATTACHMENT III Page 66 of 175 6/23/16 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 MDHHS/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 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. The Department 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 Department HOPWA Specialist is notified. Deviations over 5% of the Activity budget must be approved by the Department HOPWA Specialist. Expenditures for Administration cannot exceed 7% of the total budget as it is fixed at 7% by law. MDRHS/C0-2017 ATTACHMENT III Page 67 of 175 6/23/16 A formal amendment is required to request an increase in the total contractual a m o u n t . GRANTEE REQUIREMENTS The HOPWA OPERATING YEAR PLAN and OPERATING YEAR BUDGET. The HOPWA Operating Year is July 1st through June 30th. This coinci d e s w i t h t h e Reporting Year for HOPWA. The annual report, the Consolidated Annual Pe r f o r m a n c e and Evaluation Report (CAPER), must report on the funds expended , h o u s e h o l d demographics, and answers to narrative questions concerning the hous e h o l d s a s s i s t e d during this Operating / Reporting Year. The Department is reimbursed by H U D a c c o r d i n g to the Operating Year and Budget. HUD notifies the HOPWA Consolidated Plan Lead Agency Michigan State H o u s i n g Development Authority (MSHDA for the Michigan HOPWA program of the total H O P W A g r a n t amount available. This notification usually occurs between February and t h e e n d o f M a r c h (although at times it has been later). The Department administrative staff will r e v i e w t h e g r a n t funds available and the Department HOPWA Specialist will notify each sponso r o f t h e p l a n n e d amount of funding for the HOPWA Operating year for each sponsor. The H O P W A S p e c i a l i s t will send each Sponsor instructions for completing the Operating Year Nar r a t i v e P l a n a n d Operating Year Budget. In consultation with and assistance from the HOPWA S p e c i a l i s t , t h e Sponsor will determine the estimated Operating year budget amounts fo r e a c h a l l o w e d HOPWA Activity and complete the narrative Operating Year Plan covering J u l y 1 , t h r o u g h June 30. This Operating year Budget and Plan is to be submitted to the D e p a r t m e n t b y w i t h the Fiscal Year contract. NOTE: The 1st quarter of the HOPWA Operating year (July 1 to September 3 0 ) w i l l b e t h e amount of funds remaining from the previous fiscal year contract with the Dep a r t m e n t . T h e amount for the balance of the Operating Year Budget (October 1 to June 3 0 ) w i l l g e n e r a l l y b e calculated as 3 quarters of the new Fiscal Year (October 1 to September 30 ) b u d g e t . T h i s plan, along with an annual report (the CAPER), data from ongoing HMIS (or ot h e r ) d a t a collection systems and the Grantees FSR Supplemental Forms, will provide the D e p a r t m e n t with information to satisfy most federal reporting requirements, carry out m o n i t o r i n g a c t i v i t i e s , and assure that departmental goals for this program can be met. See Operati o n a l P l a n Details. The Operating Year Plan and Budget are to be returned to the Department wi t h t h e n e w Fiscal Year contract — generally in August. An electronic copy of the Operating Year Budget in Excel format must be submitted electronically to: colemanc9@michigan.gov B. Fiscal Year Contract and Budget The Department's Fiscal Year runs from October 1 through September 30 . T h e F i s c a l Y e a r contract from the Department is sent to Health Department Sponsors via th e M I E . Grants system in early July. The contract in the MI E-Grants system needs to b e completed and returned to the Department within 2 weeks of receipt of th e M l E - G r a n t s system contract. Billing for HOPWA reimbursement will involve completing th e Department FSR form and attaching the HOPWA FSR Supplemental form MOHHS/C0-2017 ATTACHMENT HI Page 68 of 175 6/23/16 (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://vvww.m.gov/portal/public/SAM/ The SAM Service Desk is at URL: http://www,FSagov 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. MDHHS/C0-2017 ATTACHMENT III Page 69 of 175 6/23/16 Currently the plan is that the demographic will be collected in the HMIS System and use of HMIS must continue until another Department 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 Department 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 (IDIS), therefore all narrative questions applicable to the Sponsor must be complete. b. Staff are required to attend offered HMIS training to increase skills and use of HMIS or another approved data collection system that the Department 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=viewHo_pwaFinancialTraining, 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 the Department 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. The Department 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. Status of Disability. iii. Releases of Information completed. M D H HS/CO-2017 ATTACHMENT 111 Page 70 of 175 6/23/16 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 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. \rill. 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. xiii. 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 the Department as needed. A copy must be kept in the client record. Current Documents and Forms are subject to review and modification with the Department 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 the Department approval. Grantee must have a plan to meet concerns for security, confidentiality, ease MDHHS/CO-2017 ATTACHMENT 1I Page 71 of 175 6/23/16 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. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS 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 "I 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; MDHHS/CO-2017 ATTACHMENT III Page 72 of 175 6/23/16 use of the Department specified mandatory forms; documentation relating to the annual report data; tracking of program income (tenant co- pay for TBRA; returned security deposits); adequate documentation of expenditures, etc. G. Provide services in accordance with an approved housing plan and comply with reporting requirements as specified by law, HUD and/or the Department. H. Retain documentation of the rental subsidy payment calculations, Habitability inspections, and for repayment of security deposits and other HOPWA records for a period of 4 years. Disposal of confidential records must assure confidentiality. Keep a record of their destruction. The Department of Housing and Urban Development has insisted that all employee costs that are to be billed to the HOPWA grant be documented through the use of a time sheet. All time/costs billed to the HOPWA grant must be documented and readily available to HUD and the Department staff. This includes calculations of salaries, fringe benefits, and in-direct costs as allowed. Rather than specify a particular format, the Department requires only that the tracking document conform to general accounting principles in the applicable OMB circulars, in acknowledgment of sponsor accounting system variations. J. Oversee process and performance of subcontractors for the provision of HIV related HOPWA services. Ensure a contractual requirement to adhere to all applicable state and federal laws and regulations for all subcontractors. K. Conduct an ongoing assessment of the housing assistance and supportive services required by participants as identified in Individual Housing and Service Plans, including an annual assessment of their housing situation, a reevaluation of the appropriateness of rental subsidies or other support, and a report on annual results of program activities under the HOPWA client outcome goals for achieving stable housing, reducing risks of homelessness and improving access to healthcare and other support. Specifically complete 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 HIV/AIDS in the entire eligible metropolitan statistical area (EMSA) for a city grantee, or, for a state grantee, the areas of the state that are outside of any EMSA); in addition to homeless needs, the plan's assessment of "other special needs' should include the number of persons with H1V/AIDS; d. Individuals and their families who are not homeless but require supportive housing; MDHHS/CO-2017 ATTACHMENT III Page 73 of 175 6/23/16 e. In providing a housing market analysis, including the supply, demand, condition and cost of housing and the housing stock available to serve persons with HIV/AIDS and their families; f. Address other special needs with components relative to persons with HIV/AIDS and their families who are not homeless but require supportive housing that: i. Indicate general priorities for allocating HOPWA program funds geographically within the eligible metropolitan statistical area and among priority needs; ii. Describe the basis for assigning the priority given to each category of priority needs; iii. Identify any obstacles to meeting underserved needs; iv. Summarize the priorities and specific objectives, describing how funds made available will be used to address identified needs; and v. For each specific objective, identify proposed accomplishments the jurisdiction hopes to achieve in quantitative terms over a specific time period (e.g. over two-five years), or in other measurable terms as identified and defined by the jurisdiction. g. Provide outcome measures for activities in the action plan consistent with the HOPWA reporting format; h. Provide specific one-year goals for the number of households to be provided housing through the use of HOPWA activities for STRMU assistance payments to prevent homelessness, as well as TBRA assistance and units provided in housing facilities that are developed and/or operated with HOPWA funds; Identify the method of selecting project sponsors, including providing full access of HOPWA funds to grassroots, faith-based, and other community organizations; and In annual reporting compare proposed to actual outcomes for measures in their plan; explain, if applicable, why progress was not made toward meeting goals and objectives. M. Obtaining Certification of Consistency with the Consolidated Plans in your service a r e a is not required for existing the Department 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 the Department HOPV V A 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 incom e 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 com p l y 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 t h i s MDHHS/C0-2017 ATTACHMENT IlL Page 74 of 175 6/23/16 Agreement, or any material misrepresentation, which, if known to the Grantee, would have resulted in the Grant Funds not being provided. If the Sponsor fails to comply with any term of this award, including the prompt submission of data for reporting, keeping HMIS data up- to-date, fully completing needed documents and forms, serving only qualified individuals and families, or other Sponsor requirements, the Grantee may: a. Temporarily withhold further payments pending corrective action by the Project Sponsor; b. Disallow all or part of the cost of an activity or action not in compliance; c. Wholly or partly suspend or terminate the current award for the Sponsor's program; d. Withhold further awards for the HOPWA program; e. Reduce or recapture Grant Funds; f. Require the Sponsor to reimburse program accounts with non-Federal funds for the amount of ineligible costs; or 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: colemanc9(&,michioan.qov. With approval, mail a copy to: HOPWA Program Division of Housing and Homeless Services Michigan Department of Health & Human Services Grand Tower 235 S. Grand Ave, Suite 1110 Lansing, Michigan 48933 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. MIDH HS/CO-2017 ATTACHMENT III Page 75 of 175 6/23/16 g. 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 program that will be financed by non- governmental resources. Releases by the Sponsor need to include copies sent to the Department 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 catch -iment's area. If persons from outside a catchments 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. REPORTING REQUIREMENTS Sponsors must fully implement HUD's Measurement of Performance Outcomes reporting requirements. See the HOPWA Consolidated Annual Performance and Evaluation Report (CAPER) HUD-40110-D (Expires 10/31/2015). Obtain at http://www.hudhre.info/index.cfm?do=viewResource&ResourcelD=383 . As such demographic data should be collected from HMIS as possible. Some demographic data, most financial data and all narrative responses will need to be reported separately to the Department 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: colemanc9@michigan.gov . Materials that cannot be emailed, should be sent to: HOP WA Program Division of Housing and Homeless Services Michigan Department of Health & Human Services Grand Tower 235 S. Grand Ave, Suite 1110 Lansing, MI 48933 2. Reimbursement: Financial Status Reports (FSRs) shall be prepared and submitted to the Department via the Nil E-Grants system. The FSR Supplemental (FSR-S) pages must be MDRHS/C0-2017 ATTACHMENT 111 Page 76 of 175 6/23/16 included as an attachment. Follow the instructions provide d f o r u s e o f t h i s a u t o m a t e d s y s t e m including completing a Fiscal Year (October 1 to Septembe r 3 0 ) B u d g e t , A c o p y s h o u l d b e with the documents in the Ml E-Grants system, Reimbursement for Administration is limited to the 7% of your con t r a c t a s a l l o w e d b y l a w ( 3 % for agencies providing fiduciary services only). Total expen d i t u r e s f o r o t h e r A c t i v i t y c a t e g o r i e s can vary from the ones proposed in your budget by 5% with no t i f i c a t i o n o f t h e H O P W A Specialist, but total expenditures cannot exceed the total amoun t o f t h e c o n t r a c t . C o n t a c t t h e HOPWA Program manager prior to changes exceeding 5% of the A c t i v i t y a m o u n t . A n E x c e l formatted copy of the FSR Supplemental (FSR-S) form has b e e n e m a i l e d t o a l l S p o n s o r s . Additional copies can be obtained from Housing Services staf f : c o 1 e m a n c 9 @ m i c h i g a n . g o v . Sponsor will participate in the training for and the continued im p l e m e n t a t i o n o f t h e H o m e l e s s Management Information System (HMIS). It is expected that all p e r s o n s w h o a r e r e c i p i e n t s o f HOPWA services will be entered into the HMIS system during the c u r r e n t c o n t r a c t y e a r . A t t h e end of the operating year (June 30) it is expected that service d a t a e x t r a c t e d f r o m t h e H M I S system will be consistent with the data submitted in the FSR & F S R S u p p l e m e n t a l forms and internally consistent. Continue to work with the Department staff to develop a means t o c o l l e c t d a t a o n q u a l i f i e d p e o p l e that cannot obtain housing assistance — Unmet Need. This w o u l d i n c l u d e p e o p l e , w h o a r e t u r n e d away for any reason including a decision that sufficient fund s a r e n o t a v a i l a b l e , o r t h e p e r s o n ' s financial needs are too great to be assisted at this time, or the r e a r e p e r s o n s w i t h a h i g h e r p r i o r i t y . O r other reasons that you may be aware of. OPERATING YEAR NARRATIVE PLAN AND OPERATIN G Y E A R B U D G E T C O M P O N E N T S The HOPWA Specialist will email you the amount of your budget b y M a y 3 0 . A n E x c e l f o r m a t t e d version will be emailed to sponsors or you can contact the H O P W A S p e c i a l i s t f o r a c o p y . I t i s recommended that you enter a minimum amount in every activ i t y , e v e n i f i t i s l u s t $ 5 0 . T h a t $ 5 0 c a n always be transferred to another Activity at the end of the year. H o w e v e r , i f y o u d o n o t h a v e a n y f u n d s entered into an Activity at the beginning of the year, you ca n n o t b i l l f r o m t h a t a c t i v i t y w i t h o u t completing an amendment which is a lengthy process. The H O P W A S p e c i a l i s t w i l l c o n t a c t e a c h Sponsor to review this budgeting process. This operating year b u d g e t w i l l s e r v e a s t h e b a s i s f o r reporting financial information for the CAPER. As mentioned in Grantee Requirements 2A, the completed Operating Year Budge t w i l l b e u s e d t o complete the Fiscal Year Budget quickly but with forethought. The Operating Year Plan is a narrative summary of the past O p e r a t i n g Y e a r ( J u l y 1 t h r o u g h J u n e 3 0 ) and a narrative of your plans for the upcoming Operating Year (J u l y 1 t h r o u g h J u n e 3 0 ) . The summary of the past year will be questions that need to be a n s w e r e d o n t h e u p c o m i n g C A P E R . Page references below are to the corrected CAPER. Send a Wo r d d o c u m e n t t o t h e a t t e n t i o n o f t h e HOPWA Specialist that contains the following information plu s t h e p l a n b u d g e t : MOHHS/C0-2011 ATTACHMENT III Page 77 of 175 6/23/16 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 the Department has to combine/summarize 7 sponsor's information for the Michigan Caper, however individual sponsor CAPWERs will also be completed so provide all relevant information. (B). Annual Performance under the action Plan. Questions 1 & 2 it will be difficult to answer the numeric questions until the 2012 CAPER is compiled in July or August. However you can provide information from question 2 to describe other steps you want to take with your program, (B). Annual Performance under the action Plan. Question 3 Coordination needs to be addressed by your agency as to coordination with other mainstream housing and supportive services resources - be sure to name them. (B). Annual Performance under the action Plan. Question 4 Technical Assistance. Provide your input as to training that would benefit your agency and the clients assisted. Please specify by subject: training on utility allowances, developing a Housing Plan, identifying housing plan tasks, etc. Or you can broaden your scope to a training session between various community agencies so that you can work more cooperatively. (C) Barriers and Trends overview Questions 1 through 3. When describing (1) garriers, 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 SOARtraining 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: colernanc9@michigan.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; MDH HS/CO-2017 ATTACHMENT 411 Page 78 of 175 6/23/16 02-09; 03-09; 04-10; 06-06; 06-07; 07-06; 07-07; 08-05; and 94-05; FAQ STRMU updated 813/06; 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. MDHHS/C0-2017 ATTACHMENT III Page 79 of 175 6/23/16 Staffing (6) Reimbursement Method Grant Start Date --- Grant Contract Administrator Contact Info (phone & email) ant E.r.ul:pate... • 1 9/30/2017 • Subrecipient, Contractor, or Recipient (non federal) Designation Performance Target ; ....... . Output Measure Subrecipient IMMUNIZATION ACTION PLAN II Special Requirements 10/1/2016 Robert Swanson 517-335-8159 swansonr@michigan.gov Performance Level N/A (if Applicable) BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 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. MDHHS/C0-2017 ATTACHMENT II Page 80 of 175 6/23/16 3. Adhere to requirements set forth in the Omnibus Budget Reconciliation Act of 1993, section 1928 Part IV — Immunizations and the most current CDC Vaccines for Children Operations Manual, Michigan Resource Book for VFC Providers, and documents that are updated throughout the year pertaining to the Vaccines For Children (VFC) Program. 4. Ensure that federally procured vaccine is administered to eligible children only and is properly documented per VFC guidelines. A. The VFC Program provides VFC vaccine to only eligible children who meet the following criteria: are Medicaid eligible, have no health insurance, are American Indian or Alaskan Native, are served at a Federally Qualified Health Center (FQHC), a Rural Health Center (RHC) or a public health clinic affiliated with a FQHC and are also under-insured. B. Ensure state-supplied vaccines provided in the jurisdiction are administered only to eligible clients as determined by the state. This program allows for the immunization of select populations who are underinsured and not served at a FQHC, RHC, or a public health immunization clinic affiliated with a FQHC as defined by current state program requirements. C. Ensure that all providers receiving vaccine from the state screen children for VFC eligibility for children D. Fraud or abuse of federally procured vaccine should be monitored and reported. 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 IAP 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: MDHHS/C0-2017 ATTACHMENT III Page 81 of 175 6/23/16 1. Ensure that all infants, born to women who are HBsAg positive receive hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of life, a complete hepatitis B vaccine series with post vaccination serology testing and program support services,. 2. Ensure that all susceptible household and sexual contacts associated with HBsAg positive women receive appropriate testing, vaccination, and support services. D. Ensure birthing hospitals are able to offer hepatitis B vaccine to all newborns prior to hospital discharge by enrolling them in the Universal Hepatitis B Vaccination Program for Newborns. 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 REQUIREMENTS The department will develop templates for submission of IAP reports and the annual lAP plan, and provide feedback to the local health departments. 2. Provide technical assistance in establishing and operating immunization action plans. 3. Provide technical assistance in MC1R activities through regional coordinators. 4. Provide supportive services and resource identification when needed. 5. Provide financial support for LHD and Community / Migrant Health Centers for Immunization in pocket of need (PON) areas. 6. Each LHD will have an annual VFC/ARX site visit by the Department. 7. Develop pre-formatted tools including training for new initiatives and 1AP reports / plan. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT III Page 82 of 175 6/23/16 Grant Start Date Grant Contract Administrator. 10/1/2016 Robert Swanson Contact Info 517-3.35-8159 swansonr©michigari.gov (phone 4. email): Reimburgethent Method Fixed Unit Rate (7) Performance Level I N/A Subrecipient, Contractor, or Recipient (non fed Designation Recipient IMMUNIZATION ASSESSMENT FEEDBACK INCENTIVE EXCHANGE (AFIX) FOLLOW-UP SITE VISIT iciI Ri:::!:{1§Airtrier8ts (if Applicable) Performance Target I N/A Output Measure BUDGET AND AGREEMENT REQUIREMENTS The rate of reimbursement per AFIX follow-up visit is $100 for an on-site personal visit to the provider office or $50 for a follow-up phone call (with information mailed afterward) to the provider office. GRANTEE REQUIREMENTS 1. Conduct AFIX follow-up with all providers receiving an AFIXNFC 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/AFIX 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 REQUIREMENTS 1. The Department will provide payment quarterly based on the fixed unit rate reimbursement mechanism upon completion and timely submission of the required documents mentioned above. 2. The Department will develop pre-formatted tools. The Department will provide support to the Grantees. 3. The Department will provide AFIX training module upon request by the LHD and will also provide guidance at IAP meetings and through the Department Immunization field representatives. 4. The Department will provide written guidance to agencies on annual requirements to complete AFIX site visits. MDHHS/C0-2017 ATTACHMENT HI Page 83 of 175 6/23/16 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A WWI-IS/CO-2017 ATTACHMENT III Page 84 of 175 6/23/16 Staffing (6) N/A Subrecipient, Contractor, or Recipient (non federal) Designation -- - Performance Target N/A Output Measure Subrecipient IMMUNIZATION - FIELD SERVICE REPRESENTATIVES equirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Field Representative Roles and Responsibilities- pistrict #10. Marquette. and St. Clair Counties This position serves as a liaison, resource person and as a regional expert for local health jurisdictions regarding all the Department immunization programs and initiatives. 1. PROGRAM SUPPORT: A. Assist with the regional MC1R 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 lAP 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. MDH HS/CO-2017 ATTACHMENT II t Page 85 of 175 6/23/16 D. Consult with the local health department on the immunization component of the accreditation process, including preparation for reviews and conducting a walk through or mock accreditation review. E. Consult with local coalitions and private stakeholders to promote immunizations and ensure consistent messages are relayed to the public. F. Consult with local health departments on the school and day care assessment process. G. Encourage or provide educational updates and interventions on all immunization issues with staff at local health departments, healthcare providers, school and childcare staff and other stakeholders. 3. PROGRAM COMPLIANCE: A. Monitor compliance with policies/legislation at national/state and local levels such as: 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: 1. Perform oversight of the following programs with assigned local health departments. 2. Accreditation-Conduct reviews, and monitor corrective actions. 3. 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. 4. AFIX—including assuring local feedback with providers, and follow up on recommendations. 5. Perinatal Hepatitis B-regional birth dose levels and universal vaccine program. 6. Review and summarize LHD IAP Annual Plans and Biannual 1AP Reports. 7. Monitor LHD compliance with Comprehensive agreements and special requirements relating to the Immunization program. 8. Subrecipient monitoring of funds. DEPARTMENT REQUIREMENTS 1. As financially feasible, provide necessary adjunct clerical services to the Immunization Field Representatives for the duplicating/printing of materials and the packaging and distribution of these materials. 2. Provide program direction, responsibilities and definition of Immunization Field Service Representative responsibilities. 3. Support or solicit the Immunization Field Service Representative input into policy-making decisions. MDHHS/CO-2017 ATTACHMENT III Page 86 of 175 6/23/16 GRANTEE SPECIFIC REQUIREMENTS District #10. Marauette and St. Clair Counties 1. Employ and oversee a full-time immunization Field Representative for the Immu n i z a t i o n Program who shall be acceptable to the Department and who shall be supporte d b y t h i s agreement, understanding that their full time is to be devoted for regional im m u n i z a t i o n related activities. 2. Provide the Immunization Field Representative with permanent office space and s u p p l i e s , including, but not limited to: a telephone, general office supplies, a com p u t e r w i t h h i g h s p e e d Internet capabilities, a printer, a cellular telephone and a use of vehicle or r e i m b u r s e m e n t mechanism for transportation unless otherwise arranged. 3. Ensure the Immunization Field Representative will be available to all local health departments in the assigned regions to provide immunization Program a c t i v i t i e s e q u i t a b l e and at the direction of the Department. Refer to field representative respons i b i l i t i e s a s defined by the Department and distributed to the Grantee. 4. Provide for reimbursement for reasonable telephone charges incurred in the con d u c t o f business by the Immunization Field Representative unless otherwise arrang e d . 5. Provide reasonable reimbursement for any travel and subsistence expenses in c u r r e d b y t h e Immunization Field Representative necessary to the conduct of the Immunizatio n P r o g r a m . Travel could include the annual National immunization Conference or othe r p r o f e s s i o n a l immunization related conferences, attendance at the Department Immuniza t i o n s t a f f meetings and trainings, and accreditation visits made in other areas of the state , Kent. Livinaston and Monroe Counties 1. Provide adequate office space, telephone connections, and high-speed Inter n e t a c c e s s , Also provide access to fax and photocopiers. 2. Provide feedback to Division Director as needed, on employee work related c o n d u c t . REPORTING REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT III Page 87 of 175 6/23/16 N/A Grant End Date i 9/30/2017 Grant Contract Administrator Robert Swanson COntast:Info .(phone & email) Reimbursement :Method 517-335-8159 swansonr@michigan.gov Staffing (6) Subrecipient Grant Start Date 10/1/2016 • Subrecipient, Contractor, or Recipient (non federal Designation Performance Target Output Measure : Performance Level if Applicable) N/A IMMUNIZATION MICHIGAN CARE IMPROVEMENT REGISTRY (MCIR) REGIONAL Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS The Grantee shall ensure the performance of the following activities on behalf o f t h e D e p a r t m e n t t o support the MCIR: 1. Promote and train providers and Health Care Organizations (HC0s) on all fe a t u r e s o f t h e MCIR 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 enrollme n t a n d participation in the MC1R which includes development of strategies to encourage a l l providers to fully participate with the MGR, (such as sites of excellence awar d s ) . 4. Process all user/usage agreements, according to the Department's approved p r o c e d u r e s , t o create user accounts. 5. Implement and update marketing plans in support of increased provider and paren t 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 MC1R users. 8. Work with local health departments to establish a mechanism and internal proc e s s t o a s s u r e 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 sh o u l d b e a s comprehensive as possible and should include all providers in the region. 10. Conduct regular de-duplication activities to assure that duplicate records are r e m o v e d f r o m the MC1R as quickly as possible. MDHHS/CO-2017 ATTACHMENT II Page 88 of 175 6/23/16 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 F1L7 messaging to MCIR. 18. Perform quality assurance checks on the MC1R data for the region as prescribed by the Department. A. Assist local health departments and private providers with methodologies to "clean up" their data. B. Provide assistance to the Department on User Acceptance Testing (UAT) when required to verify 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 MC1R Regional Coordinator: a) permanent office space; b) general office supplies; c) a land based telephone; d) a computer with high speed Internet capabilities; e) a printer; f) a cellular telephone; and g) use of a vehicle or in the alternative reimbursement mechanism for transportation unless otherwise arranged. 19. When sufficient funding is available, provide to the MCIR Regional Coordinator reimbursement for travel to attend the National Registry related meetings if approved by the Department. This includes travel related expenses concerning air fare, lodging, baggage processing, taxi services, etc. 20. Consult with the Department on any personnel or performance issues that could affect the above mentioned contract requirements. 21. Facilitate the Department's attendance in the interview process for hiring of a MCIR Regional Coordinator / MCIR staff. This process includes consultation with the Department regarding selection of interview candidates as well as participation in the hiring determination. DEPARTMENT REQUIREMENTS 1. Provide support and technical assistance to Regional staff. 2. Provide initial training and support to a MCIR Regional Coordinator 3, The Department shall evaluate submitted reports as described above for their completeness and adequacy. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 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). MDHHS/C0-2017 ATTACHMENT III Page 89 of 175 6/23/16 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 shag be developed and submitted by the Grantee as required by the Department. Reports and information should be submitted to: Bea Salade, 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. MDHHS/C0-2017 ATTACHMENT III Page 90 of 175 6/23/16 I Grant Start Date 10/1/2016 Grant End Date I 9/30/2017 Grant Contract Administrator . Robert Swanson 517-335-8159 swansonr@michigan.gov Contact Info (phone & email) Reimbursement Performance Level (if Applicable) Fixed Unit Rate (2) (7) N/A Subrecipient, Contractor, or Recipient (non federal) Designation Recipient Method Performance Target NIA Output Measure IMMUNIZATION - NURSE EDUCATION REIMBURSEMENT Special Requirements BUDGET AND AGREEMENT REQUIREMENTS 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. 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 [NE 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. MDHHS/C0-2017 ATTACHMENT III Page 91 of 175 6/23/16 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT III Page 92 of 175 6/23/16 Grant Start Date 10/1/2016 Robert Swanson Contact Info (phone & email) Reimbursement Staffing (6) Method Subrecipient, Contractor, or Recipient (non federal) Designation 517-335-8159 swansonr@michigan,gov Contractor Performance Level N/A Performance Target N/A (if Applicable) Output Measure Grant Contract Administrator IMMUNIZATION VACCINE QUALITY ASSURANCE PROGRAM II SPeciiV Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A 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. MDHHS/C0-2017 ATTACHMENT III Page 93 of 175 6/23/16 7. Assist Grantees with the redistribution of short dated vaccine. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT III Page 94 of 175 6/23/16 10/1/2016 Robert Swanson 9/30/2017 517-335-8159 swansonr©michigan.gov Fixed Unit Rate (2) (7) Subrecipient, Contractor, or Recipient (non federal) Designation Performance Level N/A (if Applicable) Recipient Performance Target N/A Output Measure IMMUNIZATION VFC/AFIX SITE VISIT SpeciO iir,ments BUDGET AND AGREEMENT REQUIREMENTS 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 AFIX site visits must complete the Department AFIX training module, presented by the Department AFIX Coordinator, prior to conducting any AFIX visits. Annual VFC/AFIX visit guidance and review will be provided to each LHD at the IAP Meetings and consult will be conducted by the Department Immunization Field Representative for each Grantee. 2. Jurisdictions must visit at least 50 percent of their sites every year. The requirement is that all enrolled and active VFC providers receive a VFC 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 (OAS) 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 AFIX) 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. MDHHS/C0-2017 ATTACHMENT III Page 95 of 175 6/23/16 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 (IAP), Immunization Coordinators, or through health officers, GRANTEE REQUIREMENTS N/A 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. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT III Page 96 of 175 6/23/16 Patti Kelly • SU brecipient, • Contractor, or Recipient (non federal) Designation Performance Target N/A Output Measure INFANT SAFE SLEEP Special Rhms 10/1/2016 Grant End Date I 9/30/2017 517-335-5911 kellyp2@michigan.gov Staffing (6) Performance Level N/A (if Applicable) BUDGET AND AGREEMENT REQUIREMENTS Objective: Provide funding to select local health departments (LHD) to support promotion and awareness of infant safe sleep best practices in their communities. Funding must be expended by September 30. GRANTEE REQUIREMENTS 1. LHD personnel will provide educational activities, conduct community outreach efforts and/or expand community awareness of infant safe sleep. These efforts must adhere to the guidelines for infant safe sleep safety and SIDS risk reduction issued by the American Academy of Pediatrics in 2011. Activities are to be culturally relevant to at-risk, high-risk families in the community and reflect diversity in terms of race, ethnicity, language, and socioeconomic status. 2. LHD will convene and facilitate a local advisory team that focuses on infant safe sleep, a public/private partnership that coordinates local efforts to promote infant safe sleep and reduce infant deaths related to unsafe sleep environments. If a similar community based group or team addressing infant safe sleep already exists, it is not necessary to create a new one. 3. Funds may be used for the purchase of demonstration and/or educational items. Additionally, a maximum of 15% of the funding may be used for giveaway items that are directly related to infant safe sleep such as cribs, pack-and-plays, and/or sleep sacks.. A maximum of 25% of the funding may be used for advertising, including billboards, bus signage and the purchase of radio, TV, and/or print media, DEPARTMENT REQUIREMENTS Provide technical assistance for infant safe sleep through Infant Safe Sleep Program Coordinator. MDHHS/C0-2017 ATTACHMENT III Page 97 of 175 6/23/16 GRANTEE SPECIFIC REQUIREMENTS l\l/A REPORTING REQUIREMENTS 1. Prior to the submission of the proposed FY15/16 work plan, LHD will participate in a group conference call with all mini-grantees facilitated by the Infant Safe Sleep Program Coordinator to review current data, discuss infant safe sleep best practices and answer any questions related to mini grant requirements. 2. LHD will submit a written summary to date on all activities using the template provided in the mini grant guidance. This summary will be due to the Infant Safe Sleep Program Coordinator 15 days after the end of the 2nd quarter (April 15). 3. LHD will participate in a TA call with the Infant Safe Sleep Program Coordinator by April 30 to review progress to date. 4. LHD will submit a final report on all activities, using the template provided in the mini grant guidance, by October 30 via email to Patti Kelly, MDHHS Infant Safe Sleep Program Coordinator, at kellyp2©michigan.gov. WA-IRS/CO-2017 ATTACHMENT 111 Page 98 of 175 6/23/16 10/1/2016 Orlando Todd Subrecipierit, 1 Recipient Contractor, or Recipient (non federal) Designation Performance Target 1 1 N/A Output Measure Fixed Unit Rate (2) (7) Performance Level 1 N/A (if Applicable) INFORMED CONSENT Sped toddo@michigan.gov, (517) 284-4722 BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 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 FSR through the Ml E-Grants system. MDHHS/CO-2017 ATTACHMENT HI Page 99 of 175 6/23/16 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT III Page 100 of 175 6/23/16 Grant Start Date 10/1/2016 Grant End Date 9/30/2017 Grant Contract Administrator Contact Info (phone & email) Mahad Adawe 517-335-8058 AdaweM@michigan.gov Subreci pie lit, Contractor, or Recipient (non f Designation Reimbursement Method Staffing (6) Performance Level (if Applicable) BUDGET AND AGREEMENT REQUIREMENTS N/A N/A LABORATORY SERVICES II -ial R .ilmrnertts • Performance Target Output Measure Subrecipient N/A GRANTEE REQUIREMENTS A. Meet established standards of performance and objectives in the following areas: 1. Public Health Emergency Preparedness: a. Maintain a current list of contact information for local community hospital Laboratories to facilitate communication. b. Facilitate response with local community hospital laboratories in preparation for and during public health threats. c. Coordinate and facilitate specimen collection and transport with facilities within jurisdiction. This may include specimen packaging and shipping and coordination with the courier service. d. Provide 24/7 contact information to hospital partners and BOL. e. Participate in and provide support for Department PHEP exercises with community hospital laboratories within jurisdiction. 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 Department Requirements - All Grantees: MEd-IRS/CO-2017 ATTACHMENT III Page 101 of 175 6/23/16 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 sale 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. Department Requirements for Kalamazoo County Health & Community Services, Kent County Health Department and Saginaw County Department of Public Health only A. The Department: 1. Designate and assign personnel who meet the qualifications required as a high complexity laboratory director in CUA 1988. 2. Laboratory Directors will: a. Sign the appropriate CMS paperwork for CLIA certification for their region as needed. b. Perform annual site visit of the Grantee high complexity laboratory and assist in CLIA surveys. c. Be available for consultation to the Grantee laboratory by telephone, email, and other communication methods. d. Provide technical consultation for laboratory guidelines, testing procedures, quality control methods or quality assurance in accordance with CLIA requirements. e. Review Quality Assurance program with attention to effective quality control activity and corrective action. f. Review and sign training records and competency evaluations. g. Review and sign external proficiency testing results in a timely manner. h. Review and sign procedure manual(s) annually, and any new procedure prior to its implementation. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHNS/C0-2017 ATTACHMENT III Page 102 of 175 6/23/16 Contact Info (phone & email) Reimbursement Method 617-335-8625 larueb@michigan.gov Staffing (6) • Subrecipient, Contractor, or Recipient (non federal) Designation LACTATION CONSULTANT cw Requirements 10/1/2016 Brittany LaRue BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS MDHHS WIC will collaborate with the Genesee County Health Department to increase breastfeeding and lactation services. The local agency will provide enhanced capabilities in the local community to improve and increase breastfeeding. The Grantee will report the number of consultations provided for breastfeeding. REPORTING REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT III Page 103 of 175 6/23/16 Performance Level (if Applicable) N/A Performance Target N/A Output Measure Grant Start Date 10/1/2016 —I- I Grant End Date 9/30/2017 Grant Contract Administrator Contact Info (phone & email) Trudy Esch and Robin L. Orsborn 517-241-3593 (TE) 517-335-8976 (RLO) MDHHS-Maternal-Child-Health@michigan.gov Reimbursement Method Choose an te Subrecipient, Contractor, or Recipient (non federal) Designation Subrecipient LOCAL MATERNAL AND CHILD HEALTH (MCH) PROGRAM pcq;i81 Requirements BUDGET AND AGREEMENT REQUIREMENTS 1. Projects to be supported by Local MCH in the Electronic Grants Administration and Management System (EGrAMS/MI E-Grants) are as follows: a. Direct Services Children - MCH b. Enabling Services Children - MCH C. Direct Services Women - MCH d. Enabling Services Women - MCH e. Public Hlth Functions & Infrastruct - MCH 2. The Local MCH Plan is due when the budget application is due. The department will provide the format for the LMCH Plan. 3. The previous year's activity report is due at the time of the final FSR submission. The department will provide the format for the LMCH Year-End Report. 4. 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. 5. 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. 6. 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. GRANTEE REQUIREMENTS LOCAL MATERNAL AND CHILD HEALTH MDH HS/CO-2017 ATTACHMENT UI Page 104 of 175 6/23/16 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. B. Grantees are to follow the FY 2017 Local MCH Plan I nstructions to prepare the agency's Local MCH Plan. C. Grantees are to follow the FY 2017 Local MCH Year-End Report Instructions to prepare the agency's Local MCH Year-End Report. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT III Page 105 of 175 6/23/16 Grant Start Date I Grant Contract Administrator 10/1/2016 Molly Cotant Grant End Date j 9/30/2017 989-619-1304 cotantm©michigan.goy Staffing (6) Subrecipient, Contractor, or • Recipient (non federal) Designation Subrecipient Reimbursement Method Performance Level N/A (if Applicable) Performance Target N/A Output Measure LOCAL TOBACCO PREVENTION II ill Requirements BUDGET AND AGREEMENT REQUIREMENTS No funds may be expended for lobbying as defined in Act No. 472 of the Public Acts of 1978, being sections 4.411 to 4,431 of the Michigan Compiled Laws. GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT III Page 106 of 175 6/23/16 REPORTING REQUIREMENTS Reports are due on a monthly basis. Submit reports via email to cotantm@michigan.gov on the first business day following the end of the month. December and July report due dates are extended due to holidays. October 2016: due 11/1/16 November 2016- due 1211/16 December 2016- due 1/6/17 January 2017- due 2/1/17 February 2017- due 3/1/17 March 2017- due 4/3/17 April 2017- due 5/1/17 May 2017- due 6/1/17 June 2017- due 7/6/17 July 2017- due 8/1/17 August 2017- due 9/1/17 September 2017- due 10/2/17 Complete a narrative final report due Wednesday November 1, 2017. Submit the report via email to cotantm@michigan.gov and mail a hard copy to: MDHHS Tobacco Control Program Washington Square Building, 7th Floor 109 West Michigan Avenue Lansing, MI 48913 MDHHS/CO-2017 ATTACHMENT III Page 107 of 175 6/23/16 Grant Start Date I 10/1/2016 Grant Contract Administrator Penny Eisfelder eisfelderp@michigan,gov 517-373-2039 Grant End Date I 9/30/2017 Staffing (6) Subrecipient, Contractor, or Recipient (non federa Designation I Subrecipient Contact Info (phone & emaiI)I. Reimbursement Method MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING INITIATIVE MIECHV LOCAL HOME VISITING LEADERSHIP GROUP (MIECHVLLG) II Special Requirerneots Performance Level N/A • Performance Target 1 N/A (if Applicable) Output Measure BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS All Maternal, Infant and Early Childhood Home Visiting Initiative (MIECHV) subcontracting agencies must follow the program assurances and requirements, as prescribed below. Requirements in section I-B should be reflected in each agency's respective work plan. Program Specific Assurances and Requirements 1. Each Local Leadership Group (LLG) will be required to adhere to Michigan's MIECHV Program Requirements (PRs), as outlined in the chart below. The PRs are written based on the Federal MIECHV Program Grant Application submitted to the Health Resources and Services Administration (HRSA). 2. The LLG will work with the Department contractor: Early Childhood Investment Corporation (ECIC) and the Michigan Public Health Institute (MPH). ECIC will provide technical assistance to the LLG as they seek to carry out the MIECHV activities related to local home visiting system building, engaging parent leaders, developing a continuum of models and sustainability planning. MPHI will provide expert CQI consultation and coaching to LLG 01 Learning Collaborative teams as they plan and implement QI project work. a. Year Four: 1. Continue efforts started in years one, two and three related to LLG membership, parent participation, development of a continuum of models and CQI related to outreach and engagement. 2. Begin developing a local home visiting funding sustainability plan. 3. 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. MIDHHS/C0-2017 ATTACHMENT III Page 108 of 175 6/23/16 c. Carry out the MIECHV activities, as specified in this agreement. 4. The LLG must include representatives from Public Health, Mental Health/Substance Abuse, DHS/CAN Council, MHVI funded local home visiting programs, 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. 5. Other LLG representatives strongly encouraged, but not limited to, are: education, local home visiting programs not funded through MHVI 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. 6. If a subcontracting agency wishes to produce any marketing, advertising, promotional or educational materials, using contract funds, they must: 1. Send draft materials electronically to the contract manager Chris Miller at millerc42@michigan.gov . 2. Materials must be approved by the Department staff and a written approval received by the subcontracting agency. 3. All materials must include the MHVI logo, which can be obtained from the Department, once approval is granted. 4. All materials must include the HRSA federal grant disclaimer and grant number, which can be obtained from the Department, once approval is granted. Separate approval must be obtained for each publication an agency wishes to print. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A 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 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, MDHHS PO Box 30195, Lansing, MI 48909 Phone: 517-373-2039 Fax: 517-373-4294 eisfelderpAmichidan.00v MDHHS/CO-2017 ATTACHMENT 111 Page 109 of 175 6/23/16 I Grant Start Date 10/1/2016 Grant End Date Grant Contract Administrator Contact Info (phone & email) Penny Eisfelder eisfelderp©michigan.gov 517-373-2039 I 9/30/2017 I Performance Level N/A (if Applicable) Reimbursement Method Staffing (6) MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING INITIATIVE (MIECHV) RURAL LOCAL HOME VISITING LEADERSHIP GROUP (MHVRLH) MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING INITIATIVE (MIECHV) RURAL LOCAL HOME VISITING LEADERSHIP GROUP 3 (MHVRLH3) Speciai Requirements Subrecipient, Contractor, or Recipient (non federal Designation Subrecipient • Performance Target N/A Output Measure BUDGET AND AGREEMENT REQUIREMENTS Purpose: To provide funding to support the convening of the Local Home Visiting Leadership (LLG) group in the agency's respective region. GRANTEE REQUIREMENTS Funding Requirements: All Grantees must follow the program assurances and requirements, as prescribed below. Requirements in section I-B should be reflected in each agency's respective work plan. Program specific Assurances and Requirements: 1. Each Local Leadership Group (LLG) will be required to adhere to Michigan's MIECHV Program Requirements (PRs), as outlined in the chart below. The PRs are written based on the Federal MIECHV Program Grant Application submitted to the Health Resources and Services Administration (HRSA). 2. The LLG will work with the Department contractor: Early Childhood Investment Corporation (ECIC) and the Michigan Public health Institute (MPHI). ECIC wiaie will provide technical assistance to the LLG as they seek to carry out the MIECHV activities related to local home visiting system building, engaging parent leaders, developing a continuum of models and sustainability planning. MPHI will provide expert CQI consultation and coaching to LLG QI Learning Collaborative teams as they plan and implement QI project work. a. Year Three: MDHHS/CO-2017 ATTACHMENT III Page 110 of 175 6/23/16 Continue efforts started in years one and two related to LLG membership, parent participation and CQI related to outreach and engagement. Continue to implement one strategy from the respective community's local home visiting continuum plan b. Year Four: Continue efforts started in years one, two and three. Begin developing a local home visiting funding sustainability plan. 3. 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 MHVI activities, as specified in this agreement. d. Send a minimum of two people to the annual home visiting conference. e. Send parents to the home visiting conference. 4. The LLG must include representatives from Public Health, Mental Health/Substance Abuse, DHS/CAN Council, MHVI funded local home visiting programs, 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. 5. Other representatives strongly encouraged, but not limited to, are: education, local home visiting programs not funded through MHVI 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. 6. If a subcontracting agency wishes to produce any marketing, advertising, promotional or educational materials, using contract funds, they must: a. Send draft materials electronically to the contract manager, Chris Miller at millerc42©michigan.gov . b. Materials must be approved by the Department and a written approval received by the subcontracting agency, c. All materials must include the MHVI logo, which can be obtained from the Department, once approval is granted. d. All materials must include the HRSA federal grant disclaimer and grant number, which can be obtained from the Department, once approval is granted. Separate approval must be obtained for each publication an agency wishes to print, DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A 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. MDHHS/C0-2017 ATTACHMENT RI Page 111 of 175 6/23/16 MDHHS/CO-2017 ATTACHMENT III Page 112 of 175 6/23/16 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 MDHHS P.O. Box 30195, Lansing, MI 48909 Phone: 517-373-2039 Fax: 517-373-4294 eisfelderpamichioan.00v MDHHS/C0-2017 ATTACHMENT III Page 113 of 175 6/23/16 Subrecipient, I Contractor, or • • Recipient (non federal) Designation Staffing (6) Subrecipient Performance Target Output Measure MATERNAL INFANT CHILDHOOD HOME VISITING PROGRAM (MIECHVP) HEALTHY FAMILIES AMERICA EXPANSION (BMHFAE) II ' ents Grant Start Date 10/1/2016 Grant End Date 9/30/2017 Penny Eisfelder 517-373-2013 eisfelderp@michigan.gov BUDGET AND AGREEMENT REQUIREMENTS NIA GRANTEE REQUIREMENTS 1. Maintain Fidelity to the Model: 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 the Department, Michigan Home Visiting Initiative (MHVI) and HFA requirements as required for fidelity. 2. P.A. 291 The LIA shall comply with the provisions of Public Act 291 of 2012. Staffina: 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. 4. Taraet Population: a. The LIA shall serve the target population identified in their community's Needs Assessment, which was approved by the Department (See GRANTEE SPECIFIC REQUIREMENTS) b. The [IA shall develop an Outreach Plan for HFA that is consistent with the results of the community Needs Assessment submitted to, and agreed upon by, the Department. c. The LIA shall ensure full caseloads within the established time frame determined by the Department, and based on model guidance, to account for new programs or staff turnover. A full caseload, per the Department, is not less than 20 families per full time (1,0 FTE) home visitor. d, 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. See reporting requirements. NADI-INS/CO-2017 ATTACHMENT Page 114 of 175 6/23/16 e. 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. 5. Program Monitoring. Assessment. Support and Technical Assistance (TA): The LIA shall fully participate with tf-Departmentandthe Michigan Public Health Institute (MPHI) with regards to program development and monitoring, training, support and technical assistance services. 6. Professional Development and Training: 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. 7. Supervision: 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. 8. Engage and Coordinate with Community Stakeholders: 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. 9. Coordinate with Appropriate Entities/Programs: a. The LIA shall build upon and maintain diverse community and target population collaboration and support. b. The LIA shall participate in a Local Leadership Group or if none, at the Great Start Collaborative. The group must 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. 10. Data Collection: a. The LIA shall comply with all HFA and the Department data collection requirements. b. The LIA shall work with the MHVI Evaluation contractor to develop and implement a plan to collect and report additional data. 11, Continuous Quality Improvement (Cal): a. The LIA shall participate in all HFA quality initiatives including: research, evaluation and continuous quality improvement. b. The LIA shall participate in all State and local Home Visiting CQI activities as required by the Department. 12. Work Plan Requirements a. Within 30 days of the initiation of the contract, the LIA must submit a work plan (outlining all program activities) via e-mail or fax to Penny Eisfelder (contact info below). A template for the work plan will be provided. The work plan must also include an outline of: i. The LIA's strategies for minimizing attrition rates for their respective home visiting program participants. The LIA's strategies for addressing challenges to maintaining program quality and fidelity. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS The Wayne County Babies HFA program will serve an additional 50 families living in Highland Park, Hamtramck, Redford, Westland, Taylor, Romulus, Van Buren and Inkster. MDHHS/CO-2017 ATTACHMENT III Page 115 of 175 6/23/16 The Kalamazoo County Health & Community Services Department HFA program will serve an additional 60 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. REPORTING REQUIREMENTS 1. The LIA shall adhere to the HFA National Office program reporting requirements. 2. 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. 3. Reports and information shall be submitted either electronically or via fax to: Penny Eisfelder at: eisfelderpmichician.gov or 517-373-2494 Printed Materials If the LIA wishes to produce any marketing, advertising, promotional isnFia-tprepaeti-eraa4 or education materials, using contract funds, they must: a. Send draft materials electronically to Chris Miller at millerc24michigan.dov. b. Materials must be approved by the Department and a written approval received by the LIA. c. All materials must include the MHVI logo, which can be obtained from the Department, once approval is granted. d. All materials must include the FIRSA federal grant disclaimer and grant number, which can be obtained from the Department, once approval is granted. e. Separate approval must be obtained for each publication an agency wishes to print. MDHHS/CO-2017 ATTACHMENT RI Page 116 of 175 6/23/16 Staffing (6) N/A Grant Start Date eisfelderp@michigan.gov 517-373-2039 Subrecipient, Contractor, or Recipient (non fodcral) Designation Performance Target Output Measure Contact Info (phone & email) .ReimbLirie.Men • :Method : 10/1/2016 Penny Eisfelder ..Grant. End. Date. • 9/30/2017 MI HOME VISITING INITIATIVE RURAL EXPANSION GRANT (MHVIRE) MI HOME VISITING INITIATIVE RURAL EXPANSION GRANT REGION 3 (MHVIRE3) Jirernents BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Maintain Fidelity to the Model: 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 the Department, Michigan Home Visiting Initiative (MHVI) and HFA requirements as required for fidelity. 2. P.A. 291 The LIA shall comply with the provisions of Public Act 291 of 2012. 3. Staffina: 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. 4. Target Population: a. The UA shall serve the target population identified in their community's Needs Assessment, which was approved by the Department. b. 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, the Department. c. The LIA shall ensure that the Outreach Plan results in full caseloads within the pre- determined mutually agreed upon date with the Department. d. The [IA shall demonstrate that enrollment reflects the use of the outreach plan and shall submit bi-annual reports on outreach activities and caseload population status. MD1-I HS/CO-2017 ATTACHMENT III Page 117 of 175 6/23/16 e. 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. 5. Proaram Monitorina. Assessment. Supp_ort and Technical Assistance (TA: Fully participate with the Department and the Michigan Public Health Institute (MPH) with regards to program development and monitoring, training, support and technical assistance services. 6. professional Development and Trainina: 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. 7. Supervision: 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. 8. Enaaue and Coordinate with Community Stakeholders: The Ll A 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. 9. coordinate with Appropriate Entities/Proarams:, a. The LIA shall build upon and maintain diverse community and target population collaboration and support. b. 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. 10. pata Collection: a. The LIA shall comply with all HFA and the Department data collection requirements. b. The LIA shall work with the MHVI Evaluation contractor to develop and implement a plan to collect and report additional data. i t Continuous Quality Improvement (COW, a. The LIA shall participate in all HFA quality initiatives including: research, evaluation and continuous quality improvement. b. The LIA shall participate in all State and local Home Visiting CQI activities as required by the Department. 12. Work Plan Requirements Within 30 days of the initiation of the contract, the LIA must submit a work plan (outlining all program activities) via e-mail or fax to Penny Eisfelder at eisjelder mgartiav 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. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT HI Page 118 of 175 6/23/16 REPORTING REQUIREMENTS The LIA shall adhere to the HFA National Office program reporting requirements. 2. 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°' of each month 3. Reports and information shall be submitted either electronically or via fax to: Penny Eisfelder at: eisfedor.gpzichictap,ciov or 517-373-4294. MDHHS/CO-2017 ATTACHMENT III Page 119 of 175 6/23/16 L Grañt End Date 9/30/2017 SLibrecipient, Subrecipient Contractor, or Recipient (non federal) Designation Grant Start Date 10/1/2016 Contact Info (phone & email) Reimbursement Method Robyn Corey Click hem to enter text, Choose an iterr. MEDICAID OUTREACH II Sper rements Performance Target Output Measure N/a BUDGET AND AGREEMENT REQUIREMENTS See Attachment I for instructions. MDFIRS/C0-2017 ATTACHMENT III Page 120 of 175 6/23/16 ... Subrecipient, Contractor, or Recipient (non federal Designation Subrecipient Performance Target Output Measure Number of 1 unduplicated youth to be served Grant Start Date Grant Contract Administrator Contact Info (phone & email) Coreyr1@michigan.gov Performance (8) (18) 90% MICHIGAN ABSTINENCE PROGRAM (MAP) II Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Provide fourteen (14) or more hours of structured intervention to youth ages 10-15 (up to 21 for special education populations), spread across at least a four week period. Activities that are solely recreational or social shall not be included. 2. Develop and/or maintain a coalition/advisory council representative of the diversity of the community (including teens and parents/guardians) who are instrumental in all phases of the program planning, implementation and evaluation. The coalition/advisory council must meet at least quarterly throughout the funding period. 3. If programming will be provided by a subcontractor, a Letter of Understanding (LOU) detailing the responsibilities to which both parties agree must be completed. 4. Secure local matching funds (either cash or in-kind resources) totaling 50 percent or more of the amount requested. 5. A minimum of 90% of the proposed users must be served to access the total amount of allocated funds. 6. In addition to those mentioned here, the Grantee must adhere to all of the Michigan Abstinence Program's Minimum Program Requirements (MPRs). DEPARTMENT REQUIREMENTS 1, Provide administrative professional and technical consultation to the program. 2. Provide a minimum of one MAP-sponsored coordinator meetings/trainings per year. MDHHS/CO-2017 ATTACHMENT III Page 121 of 175 6/23/16 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 1. The Grantee shall submit program narrative reports on the following dates: Tyne of Report and Timeframe Due Date Quarterly Report (October 1 — December 31) January 16 Quarterly Report (January 1 — March 31) April 16 Quarterly Report (April 1 — June 30) July 16 Year-End Report (October 1 — September 30) November 16 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, State Abstinence Coordinator Michigan Department of Health & Human Services P.O. Box 30195, 109W. Michigan Ave.8th 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. MDHHS/C0-2017 ATTACHMENT III Page 122 of 175 6/23/16 I. Grant Start Date 1 10/1/2016 Grant End Date 1 9/30/2017 Grant Contract Administrator Contact Info (phone & email) I Hillary Turner 517335-5928 turnerh@michigan.gov Performance Level (if Applicable) N/A Performance Target N/A Output Measure Staffing (6) Subrecipient, Contractor, or Recipient (non federal Designation Subrecipient Reimbursement Method MICHIGAN ADOLESCENT PREGNANCY & PARENTING PROGRAM (MI- APPP) II SpeCia:i R. • Ord BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Implement approved Adolescent Family Life Project-Positive Youth Development (AFLP-PYD) case management program for pregnant and parenting teens and fathers 15-19 years of age. Activities that are solely recreational or social shall not be included. 2. Develop and/or maintain a local steering committee representative of the diversity of the community, including pregnant/parenting mothers and fathers, who are instrumental in all phases of the program planning, implementation and evaluation. The steering committee must meet at least quarterly throughout the funding period. 3 If programming will be provided by a subcontractor, a Letter of Understanding (LOU) detailing the responsibilities to which both parties agree must be completed. 4. Secure local matching funds (either cash or in-kind resources) totaling 20 percent or more of the amount requested. 5. In addition to those mentioned here, the Grantee must adhere to its approved program work plan and all of the MI-APPP Minimum Program Requirements (MPRs). 6, A minimum of 90% of the proposed users must be served to access the total amount of allocated funds. 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. MDHHS/CO-2017 ATTACHMENT RI Page 123 of 175 6/23/16 9. Programs must administer, following the approved implementation guidelines, the MI-APPP youth intake and exist forms arid 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 a two-day MI-APPP sponsored learning collaborative two times per year. GRANTEE SPECIFIC REQUIREMENTS N/A 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, Narrative (October 1 — December 31) January 30 Quarterly Report, Narrative (January 1 — March 31) April 30 Quarterly Report, Narrative (April 1 — June 30) July 30 Quarterly Report, Narrative (July 1 — September 30) October 30 Program Participant Data (Monthly) Submit the 7th of the Following Month 2. Any such information as specified in the contract requirements and MI-APPP Report Fact Sheet shall be developed and submitted by the Grantee as required by the Contract Manager, 3. Reports and information shall be submitted to the Contract Manager at: Hillary Turner, MI-APPP Program Coordinator Michigan Department of 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. MDHHS/CO-2017 ATTACHMENT III Page 124 of 175 6/23/16 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. MONKS/CO-2017 ATTACHMENT ill Page 125 of 175 6/23/16 Grant Start Date Grant Contract Administrator Contact Info (phone & email) Reimbursement Method -- Performance Leve (if Applicable) Subrecipient, Contractor, or Recipient (non federal) Designation -- Performance Target Output Measure Subrecipient Number of women and men that complete a screen test 517-335-9729 hagerp©michigan.gov Performance (8) MICHIGAN COLORECTAL CANCER EARLY DETECTION PROGRAM II Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 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 Immunochemical 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.michiciancancer.orq/Colorectal/. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT III Page 126 of 175 6/23/16 Grant Start Date 10/1/2016 Grant End Date I 9/30/2017 Penny Eisfeider eisfelderp@michigan.gov 517-373-2039 Reimbursement I Staffing (6) Method Subrecipient, Contractor, or Recipient (non federal) Designation Subrecipient Performance Level N/A (if Applicable) Performance Target I N/A Output Measure Grant Contract Administrator Contact info (phone & email) NURSE FAMILY PARTNERSHIP (NFP) SERVICES NURSE FAMILY PARTNERSHIP MEDICAID OUTREACH II Peaciai Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Maintain Fidelity to the Model: 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 Department and the Nurse Family Partnership (NFP) National Service Office (NSO) Application Review Team approved Implementation Plan. Projects must incorporate the Department, Michigan Home Visiting Initiative (MHVI) and NSO NFP requirements as required for fidelity. 2. P.A. 291 The LIA shall comply with the provisions of Public Act 291 of 2012. 3. Staffing: The LlA'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. 4. Target Pooulation: a. 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. b. 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 the Department. MDHHS/C0-2017 ATTACHMENT III Page 127 of 175 6/23/16 c. The L1A shall ensure full caseloads within the established time frame determined by the Department, and based on model guidance, to account for new programs or staff turnover. A full caseload, per the Department, is no less than 22.5 families per full time (1.0 FTE) home visitor. d. 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. See reporting requirements. e. 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. 5. proaram Monitorina. Assessment,SupPort and Technical Assistance (TA): The L1A shall fully participate with the NFP NSO, the Department and the Michigan Public Health Institute (MPH1) with regards to program monitoring, assessment, support and technical assistance services. 6. Professional Development and Trainina: All L IA NF P staff associated with this funding will participate in professional development and training activities, as required by NFP. In addition, as required by the Department, LIAs 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 budget must reflect this activity. 7. Supervision The LIA shall adhere to the NFP supervision requirements. 8. Enaaae and Coordinate with Community Stakeholders: The LIA shall assure that there is a broad-based community advisory committee that is providing oversight for NEP. 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. 9. Coordinate with Approoriate Entities/Proarams: a. The L1A shall build upon and maintain diverse community and target population collaboration and support. b. The LIA shall participate in the Local Leadership Group (LLG) or, if none, at the Great Start Collaborative. The group must 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. 10. Data Collection: a. The LIA shall comply with all NFP and the Department data collection requirements. b. The LIA shall authorizethe Deparlrnentand the MPHI to receive information from the national NFP clinical information system known as Efforts to Outcomes (ETO). c. The LIA shall Work with the MHVI evaluation contractor to develop and implement a plan to collect and report additional data beyond that required for NFP. 11. Continuous Qualjty Improvement (COI); a. The LIA shall participate in all NFP quality initiatives including: research, evaluation and continuous quality improvement. b. The L1A shall participate in all State and local Home Visiting CQI activities as required by the Department. 12 Work Plan Reauirements a. Within 30 days of the initiation of the contract, the LIA must submit a work plan (outlining all program activities) via e-mail or fax to Penny Eisfelder (contact info below). A template for the work plan will be provided. The work plan must also include an outline of: i. The LIA's strategies for minimizing attrition rates for their respective home visiting program participants. ii. The LIA's strategies for addressing challenges to maintaining program quality and fidelity. MDHHS/CO-2017 ATTACHMENT III Page 128 of 175 6/23/16 DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 1. The LIA shall adhere to the NFP, Inc., National Office program reporting requirements. 2. 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 15th of each month. e. Medicaid Outreach Report (Berrien, Calhoun, Kalamazoo and, Kent only): within 30 days of the end of each quarter. 3. Reports and information shall be submitted either via e-mail orfax to: Penny Eisfelder at eisfelderomichioan.qov or 517-373-2494. 4. Printed Materials If the LIA wishes to produce any marketing, advertising, or education materials, using contract funds, they must: a. Send draft materials electronically to Chris Miller at millerc42@michigan.gov . b. Materials must be approved by the Department and a written approval received by the [IA. c. All materials must include the MHVI logo, which can be obtained from the Department, once approval is granted d. All materials must include the HRSA federal grant disclaimer and grant number which can be obtained from the Department, once approval is granted. e. Separate approval must be obtained for each publication an agency wishes to print. MDHHS/C0-2017 ATTACHMENT III Page 129 of 175 6/23/16 Performance Level N/A (if Applicable) 51 7-335-81 50 GuyskyP1 @michigan.gov Staffing (6) (14) (18) Grant Contract Administrator Contact Info (phone & email) Subrecipient, Contractor, or Recipient (non federal) Designation - Performance Target Output Measure Subrecipient PUBLIC HEALTH EMERGENCY PREPAREDNESS (PHEP) II ements T 1 9/30/2017 BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Grantee Requirements (Base/ CRI) The Public Health Emergency Preparedness section of Attachment III is effective from October 1, 2016 throuqh June 30, 2017. Funds are provided by the Department for nine months based on the Department's fiscal year. 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 2016-2017 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 BP5 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 ([PC), 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 PREP cooperative agreements, LHD's must partner with the Regional Healthcare Coalition (HCC) and support HCC initiatives to ensure that healthcare organizations receive resources to meet medical surge demands. Working well together during a crisis is facilitated by meeting on a regular basis. To this end, EPCs, MDHHS/CO-2017 ATTACHMENT Itl Page 130 of 175 6/23/16 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 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 supplemental opportunities is required to comply with all CDC and the Department DEPR guidance, and all accompanying work plan and budgeting requirements implemented for the purpose of subrecipient monitoring and accountability. Some or all supplemental opportunities 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 supplemental opportunities 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 BETP- DEPR-PHEP(michigan.gov by May 1, 2016. 5. ALL activities funded through the PHEP cooperative agreement must be completed between July 1, and June 30, and all BP5 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 Mary MacQueen at macgueenmmichigan.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, 2017. 8. The ace of supplantation is the replacement of non-federal funds with federal funds to support the same activities. The Public Health Service Act, Title I, Section 319(c) specifically states, "SUPPLEMENT NOT SUPPLANT. — Funds appropriated under this section shall be used to supplement - 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. MDHHS/CO-2017 ATTACHMENT hl Page 131 of 175 6/23/16 h. Payment or reimbursement of backfilling costs for staff is not allowed. 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. 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 BP5 work plan. 12. Each subrecipient Grantee must retain program-related documentation for activities and expenditures consistent with Title 2 CFR Part 200; Uniform Administrative Requirements, Cost Principles and Audit Requirements 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 PHEP 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 1,2016 through September 30, 2016 and October 1, 2016 through June 30, 2017. Grantees are required to submit a letter (on agency letterhead) stating the source, calculation and narrative description of how the match was achieved, unless said match is met using local dollars. This was due with the narrative budget submission to the Department — DEPR. 15. Administrative preparedness - During BPS, Grantees must continue to strengthen and test its administrative preparedness plan, 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 MDHHS/CO-2017 ATTACHMENT III Page 132 of 175 6/23/16 PHEP benchmarks have been identified by CDC and the Department -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 BP5 work plan. b. Demonstrated capability to receive, stage, store, distribute, and dispense medical countermeasures (MCM) I during a public health emergency, per the BP 5 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 the Department — 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 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. Reoional Eoidemioloav 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. DEPARTMENT REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT III Page 133 of 175 6/23/16 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT III Page 134 of 175 6/23/16 Grant Start Date Grant Contract Administrator Contact Info (phone & email) 10/1/2016 Patrick Guysky Grant End Date 517-335-8150 GuyskyPl@michigan.gov Reimbursement Method Performance Level (if Applicable) Staffing (6) N/A Su brecipient, Su brecipient Contractor, or Recipient (non federal) 1 Designation Performance Target Output Measure I N/A PUBLIC HEALTH EMERGENCY PREPAREDNESS (PHEP) EBOLA VIRUS DISEASE (EVD) PHASE ii II Special Requirements •1 9/3012017 BUDGET AND AGREEMENT REQUIREMENTS N/A 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 2016 — 2017, plus any and all related guidance from the CDC and The Bureau of EMS, Trauma and Preparedness (BETP) that is issued for the purpose of clarifying or interpreting overall program requirements. Grantee activities shall be consistent with all approved PHEP EVD PHASE 11 work plan(s) on file with BETP. 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. Ebola Education and Training b. Special Pathogen response such as Zika 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. MDHHS/C0-2017 ATTACHMENT III Page 135 of 175 6/23/16 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. 9. 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 ll or $181,500 per year 4. Funding is for an 18 month period which runs from 4/1/16 — 9/30/17. There will be an opportunity to roll unspent funds from FY 16 into FY17. Limitations to roil unspent funds will be determined prior to June 30, 2016. 5. All funds and activity need to be complete by 9/30/17. 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 11/30/17. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT III Page 136 of 175 6/23/16 Grant Start Date Grant Contract Administrator 10/1/2016 Grant End Date I 9/30/2017 Reimbursement • Method Staffing (6) Subrecipient, Contractor, or Recipient (non federal) Designation Subrecipient Performance Level (if Applicable) N/A Performance Targe I N/A Contact info (phone & email) Jill Moore 517-373-4943 MooreJ14@Michigan.gov SEAL! MICHIGAN DENTAL SEALANT PROGRAM II Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1 Administer screening, oral health education 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 the Department SEAL! Michigan Student Data Form and the Department SEAL! Michigan Event Data Form and provide hard copy forms to the Department by October 15, 2017 and upon request. 5. Ensure all staff have received training in the SEAL! Michigan Program provided by the Department, which includes the Department data form training. Note: even if training has been completed by grantees in previous years, attendance for the current grant cycle 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, has no more than 20% filler, and is 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. M DH HS/CO-2017 ATTACH M ENT ill Page 137 of 175 6/23/16 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. 1. Grantees must track separately the amount of schools they serve, how many children received dental sealants, and how many dental sealants have been placed separately from SEALS and be able to provide this information upon request and at a minimum quarterly, 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. 100% of retention must be checked when sealant is placed by dental or dental hygiene student. 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 optional conference call. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS The Grantee shall submit the following reports within 15 days as stated on the following dates: • End Date Report Due Date January 15 April '15 July 15 1 st Qtr (December 31) 2nd Qtr (March 31) 3rd Qtr (June 30) 4th Qtr (September 30) October 15 1. The Quarterly Dental Sealant Tracking Data Form shall be completed quarterly and provided to the Department Dental Sealant Coordinator. Reports are due within 15 days after the end of the quarter. The work plan must be evaluated and noted on each Quarterly Dental Sealant Tracking Data Form. The work plan should include an update on all of the Grantee requirements. All line items on the Quarterly Dental Sealant Tracking Data Form shall be completed with accuracy and signed. 2. Provide documentation that emergency dental restorative services are tracked for children referred through the SEAL! Michigan dental sealant program within a 20 mile radius of the sealant program. 3. All requirements of the program, as listed in individual funding proposals shall be honored and addressed. Any barriers that may affect overall quality and quantity of the program will be brought to the attention of the Dental Sealant Coordinator. Funds may be adjusted and MDHRS/C0-2017 ATTACHMENT Ill Page 138 of 175 6/23/16 amended according to program outcomes throughout the year according to workplan goals and objectives. 4. Send reports to: Jill Moore, Dental Sealant Coordinator Oral Health Program — SEAL! Michigan MDHHS, Division of Chronic Disease and Injury Control P.O. Box 30195, Lansing MI 48909 Phone: (517) 373-4943 Fax: (517) 335-8697 MooreJ14rnichioan.qov MDHHS/CO-2017 ATTACHMENT III Page 139 of 175 6/23/16 517-241-8563, mcelhoneh@michigan.gov Grant Start Date Contact Info (phone & email) Staffing (6) 10/1/2016 Hope McElhone Subrecipient, • Contractor, or Recipient (non federal) Designation 9/30/2017 Grant End Date Subrecipient SEXUALLY TRANSMITTED DISEASE (STD) CONTROL II Special Requirements Performance Level NIA (if Applicable) BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 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 to the STD Section. 3. Participate in technical assistance/capacity development, quality assurance, and program evaluation activities as directed by DHSP/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 DHSP/STD at least two weeks prior to changes in clinic operation (hours, scope of service, etc.). 6. 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. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS Additionally for Kalamazoo County Public Health Department MDHRS/C0-2017 ATTACHMENT Ill Page 140 of 175 6/23/16 1. Between October 1 and September 30, Kalamazoo County Public Health Department will conduct 10 STD presentations to adolescents and young adults in area middle schools and high schools. 2. Between October 1 and September 30, Kalamazoo County Health Department STD staff will conduct provider outreach and training to a minimum of 10 providers. This activity will help reduce syphilis, gonorrhea, and chlamydia through improved client adherence to provider messages about testing, treatment, risk reduction, and partner management. REPORTING REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT III Page 141 of 175 6/23/16 Grant Sta Date , 10/1/2016 Grant End Date j 9/3012017 Jessica Grzywacz 517-335-8627; grzywaczj@michigan.gov Staffing (6) Subreciplent, Contractor, or • Recipient (non federal Designation Subrecipient Contact Info (phone & email) Performance Level (if Applicable) N/A Performance Target I N/A Output Measure Grant Contract Administrator SEXUAL VIOLENCE PREVENTION II :cial Requirements BUDGET AND AGREEMENT REQUIREMENTS No indirect costs may be charged to this grant. 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 use funds for indirect costs. Payment or reimbursement of backfilling costs for staff is not allowed. MDH HS/CO-2017 ATTACHMENT til Page 142 of 175 6/23/16 DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS The Grantee shall submit the following reports on the following dates: Quarterly Proiect Reports 1st Quarter (October 1 through December 31) due January 17 2nd Quarter (January 1 through March 31) due April 17 ad Quarter (April 1 through June 30) due July 17 4th Quarter (July 1 through September 30) due October 16 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: grzwaczimichioan.dov. MDHHS/CO-2017 ATTACHMENT III Page 143 of 175 6/23/16 1 10/1/2016 Grant Start Date Grant End Date Subrecipient, Contractor, or Recipient (non federal Designation 1 Performance Target 1 N/A Output Measure Contractor Reimbursement Method SUDDEN UNEXPLAINED INFANT DEATH (SUID) AND OTHER FETAL INFANT DEATH I I Spec i ; , .rnents 1 Grant Contract Administrator • Contact Info (phone & email) Jeff Spitzley 51 7-335-81 31 spitzleyj2@michigan.gov Fixed Unit Rate (2) (11) Performance Level N/A • (if Applicable) BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Grantee personnel will maintain current expertise in fetal/infant death research, bereavement and counseling techniques through educational in-service and/or personal professional development. 2. The Grantee will update current curriculum and materials for maternal and child health programs to incorporate Sudden Unexplained Infant Death (SUID) and other fetal/infant death risk reduction information and interconception care education and/or counseling. Interconception care, per the joint program brief issued by the CDC and HRSA in 2008, is comprised of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management, emphasizing those factors which must be acted on before conception or early in pregnancy to have maximal impact. Thus, it is 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 SUID diagnosis. MDH HS/CO-2017 ATTACHMENT III Page 144 of 175 6/23/16 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 Fl MR Maternal Interview. 2. Provide training for certification of family support providers. 3. Provide technical assistance for bereavement support. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT III Page 145 of 175 6/23/16 Grant Start Da Grant Contract Administrator Contact Info (phone & email) 10/1/2016 Kara Anderson andersonkl 0@michigan.gov 517-373-3864 TGrant End Date Performance (8) (18) ,Subrecipierit, Contractor, or Recipient (non federal) Designation I Subrecipient I Performance Level 90% (if Applicable) TAKING PRIDE IN PREVENTION (TPIP) Special Requirements . Performance Target i Number of Output Measure unduplicated youth who complete at leas 75% of the program BUDGET AND AGREEMENT REQUIREMENTS Secure local matching funds (either cash or in-kind) totaling at least 35 percent (35%) of the state allocation. GRANTEE REQUIREMENTS 1. Comprehensive pregnancy prevention (abstinence and contraception) programming must be taught using an evidence-based intervention approved by the Department and address the following three adulthood preparation subjects: parent-child communication, healthy relationships, and adolescent development. 2. Information provided must be medically accurate, age-appropriate, culturally relevant, and up- to-date. 3. TPIP grantees must track participant, cohort, parent programming and community awareness activities, as well as administer the required state pre/post-tests and federal entry/exit surveys, following the approved implementation guidelines, and enter the data into ODE quarterly. 4. Pregnancy prevention programming must be welcoming and accessible to LGBTQ youth. Within 30 days of grant award, TPIP grantees must have in place or plan to have in place, policies prohibiting harassment based on race, sexual orientation, gender, gender identity (or expression), religion, and national origin. 5. Pregnancy prevention programming must be strengths-based and target risk and protective factors, in addition to primary prevention of pregnancy, STDs and HIV. 6. Pregnancy prevention programming must be delivered separate and apart from any religious education or promotion. TPIP funding cannot be used to support inherently religious activities including, but not limited to, religious instruction, worship, prayer, or proselytizing (45 CFR Part MDHHS/CO-2017 ATTACHMENT II Page 146 of 175 6/23/16 January 1 - March 31, 2017 April 15, 2017 April 1 - June 30, 2017 July 30, 2017 Email to Contract Manager Program Narrative 87.2). 7. 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/TPPI as mandated in the Michigan School Code (§380.1507, 388.1766). 8. Abortion services, counseling and/or referrals for abortion services cannot be provided as part of the pregnancy prevention education funded under TPIP. 9. TPIP funding cannot be used to supplant funding for an existing program supported with another source of funds. 10. TPIP grantees must adhere to all of the TPIP Minimum Program Requirements (MPRs). DEPARTMENT REQUIREMENTS 1. Provide ongoing program monitoring and technical assistance to funded grantees and program partners, 2. Provide two, two-day TPIP-sponsored learning Institutes each fiscal year. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 1. The Grantee shall submit the following reports via the appropriate electronic reporting method on the dates specified below: October 1 - December 31, 2016 January 30, 2017 July 1 - September 30, 2017 October 15, 2017 MDHHS/C0-2017 ATTACHMENT III Page 147 of 175 6/23/16 Work Plan October 1 - December 31, 2016 January 30, 2017 Email to Contract Manager January 1 - March 31, 2017 April 15, 2017 April 1 - June 30, 2017 July 30, 2017 July 1 - September 30, 2017 October 15, 2017 Local Match Report October 1 - December 31, 2016 January 30, 2017 Email to Contract Manager January 1 - March 31, 2017 April 15, 2017 April 1 - June 30, 2017 July 30, 2017 July 1 - September 30, 2017 October 15, 2017 Program & Participant Data October 1 - December 31, 2016 January 30, 2017 ODE January 1 - March 31, 2017 April 15, 2017 April 1 - July 31, 2017 August 5, 2017 August 1 - September 30, 2017 October 15, 2017 Youth Surveys October 1 - December 31, 2016 January 30, 2017 ODE January 1 - March 31, 2017 April 15, 2017 April 1 - July 31, 2017 August 5, 2017 August 1 - September 30, 2017 October 30, 2017 MDHHS/C0-2017 ATTACHMENT III Page 148 of 175 6/23/16 Structure & TA Survey October 1, 2016-September 30, 2017 August 15, 2017 Qualtrics 2. Any such other information as specified in the Statement of Work and TPIP Report Fact Sheet shall be developed and submitted by the Grantee as required by the Contract Manager. 3. The Contract Manager shall evaluate the reports submitted as described in items 1 and 2 for their completeness and adequacy, 4, 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. 5. MDHHS/CO-2017 ATTACHMENT III Page 149 of 175 6/23/16 Tracy Liichow (517) 373-3267 Staffing (6) Performance Level N/A (if Applicable) I Grant End Date 9/30/2017 Subrecipient • • Subrecipient .Contractor,: or 136013 ient (don federal). Designation • Performance Target I N/A Output Measure TOBACCO DEPENDENCE TREATMENT II Special Rdrernents BUDGET AND AGREEMENT REQUIREMENTS No funds may be expended for lobbying as defined in Act No. 472 of the Public Acts of 1978, being sections 4.411 to 4.431 of the Michigan Compiled Laws. GRANTEE REQUIREMENTS Complete Tobacco Dependence Treatment program and Getting to the Heart of the Matter initiative evaluation requirements, which may include periodic data collection and submission. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Complete requirements and update information in attached reports: Period Covered Quarterly Report (January 1 — March 31) Quarterly Report (April 1 — June 30) Quarterly Report (July 1 — September 30) Final comprehensive report (1/1/17-9/30117) Report Due Dates April 30 July 30 October 30 November 15 MDHHS/CO-2017 ATTACHMENT III Page 150 of 175 6/23/16 Grant Start Date 10/1/2016 Grant Contract Lynne Stauff Administrator Grant End Date 9/30/2017 stauffl@michigan.gov 51 7-335-1 818 Subrecipient, Contractor, or Recipient (non federal) I Designation Performance Level i N/A [(if Applicable) Performance Target 1 N/A Output Measure TOBACCO REDUCTION IN PEOPLE LIVING WITH HIV/AIDS II Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. implement work plan; correspondence and budget will be maintained on file at the Department. 2. Submit monthly progress reports for the indicated time periods: Period Covered Report Due Dates October 1- December 31 Tuesday, January 3 January 1- March 31 Friday, April 28 April 1-June 30 Monday, July 31 July 1-September 30 Tuesday, October 31 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. Failure to comply with these requirements may result in punitive consequences such as denial of future funding or other consequences as appropriate. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A MDHHS/C0-2017 ATTACHMENT III Page 151 of 175 6/23/16 REPORTING REQUIREMENTS Complete and send quarterly CAREWare reports on the same period covered and reporting dates as mentioned above. Reports should be sent in electronically to your contract manager. Complete the program report provided to you which will entail responsible staff, timeline, expected outcome and measurement. MDHHS/C0-2017 ATTACHMENT Ill Page 152 of 175 6/23/16 10/1/2016 Peter Davidson Subrecipient Staffing (6) Reimbursement Method Subrecipient, Contractor, or Recipient (non federal) Designation Performance Targe N/A Output Measure Performance Leve (if Applicable) TUBERCULOSIS CONTROL AND ELIMINATION II Special Requirements davidsonP@michigan.gov 517-335-8173 BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS N/A DEPARTMENT 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/ss9reading3.htm. GRANTEE 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). MDHHS/CO-2017 ATTACHMENT II Page 153 of 175 6/23/16 2. Document in MDSS all changes to treatment regimen using the Report of Verified Case of Tuberculosis (RVCT) comments field (pg. 12), and completion of therapy using RVCT Follow- Up 2 (pg. 7). 3. Maintain evidence of monthly DOT logs on site (to be made available if needed). Monthly submission of DOT logs is no longer required. 4. Achieve at least 94% completion of treatment within 12 months for eligible TB cases. The determination of treatment completion is based on the total number of doses taken, not solely on the duration of therapy. Consult the most current ATS document Treatment of Tuberculosis for guidance in the number of doses needed and the length of treatment required following any interruptions in therapy. 5. Maintain appropriate documentation on site (to be made available if needed). Document the appropriate use of expenditures for incentive and enablers for clients to best meet their needs to complete DOT and appropriate therapy. 6. Ensure >90% completion of RVTC pages 1 - 6 in MOSS 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" httb://wvvw.cdc.govinch hstp/proq rami nteqration/docs/PCS I DataSecurityGu idel i nes .pdf REPORTING REQUIREMENTS DOT Logs are maintained on site and available if needed. All other data must be entered into MOSS as stipulated in contract specific requirements. MDH HS/CO-2017 ATTACHMENT III Page 154 of 175 6/23/16 10/1/2016 Robin Roberts Grant End Date 517-335-1178 robertsr6@michigan.gov WISEWOMEN: WELL-INTEGRATED SCREENING AND EVALUATION FOR WOMEN ACROSS THE NATION PROJECT II Special Requirements Performance (8) (9) Subrecipient, Contractor, or . Recipient (non federal) Designation Performance Target Output Measure Subrecipient # Clients Screened for Cardiovascular Disease Risk Factors BUDGET AND AGREEMENT REQUIREMENTS N/A 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. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS Recruitment Pilot The WISEWOMAN Recruitment Pilot will award Grantees a staffing grant to fund a Community Navigator or a Community Health Worker position. The objectives of the pilot is to test novel recruitment methods to enroll new women into the WISEWOMAN program, The WISE WOMAN Recruitment 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. MDHEIS/C0-2017 ATTACHMENT III Page 155 of 175 6/23/16 Entrepreneurial Gardening Project 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 trairtings 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. the Department will only reimburse for clients enrolled and participating in the Gardening Project. Any unused funds will be returned to the Department. Entrepreneurial Gardening Project Coordinator The WISEWOMAN Program will fund Caitlin Hills, Community Navigator, to coordinate the Entrepreneurial Gardening Project in the Northern Lower Peninsula VV1SEWOMAN Counties. The Entrepreneurial Gardening Project Coordinator 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 Coordinator funds 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. Systems and Environmental Change Project 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 All Grantees implementing WISEWOMAN: Quarterly Quality Improvement phone calls with the Community Navigator and the Department WISEWOMAN staff members to discuss progress toward meeting performance measures. Recruitment Pilot Grantees: Quarterly calls to report on activities, discuss any problems, and brainstorm solutions. Entrepreneurial Gardening Program Grantees: Conference calls as needed to discuss program requirements. Final progress report (Mayl — September 30) due October 20, 2017 (template provided) Entrepreneurial Gardening Program Coordinator Grantees: Quaterly calls to report on activities, discuss problems, and brainstorm solutions. Final Progress Report (October 1 — September 30) due October 20, 2017 (template provided) Systems and Environmental Change Project Grantees: Quarterly Progress Reports Covering: MDHHS/C0-2017 ATTACHMENT III Page 156 of 175 6/23/16 Period Covered Report Due Dates October 1 — December 31 January 15 January 1 — March 31 April 15 April 1 — June 30 July 15 Final Progress Report covering the entire project through September 30 October 20 (May be submitted sooner if project is completed earlier) Reports shall be submitted to the Contract Manager at: Robin Roberts, Program Director MDHHS - WISEWOMAN Program P.O. Box 30195 Lansing, MI 48909 Phone: (517) 335-1178; E-mail: robertsr6@michigan.gov MDHHS/CO-2017 ATTACHMENT III Page 157 of 175 6/23/16 Performance eVel N/A (if Applicable) Staffing (6) Brittany LaRue 517-335-8625 larueb@rhichigan.gov Subrecipient, Contractor or Recipient (non federal Designation Subrecipient Performance Target Output Measure 1 N/A WIC — Breastfeeding and WIC - Migrant Subrecipient, Contractor, or Recipient (non federal) Designation Subrecipient N/A Performance Target 1 N/A Output Measure WIC - Resident 110/112016 WOMEN INFANT CHILDREN (WIC) If Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 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)]. MDHHS/CO-2017 ATTACHMENT 111 Page 158 of 175 6/23/16 3. Maintain an inventory of all equipment purchased with WIC program funds and maintain such inventory at each WIC clinic location. 4. Assure each Grantee employee authorized for or requesting access to the automated WIC system complete and sign a security agreement. 5. The Grantee in accordance with the general purposes and objectives of this agreement, will comply with the federal regulations requiring that any individual that embezzles, willfully misapplies, steals or obtains by fraud, any funds, assets or property provided, whether received directly or indirectly from the USDA, that are of a value of $100 or more, shall be subject to a fine of not more than $25,000. 6. The Grantee is responsible for installation and maintenance of WIC hardware according to guidance provided by the Department WIC Program. 7. The Grantee is required to abide by the Dissemination License Agreement between Michigan State University and Michigan Department of Health and Human Services for "Mothers in Motion." Any use of these licensed materials in the provision of program related services is subject to the terms and conditions outlined in the licensure agreement, which is included in Addendum 1, as reference. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS Snecial Reauirements for the WIC Breastfeedina Peer Counselina Program Funds allocated for the Breastfeeding Peer Counseling Program are exempt from the WIC Nutrition Education and Breastfeeding Time Study. The Grantee may only charge certain allowed expenses to the Peer Counselor Grant. Expenses for Breastfeeding education and supplies must be charged to the normal WIC budget; not the Peer Counselor Grant. See "Allowable Expenses". 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 15 th day of: January, March, July and October. Allowable Expenses The primary purpose of these funds is to provide breastfeeding support services through peer counseling to WIC participants. Expenses may include: 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 MDH HS/CO-2017 ATTACHMENT III Page 159 of 175 6/23/16 4. Voicemail, cell phones or phone-line expenses 5. Equipment or office furniture 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 MD-HS/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. MOHHS/C0-2017 ATTACHMENT III Page 160 of 175 6/23/16 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 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. 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 reaularWIC funds shoultibe 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. MDH HS/CO-2017 ATTACHMENT HI Page 161 of 175 6/23/16 8. Costs of reimbursable agreements with other organizations, public or private, to provide NE to WIC participates. Allowable Breastfeeding (BF) Promotion & Support Expenses are: Peer counseling if supported with funds allocated through the WIC funding formula. (Report as time study data.) 2. Cost of procuring BF educational materials. 3. Interpreter or translator services to facilitate BF promotion and support. 4. Costs of training BE promotion & support educators, including costs related to conducting training sessions and purchasing and producing training materials. 5. Costs of clinic space devoted to BF promotion & support educational and training activities, including space set aside for BF WIC infants. 6. BF aids which directly support the initiation and continuation of BF, as purchased with WIC funds allocated through the funding formula. 7. Costs of documenting, monitoring and/or evaluating BE 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 BE 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. MDH HS/CO-2017 ATTACHMENT HI Page 162 of 175 6/23/16 • Grant.End 9/30/2017 ,Grant Start Date. Grant Contract Administrator 10/1/2016 Tracy Liichow 517-373-3267 and iiichowt@michigan.gov Subrecipient Staffing (6) Subrecipient, Contractor, or Recipient (non federal) Designation Reimbursement' Method N/A N/A Performance Level (if Applicable) Performance Target• Output Measure Contact Info (phone & email) WORKSITE WELLNESS — GETTING TO THE HEART OF THE MATTER Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. The Grantee will develop, submit and implement a work plan and budget which will be approved by and maintained on file at the Department. 2. Complete Worksite Wellness program and Getting to the Heart of the Matter initiative evaluation requirements, which may include periodic data collection and submission. 3. The Grantee will submit a progress report to the the Department consultant. Period Cgvered January 1 — January 31 February 1 — February 29 March 1 — March 31 April 1 April 30 May 1 — May 31 June 1 June 30 July 1 — July 31 August 1 August 31 September 1 — September 30 (FINAL) 4. The Grantee will attend required meetings. Report Due Dates February 15, 2017 March 15, 2017 April 15, 2017 May 15, 2017 June 15, 2017 July 15, 2017 August 15, 2017 September 15, 2017 September 30, 2017 5. The Grantee shall collaborate with the program consultant to schedule and participate in site visits. MOHHS/C0-2017 ATTACHMENT111 Page 163 of 175 6/23/16 6. 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. 7 Failure to comply with these requirements may result in punitive consequences including but not limited to reimbursement of activities that were not performed, denial of future funding and/or other consequences as appropriate. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/CO-2017 ATTACHMENT III Page 164 of 175 6/23/16 ADDENDUM 'I Dissemination LicenseAgreementfor"Mothers in Motion" Between Michigan State University And Michigan Department of Health and Human Services This License Agreement ("Agreement"), effective as of October 16,2015 ("Effective Date"), is made by and between Michigan State University, having offices at 325 E. Grand River, Suite 350, East Lansing, MI 48823 ("Licensor") and State of Michigan Department of Health and Human Services Women, Infants and Children, having offices at 320 S. Walnut, Lansing, MI 48913 ("Licensee") (individually a "Party" and collectively, the 'Parties"). WHEREAS, Licensor has created the "Mothers in Motion" materials (herein, "Physical Materials"), MSU reference number TEC2015-0036 utilizing funds from a grant from the National Institutes of Health (MN), grant number 1R18-DK083934-01A2 ("Grant"). WHEREAS, Licensor isthe owner of certain rights, titleand interest inthe Physical Materials and has the right to grant licenses thereunder. WHEREAS, Licensee wishes to license the Physical Materials for dissemination purposes and Licensor, in orderto meet its obligations under the NI H grant, desires togrant such license to Licensee on the terms and conditions herein. WHEREAS, Licensee wishes to obtain this Agreement in orderto carry outthe intent of their master agreement between Licensee and Licensor with an effective date of FY 2015-2016. NOW THEREFORE, the parties agree as follows: I. Definitions. a. 'Physical Materials" shall mean all physical items listed in Schedule A. b. 'Sublicenseable Materials" shall mean one electronic copy of the Physical Materials. c. "Materials Modification Guide" shall mean the specifications outlined in Schedule B. d. 'Derivative Works" means all works developed by Licensee or Sublicensee which would be characterized as derivative works of the Physical Materials and/or Sublicenseable Materials under the United States Copyright Act of 1976, or subsequent revisions thereof, specifically including, but not limited to, translations, abridgments, condensations, recastings, transformations, or adaptations thereof, or works consisting of editorial revisions, annotations, elaborations, or other modifications thereof. The term "Derivative Work" shall not include those derivative works which are developed by Licensor. e. "Sublicense" means an agreement which may take theform of, but is not limited to, a sublicense agreement, memorandum of understanding, or special provisions added as an amendment to an existing agreement between Licensee and a Sublicensee in which Licensee grants or otherwise transfers any of the rights licensed to Licensee hereunderorother rig hts that are relevant to using the Sublicenseable Materials. AGR2015-01 146 1 TEC2015- 0036 f. "Sublicensee" means any entity to which a Sublicense is granted. MDHHS/C0-2017 ATTACHMENT III Page 165 of 175 6/23/16 1, Grant of License 1.1 Subject to the terms and conditions of this Agreement, to the extent that Licensee's rights to Physical Materials as a result of Licensor's grant of rights to the Federal Government in accordance with the terms and conditions of the Grant are insufficient for Licensee's activities hereunder, Licensor hereby grants to Licensee a nonexclusive, nontransferable, worldwide, license to use, perform, reproduce, publically display and create Derivative Works (as outlined in the Physical Materials Modification Guide) of the Physical Materials. Notwithstanding the foregoing, Licensee may only distribute the Physical Materials within Licensee managed locations within the state of Michigan. Licensee is not permitted to sell or receive consideration for any of the Physical Materials or reproductions of the Physical Materials. 1.2. Licensor grants Licensee the right to grant Sublicenses of its rights under Section 1.1 of the Sublicensable Materials to Sublicensee for the sole purpose of placing the content contained in the Sublicenseable Materials on a website that is controlled by Sublicensee and that is access limited, password protected. Any Sublicense shall be in accordance with Article 3 below. Sublicensee may be granted the right to create Derivative Works of the Sublicenseable Materials limited to that which is described in the Materials Modification Guide and only to ensure that the Sublicenseable Materials meet - technical specifications necessary to place the content contained in the Sublicenseable Materials on Sublicensee's controlled website. Notwithstanding the foregoing, Sublicensee may create split-up lessons (meaning placing the content of a full-length lesson into multiple videos) of the full-length lessons contained in the DVD portion of the Sublicenseable Materials only in order to confonn to the technical fonnat of Sublicensee's website platfonn; the content, however, shall not be modified. Sublicensee is not pennitted to sell or receive consideration for the Sublicenseable Materials in any fonnat. Any content created solely by Sublicensee that supports the implementation of the Sublicensable Materials shall be owned by Sublicensee. Ifs Derivative Work is created by Sublicensee, Sublicensee shall own their creative contribution to the Derivative Work and Licensor retain all copyright rights to the original Sublicensable Materials contained in such Derivative Work. Licensee and Sublicensee may address ownership of Sublicensee's creative contribution to Derivative Works in the Sublicense agreement. 1.3 In such incidences where, for financial reasons, Licensee is not able to reproduce the label displayed on the original master copy of the DVD portion of the Physical Materials, Licensee must ensure that the entire content of the DVD portion of the Physical Materials are reproduced in its entirety so that the inclusion of the copyright notice, Licensor owned logos (including wordmark), grant number information, title of each lesson, and acknowledgements are maintained. 1.4 Except as provided in Section 1.2 and 1.3, Licensee will refrain, and shall require Sublicensees to refrain, from using the name of the Licensor in publicity or advertising without the prior written approval of Licensor. Notwithstanding the foregoing, Licensee may, without prior approval from Licensor, use Licenser's name in a manner that is (a) informational in nature (i.e. describes the existence, scope and/or nature of the relationship of the Parties and/or the fact that the Physical Materials were developed by Licensor), (b) does not suggest Licenser's endorsement of Licensee or its goods or services, (c) does not create the appearance that the source of the communication is Licensor or any party other than Licensee, and (d) otherwise consistent with the terms of the Agreement. MDHHS/CO-2017 ATTACHMENT ill Page 166 of 175 6/23/16 AGR2015-0I 146 2 TEC2015-0036 Except as described in Section 1.2 and 1.3 and this Section 1.4, the use of the name of the Licensor does not extend to any trademark, logo, or other name or unit of Licensor. 1.5 Licensor shall provide Physical Materials to Licensee by October 31, 2015. Licensor assumes no responsibility for distributing Physical Materials to the state of Michigan Licensee locations. 2. Licensor's Rights 2.1 Notwithstanding the rights granted in Article I hereof, Licensee acknowledges that all right, title and interest in the Physical Materials, including any copyright applicable thereto, shall remain the property of Licensor and/or the third party rights holders. With the exception of the portion contributed by Licensee or Sublicensee in a Derivative Work of the Physical Materials, Licensee or Sublicensee shall have no right, title or interest in the Physical Materials, including any copyright applicable thereto, except as expressly set forth in this Agreement. 2.2 Any rights not granted hereunder are reserved by Licensor and/or the third party rights holders. 2.3 As of Licensor's present knowledge, MSU Extension (which is a unit within Licensor) is the copyright holder of the pizza recipe included in the Physical Materials. If Licensor is notified that a third party is the copyright holder to the pizza recipe, Licensor will in good faith attempt to secure the copyright rights from the third party rights holder in order for Licensor, Licensee and Sublicensee to maintain using the Physical Materials as described in the Agreement herein. In the event Licensor is unable to secure such rights, Licensor will use reasonable efforts to identify a replacement for such third party material. 3. Sublicense 3.1 (a) Any Sublicense entered into hereunder (I) shall contain terms no less protective of Licensor's rights than those set forth in this Agreement, (ii) shall not be in conflict with this Agreement, and (iii) shall identify Licensor as an intended third party beneficiary of the Sublicense. Licensee shall provide Licensor with a complete electronic or paper copy of each Sublicense within thirty (30) days after execution of the Sublicense. Licensee shall provide Licensor with a copy of each report received by Licensee pertinent to any data produced by Sublicensee that would pertain to the report due under Section 4. Licensee shall be fully responsible to Licensor for any breach of the terms of this Agreement by a Sublicensee. Licensee and Sublicensee may address ownership of Sublicensee's creative contribution to Derivative Works in the Sublicense agreement. (b) Upon termination of this Agreement for any reason, all Sublicenses shall terminate. If a Sublicensee was in compliance with the terms of its Sublicense in effect on the date of termination, Licensor may grant such Sublicensee that so requests, a license with terms and use _ rights as are acceptable to Licensor. In no event shall Licensor have any obligations of any nature whatsoever with respect to (i) any past, current or future obligations that Licensee may have had, or may in the future have, for the payment of any amounts owing to any Sublicensee, (ii) any past obligations whatsoever, and (iii) any future obligations to any Sublicensee beyond those set forth in the new license between Licensor and such Sublicensee. AG R2015-0 I 146 3 TEC2015-0036 MDHHS/CO-2017 ATTACHMENT II Page 167 of 175 6/23/16 4. Consideration In consideration of the rights granted herein, Licensee will provide to Licensor two effectiveness and utilization data reports based on the use of the Physical Materials. One data report shall include: a) number of clients who access the Physical Materials lessons; h) number of times specific lessons are completed; c) number of unique users; d) client perceptions for useful ness and helpfulness of lessons; and e) client beliefs in relation to ability to make changes based on lesson completion and shall be due to Licensor two years from the Effective Date and one data report containing the same data as described above shall be due thirty (30) days lifter the end of the five (5) year term. The reports shall be sent to Mci-Wei.Chang@.ht.msu.edu and msulagrr@rnsu.edu . S. Diligence Licensee shall use its reasonable efforts to disseminate the Physical Materials in a fashion that Licensee determines aliens with its mission in order to provide public benefit. 6. Term and Termination 6.1 This Agreement shall commence as of the Effective Date and shall extend for a period of five (5) years unless earlier terminated in accordance with paragraph 6.2 hereof. 6.2. Inthe eve1it that either Pruty believes that the other has materially breached any obligation under this Agreement, such Party shall so notify the breaching Party in writing. The breaching Party shall have thirty (30) days from the receipt of notice to cure the a Ileged breach and to notify the non-breaching Party in writing that said cure has been affected. If the breach is not cured within said period, the non- breaching Party shall have the right to terminate the Agreement without further notice. 1.3 Effect of Termination. 6.3.1 Upon termination, Licensee shall cease using, distributing and displaying the Physical Materials, and shall confirm in writing to Licensor that the Physical Materials have either been returned to Licensor or have been destroyed (in Licensors sole discretion). All Sublicenses shall terminate upon termination of this Agreement pursuant to Section 3(b). 6.3.2 Upon termination, the following provisions shall survive and remain in effect; 2.1; 4; 6.3; 8. 7. Representations and Warranties 7.1 Licensor and third parties hereby represent that it has, full right, power and authority to enter into this Agreement and to provide the license of rights granted under this Agreement. 7.2 LICENSOR, INCLUDING ITS TRUSTEES, OFFICERS AND EMPLOYEES, MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE PHYSICAL MATERIALS AND SUBLICENSEABLE MATERIALS AND HEREBY DISCLAIMS ALL REPRESENTATIONS AND WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR NONJNFRINGEMENT. LICENSEE ASSUMES THE ENTIRE RISK A6R2015-01 146 4 TEC1015-0036 MDHHS/C0-2017 ATTACHMENT HI Page 168 of 175 6/23/16 AND RESPONSIBILITY FOR THE SAFETY, EFFICACY, PERFORMANCE, DESIGN, MARKETABILITY AND QUALITY OF THE PHYSICAL MATERIALS AND SUBLICENSEABLE MATERIALS. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, THE PARTIES, INCLUDING THEIR OFFICERS AND EMPLOYEES, ACKNOWLEDGE THAT (A) THE PHYSICAL MATERIALS AND SUBLICENSEABLE MATERIALS AND DERIVATIVE WORKS ARE PROVIDED "AS IS"; (B) NEITHER THE PHYSICAL MATERIALS NOR SUBLICENSEABLE MATERIALS MAY BE FUNCTIONAL ON EVERY MACHINE OR IN EVERY ENVIRONMENT; AND (C) THE PHYSICAL MATERIALS AND SUBLICENSEABLE MATERIALS ARE PROVIDED WITHOUT ANY WARRANTIES THAT LT IS ERROR-FREE OR THAT LICENSOR IS UNDER ANY OBLIGATION TO CORRECT SUCH ERRORS. 8. Limitation of Liability 8.1 Each Party acknowledges and represents that it will be responsible for any claim for personal injury or property damage asserted by a third party and arising out of or related to its acts or omissions in the performance of its obligations hereunder to the extent that a court of competent jurisdiction determines such Party to be at fault or otherwise legally responsible for such claim. 8.2 In no event shall either Party be liable to the other Party or to any third party, whether under theory of contract, tort or otherwise, for any indirect, incidental, punitive, consequential, or special damages, whether foreseeable or not and whether such Party is advised of the possibility of such damages. 9. Assignment and Transfer Neither Party may assign, directly or indirectly, all or part of its rights or delegate its obligations under this Agreement without the prior written consent of the other Party. 10. Dispute Resolution 10.1 In the event of any dispute or controversy arising out of or relating to this Agreement or the subject matter hereof, the Parties shall use their best efforts to resolve the dispute as soon as possible. The Parties shall, without delay, continue to perform their respective obligations under this Agreement which are not affected by the dispute. 10.2 This Agreement and any disputes arising out of or relating to this Agreement shall be governed by and construed in accordance with the laws of the State of Michigan without regard to the conflicts of law provisions thereof. in any action to enforce this Agreement, the prevailing Party will be entitled to recover reasonable costs and attorneys' fees. 11. Force Majeure Neither Party shall be liable for damages or subject to injunctive or other relief, or have the right to terminate this Agreement, for any delay or default in performance hereunder if such delay or default is caused by conditions beyond its control including, but not limited to, Acts of God or force majeure, government restrictions (including the denial or cancellation of any necessary license), wars, insurrections and/or any other cause beyond the reasonable control of the Party whose performance is affected. AGR2015-0I 146 5 TEC2015-0036 12. Entire Agreement MDHHS/C0-2017 ATTACHMENT 111 Page 169 of 175 6/23/16 This Agreement constitutes the entire agreement of the Parties and supersedes all prior communications, understandings and agreements relating to the subject matter hereof, whether orator written. 13 Amendment No modification or claimed waiver of any provision of this Agreement shall be valid except by written amendment signed by authorized representatives of Licensor and Licensee. 14 Severability If any provision of this Agreement is determined to be invalid or unenforceable under applicable law, it shall not affect the validity or enforceability of the remainder of the terms of this Agreeme lit, and without further action by the Parties hereto, such provision shall be reformed to the minimum extent necessary to make such provision valid and enforceable. 15 Waiver Waiver of any provision herein .shall not be deemed a waiver of any other provision herein, nor shall waiver of any breach of this Agreement be construed as a continuing waiver of other breaches of the same or other provisions of this Agreement. 16. Notices All notices given pursuant to this Agreement shall be in writing and may be hand delivered, or shall be deemed received within three (3) days after mailing if sent by registered or certified mail, return receipt requested. Ifany notice is sent by facsimile, confirmation copies must be sent by mail or hand delivery to the specified address. Either party may from time-to-time change its notice address by written notice to the other Party. If to Licensor: Licensing Notices: MSU Technologies Attention: Agreement Coordinator AGR2015-01146 325 E. Grand River Suite 350 City Center Building East Lansing, MI 48823 517-884.1605 msutagr@.msu.edu AGR201 5-0 I 146 6 TEC2015-0036 If to Licensee: Michigan Department of Health and Human Services, WIC Division Attn: Kristen Hanulcik Manager, Consultation and Nutrition Services Unit MDH HS/CO-2017 ATTACHMENT Ill Page 170 of 175 6/23/16 320S.Walnut, Lewis Cass Bldg., 61/1 Floor Lansing, MI 48913 517-335-8545 hanulcikk@michigan.gov 17. Article Headings The Parties have carefully considered thisAgreementand have determined that ambiguities, if any, shall not be construed or enforced against the drafter. Furthermore, lhe beadings of Articles have been inserted for convenience of reference only and shall not control or affect the meaning or construction of any of the agreements, terms, cove1lantsorconditions of thisAgreement I nanymanner. IS Relationship of Pa rties Licensor and Licensee each acknowledge and agree that the other is an independent contractor in the performance of each and every part of this Agreement and is solely responsible for all of its employees and students and such Party's labor costs and expenses arising in connection therewith. The Parties are not partners, joint venturers or otherwise affiliated, and neither has any right or authority to make any statements, representations or commitments of any kind, or to take any action, which shall be binding on the other Party, without the prior written consent of such other Party. (remainder of page intentionally left blank) AG R2015-0 I 146 7 TEC201 5-0036 IN WITNESS WHEREOF, the Parties have executed this Agreement by their respective, duly authorized representative as of the date first above written. MDHHS/CO-2017 ATTACHMENT III Page 171 of 175 6/23/16 LICENSOR: Michigan State University &mature on tile Date: 10/15/15 By: Dr. Richard W. Chylla Executive Director, MSU Technologies LICENSEE: State of Michigan Department of Health and Human Services Women; Infants & Children Signature on file BY: Kim Stephen Date: 10/16/15 Bureau of Purchasing Michigan Department of Health and Human Services stephenk@michigan.gov 517-241-1196 Signature on file By: Stan Bien, Director Date: 10/16/15 WIC Division Michigan Department of Health and Human Services 320 S. Walnut, Lewis Cass Bldg., 6th Floor Lansing, M148913 bierts@michigan.gov 517-335-8448 AGRZ015-Q1 146 8 TEC2015-0036 Schedule A MDHHS/CO-2017 ATTACHMENT III Page 172 of 175 6/23/16 Physical Materials I. Client Materials A. Mothers in Motion intervention materials I . 260 sets packaged in Mothers in Motion bag. One set includes: a. I Mothers in Motion DVD set (I set is comprised of 3 DVDs) b. I looped DVD of Mothers in Motion Overview and Introduction c. Folder containing Mothers in Motion worksheets (e.g., "Goal and Plans" and 'Where Do I Go from Here?" worksheets, and stress log) and reference/guidance sheet detailing contents of each Mothers in Motion lesson (Total of 11lessons) d. 1 CD containing PDF formatted documents of Mothers in Motion worksheets to accommodate additional printing needs. 2. All Mothers in Motion intervention materials listed above will also be saved on 2 external drives provided by WIC. II. Staff Materials A. 'Rethinking How We Listen and Respond in WIC" Videos/DVDs I. 260 "Rethinking How We Listen and Respond in WIC" DVDs [included in Mothers In Motion bag described above (I DVD per bag)] 2. "Rethinking How We Listen and Respond in WIC" contents saved in video format on 2 external drives provided by WIC **All Items listed above will be saved on total of 4 external drives, provided by WIC** AGR2015-01146 9 TEC2015-0036 MDHHS/CO-2017 ATTACHMENT III Page 173 of 175 6/23/16 Schedule B Materials Modification Guide I. Client Materials 1 A. Mothers In Motion DVD I. The following Items are NOT permitted to be altered on DVDs a. DVD content i. MSU and Mothers in Motion logo ii. Grant number (N1H-N1DDK, 1R18-DK083934-01A2) iii. All lesson module and intervention content [exception: food label reading if contents become outdated] iv. Acknowledgement section v. Copyright notice b. Label on Disks* i. MSU and Mothers in Motion logo ii. Grant number (NIH-NIDDK, 1R18-DK083934-01A2) iii. Title of each lesson iv. Copyright notice 2. Items that may be reproduced a. Mothers in Motion DVDs b. CD contains all Mothers in Motion worksheets B. Mothers In Motion Worksheets I. The following items are NOT permitted to be altered on worksheets a. Grant number (N1H-NIDDK, IR18-DK083934-01A2) b. Mothers in Motion logo c. Title of each lesson d. Copyright notice 2. The following items are permitted to be altered on Worksheets A. Contents in the worksheets 3. Items that may be reproduced a. All worksheets b. Reference/guidance sheet detailing contents of each Mothers In Motion lesson II. Staff Materials 1 A. "Rethinking How We Listen and Respond in WIC" Videos/DVD I. Items that are NOT permitted to be altered on DVD a. DVD content i. MSU and Mothers in Motion logo ii. Grant number (N1H-NIDDK, 1R18-DK083934-01A2) iii. Acknowledgement section iv. Video/DVD Contents v. Copyright notice b. Label on Disks* i. MSU and Mothers in Motion logo ii. Grant number (N1H-NIDDK, I R18-DK083934-01A2) iii. Title of each lesson iv. Copyright notice AGR2015-01 146 10 TEC2015-0036 MDH HS/CO-2017 ATTACHMENT 111 Page 174 of 175 6/23/16 *WIC isallowed toduplicate DVDs without label orgrant numberonthe disks, if necessary. 1Sublicensee may create contentthat supports the implementation of the content contained in the Mothers in Motion DVDs, Mothers in Motion Worksheets and "Rethinking How We Listen and Respond in WIC" Videos/DVD. Any content created solely by Sublicenseeshall be owned in accordance with Section L2 and Section 3.1(a). Implementation of the content contained in the Mothers in Motion DVDs, Mothers in Motion Worksheets and "Rethinking How We Listen and Respond inWIC"Videos/DVD shallbe in accordance with Section1.2. AGR2015-01 146 11 TEC2015-0036 MDHHS/CO-2017 ATTACHMENT III Page 175 of 175 6/23/16 FOOTNOTES: FY 2016/2017 (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. Negotiated starting from the average of the past two complete years' actual number where available. 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). Calculated by multiplying the "State Funded Element Target Performance" column by the "Percent" column. Refer to master comprehensive agreement and budget instructions package for further explanation regarding these designations. (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 II Care Coordination is reimbursed at $30.00 per unit 2. A maximum of 10 units per beneficiary per eligibility year will be reimbursed. (2) Reimbursement Chart for Fixed Rates AIDS/HIV Prevention Non- 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 $255.33/appl. annual license prior to 7/1; $127.67/appl. annual license after 7/1; $114.89/appl. temporary license; $ 261.61/appl. renewal prior to 12/1; $383.00/appl. renewal after 12/1; $25.53/duplicate license FDA Tobacco Retailer (A&L) Inspections - Oakland orily $326.20 per inspection. Immunization Assessment Feedback Incentive Exchange (AF1X) 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/AF1X 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 ch amydia testing reimbursement performance requirements, AIDS SIDS $125 for each family support visit. A maximum of six (6) visits per infant death is reimbursable (c) (d) (e) (f) Original Notes FY 2017 6/24/2016 Allocation to be reflected in individual programs during budgeting process. Funding Source (not a single element). Hearing and Vision are single elements. Subject to Statewide Maintenance of Effort requirement for Title X. State funding is first source (after fees and other earmarked sources). Fixed unit rate subject to actual costs. The performance reimbursement target will be the base target caseload established by MDHHS. Subject to a match requirement (hard or in-kind) of $1 for each $3 of MDHHS agreement funding for Coordination. Fixed rate limited to contract amount Up to six (6) visits per family. Non-categorically funded Health Departments will be reimbursed at $11.00 per HIV test conducted up to a maximum of $2,000 annually. 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. 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 III - Program Assurances and Specific Requirements. NOTE: Some footnotes may not apply to this agency. Original Notes FY 2017 6/24/2016 Resolution #16254 September 22, 2016 Moved by Kochenderfer supported by McGillivray the resolutions (with fiscal notes attached) on the amended Consent Agenda be adopted (with accompanying reports being accepted). AYES: Dwyer, Fleming, Gershenson, Gingell, Gosselin, Hoffman, Jackson, Kochenderfer, KowaII, Long, McGillivray, Middleton, Quarles, Scott, Spisz, Taub, Weipert, Woodward, Zack, Bowman, Crawford. (21) NAYS: None. (0) A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the amended Consent Agenda were adopted (with accompanying reports being accepted). GERALD D. POISSON CHIEF DEPUTY COUNTY EXECUTIVE ACTING PURSUANT TO MCL 45,559A(7) STATE OF MICHIGAN) COUNTY OF OAKLAND) I, Lisa Brown, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and accurate copy of a resolution adopted by the Oakland County Board of Commissioners on September 22, 2016, with the original record thereof now remaining in my office. In Testimony Whereof, I have hereunto set my hand and affixed the seal of the County of Oakland at Pontiac, Michigan this 22" day of September, 2016. „4 Lisa Brown, Oakland County 47-7,76k,