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Resolutions - 2017.08.23 - 23073
REPORT (MISC . #17237) August 23, 2017 BY: Bob Hoffm2n, Chairperson, Human Resources Committee IN RE: - DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION - 2017/2018 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 August 23, 2017, 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. Commis-sioner Bo offmaXSZhairperson Human Resources Committee HUMAN RESOURCES COMMITTEE VOTE: Motion carried unanimously on a roll call vote. MISCELLANEOUS RESOLUTION #17237 August 23,2017 BY: Commissioner Christine Long, Chairperson, General Government Committee IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION - 201712018 COMPREHENSIVE PLANNING, BUDGETING AND CONTRACTING (CPBC) AGREEMENT ACCEPTANCE To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: WHEREAS the Michigan Department of Health and Human Services (MDHHS) has awarded the Oakland County Health Division funding through the Comprehensive Planning, Budgeting, and Contracting (CPBC) Agreement for the period October 1, 2017 through September 30, 2018; and WHEREAS the 2016/2017 CPBC Agreement included total funding of $10,239,784; and WHEREAS the 2017/2018 CPBC Agreement reflects grant funding in the amount of $10,342,094, an increase of $102,310 from the previous year; and WHEREAS the grant agreement and anticipated fiscal year 2018 contract amendments include sufficient funding for the sixty-three (63) positions listed in Schedule B; and WHEREAS the fourteen (14) special revenue (SR) positions listed in Schedule C to be deleted are vacant and will not be filled during the 2017/2018 CPBC grant period; and WHEREAS the budget detail for the various programs is a matter of negotiation between the Health Division and MDHHS; amendments will be recommended to the FY 2018 Budget when details are finalized; and WHEREAS the CPBC Agreement has completed the Grant Review Process in accordance with the Board of Commissioners Grant Acceptance Procedures and is recommended for approval. NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners hereby accepts the 2017/2018 Comprehensive Planning, Budgeting, and Contracting (CPBC) agreement for funding in the amount of $10,342,094 for the period of October 1, 2017 through September 30, 2018. BE IT FURTHER RESOLVED to continue sixty-three (63) SR positions included in Schedule B. BE IT FURTHER RESOLVED to delete fourteen (14) SR positions included in Schedule C. BE IT FURTHER RESOLVED that acceptance of this grant does not obligate the county to any future commitment and continuation of the Special Revenue positions in the grant is contingent upon continued future levels of grant funding. BE IT FURTHER RESOLVED that the Board Chairperson is authorized to execute this agreement and to approve any grant extensions or changes, within fifteen percent (15%) of the original award, which is consistent with the agreement as originally approved. BE IT FURTHER RESOLVED that the Oakland County Board of Commissioners authorizes its Chairperson to execute this Agreement subject to the following additional condition: That the County's approval for entering into this Agreement is specifically conditioned and premised upon the acceptance, approval and execution of the Agreement containing Addendum A, by the Michigan Department of Health and Human Services, and that the failure of the Michigan Department of Health and Human Services to execute the Agreement as specified shall, without any further act of the Oakland County Board of Commissioners, automatically negate and void the County's approval and/or acceptance of this agreement as provided for in this resolution. Chairperson, on behalf of the General Government Committee, I move the adoption of the foregoing resolution. Commissioner Christine Long, Distlict #7 Chairperson, General Governmeht Committee GENERAL GOVERNMENT COMMITTEE VOTE: Motion carried unanimously on a roll call vote with Kowall and Kochenderfer absent. GRANT REVIEW SIGN OFF — Health Division GRANT NAME: FY 2018 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: July 24, 2017 Pursuant to Misc. Resolution 417194, please be advised the captioned grant materials have completed internal giant 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 (7/11/2017) Department of Human Resources: HR Approved (Needs HR Committee) — Lori Taylor (7/10/2017) Risk Management and Safety: Approved by Risk Management. — Robert Erlenbeck (7/12/2017) Corporation Counsel: Approved. Please let me know if you have any questions. — Bradley G. Berm (7/21/2017) OAKLAND COUNTY, MICHIGAN GRANT AWARD HEALTH DIVISION CPBC GRANT SCHEDULE B FY18 Special Revenue Grant Positions - Position # Classification.(PTE or PTNE) Position Title Notes 00674 Full-Time Eligible Auxiliary Health Worker 00752 Full-Time Eligible Public Health Nurse Ill 00866 Full-Time Eligible Lactation Specialist Filled with PTNE 00906 Full-Time Eligible Public Health Nurse III 00912 Full-Time Eligible Public Health Nutritionist III 00958 Full-Time Eligible Office Supervisor I 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 PTN 02436 Full-Time Eligible Vaccine Supply Coordinator 02509 Full-Time Eligible Nutrition Technician - WIC 03073 Full-Time Eligible Office Supervisor II 03094 Full-Time Eligible Health Program Coordinator 03107 Full-Time Eligible Public Health Nurse ill 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 III Filled with PTNE 04771 Full-Time Eligible Auxiliary Health Worker Filled with PTNE 04773 Full-Time Eligible Auxiliary Health Worker Filled with PTNE 05128 Part-time Non-Eligible Student 05129 Full-Time Eligible Office Assistant II 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 PTNE 05204 Full-Time Eligible Lactation Specialist Filled with 2 PTNEs 05205 Full-Time Eligible Auxiliary Health Worker Filled with PTNE 05233 Full-Time Eligible Nutrition Technician - WIC 05234 Full-Time Eligible Nutrition Technician - WIC 05235 Full-Time Eligible Nutrition Technician - WIC 05246 Full-Time Eligible Office Leader 05401 Full-Time Eligible Public Health Nutritionist II 05526 Full-Time Eligible Office Assistant I Filled with 3 PTNEs 05693 Full-Time Eligible Public Health Nutritionist II 06099 Full-Time Eligible Public Health Nurse II Filled with PTNE 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 FY18 Special Revenue Grant Positions :Position. # Classification (FTE or PINE) Position Title Notes 06538 Full-Time Eligible Office Assistant II 06747 Full-Time Eligible Technical Assistant 06824 Full-Time Eligible Office Assistant 11 07346 Full-Time Eligible Public Health Nutritionist II Filled with PTNE 07381 Full-Time Eligible Public Health Nutritionist 111 07382 Full-Time Eligible Nutrition Technician - WIC 07384 Full-Time Eligible Auxiliary Health Worker 07413 Full-Time Eligible Public Health Nurse II 07414 Full-Time Eligible Office Leader 07415 Full-Time Eligible Office Assistant II 07416 Full-Time Eligible Public Health Educator I11 07557 Full-Time Eligible Public Health Nurse ill 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 07565 Full-Time Eligible Public Health Nurse III Filled with 2 PTNEs 07814 Full-Time Eligible Public Health Educator II Filled with PTNE 07839 Part-time Non-Eligible Auxiliary Health Worker 09668 Full-Time Eligible Public Health Nurse Ill 09999 Full-Time Eligible Public Health Preparedness Specialist 10012 Full-Time Eligible Medical Technologist Filled with PTNE 11579 Full-Time Eligible Lactation Specialist OAKLAND COUNTY, MICHIGAN GRANT AWARD HEALTH DIVISION CPBC GRANT SCHEDULE C Special Revenue Positions To Be Deleted Position # Classification (FTE.or, PTNE) . • I. Position Title 00515 Full-Time Eligible Office Assistant II 01234 Full-Time Eligible Office Assistant II 02636 Full-Time Eligible Office Assistant II 02740 Full-Time Eligible Clerk 04738 Full-Time Eligible Office Assistant II 05135 Full-Time Eligible Office Assistant II 05492 Full-Time Eligible Public Health Nurse Ill 06514 Part-Time Non-Eligible Public Health Nurse III 06515 Part-Time Non-Eligible Public Health Nurse ill 07383 Full-Time Eligible Office Assistant Ii 07412 Full-Time Eligible Public Health Nurse Ill 07558 Full-Time Eligible Public Health Nurse ill 09552 Part-Time Non-Eligible Public Health Nurse III 10902 Part-Time Non-Eligible Public Health Nurse Ill 06/23/2017 Agreement #: Agreement Between Michigan Department of Health and Human Services 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 WI: 38-6004876, DUNS #: 136200362 hereinafter referred to as the "Grantee" for The Delivery of Public Health Services under the Local Health Department Agreement 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 the date of the Department's signature, Grantee's signature or October 1, 2017 whichever is later and continue through September 30, 2018. 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 $10,342,094.00. Local Health Department - 2018, Date: 08/23/2011 Page, 1 of 186 06/23/2017 B. Equipment Purchases and Title Any Grantee equipment purchases supported in whole or in part through this agreement must be specified in the Supporting Equipment Inventory Schedule as an attachment to the Final Financial Status Report. 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 It - General Provisions, which are part of this agreement through reference: 1. Attachment! - Annual Budget 2. Attachment III - Program Specific Assurances and Requirements 3. Attachment IV - Funding/Reimbursement Matrix 4. Attachment V - FY 2017 Agreement Addendum A B. The attachments are added into this Agreement as follows: 1. Original Agreement (Part I and Part II) - Attachment 1, III, IV Local Health Department- 2018, Date: 08/23/2017 Page: 2 of 186 06/23/2017 Local Health Department - 2018, Date: 06/23/2017 Page: 3 of 186 06123/2017 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: Brenda Rays Title: Departmental Analyst Telephone No.: 517-373-1207 E-Mail Address roysb@rnichigan.gov 10. Special Conditions A. This agreement is valid upon approval and execution by the Department which may be contingent upon State Administrative Board and Signature by the Grantee. 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 -2018, Date: 0812312017 Page: 4 of 186 06/23/2017 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 Christine H. Sanches 06/23/2017 Christine H. Sanches, Director Date Bureau of Purchasing Local Health Department - 2018, Date: 0612312017 Page: 5 of 186 06/23/2017 Part II General Provisions Responsibilities - Grantee The Grantee in accordance with the general purposes and objectives of this agreement will: A. Publication Rights 1. Where the Grantee exclusively develops books, films, or other such copyrightable materials through activities supported by this agreement, the Grantee may copyright those materials. The materials that the Grantee copyrights cannot include service recipient information or personal identification data. Grantee grants the Department a royalty- free, non-exclusive and irrevocable license to reproduce, publish and use such materials copyrighted by the Grantee 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 Bureau of Purchasing 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 Grantee must collect 1st and 3rd party fees, where applicable, and report those collections on the Financial Status Report. Any underrecoveries of otherwise available fees resulting from failure to bill for eligible services will be excluded from reimbursable expenditures. Local Health Department - 2018, Date: 06/232017 Page: 6 of 186 06123/2017 C. Grant Program Operation Provide the necessary administrative, professional, and technical staff for operation of the grant 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 grant project or grant program identified in this agreement will be maintained for a period of not less than three 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 1. Permit within 10 calendar days of providing notification and at reasonable times, access by authorized representatives of the Department, Federal Grantor Agency, Inspector Generals, Comptroller General of the United States and State Auditor General, or any of their duly authorized representatives, to records, papers, files, documentation and personnel related to this agreement, to the extent authorized by applicable state or federal law, rule or regulation. 2. The rights of access is this section are not limited to the required retention period but last as long as the records are retained. 3. Grantee must cooperate and provide reasonable assistance to authorized representatives of the Department and others when those individuals have access to Grantee's grant records. G. Audits 1. Single Audit Grantee must submit to the Department a Single Audit consistent with the regulations set forth in Title 2 Code of Federal Regulations (CFR) Part 200, Subpart F. The Single Audit reporting package must include all components described in Title 2 Code of Federal Regulations, Section 200.512 (c) including a 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. Local Health Department- 2018, Date: 06123/2017 Page: 7 of 186 06/23/2017 2. Other Audits The Department or federal agencies, may also conduct or arrange for "agreed upon procedures" or additional audits to meet their needs. 3. Due Date and Where to Send 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. Submit 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 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. 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. Local Health Department - 2018, Date: 06/23/2017 Page- 8 of 186 06/23/2017 H. Subrecipient/Contractor Monitoring When passing federal funds through to a subreciplent (if the agreement does not prohibit the passing of federal funds through to a subrecipient), the Grantee must: 1. Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the information required by 2 CFR 200.331 (a). 2. Evaluate each subrecipient's risk for noncompliance as required by 2 CFR 200.331(b). 3. Monitor the activities of the subrecipient as necessary to ensure that the subaward is used for authorized purposes, in compliance with federal statutes, regulations, and the terms and conditions of the subawards; that subaward performance goals are achieved; and that all monitoring requirements of 2 CFR 200.331(d) are met including reviewing financial and programmatic reports, following up on corrective actions, and issuing management decisions for audit findings. 4. Verify that every subrecipient is audited as required by Subpart F of 2 CFR 200. The Grantee must develop a subrecipient monitoring plan that addresses the above requirements and provides 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 for 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 Local Health Department -2018, Date: 06/23/2017 Page'. 9 of 166 08/23/2017 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 IRB Authorization Agreement. The manner of the review will be agreed upon between the Department's Signatory Official and the Grantee's IRB chairperson or executive officer(s). L. Mandatory Disclosures The Grantee must disclose to the Department in writing within 14 days of receiving notice of any litigation, investigation, arbitration, or other proceeding (collectively, "Proceeding") involving Grantee, a subcontractor, or an officer or director of Grantee or subcontract, or that arises during the term of this Agreement including: 1. All violations of federal and state criminal law involving fraud, bribery, or gratuity violations potentially affecting the agreement. 2. A criminal Proceeding; 3 A parole or probation Proceeding; 4 A Proceeding under the Sarbanes-Oxley Act; 5, A civil Proceeding involving; a. A claim that might reasonably be expected to adversely affect Grantee's viability or financial stability; or b. A governmental or public entity's claim or written allegation of fraud; or 6. A Proceeding involving any license that Grantee is required to possess in order to perform under this Agreement. Local Health Department - 2018, Date: 06123/2017 Page. 10 of 186 06/23/2017 M. Minimum Program Requirements The Grantee must comply with Minimum Program Requirements established in accordance with Section 2472.3 of 1978 PA 368 as amended, MCL 333.2472.3, MSA 14.15 (2472.3), for each applicable program element funded under this agreement. N. Annual Budget and Plan Submission To submit an Annual Budget and Plan request to the Department, in accordance with instructions established by the Department, to serve as the basis for completion of specific details for Attachments I, III, and IV of this agreement via Grantee/Department negotiated amendment(s). Failure to submit a complete Annual Budget and Plan by the due date through MI E- Grants will result in the deferral of Department payments until these documents are submitted. 0. Maintenance of Effort All agencies shall comply with maintenance of effort requirements for Essential Local Public Health Services (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 I. P. Accreditation 1. All Grantees shall comply with the local public health accreditation standards and follow the accreditation process and schedule established by the Department to achieve full accreditation status. a, 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. b. 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 Local Health Department - 2018, Date: 0612312017 Page: 11 of 136 06/23/2017 review the package, meet with the Department, and sign/return the Consent Agreement. 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. Within 60 working days after receipt of an Administrative Compliance Order and proposed compliance period, a local governing entity may petition the Department for an administrative hearing. If the local governing entity does not petition the Department for a hearing within 60 days after receipt of an Administrative Compliance Order, the order and proposed compliance date shall be final, After a hearing, the Department may reaffirm, modify, or revoke the order or modify the time permitted for compliance. e. if the local governing entity fails to correct a deficiency for which a final order has been issued within the period permitted for compliance, the Department may petition the appropriate circuit court for a writ of mandamus to compel correction. Q. Medicaid Outreach Activities Reimbursement The Grantee agrees to report allowable costs and request reimbursement for the Medicaid Outreach activities it provides in accordance with 2 CFR, Part 225 (OMB Circular A-87) and the requirements in Medicaid Bulletin number: MSA 05-29. The Grantee agrees to submit a Cost Allocation Plan Certification to the Department to bill for the Medicaid Outreach Activities. The Cost Allocation Plan Certification is valid until a change is made to the cost allocation plan or the Department determines it is invalid. The Grantee will submit quarterly FSRs for the Medicaid Outreach activities and an annual FSR for the Children with Special Health Care Services Medicaid Outreach activities in accordance with the instructions contained in Attachment 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 17, the Department priorities are: lead testing, outreach and Local Health Department - 2018, Date: 06/23/2017 Page: 12 of 186 06/23/2017 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 MDHHS Local Health Department Medicaid Outreach form describing their outreach activities targeting the priorities 30 days after the end of a fiscal year quarter and at the same time as the final COMPREHENSIVE FSR is due into the Department. The Local Health Department Medicaid Outreach report are to be sent through MI E-Grants as an attachment report to the Financial Status Report. R. Conflict of interest and Code of Conduct Standards 1. The Grantee is subject to the provisions of 1968 PA 317, as amended, 1973 PA 196, as amended, and Title 2 Code of Federal Regulations, Section 200.318 (c) (1) and (2). 2. The Grantee will uphold high ethical standards and is prohibited from: a. Holding or acquiring an interest that would conflict with this Agreement; b. Doing anything that creates an appearance of impropriety with respect to the award or performance of this Agreement; c. Attempting to influence or appearing to influence any State employee by the direct or indirect offer of anything of value; or d. Paying or agreeing to pay any person, other than employees and consultants working for Grantee, any consideration contingent upon the award of this Agreement. Grantee must immediately notify the Department of any violation or potential violation of these standards. This Section applies to Grantee, any parent, affiliate, or subsidiary organization of Grantee, and any subcontractor that performs Agreement activities in connection with this agreement. S. Terms The Grantee must abide by the terms of this agreement including all attachments. II. Responsibilities - Department The Department in accordance with the general purposes and objectives of this agreement will: A. Payment Provide payment in accordance with the terms and conditions of this agreement based upon appropriate reports, records, and documentation maintained by the Grantee. B. Report Forms Provide any report forms and reporting formats required by the Department at the effective date of this agreement, and provide to the Grantee any new report forms and reporting formats proposed for issuance thereafter at least ninety (90) days prior to their required usage in order to afford the Grantee an Local Health Department - 2018, Date: 06123/2017 Page: 13 of 186 06/23/2017 opportunity to review and offer comment. Local Health Department - 2018, Date: 06/2312017 Page: 14 of 186 06/23/2017 C. Notification of Modifications To notify the Grantee in writing of modifications to Federal or State laws, rules and regulations affecting this agreement. D. Identification of Laws To identify for the Grantee relevant laws, rules, regulations, policies, procedures, guidelines and State and Federal manuals, and provide the Grantee with copies of these documents to the extent they are not otherwise available to the Grantee. E. Modification of Funding To notify the Grantee in writing within thirty (30) calendar days of becoming aware of the need for any modifications in agreement funding commitments made necessary by action of the Federal Government, the Governor, the Legislature or the Department of Management and Budget on behalf of the Governor or the Legislature. Implementation of the modifications will be determined jointly by the Grantee and the Department. F. Monitor Compliance To monitor compliance with all applicable provisions contained in federal grant awards and their attendant rules, regulations and requirements pertaining to program elements covered by this agreement. G. Reimbursement To reimburse local agencies for costs based upon timely, accurately completed Financial Status Reports in accordance with Section IV. H. Technical Assistance To make technical assistance available to the Grantee for the implementation of this agreement. I. Health Insurance Portability and Accountability The Department assures that it will be in compliance with the Health Insurance Portability and Accountability Act. J. 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. K. 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 Local Health Department - 2018, Date: 08/23/2017 Page: 15 of 186 06/23/2017 identify each fiscal year the Medicaid Outreach priorities and establish a reporting requirement for the Grantee. 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 Title 2 Code of Federal Regulations (CFR) covering cost principles, grant/agreement principles, and audits in carrying out the terms of this agreement. B. Anti-Lobbying Act The Grantee will comply with the Anti-Lobbying Act, 31 USC 1352 as revised by the Lobbying Disclosure Act of 1995, 2 USC 1601 et seq, and Section 503 of the Departments of Labor, Health and Human Services, and Education, and Related Agencies section of the FY 1997 Omnibus Consolidated Appropriations Act (Public Law 104-208). Further, the Grantee shall require that the language of this assurance be included in the award documents of all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. C. Non-Discrimination 1. In the performance of any contract or purchase order resulting herefrom, the Grantee agrees not to discriminate against any employee or applicant for employment or service delivery and access, with respect to their hire, tenure, terms, conditions or privileges of employment, programs and services provided or any matter directly or indirectly related to employment, because of race, color, religion, national origin, ancestry, age, sex, height, weight, marital status, physical or mental disability unrelated to the individual's ability to perform the duties of the particular job or position or to receive services. The Grantee further agrees that every subcontract entered into for the performance of any contract or purchase order resulting herefrom will contain a provision requiring non-discrimination in employment, service delivery and access, as herein specified binding upon each subcontractor. This covenant is required pursuant to the Elliot-Larsen Civil Rights Act, 1976 PA 453, as amended, MCL 37.2201 et seq., and the Persons with Disabilities Civil Rights Act, 1976 PA 220, as amended, MCL 37,1101 et seq., and any breach thereof may be regarded as a material breach of the contract or purchase order. 2. The Grantee will comply with all Federal statutes relating to Local Health Department - 2018, Date: 06/23/2017 Page: 16 of 186 g. 06/23/2017 nondiscrimination. These include but are not limited to a. Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; b. Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; c. Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of 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; §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records 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 The Grantee will comply with Federal Regulation, 2 CFR 180 and certifies to the best of it knowledge and belief that the Grantee's local health department employees, official of the Grantee's local health department and the Grantee's subcontractors: Local Health Department - 2018, Date: D8123,12017 Page: 17 of 1 86 06/23/2017 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. The Grantee will comply with Public Law 103-227, also known as the Pro-Children Act of 194, 20 USC 6081 et seq, which requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted by and used routinely or regularly for the provision of health, day care, early childhood development services, education or library services to children under the age of 18, if the services are funded by federal programs either directly or through state or local governments, by federal grant, contract, loan or loan guarantee. The law also applies to children's services that are provided in indoor facilities that are constructed, operated, or maintained with such federal funds. The law does not apply to children's services provided in private residences; portions of facilities used for inpatient drug or alcohol treatment; service providers whose sole source of applicable federal funds is Medicare or Medicaid; or facilities where Women, Infants, and Children (WIC) coupons are redeemed. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity. The 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 Local Health Department - 2018, Date: 08/23/2017 Page 18 of 186 06/23/2017 the facility under the control of the Grantee. If activities or services are delivered in facilities or areas that are not under the control of the Grantee (e.g., a mall, restaurant or private work site), the activities or services shall be smoke-free. F. Hatch Political Activity Act and Intergovernmental Personnel Act The Grantee will comply with the Hatch Political Activity Act, 5 USC 1501-1509 and 7324-7328, and the Intergovernmental Personnel Act of 1970, as amended by Title VI of the Civil Service Reform Act, Public Law 95-454, 42 USC 4728 - 4763. Federal funds cannot be used for partisan political purposes of any kind by any person or organization involved in the administration of federally-assisted programs. G. National Defense Authoriation Act Employee VVhistleblower 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 whistieblower protections established at 41 U.S.C. 4712 by section 828 of the National Defense Authorization Act for Fiscal Year 2012 and FAR 3.908. 2. The Grantee shall inform its employees in writing, in the predominant language of the workforce, of employee whistleblower rights and protections under 41 U.S.C. 4712, as described in section 3.908 of the Federal Acquisition Regulation. 3. The Grantee shall insert the substance of this clause, including this paragraph (3), in all subcontracts over the simplified acquisition threshold. H. Clean Air Act and Federal Water Pollution Control Act The Grantee will comply with the Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), as amended. a. This agreement and anyone working on this agreement will be subject to the Clean Air Act and Federal Water Pollution Control Act and must comply with all applicable standards, orders or regulations issue pursuant to these Acts. Violations must be reported to the Department. 1. Subcontracts For any subcontracted service, activity or product, the Grantee will ensure: 1. That a written subcontract is executed by all affected parties prior to the initiation of any new subcontract activity. Exceptions to this policy may be granted by the Department upon written request. 2. That any executed subcontract shall require the subcontractor to comply with all applicable terms and conditions of this agreement. In the event of a conflict between this agreement and the provisions of the Lace! Health Department- 2018, Date: 06123/2017 Page: 19 of 186 06/23/2017 subcontract, the provisions of this agreement shall prevail. A conflict between this agreement and a subcontract, however, shall not be deemed to exist where the subcontract: a. Contains additional non-conflicting provisions not set forth in this agreement; or b. Restates provisions of this agreement to afford the Grantee the same or substantially the same rights and privileges as the Department; or c. Requires the subcontractor to perform duties and/or services in less time than that afforded the Grantee in this agreement. 3. That the subcontract does not affect the Grantee's accountability to the Department for the subcontracted activity. 4. That any billing or request for reimbursement for subcontract costs is 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 Local Health Department- 2018, Date: 06/23/2017 Page: 20 of 186 96/23/2017 CFR, Part 3). b. For compliance with the Davis-Bacon Act (40 USC 276a to a-7) and as supplemented by Department of Labor regulations (29 CFR, Part 5) (if required by Federal Program Legislation). c. For compliance with Section 103 and 107 of the Contract Work Hours and Safety Standards Act (40 USC 327-330) as supplemented by Department of Labor regulations (29 CFR, Part 5). This provision also applies to all other contracts in excess of $2,500 that involve the employment of mechanics or laborers. J. Procurement Grantee will ensure that 01 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. Funding from this agreement shall not be used for the purchase of foreign goods or services or both. Records shall be 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 Local Health Department. 2018, Date; 06/23/2017 Page: 21 of 186 06/23/2017 disclosure of protected health data and information that falls under the HIPAA requirements of which the Grantee becomes aware. The Grantee will work with the Department to mitigate the breach, and will provide assurances to the Department of corrective actions to prevent further unauthorized uses or disclosures. 6. Failure to comply with any of these contractual requirements may result in the termination of this agreement in accordance with Part II, Section V. Agreement Termination. 7. In accordance with HIPAA requirements, the Grantee is liable for any claim, loss or damage relating to unauthorized use or disclosure of protected health data and information by the Grantee received from the Department or any other source. 8. The Grantee will enter into a business associate agreement should the Department determine such an agreement is required under HIPAA. L. Home Health Services If the Grantee provides Home Health Services (as defined in Medicare Part B), the following requirements apply: 1. The Grantee shall not use State ELPHS or categorical grant funds provided under this agreement to unfairly compete for home health services available from private providers of the same type of services in the Grantee's service area. 2. For purposes of this agreement, the term "unfair competition" shall be defined as offering of home health services at fees substantially less than those generally charged by private providers of the same type of services in the Grantee's area, except as allowed under Medicare customary charge regulations involving sliding fee scale discounts for low-income clients based upon their ability to pay. 3. If the Department finds that the Grantee is not in compliance with its assurance not to use state ELPHS and categorical grant funds to unfairly compete, the Department shall follow the procedure required for failure by local health departments to adequately provide required services set forth in Sections 2497 and 2498 of 1978 PA 368 as amended (Public Health Code), MCL 333.2497 and 2498, MSA 14.15 (2497) and (2498). M. Website Incorporation The Department is not bound by any content on Grantee's website unless expressly incorporated directly into this Agreement. N. Survival The provisions of this Agreement that impose continuing obligations will survive the expiration or termination of this Agreement. Local hearth Department 2016, Date: 06123/2017 Page: 22 of 186 06/23/2017 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 - 2018, Date; 06123/2017 Page: 23 of 186 06/23/2017 (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. Local Health Department- 2018, Date: 06/23/2017 Page: 24 of 186 06/23/2017 F. Reimbursement Mechanism All Grantees must sign up through the on-line vendor registration process to receive all State of Michigan payments as Electronic Funds Transfers (EFT)/Direct Deposits. Vendor registration information is available through the Department of Management and Budget's web site: http://www.cpexpress.state.mi.us/ G. Unobligated Funds Any unobligated balance of funds held by the Grantee at the end of the agreement period will be returned to the Department or treated in accordance with instructions provided by the Department. H. Fiscal Year-End Reporting An Obligation Report is based on annual guidelines and due date using the format provided by the Department through MI E-Grants. The Grantee must provide, by program, an estimate of total expenditures for the entire agreement period (October 1 through September 30). This report must represent the Grantee's best estimate of total program expenditures for the agreement period. The information on the report will be used to record the Department's year-end accounts payables and receivables by program for this Agreement. The report assists the Department in reserving sufficient funding to reimburse the final expenditures that will be reported on the Final FSR without materially overstating or understating the year-end obligations for this agreement. The Department compares the total estimated expenditures from this report to the total amount reimbursed to the Grantee in the monthly prepayments and quarterly fee-for-service payments to establish accounts payable and accounts receivable entries at fiscal year-end. The Department recognizes that based upon payment adjustments and timing of agreement amendments, the Grantee may owe the Department funding for overpayment of a program and may be due funds from the Department for underpayment of a program at fiscal year-end. Within 75 days after the agreement fiscal year-end, the Grantee must liquidate any unpaid year-end commitments and obligations. Any obligation remaining unliquidated after 75 days from the end of the agreement period shall revert to the Department for disposition in accordance with applicable state and/or federal requirements, except as specifically authorized in writing by the Department. Final Total Grantee FSR Project Public Health Emergency Preparedness WIC All Remaining Projects Final FSR Due Date 11/15/2017 11/30/2017 12/15/2017 The final total Grantee FSR is due December 15, after the agreement period Local Health Department -2018, Date: 06123/2017 Page: 25 of 186 06/23/2017 end date. WIC financial data reporting and final FSR must be received by November 30. Upon receipt of the final FSR electronically through MI E- Grants, the Department will determine by program, if funds are owed to the Grantee or if the Grantee owes funds to the Department. If funds are owed to the Grantee, payment will be processed. However, if the Grantee underestimated their year-end obligations in the Obligation Report as compared to the final FSR and the total reimbursement requested does not exceed the agreement amount that is due to the Grantee, the Department will make every effort to process full reimbursement to the Grantee per the final FSR. Final payment may be delayed pending final disposition of the Department's year-end obligations. If funds are owed to the Department, it will generally not be necessary for Grantee to send in a payment. Instead the Department will make the necessary entries to offset other payments and as a result the Grantee will receive a net monthly prepayment. When this does occur, clarifying documentation will be provided to the Grantee by the Department's Accounting Division. J. Penalties for Reporting Noncompliance For failure to submit the final total Grantee FSR report by December 15, through MI E-Grants after the agreement period end date, the Grantee may be penalized with a one-time reduction in their current ELPHS allocation for noncompliance with the fiscal year-end reporting deadlines. Any penalty funds will be reallocated to other Comprehensive Grantees (local health departments). Reductions will be one-time only and will not carryforward to the next fiscal year as an ongoing reduction to a Grantee's ELPHS allocation. Penalties will be assessed based upon the submitted date in MI E-Grants: ELPHS Penalties for Noncompliance with Reporting Requirements: 1. 1% - 1 day to 30 days late; 2. 2% - 31 days to 60 days late; 3. 3% - over 60 days late with a maximum of 3% reduction in the Grantee's ELPHS allocation. K. Indirect Costs and Cost Allocations/Distribution Plans The Grantee is allowed to use approved federal indirect rate, 10% de minimis indirect rate and/or cost allocation/distribution plans in their budget 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 Local Health Department - 2018, Date: 06/23/2017 Page: 26 of 166 06123/2017 certified plan in accordance with the requirements described in Title 2 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 II, Section III D, of this agreement during the term of this agreement or any extension thereof. VI. Final Reporting upon Termination Should this agreement be terminated by either party, within thirty (30) days after the termination, the Grantee shall provide the Department with all financial, performance and other reports required as a condition of this agreement. The Department will make payments to the Grantee for allowable reimbursable costs not covered by previous payments or other state or federal programs. The Grantee shall immediately refund to the Department any funds not authorized for use and any payments or funds advanced to the Grantee in excess of allowable reimbursable expenditures. Any dispute arising as a result of this agreement shall be resolved in the State of Michigan. VII. Severability If any provision of this agreement or any provision of any document attached to or incorporated by reference is waived or held to be invalid, such waiver or invalidity shall not affect other provisions of this agreement. Local Health Department - 2018, Date: 06/23/2017 Page: 27 of 186 06/23/2017 VIII. Amendments Any changes to this agreement will be valid only if made in writing and accepted by all parties to this agreement. A. This agreement, including attachments, may be amended by mutual written consent of the Grantee and the Department. When submitting a proposed agreement/budget amendment, the Grantee must submit copies of the revised sheets and a summary description of the changes. B. In the event that circumstances occur that are not reasonably foreseeable, or are beyond the Grantee's or Department's control, which reduce or otherwise interfere with the Grantee's or Department's ability to provide or maintain specified services or operational procedures, immediate written notification must be provided to the other party and an amendment to this agreement negotiated. C. Amendments to this agreement shall be made as follows: 1. Any change proposed by the Grantee which would affect the State funding of any element funded in whole or in part by funds provided by the Department, subject to Part I, Section 3.C, of the agreement, must be submitted in writing to the Department immediately upon determining the need for such change. The proposed change may be implemented upon receipt of written notification from the Department. Within thirty (30) days after receipt of the proposed change, the Department shall advise the Grantee in writing of its determination. Subsequently the Department will initiate any necessary formal amendment to the agreement for execution by all parties to the agreement. 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. Local Health Department- 2018, Date: 0612312017 Page: 28 of 186 06/23/2017 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, 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. Waiver Failure to enforce any provision of this Agreement will not constitute a 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. 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. Local Health Department -2018, Date., 06/23/2017 Page: 29 of 186 06/23/2017 XII. Confidentiality Both the Department and the Grantee shall assure that medical services to and information contained in medical records of persons served under this agreement, or other such recorded information required to be held confidential by federal or state law, rule or regulation, in connection with the provision of services or other activity under this agreement shall be privileged communication, shall be held confidential, and shall not be divulged without the written consent of either the patient or a person responsible for the patient, except as may be otherwise permitted or required by applicable state or federal law or regulation. Such information may be disclosed in summary, statistical, or other form, which does not directly or indirectly identify particular individuals. XIII. Funding A. State funding for this agreement shall be provided from the applicable and available Department appropriations for the current fiscal year. The Department provided funds shall be as stated in the approved Annual Budget - Attachment I Instructions for the Annual Budget, Attachment III, Program Specific Assurances and Requirements, and as outlined in Attachment IV, Funding/Reimbursement Matrix. B. The funding provided through the Department for this agreement shall not exceed the amount shown for each federal and state categorical program element except as adjusted by amendment, The Grantee must advise the Department in writing by May 1, if the amount of Department funding may not be used in its entirety or appears to be insufficient for any program element. ELPHS transfer requests between MDHHS, MDARD and MDEQ must also be requested in writing by May 1. All ELPHS required services must be maintained throughout the entire period of the agreement. C. The Department may periodically redistribute funds between agencies during the agreement period in order to ensure that funds are expended to meet the varying needs for services. Such redistributions will be based upon projections obtained in consultation with the Grantee. Any redistributions will be effected through the established amendment process. AA Attachments Al Attachment I - Instructions for the Annual Budget Attachment I - Instructions for the Annual Budget A2 Attachment III - Program Specific Assurances and Requirements Attachment III - Program Specific Assurances and Requirements A3 Attachment V - Agreement Addendum A Oakland County FY Agreement Addendum A Local Health Department. 2018, Date: 06/23/2017 Page: 30 of 186 Contract # Date: 0612312017 MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTACHMENT IV - Local Health Department - 2018 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source (a) MDHHS 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 Recepient ers Children's Special Hlth Care Calc. Amt. 150.00Nario Fixed Unit Rate (1), N/A N/A N/A N/A N/A Recepient 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. Alloc. S 142,500 CSHCS Medicaid Elevated Blood Calc. Amt. 201.58Nario Fixed Unit Rate (2) N/A N/A N/A N/A N/A Contractor Lead Case Mgmt . us .•. Enabling Services Women - MCH Local MCH S 163,108 Local MCH (3), (6) N/A N/A N/A N/A N/A Subrecepient Fetal Infant Mortality Review Cab. Amt. 270.00Nario Fixed Unit Rate (2) N/A N/A N/A N/A N/A Subrecepient (FIMR) Case Abstraction , us Food ELPHS ELPHS Food S 859,213 ELPHS (3), (4) N/A N/A N/A N/A N/A Recepient General Communicable Disease ELPHS S 463,192 ELPHS (3), (6) N/A N/A N/A N/A N/A Recepient ELPHS MDH HS Other Gonococcal Isolate Surveillance Reg. Alloc. F 39,000 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Project Hearing ELPHS ELPHS s 253,969 ELPHS (3), (6) N/A N/A N/A N/A N/A Recepient Hearing FIN ELPHS ELPHS S 311,659 ELPHS (3), (4) N/A N/A N/A N/A N/A Recepient MDHHS Other HIV Prevention Reg. Alloc. F 166,514 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Reg. Alloc. S 363,386 HIV Surveillance Support Reg. Alloc. F 39,071 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Immunization Action Plan (IAP) Reg. Alloc. F 503,403 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Local Health Department - 2018, Date: 0612312017 Page 31 of 186 Contract* Date: 0612312017 MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTACHMENT IV - Local Health Department - 2018 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source (a) MDHHS 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 (t) Immunization ELPHS ELPHS S 879,147 ELPHS (3), (6) N/A N/A N/A N/A N/A Recepient MDI-IHS Other Immunization Fixed Fees Cale. Amt. 300.00/Numb Fixed Unit Rate (2), N/A N/A N/A N/A N/A Recepient ers (7) Immunization Vaccine Quality Reg. Alloc. S 110,181 Staffing (6) N/A N/A N/A N/A N/A Recepient Assurance Infant Safe Sleep Reg. Alloc. F 2,813 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Reg. Alloc. S 19,687 Laboratory Services Bio Reg. Alloc. F 20,000 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Local Tobacco Reduction Reg. Alioc. S 30,000 Staffing (6) N/A N/A N/A N/A 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 Recepient MDEQ Private and Type III Water ELPHS S 514,301 ELPHS (3), (6) N/A N/A N/A N/A N/A Recepient Supply Private and Ty Ml Health and Wellness 4x4 Plan Reg. Alloc. S 65,000 N/A N/A N/A N/A N/A Subrecepient - implementation Nurse Family Partnership Reg. Alloc. F 31,052 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Services Reg. Alloc. S 589,988 Public Health Emergency Preparedness (PHEP) 10/1/17 - Reg. Alloc, F 222,390 Staffing (6), (14), (18) N/A N/A N/A NIA N/A Subrecepient 6/30/18 Public Health Emergency Preparedness (PHEP) CRI Reg. Alice. F 152,128 Staffing (6), (14), (18) N/A N/A N/A N/A N/A Subrecepient 10/1/17 - 6/30/18 Public Hlth Functions & lnfratruct - Local MCH S 158,349 Staffing (6) N/A N/A NIA N/A N/A Subrecepient MCH Sexually Transmitted Disease Reg. Alloc. F 40,135 Staffing (6) N/A N/A N/A N/A N/A Subrecepient (STD) Control Reg. Alloc. S 42,515 Local Health Department - 2018, Date: 0612312017 Page: 32 of 186 Contract # Date: 0612312017 MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTACHMENT IV - Local Health Department - 2018 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source (a) MDHHS 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) Sexually Transmitted Disease ELPHS S 597,292 ELPHS(3), (6) N/A N/A N/A N/A N/A Recepient (STD-ELPHS) MDFIFIS Other Sudden Unexplained Infant Death Calc. Amt. 85.00/Numbe rs Fixed Unit Rate (2), (11) N/A N/A N/A N/A N/A Recepient Tuberculosis (TB) Control Reg. Alloc. F 48,678 Staffing (6) NIA N/A N/A N/A N/A Subrecepient Vision ELPHS ELPHS S 253,968 ELPHS (3), (6) N/A N/A N/A N/A N/A Recepient Vision West Nile Virus Community Reg. Alloc. F 8,000 Staffing N/A N/A N/A N/A N/A NIA Surveillance WIC Breastfeeding Reg. Alloc. F 219,199 Staffing (6) N/A N/A N/A N/A N/A Subrecepient WIC Resident Services Reg. Alloc, F 2,435,330 Performance (8) # Average Monthly N/A N/A 97 0 Subrecepient Participation ZIKA Virus Community Support Reg. Alloc. F 10,000 Staffing N/A N/A N/A N/A N/A N/A ZIKA Virus Mosquito Surveillance Req. Alive. F 10,000 Staffing N/A N/A N/A N/A N/A N/A TOTAL MDHHS FUNDING 10,342,094 *SPECIFIC OUTPUT PERFORMANCE MEASURES WILL BE INCORPORATED VIA AMENDMENT Attachment IV Notes Attachment IV Notes Local Health Department- 2018, Date: 0612312017 Page: 33 of 186 Contract # Date- 06123/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Administration DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To: 9/30/2018 MAILING ADDRESS (Number and Street) 1200 a N. Telegraph Rd. 34 Est BUDGET AGREEMENT (V. 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 5,176,063,00 5,176,063.00 2 Fringe Benefits 3,495,062.00 3,495,062.00 3 Cap. Exp. for Equip & Fac. 0.00 0,00 4 Contractual 148,455.00 148,455.00 5 Supplies and Materials 368,860.00 368,860.00 6 Travel 58,052.00 58,052.00 7 Communication 79,764.00 79,764.00 8 County-City Central Services - 0.00 0.00 9 Space Costs i 742,367.00 742,367.00 10 All Others (ADP, Con. Employees, Misc.) 1,391,152.00 1,391,152.00 Total Program Expenses 11,459,775,00 11,459,775.00 TOTAL DIRECT EXPENSES 11,459,775.00 11,459,775.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 616,469.00 616,469.00 2 Other Costs Distributions -9,482,702.00 -9,482,702.00 Total Indirect Costs -8,866,233.00 -8,866,233.00 TOTAL INDIRECT EXPENSES -8,866,233.00 -8,866,233.00 TOTAL EXPENDITURES 2,593,542.00 2,593,642.00 Local Health Department- 2018, Date: 06/2312017 Page: 34 Of 186 Contract # Date: 061231201 7 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash I Inkind Total .1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 685,600.00 ,______ 0.00 685,600.00 Fees and Collections - 3rd Party 0.00 111,928.00 0.00 111,928.00 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 MDHHSComprehensive - 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 1,796,014.00 0.00 1,796,014.00 Inkind Match 0.00 0.00 0.00 0.00 MD1-11-1S Fixed Unit Rate 0.00 0.00 0.00 0.00 Total Source of Funds 0.00 2,593,542.00 0.00 2,593,542.00 Totals 0.00 2,593,542.00 0.00 2,593,642.00 Local Health Department - 2018, Date: 0803/2017 Page: 35 of 186 Contract # Date: 06/2312017 3 Program Budget - Cost Detail Line Item 1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 5,176,063.00 2 Fringe Benefits 3,495,062.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 148,455.00 5 Supplies and Materials 368,860.00 6 Travel 58,052.00 7 Communication 79,764.00 8 County-City Central Services 0.00 9 Space Costs 742,367.00 10 All Others (ADP, Con. Employees, Misc.) 1,391,152.00 Total Program Expenses 11,459,775.00 TOTAL DIRECT EXPENSES 11,459,775.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 616,469.00 2 Other Costs Distributions Other Cost Distributions-Other Inf Disease/CD -855,502.00 Other Cost Distributions-Misc Distribution -1,612,393.00 Other Cost Distributions-SIDS fee -2,000.00 Health Adm Distribution -7,125,944.00 Other Cost Distributions-Education 113,137.00 Total for Other Costs Distributions -9.482,702.00 Total Indirect Costs -8,866,233.00 TOTAL INDIRECT EXPENSES -8,866,233.00 TOTAL EXPENDITURES 2,593,542.00 Local Health Department- 2018, Date: 06/23/2017 Page: 36 of 186 Contract # Date: 06123/2017 1 Program Budget Summary PROGRAM/PROJECT Local Health Department - 2018 / Administration - Environmental P DATE REPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 1011/2017 To: 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 171 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 , 4,758,713.00 4,758,713.00 2 Fringe Benefits 3,064,311.00 3,064,311.00 3 Cap, Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 58,285.00 58,285.00 Travel 267,200.00 267,200.00 7 Communication 80,156.00 80,156.00 8 County-City Central Services 0.00 0.00 9 Space Costs 133,058.00 133,058.00 10 All Others (ADP, Con. Employees, Misc.) 675,407.00 675,407.00 Total Program Expenses 9,037,130.00 9,037,130.00 TOTAL DIRECT EXPENSES 9,037,130.00 9,037,130.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 566,763.00 566,763.00 2 Other Costs Distributions -2,743,508.00 -2,743,508.00 Total Indirect Costs -2,176,745.00 -2,176,745.00 TOTAL INDIRECT EXPENSES -2,176,745.00 -2,176,745.00 TOTAL EXPENDITURES 6,860,385.00 6,860,385.00 Local Health Department - 2018, Date: 08/2812017 Page: 37 of 186 Contract 4 Date: 06/2312017 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections - lst and 2nd Party 0.00 781,794.00 0.00 781,794.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 2,027,438.00 0.00 2,027,438.00 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 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 4,051,153.00 0.00 4,051,153.00 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 6,860,385.00 0.00 6,860,385.00 Totals 0.00 6,860,385.00 0.00 6,860,385.00 Local Health Department - 2018, Date: 0612312017 Page: 38 of 186 Contract # Date. 06/23/2017 3 Program Budget - Cost Detail 'Line Item L Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 4,768,713.00 2 Fringe Benefits 3,064,311.00 3 Cap. Exp. for Equip & Fac. 0.00 4 Contractual 0.00 5 Supplies and Materials 58,285.00 6 Travel 267,200.00 7 Communication 80,156.00 8 County-City Central Services 0.00 9 Space Costs 133,058.00 10 All Others (ADP, Con. Employees, Misc.) 675,407.00 Total Program Expenses 9,037,130.00 TOTAL DIRECT EXPENSES 9,037,130.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 566,763.00 2 Other Costs Distributions EH Adm Distribtions -6,055,426.00 Other Cost Distributions-Body Art Fees -15,000.00 Health Adm Distribution - 3,317,942.00 Other Cost Distributions-Misc 8,976.00 Total for Other Costs Distributions -2,743,508.00 Total Indirect Costs -2,176,745.00 TOTAL INDIRECT EXPENSES -2,176,745.00 TOTAL EXPENDITURES 6,860,385.00 Local Health Department - 2018, Date: 08/23/2017 Page: 39 of 186 Contract # Date: 06/23/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Adolescent STD Screening_ DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To: 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Wi Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 41,896.00 41,896.00 2 Fringe Benefits 16,273.00 16,273.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 6,192.00 6,192.00 6 Travel 669.00 669.00 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.) 2,980.00 2,980.00 Total Program Expenses 68,010.00 68,010.00 TOTAL DIRECT EXPENSES 68,010.00 68,010.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 14,328.00 14,328.00 Total Indirect Costs 14,328.00 14,328.00 TOTAL INDIRECT EXPENSES 14,328.00 14,328.00 TOTAL EXPENDITURES 82,338.00 82,338.00 Local Health Department - 2018, Date: 06/2312017 Page: 40 of 166 Contract # Date: 06/23/2017 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 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 IllWater . 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 9,338.00 0.00 9,338.00 Inkind Match 0.00 0.00 0.00 0.00 N1DH1-IS Fixed Unit Rate Totals 73,000.00 9,338.00 0.00 82,338.00 Local Health Deparlment - 2018, Date: 0612312017 Page 41 of 186 Contract # Date: 0612312017 3 Program Budget - Cost Detail 'Line Item ¶ QtYI Rate Units UOM Total DIRECT EXPENSES Program Expenses I Salary & Wages Public Health Nurse Notes : GFGP position - overtime only 0.0962 104065.000 0,000 FTE 10,011.00 Public Health Nurse Notes : GFGP Position-overtime only 0.0962 99255.000 0.000 FTE 9,548.00 Technician 0.1236 54305.000 0.000 FTE 6,712.00 Public Health Nurse Notes : CV, PT non-eligible 0.0721 58580.000 0.000 FTE 4,224.00 Assistant 0.2769 41175.000 0.000 FTE 11,401.00 Total for Salary & Wages 41,896.00 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 38,842 41896.000 16,273.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 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 0.000 300.00 Educational Supplies 0.0000 0,000 0.000 4,500.00 Total for Supplies and Materials 6,192 00 6 Travel Mileage Notes : 1,250 miles @ .535 0,0000 0.000 0.000 669.00 7 Communication Local Health Department- 2018, Date: 06123/2017 Page: 42 of 186 Contract # Date: 06/23/2017 Line Item City I Rate' Units I UOM Total 8 County-City Central Services 9 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 Total for All Others (ADP, Con. Employees, Misc.) 2,980.00 Total Program Expenses 68,010.00 TOTAL DIRECT EXPENSES 68,010.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan I Other Health Adm Distribution 0,0000 0.000 0.000 7,192.00 Nursing Adm Distribution 0.0000 0.000 0.000 2,146.00 Cost Allocation Plan Notes : 11.91% 0.0000 0.000 0.000 4,990.00 Total for Cost Allocation Plan! Other 14,328.00 Total indirect Costs 14,328.00 TOTAL INDIRECT EXPENSES 14,328.00 TOTAL EXPENDITURES 82,338.00 Local Health Department - 2018, Date: 0612312017 Page: 43 of 186 Contract # Date: 06123/2017 1 Program Budget Summary PROGRAM /PROJECT Local Health Department - 2018 / Public Health Emergency Preparedness (PHEP) 10/1/17 - 6/30/18 DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 6/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p; Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 119,611.00 119,611.00 2 Fringe Benefits 91,837.00 91,837.00 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 2,518.00 2,518.00 7 Communication 2,550.00 2,550.00 8 County-City Central Services H. 0.00 0.00 9 Space Costs 8,780.00 8,780.00 10 All Others (ADP, Con. Employees, Misc,) 5,661.00 5,661.00 Total Program Expenses 230,967.00 230,957.00 TOTAL DIRECT EXPENSES 230,957.00 230,957.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 37,773.00 37,773.00 Total Indirect Costs 37,773.00 37,773.00 TOTAL INDIRECT EXPENSES 37,773.00 37,773.00 TOTAL EXPENDITURES 268,730.00 268,730.00 Local Health Department- 2018, Date: 06/23/2017 Page: 44 of 186 Contract # Date: 06/23/2017 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 222,390,00 0.00 0.00 222,390.00 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 22,239.00 0.00 22,239.00 Inkind Match 0.00 0.00 24,101.00 24,101.00 MDFIFIS Fixed Unit Rate Totals 222,390.00 22,239.00 24,101.00 268,730.00 Local Health Department - 2018, Date: 0612312017 Page: 45 of 186 Contract # Date: 06/2312017 3 Program Budget - Cost Detail Line Item Qtyf Rate Units UOM -----1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Coordinator Notes : EP Coordinator 0.7500 62624.000 0.000 FTE 46,968.00 Specialist Notes : EP Specialist 0.3750 54059.000 0.000 FTE 20,272.00 Health Educator Notes : Public Health Educator II 0.3750 44721.000 0.000 FTE 16,770.00 Assistant Notes : Technical Assistant 0.3750 42988.000 0.000 FTE 16,121.00 Office Manager Notes : Office Leader 0.3750 39112.000 0.000 FTE 14,667.00 Administrator Notes : MATCH 0.0538 89470.000 0.000 FTE 4,813.00 Total for Salary & Wages 119,611.00 2 Fringe Benefits All Composite Rate Notes : PORTION MATCH $3696 FICA Unemp Ins Retirement Hospital Ins Life Ins Vision Ins Short/Long Term Disability Dental Ins Work Comp 0.0000 76.780 119611.000 91,837.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 6 Supplies and Materials 6 Travel Mileage Notes : 1,000 miles @ .535 0.0000 0.000 0.000 535.00 Conferences 0.0000 0.000 0.000 1,983.00 Total for Travel 2,518.00 7 Communication Telephone Communications 0.0000 0.000 0.000 2,550.00 Local Health Department - 2018, Date: 06/23/2017 Page: 46 of 166 Contract # Date: 06/23/2017 Line Item I My! Rate I Units UOM Total 8 County-City Central Services 9 Space Costs Building Space Rental Notes : MATCH 0.0000 0.000 0.000 8,780.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 135.00 Copier 0.0000 0.000 0.000 576.00 IT Operations Notes : MATCH 0.0000 0.000 0.000 4,950.00 Total for All Others (ADP, Con. Employees, Misc.) 5,661.00 Total Program Expenses 230,957.00 TOTAL DIRECT EXPENSES 230,957.00 INDIRECT EXPENSES Indirect Costs I Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 24,101.00 Cost Allocation Plan Notes : 11.91% 0.0000 0.000 0.000 13,672.00 Total for Cost Allocation Plan I Other 37,773.00 Total Indirect Costs 37,773.00 TOTAL INDIRECT EXPENSES 37,773.00 TOTAL EXPENDITURES 268,730.00 Local Health Department- 2018, Date: 06/23/2017 Page: 47 of 186 Contract # Date. 06123/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Body Art Fixed Fee DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD Fm: 101112017 To: 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT f;;; Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0,00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0,00 0.00 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 Cost Allocation Plan / Other 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 - 2018, Date, 0612312017 Page: 48 of 186 Contract # Date: 06123/2017 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 0.00 0.00 0.00 0,00 ELPHS - MDHHS Hearing 0.00 0.00 0,00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0,00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0,00 0.00 0.00 0,00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0,00 0.00 0.00 lnkind Match 0.00 0.00 0.00 0.00 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 - 2018, Date: 06/23/2017 Page: 49 of 186 Contract # Date; 06/2312017 3 Program Budget - Cost Detail 'Line Item QtyI 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 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan I Other Cost Distributions for Fees-from Environmental Administration '0.0000 0,000 0.000 15,000.00 Total Indirect Costs 15,000.00 TOTAL INDIRECT EXPENSES 16,000.00 TOTAL EXPENDITURES 15,000.00 Local Health Department - 2018, Date: 06/23/2017 Page; 50 of 186 Contract # Date: 06/23/2017 1 Program Budget Summary PROGRAM I PROJECT Local Health Department - 2018 / Children's Special Hlth Care Services (CSHCS) Care Coordination DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9130/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd, 34 East BUDGET AGREEMENT Pl Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0,00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0,00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0,00 6 Travel 0.00 0.00 7 Communication 0,00 0.00 County-City Central Services 0.00 0.00 9 Space Costs 0,00 0.00 10 All Others (ADP, Con. Employees, MIsa) 0.00 0.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 202,537,00 202,537.00 Total Indirect Costs 202,537.00 202,537.00 TOTAL INDIRECT EXPENSES 202,537.00 202,537.00 TOTAL EXPENDITURES 202,537.00 202,537.00 Local Heath Department- 2018, Date: 08/2312017 Page: 51 of 186 Contract # Date: 06/23/2017 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 - 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 CSHCS Care Coordination 202,537,00 0.00 0.00 202,537.00 Totals 202,537.00 0,00 0.00 202,537.00 Local Health Department - 2018, Date: 06/2312017 Page: 52 of 186 Contract # Date: 06/23/2017 3 Program Budget - Cost Detail Line Item I QtYI 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 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Cost Distributions for Fees-from CSI-ICS Outreach & Advoc 0.0000 0.000 0.000 202,537.00 Total Indirect Costs 202,537.00 TOTAL INDIRECT EXPENSES 202,537.00 TOTAL EXPENDITURES 202,537.00 Locat Health Department - 2018, Date: 08/23/2017 Page: 53 of 186 Contract # Date: 06/2312017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / CSHCS Medicaid Outreach DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT r Original r-, Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category 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 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 Cost Allocation Plan /Other 1,735,370.00 1,735,370.00 Total Indirect Costs 1,735,370.00 1,735,370.00 TOTAL INDIRECT EXPENSES 1,736,370.00 1,735,370.00 TOTAL EXPENDITURES 1,735,370.00 1,735,370.00 Local Health Department - 2018, Date' 06/23/2017 Page: 54 of 186 Contract # Date: 0812312017 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 547,423.00 0.00 0.00 547,423.00 Required Match - Local 0.00 547,423.00 0.00 547,423.00 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 0.00 640,524.00 0.00 640,524.00 lnkind Match 0.00 0.00 0.00 0.00 MDI-11-IS Fixed Unit Rate Totals 547,423.00 1,187,947.00 0.00 1,735,370.00 Local Health Department - 2018, Date: 06/23/2017 Page: 55 of 186 Contract # Date: 06/2312017 3 Program Budget - Cost Detail Line item I Qty Rate! Units I 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 Cost Allocation Plan / Other Distributions for Medicaid 0.0000 0.000 0.0001 1,735,370.00 Total ndirect Costs 1,735,370.00 TOTAL INDIRECT EXPENSES 1,735,370.00 TOTAL EXPENDITURES 1,735,370.00 Locat Health Department -2018, Date; 0612312017 Page: 56 of 186 Contract # Date: 0612312017 1 Program Budget Summary PROGRAM /PROJECT Local Health Department - 2018 / CSHCS Medicaid Elevated Blood Lead Case Mgmt DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To: 9130/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Original r Amendment AMENDMENT # (;) 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 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 Cost Allocation Plan / Other 71,359,00 71,359,00 Total Indirect Costs 71,359.00 71,359.00 TOTAL INDIRECT EXPENSES 71,359.00 71,359.00 TOTAL EXPENDITURES 71,359.00 71,359.00 Local Health Department 2018, Data: 06/23/2017 Page: 57 of 186 Contract # Date: 0612312017 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 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 CSHCS Medicaid Elevated Blood Lead Case 71,359.00 0.00 0.00 71,359.00 - Totals 71,359.00 0.00 0.00 71,359.00 Local Health Department- 2018, Date: 0612312017 Page: 58 of 186 Contract # Date: 06/23/2017 3 Program Budget - Cost Detail Line Item j QtYl Rate Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip 8, Fac. 4 Contractual 5 Supplies and Materials Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.} INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan I Other Cost Distributions for Fees Fees for Lead Case Mgt 0,0000 0.000 0.000 71,359.00 Total Indirect Costs 71,359,00 TOTAL INDIRECT EXPENSES 71,359.00 TOTAL EXPENDITURES 71,359.00 Local Health Department- 2018, Date: 08/23/2017 Page: 59 of 186 Contract # Date: 0612312017 1 Program Budget Summary PROGRAM I PROJECT Local Health Department - 2018 / Public Health Emergency Preparedness (PHEP) CR1 10/1/17 - 6/30/18 DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 6/30/2018 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 I Amount ] Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 74,345.00 74,345.00 2 Fringe Benefits 57,082.00 57,082.00 3 Cap. Exp. for Equip & Fac, 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 2,077.00 2,077.00 6 Travel 161.00 161.00 7 Communication 10,224.00 10,224.00 8 County -City Central Services 0.00 0.00 9 Space Costs 7,236.00 7,236.00 10 All Others (ADP, Cori. Employees, Misc.) 7,887.00 7,887.00 Total Program Expenses .. 159,012.00 159,012.00 TOTAL DIRECT EXPENSES 159,012.00 159,012.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 24,817.00 24,817,00 Total Indirect Costs 24,817.00 24,817.00 TOTAL INDIRECT EXPENSES 24,817.00 24,817.00 TOTAL EXPENDITURES 183,829.00 183,829.00 Local Health Department - 2018, Date: 08/2312017 Page: 60 of 186 Contract # Date: 06/23/2017 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 16,213.00 0.00 15213.00 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 152,128.00 0.00 0.00 152,128,00 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 16,488.00 0.00 16,488.00 lnkind Match 0.00 0.00 0.00 0.00 NID1-11-IS Fixed Unit Rate Totals 152,128.00 31,701.00 0.00 183,829.00 Local Health Department - 2018, Date: 06/2312017 Page: 61 of 186 Contract* Date: 06/23/2017 3 Program Budget - Cost Detail ILine Item QtYI Rate UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Specialist Notes : PH Emer Prep Specialist 0.3750 54059.000 0.000 FTE 20,272.00 Health Educator Notes : PH Educator 1 0.3750 44721.000 0.000 FTE 16,770.00 Assistant Notes ; Tech Assistant 0.3750 42990.000 0.000 FIE 16,121.00 Office Manager Notes : Office Leader 0.3750 39112.000 0.000 FTE 14,667.00 Health Educator 0.0513 41120.000 0.000 FTE 2,109.00 Chief-Admit' Services Notes : MATCH 0.0492 89550.000 0.000 FTE 4,406.00 Total for Salary & Wages 74,345.00 2 Fringe Benefits All Composite Rate Notes : MATCH $3382 FICA Unemp Ins Retirement Hospital Insurance Life Insurance Vision Ins, Short/Long Term Disability Dental Insurance Work Comp 0.0000 76.780 74345.000 57,082.00 Cap. Exp. for Equip & Fac. 4 Contractual 6 Supplies and Materials Disaster Supplies 0.0000 0.000 0.000 1,450.00 Postage 0.0000 0.000 0.000 127.00 Office Supplies 0.0000 0.000 0.000 500.00 Total for Supplies and Materials 2,077.00 6 _ Travel Mileage Notes : 300 miles @ .535 0.0000 0.000 0.000 161.00 7 Communication Local Health Department - 2018, Date: 08128/2017 Page: 62 of 186 Contract # Date: 0612312017 Line Item Qty Rate Units UOM Total Telephone 0.0000 0.000 0.000 2,799.00 Radio Communications Notes : MATCH 0.0000 0.000 0.000 7,425.00 Total for Communication 10,224.00 8 County-City Central Services 9 Space Costs Space/Rental Costs 0.0000 0.000 0.0001 7,236.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 135.00 IT Operations 0.0000 0.000 0.000 7,512.00 Workshops & Meetings 0.0000 0.000 0.000 240.00 Total for All Others (ADP, Con. Employees, Misc.) 7,887.00 Total Program Expenses 159,012.00 TOTAL DIRECT EXPENSES 159,012.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Cost Allocation Plan Notes : 11.91% 0.0000 0.000 0.000 8,330.00 Health Adm Distribution 0.0000 0.000 0.000 16,487.00 Total for Cost Allocation Plan! Other 24,817.00 Total Indirect Costs 24,817.00 TOTAL INDIRECT EXPENSES 24,817.00 TOTAL EXPENDITURES 183,829.00 Lee& Health Department - 2018, Date: 06/23/2017 Page: 63 of 186 Contract # Date: 0612312017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Children's Special 1-11th Care Services (CSHCS) Outreach & Advocacy DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To: 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT iv, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary 8, Wages 257,597.00 257,597.00 2 Fringe Benefits 119,854.00 119,854.00 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 775.00 775.00 7 Communication 6,380.00 6,380.00 8 County-City Central Services 0.00 0.00 9 Space Costs 25,241.00 25,241.00 10 All Others (ADP, Con. Employees, Misc.) 41,010.00 41,010.00 Total Program Expenses r 456,857.00 466,867.00 TOTAL DIRECT EXPENSES 456,857.00 456,857.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 30,680.00 30,680.00 2 Cost Allocation Plan / Other -202,537.00 -202,537.00 Total Indirect Costs -171,857.00 -171,857.00 TOTAL INDIRECT EXPENSES -171,857.00 -171,857.00 TOTAL EXPENDITURES 285,000.00 285,000.00 Local Health Department - 201B, Date; 0612312017 Page: 64 of 186 Contract # Date: 06/23/2017 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 (lob am aoo 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 MD1-11-IS Fixed Unit Rate Totals 286,000.00 0.00 0.00 285,000.00 Local Health Department - 2018, Date: 06/23/2017 Page: 65 of 186 Contract # Date: 06/23/2017 3 Program Budget - Cost Detail Line Item [ Qty Ratel UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Supervisor 1.0000 83333.000 0.000 FTE 83,333.00 Public Health Nurse 0.4808 58567.000 0.000 FTE 28,169.00 Public Health Nurse 0.4808 52710.000 0.000 FTE 25,343.00 Outreach Worker 0.3846 43351.000 0.000 FIE 16,673.00 Assistant 1.0000 33518.000 0.000 FTE 33,518.00 Assistant 1.0000 41171.000 0.000 FTE 41,171.00 Assistant Notes : in MCH 0.9615 30576.000 0.000 FTE 29,400.00 Total for Salary & Wages 257,597.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 46.528 257597.000 119,854.00 3 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 6 Travel Mileage Notes : 380 miles @.535 0.0000 0.000 0.000 203.00 Conferences 0.0000 0.000 0.000 300.00 client transportation 0.0000 0.000 0.000 272.00 Local Health Department - 2018, Date: 06/23/2017 Page: 66 of 186 Contract* Date: 06/2312017 Line Item Qty Rate Units UOIVI Total Total for Travel 775.00 7 Communication Telephone 0.0000 0.000 0.000 6,380.00 8 County-City Central Services 9 Space Costs Building Space Rental I 0.0000 0.000 0.000 25,241.00 10 All Others (ADP, Con. Employees, Misc.) Convenience Copier 0.0000 0.000 0.000 2,500.00 Insurance 0.0000 0.000 0.000 180.00 IT Operations 0.0000 0.000 0.000 38,330.00 Total for All Others (ADP, Con. Employees, Misc.) 41,010.00 Total Program Expenses 456,857,00 TOTAL DIRECT EXPENSES 456,857.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Other Approval Notes : Cost Allocation Plan 0.0000 11.910 257597.000 30,680,00 2 Cost Allocation Plan / Other Other Cost Distributions-CSHCS Care Coor Fees 0.0000 0.000 0.000 -202,537.00 Health Adm Distribution 0.0000 0.000 0.000 48,033.00 Other Cost Distributions-Nursing Staff 0.0000 0.000 0.000 1,673,007.00 Nursing Adm Distribution 0.0000 0.000 0.000 14,330.00 Other Cost Distributions-CSHCS - Medicaid Outreach 0.0000 0,000 0.000 -1,735,370.00 Total for Cost Allocation Plan / Other -202,537.00 Total Indirect Costs -171,857.00 TOTAL INDIRECT EXPENSES -171,857.00 TOTAL EXPENDITURES 285,000.00 Local Health Department - 2018, Date: 06/23/2017 Page: 67 of 186 Contract # Date: 06/2312017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Enabling Services Women - MCH DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 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 I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages _. H 84,413.00 84,413,00 2 Fringe Benefits 49,563.00 49,563.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 Supplies and Materials 6,450.00 6,450,00 6 Travel 3,478.00 3,478.00 7 Communication H 1,050.00 1,050.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 8,100,00 8,100,00 Total Program Expenses 153,054.00 153,054.00 TOTAL DIRECT EXPENSES 153,054.00 153,054.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 30,918.00 30,918.00 Total Indirect Costs 30,918.00 30,918,00 TOTAL INDIRECT EXPENSES 30,918.00 30,918.00 TOTAL EXPENDITURES 183,972.00 183,972.00 Local Health Department - 2018, Date: 06/23/2017 Page: 68 of 186 Contract # Date: 06/23/2017 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 - 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 163,108.00 0.00 0.00 163,108.00 Local Funds - Other 0.00 20,864.00 0.00 20,864.00 Inkind Match 0.00 0.00 0.00 0.00 MDFIRS Fixed Unit Rate Totals 163,108.00 20,864.00 0.00 183,972.00 Local Health Depalment - 2018, Date: 06123/2017 Page: 69 of 186 Contract # Date: 06/23/2017 3 Program Budget - Cost Detail Line Item Qtyi Rate Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Nutritionist/Dietician 0.4808 49407.000 0.000 FTE 23,755.00 Nutritionist/Dietician 1.0000 60658.000 0.000 FTE 60,658.00 Total for Salary & Wages 84,413.00 2 Fringe Benefits Composite Rate Notes : FICA, UNEMPLY INS, RETIREMENT, HOSPITAL INS, LIFE INS, VISION, DENTAL, WORK COMP, SHORT/LONG- TERM DISABILITY 0.0000 58.715 84413.000 49,663.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Printing 0.0000 0.000 0.000 3,000.00 Educational Supplies 00000 0.000 0.000 2,950.00 Office Supplies 0.0000 0.000 0.000 500,00 Total for Supplies and Materials 6,450.00 6 Travel Mileage Notes : 6500 miles @ .535 0.0000 0.000 0.000 3,478.00 7 Communication Telephone 0.0000 0.000 0.000 1,050.00 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 Interpretation 0.0000 0.000 0.000 2,500,00 Total for All Others (ADP, Con. Employees, Misc.) 8,100.00 Total Program Expenses 153,054.00 TOTAL DIRECT EXPENSES 153,054.00 INDIRECT EXPENSES Indirect Costs Indirect Costs LOCa Health Department - 2018, Date: 00123/2017 Page: 70 of 186 Contract # Date: 06/23/2017 Line Item I QtYI Rate I Units' UONI Total 2 Cost Allocation Plan 1 Other Health Adm Distribution 0.0000 0.000 0.000 16,070.00 Nursing Adm Distribution 0.0000 0.000 0,000 4,794.00 Cost Allocation Plan Notes : 11.91% 0.0000 0.000 0.000 10,054.00 Total for Cost Allocation Plan / Other 30,918.00 Total Indirect Costs 30,918.00 TOTAL INDIRECT EXPENSES 30,918.00 TOTAL EXPENDITURES 183,972.00 Local Health Department - 2018, Date: 06/2312017 Page: 71 of 186 Contract # Date: 06/2312017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Fetal Infant Mortality Review (FIMR) Case Abstraction DATE PREPARED W23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Heatth Division BUDGET PERIOD From : 10/1/2017 To : 913012018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT pl Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category 1 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 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 Cost Allocation Plan / Other 0.00 0.00 Total Indirect Costs 0.00 0.00 TOTAL INDIRECT EXPENSES 0.00 0.00 TOTAL EXPENDITURES 0.00 0.00 Laeal Health Department - 2018, Date: 06/23/2017 Page: 72 of 186 Contract # Date: 06/23/2017 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 0.00 000 0.00 MDHI-IS 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 - MDI-IHS 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 , Totals 0.00 0.00 I 0.00 0.00 Local Health Department- 2016, Date: 06/23/2017 Page: 73 of 186 Contract # Date: 0612312017 3 Program Budget - Cost Detail Line Item I Qty Rate_ Unitsi 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 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan /Other Total Indirect Costs 0.00 TOTAL INDIRECT EXPENSES 0.00 TOTAL EXPENDITURES 0.00 Local Health Department- 2018, Date: 06/23/2017 Page: 74 of 186 Contract # Date: 06(23/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Food ELPHS DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD Fm: 10/1/2017 To : 9/30/2018 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 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 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0,00 2 Cost Allocation Plan / Other 3,360,418.00 3,360,418.00 Total Indirect Costs 3,360,418.00 3,360,418.00 TOTAL INDIRECT EXPENSES 3,360,418.00 3,360,418.00 TOTAL EXPENDITURES 3,360,418.00 3,360,418.00 Local Health Department - 2018, Date: 0612312017 Page: 75 of 186 Contract # Date: 0612312017 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 1,245,000.00 0.00 1,245,000.00 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 MDFIHS 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 1,256,205.00 0.00 1,256,206.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 859,213.00 2,501,205.00 0.00 3,360,418.00 Local Health Department- 2018, Date: 06/2312017 Page: 76 of 186 Contract # Date 06/23/2017 3 Program Budget - Cost Detail 1Line Item L 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 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Environmental Hlth Adm Distribution 0.0000 0.000 0.000 3,360,418,00 Total Indirect Costs 3,360,418.00 TOTAL INDIRECT EXPENSES 3,360,418.00 TOTAL EXPENDITURES 3,360,418.00 Local Health Department - 2018, Date: 06/23/2017 Page: 77 of 186 Contract # Date: 06/23/2017 1 Program Budget Summary PROGRAM I PROJECT Local Health Department - 2018/ General Communicable Disease ELPHS DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Divsion BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fn. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services . 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc,) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 999,874.00 999,874.00 Total Indirect Costs 999,874.00 999,874.00 TOTAL INDIRECT EXPENSES 999,874.00 999,874.00 TOTAL EXPENDITURES 999,874.00 999,874.00 Local Heath Department - 2018, Date: 08/2312017 Page: 78 of 186 Contract # Date. 06/2312017 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 dm am 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 MOHHS 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 - MOHHS Other 463,192.00 0.00 0.00 463,192.00 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 0.00 536,682.00 0.00 536,682.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 463,192,00 536,682.00 0.00 999,874.00 Local Health Department- 2018, Date: 06123/2017 Page: 79 of 186 Contract # Date: 06123/2017 3 Program Budget - Cost Detail Line Item I 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 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Other Cost Distributions -CD Unit Staff Notes : 50% of FTE Medical Director's salary and fringes 100% of CD Staff Unit time includes,Epiclemiologists, PHN's, PHN Supervisor, Office Assistants a0000 0.000 0.000 855,502.00 Other Cost Distributions-Misc Cost distibution 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 27,337.00 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 91,691.00 Nursing Mm Distribution 0.0000 0.000 0.000 25,344.00 Total for Cost Allocation Plan / Other 999,874.00 Total Indirect Costs 999,874.00 Local Health Department - 2018, Date: 05123/2017 Page; 80 of 186 Contract # Date: 06/23/2017 Line Item CnYI Ratel UnitslUOM Total TOTAL INDIRECT EXPENSES 999,874.00 TOTAL EXPENDITURES 999,874.00 Local Health Department - 2018, Date: 06123/2017 Page: 81 of 186 Contract # Date: 06/23/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2018 / Gonococcal Isolate Surveillance Project DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To: 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. 34 Ea Telegraph Rd. st BUDGET AGREEMENT r47, Original r• Amendment AMENDMENT # 0 CITY STATE Pontiac ,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 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 39,000.00 39,000.00 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 Total Program Expenses 39,000.00 39,000.00 TOTAL DIRECT EXPENSES 39,000.00 39,000.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 4,988.00 4,988.00 Total Indirect Costs 4,988.00 4,988.00 TOTAL INDIRECT EXPENSES 4,988.00 4,988,00 TOTAL EXPENDITURES 43,988.00 43,988,00 Local Health Department - 2018, Date: 08/23/2017 Page: 82 of 186 Contract # Date: 06/23/2017 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 39,000.00 0.00 0.00 39,000.00 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 I I 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 4,988.00 0,00 4,988.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 39,000,00 4,988.00 0.00 43,988.00 Local Health Department - 2018, Date: 06/23/2017 Page: 83 of 186 Contract # Date: 06123/2017 3 Program Budget - Cost Detail Line Item QtYI 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 Laboratory Supplies 0.0000 0.000 0.000 39,000.00 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses 39,000.00 TOTAL DIRECT EXPENSES • 39,000.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan I Other Health Adm Distribution 0.0000 0.000 0.000 3,842.00 Nursing Mm Distribution 0.0000_ 0.000 0.000 1,146.00 Total for Cost Allocation Plan I Other 4,988.00 Total Indirect Costs 4,988.00 TOTAL INDIRECT EXPENSES 4,988.00 TOTAL EXPENDITURES 43,988.00 Local Health Department - 2018, Date: 0812312017 Page: 54 of 186 Contract # Date: 06/23/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2018 / Hearing ELPHS DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Fo 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 MI Salary El Fringe il Cap. illa 5 & Wages 326,100.00 326,100.00 Benefits '102,282.00 102,282.00 Exp. for Equip & Fac. 0.00 0.00 Contractual 0.00 0.00 Supplies and Materials 4,095,00 4,095.00 6 Eilli 5,442.00 5,442.00 7 Communication 1,188.00 1,188.00 9 El County-City Central Services 0,00 0.00 Space Costs 14,922.00 14,922.00 10 All Others (ADP, Con: Employees, Misc.) 6,928.00 6,928.00 Total Program Expenses 460,957.00 460,957.00 TOTAL DIRECT EXPENSES 460,957.00 460,957.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan/Other 173,562.00 173,562.00 Total Indirect Costs 173,562.00 173,562.00 TOTAL INDIRECT EXPENSES 173,562.00 173,562.00 TOTAL EXPENDITURES 634,519.00 634,519.00 Local Health Department - 2018, Date: 08/23/2017 Page: 85 of 186 Contract # Date: 06/23/2017 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 aop 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 aoo a oo 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 253,969.00 0.00 0.00 253,969.00 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 0.00 380,550.00 0.00 380,550.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 253,969.00 380,550.00 0.00 634,519.00 Local Health Department - 2018, Date: 080312017 Page: 66 of 186 Contract # Date: 06/2312017 3 Program Budget - Cost Detail 'Line Item I Qty I Rate Units' UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Supervisor 1.0000 50186.000 0.000 FTE 50,186.00 Technician 0.4808 33282.000 0.000 FTE 16,002.00 Technician 0.4808 33282.000 0.000 FTE 16,002.00 Technician 0.4808 33282.000 0.000 FTE 16,002.00 Technician 0.4808 33282.000 0.000 FTE 16,002.00 Technician 0.4808 33282.000 0.000 FTE 16,002.00 Technician 0.4808 33282,000 0.000 FTE 16,002.00 Technician 0.4808 33282.000 0.000 FTE 16,002.00 Technician 0.4808 33282.000 0.000 FTE 16,002.00 Technician 0.4808 41333.000 0.000 FTE 19,873.00 Technician 0.4808 35293.000 0.000 FTE 16,969.00 Coordinator 0.5000 •73190.000 0.000 FTE 36,595.00 Technician 0,5000 41171.000 0.000 FTE 20,586.00 Technician 0.4808 41333,000 0.000 FIE 19,873,00 Technician 0.4808 33285.000 0.000 FTE 16,002.00 Technician 0.4808 37438.000 0.000 FT E 18,000.00 Total for Salary & Wages 326,100.00 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 31,365 326100.000 102,282.00 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 Local Health Department - 2018, Date: 06/23/2017 Page. 87 of 186 Contract # Date: 06/23/2017 Line Item Qty Rate Units UOM Total Printing 0.0000 0.000 0.000 2,177.00 Total for Supplies and Materials 4,095.00 6 Travel Personal Mileage Notes : 10,171.96 miles @ .535 0.0000 0.000 0.000 5,442.00 7 Communication Telephone 0.00001 0.0001 0.0001 1,188.00 8 County-City Central Services 9 Space Costs Space/Rental Costs 1 0.00001 0.0001 0.0001 I 14,922.00 10 All Others (ADP, Con. Employees, Misc.) Copier 0.0000 0.000 0.000 159.00 Insurance 0.0000 0.000 0.000 1,586.00 Equipment Repair 0.0000 0.000 0.000 2,333.00 Staff Training 0.0000 0.000 0.000 2,850.00 Total for All Others (ADP, Con. Employees, Misc.) 6,928.00 Total Program Expenses 460,957.00 TOTAL DIRECT EXPENSES 460,957.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan (Other Other Cost Distributions-Misc. 0.0000 0.000 0.000 49,241.00 Health Adm Distribution 0.0000 0.000 0.000 85,483.00 Cost Allocation Plan Notes : 11.91% 0.0000 0.000 0.000 38,838,00 Total for Cost Allocation Plan / Other 173,562.00 Total Indirect Costs 173,562.00 TOTAL INDIRECT EXPENSES 173,562.00 TOTAL EXPENDITURES 634,519.00 Local Health Department - 2016, Dale: 06123/2017 Page: 88 of 186 Contract # Date: 0612312017 1 Program Budget Summary PROGRAM! PROJECT Local Health Department - 2018 / HIV ELPHS DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To: 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT f v. 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 0.00 0.00 2 Fringe Benefits 0.00 0.00 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0,00 0.00 2 Cost Allocation Plan/Other 1,018,621.00 1,018,621.00 Total Indirect Costs 1,018,621.00 1,018,621.00 TOTAL INDIRECT EXPENSES 1,018,621.00 1,018,621.00 TOTAL EXPENDITURES 1,018,621.00 1,018,621.00 Local Health Department - 2018, Date: 08123/2017 Page: 89 of 186 Contract # Date: 06/23/2017 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 - MDHHS Vision 0.00 0.00 0,00 0.00 ELPHS - MDHHS Other 311,659.00 0.00 0.00 311,659.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private I 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 0.00 706,962.00 0.00 706,962.00 lnkind Match 0,00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 311,659.00 706,962.00 0.00 1,018,621.00 Loca Heaith Department - 2018, Date: 0612312017 Page: 90 of 186 Contract # Date: 06/23/2017 3 Program Budget- Cost Detail 'Line Item I Qty I Rate Units I 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 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 Cost Allocation Plan I Other Nursing Adm Distribution 0.0000 0.000 0.000 15,289.00 Other Cost Distributions-Misc 0.0000 0.000 0,000 1,003,332.00 Total for Cost Allocation Plan / Other 1,018,621.00 Total Indirect Costs 1,018,621,00 TOTAL INDIRECT EXPENSES 1,018,621.00 TOTAL EXPENDITURES 1,018,621.00 Local Health Department - 2018, Date: 08/2312017 Page: 91 of 186 Contract # Date: 06123/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018/ HIV Prevention DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To: 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p'.. Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 290,006.00 290,006.00 2 Fringe Benefits 130,116.00 130,116.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 18,790.00 18,790.00 6 Travel 11,714.00 11,714.00 7 Communication 2,000.00 2,000.00 8 County-City Central Services 0.00 0.00 9 Space Costs 7,754.00 7,754,00 10 Alt Others (ADP, Con. Employees, Misc.) 23,980.00 23,980.00 Total Program Expenses - 484,360.00 484,360.00 TOTAL DIRECT EXPENSES 484,360.00 484,360.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 85,663.00 85,663.00 Total Indirect Costs 85,663.00 85,663.00 TOTAL INDIRECT EXPENSES 85,663.00 85,663.00 TOTAL EXPENDITURES 570,023.00 570,023.00 Local Health Department- 2018, Date: 06123/2017 Page: 92 of 186 Contract # Date: 06/2212017 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 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 - 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 51,123.00 0.00 51,123.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 518,900.00 51,123.00 0.00 570,023.00 Local Haan Department - 2018, Date: 0612312017 Page: 93 of 186 Contract # Date: 0612312017 3 Program Budget - Cost Detail 'Line Item QtYl Rate Units UOM Total DIRECT EXPENSES Program Expenses I Salary & Wages Public Health Nurse 0.4808 69405.000 0.000 FTE 33,370.00 Coordinator 1.0000 73190.000 0.000 FTE 73,190.00 Assistant 0.7404 41171.000 0.000 FTE 30,482.00 Public Health Nurse 0.4808 55404.000 0.000 FTE 26,637.00 Public Health Nurse 0.4808 62979.000 0.000 FTE 30,280.00 Public Health Nurse 1.0000 69410.000 0.000 FTE 69,410.00 Public Health Nurse 0,4808 55401.000 0.000 FTE 26,637.00 Total for Salary & Wages 290,006.00 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 44.867 290006.000 130,116.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 6 Supplies and Materials Office Supplies 0.0000 0.000 0.000 2,000.00 Medical Supplies 0.0000 0.000 0.000 3,000.00 Postage 0.0000 0.000 0.000 1,000.00 Lab Supplies 0.0000 0.000 0.000 1,000.00 Printing 0.0000 0.000 0.000 6,000.00 Educational Supplies 0.0000 0.000 0.000 5,790.00 Total for Supplies and Materials 18,790.00 6 Travel Mileage Notes : 10,970 miles @ .535 0.0000 0.000 0.000 5,869.00 Client Transportation 0.0000 0.000 0.000 345.00 Local Health Department - 2018, Date: 05123/2017 Page: 04 of 166 Contract # Date: 06/23/2017 Line Item Qty Rate Units UOM Total Conferences 0.0000 0.000 0.000 5,500.00 Total for Travel 11,714.00 7 Communication Telephone 0.0000 0.000 0.000 2,000.00 8 County-City Central Services 9 Space Costs Building Space Rental 0.0000 0.000 0.000 7,75400 10 All Others (ADP, Con. Employees, Misc.) IT Operations 0.0000 0.000 0.000 15,000.00 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 0,000 180.00 Advertising 0.0000 0.000 0.000 5,500.00 Lab Fees 0.0000 0.000 0.000 1,500,00 Total for All Others (ADP, Con. Employees, Misc ) 23,980.00 Total Program Expenses 484,360.00 TOTAL DIRECT EXPENSES 484,360.00 INDIRECT EXPENSES Indirect Costs i Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 51,123.00 Cost Allocation Plan Notes : 11.91% 0.0000 0.000 0.000 34,540.00 Total for Cost Allocation Plan I Other 85,663.00 Total Indirect Costs 85,663.00 TOTAL INDIRECT EXPENSES 85,663.00 TOTAL EXPENDITURES 570,023.00 Local Health Department - 2016, Date: 05/23/2017 Page: 95 of 166 Contract # Date: 06123/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018/ HIV Surveillance Support DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/112017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT P: Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2,460.00 2,460.00 2 Fringe Benefits 142.00 142.00 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 8,772.40 8,772,00 8 County-City Central Services 0.00 0.00 9 Space Costs 27,404.00 27,404.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 Total Program Expenses 38,778.00 38,778.00 TOTAL DIRECT EXPENSES 38,778.00 38,778.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 5,290.00 5,290.00 Total Indirect Costs 5,290.00 5,290.00 TOTAL INDIRECT EXPENSES 5,290.00 5,290.00 TOTAL EXPENDITURES 44,068.00 44,068.00 Locai Health Department - 2018, Date: 06/23/2017 Page: 96 Of 188 Contract 4 Date: 08/23/2017 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount _ Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non 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 39,071.00 0.00 0.00 39,071.00 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 HI 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 4,997.00 0.00 4,997.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 39,071.00 4,997.00 { 0.00 44,068.00 Local Health Department - 2018, Date: 0612312017 Page: 97 of 186 Contract # Date: 06/2312017 3 Program Budget - Cost Detail -1Line Item Qty Rate Units UOM Total DIRECT EXPENSES Program Expenses I Salary & Wages Medical Technologist 0.0466 52780.000 0.000 FTE 2,460.00 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 2460.000 142.00 1 3 Cap. Exp. for Equip & Fac 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication Telephone Communications 0.0000 0.000 0.000 8,772.00 8 County-City Central Services 9 Space Costs Building Space - 0.0000 0.000 0.000 27,404.00 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses 38,778.00 TOTAL DIRECT EXPENSES 38,778.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan 1 Other Health Adm Distribution 0.0000 0.000 0.000 3,849.00 Nursing Adm Distribution 0.0000 0.000 0.000 1,148.00 Cost Allocation Plan Notes : 11.91% 0.0000 0.000 0.000 293.00 Total for Cost Allocation Plan / Other 5,290.00 Total Indirect Costs 5,290.00 TOTAL INDIRECT EXPENSES 5,290.00 TOTAL EXPENDITURES 44,068.00 Local Health Department - 2018, Date: 06/23/2017 Page: 98 of 186 Contract # Date: 06/2312017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Immunization Action Plan (IAP) DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount _..I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 249,642.00 249,642.00 2 Fringe Benefits 187,682.00 187,682.00 3 Cap. Exp. for Equip & Fee, 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 15,839,00 15,839.00 6 Travel 3,669.00 3,669,00 7 Communication 2,020.00 2,020.00 8 County-City Central Services 0.00 0.00 9 Space Costs 11,190.00 11,190.00 10 All Others (ADP, Con. Employees, Misc.) 25,660.00 25,660.00 Total Program Expenses - 495,702.00 495,702.00 TOTAL DIRECT EXPENSES 495,702.00 495,702.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 74,912.00 74,912.00 Total Indirect Costs 74,912.00 74,912.00 TOTAL INDIRECT EXPENSES 74,912.00 74,912.00 TOTAL EXPENDITURES 570,614.00 570,614.00 Local Health Department - 2018, Date: 06123/2017 Page: 99 of 186 Contract # Date: 06/23/2017 2 Program Budget - Source of Funds SOURCE OF FUNDS El Category Source of Funds Amount Cash Inkind Total Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 I. III Federal or State (Non MOHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 II Federally Provided Vaccines 0.00 0.00 0.00 0.00 III 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 MCIHHS Non Comprehensive 0.00 0.00 0.00 0.00 MCHHS Comprehensive 503,403.00 0.00 0.00 503,403.00 ELPHS - MDHHS Hearing 0.00 0.00 0,00 0.00 ELPHS - MOHHS 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 67,211.00 0.00 67,211.00 lnkind Match 0.00 0,00 0.00 0.00 MDHHS Fixed Unit Rate Totals 503,403.00 67,211.00 0.00 570,614.00 Local Health Department -2018, Date: 0812312017 Page: 100 of 186 Contract # Date: 0612312017 3 Program Budget - Cost Detail -1Line Item Qty Rate Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Coordinator 1.0000 73190.000 0.000 FTE 73,190.00 Vaccine Supply Clerk Notes : Shared Vaccine Quality 0.7500 47859.000 0.000 FTE 35,894.00 Public Health Nurse 1.0000 52713.000 0.000 FTE 52,713.00 Office Leader 1.0000 45660.000 0.000 FTE 45,680.00 Assistant 1.0000 41171.000 0.000 FTE 41,171.00 Overtime 0.0144 70390.000 0.000 FTE 1,014.00 Total for Salary & Wages E 249,642.00 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 75.180 249642.000 187,682.00 3 Cap. Exp. for Equip & Fac. 4 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 1,500.00 Educational Supplies 0.0000 0.000 0.000 1,339.00 Total for Supplies and Materials 15,839.00 6 Travel Mileage Notes : 4055 miles @ .535 0.0000 0.000 0.000 2,169.00 Conferences 0.0000 0.000 0.000 1,500.00 Total for Travel 3,669.00 7 Communication Telephone 0.0000 0.000 0.000 2,020.00 Local Health Department - 2018, Date: 0612312017 Page: 101 of 186 Contract # Date: 06/23/2017 Line Item Qty[ Rate UnitslUOM Total 8 ICounty-City Central Services 9 Space Costs Building Space Rental 0.0000 0.000 0.000 11,190.00 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 22,000.00 Insurance 0.0000 0.000 0,000 180.00 Total for All Others (ADP, Con. Employees, Misc.) 25,660.00 Total Program Expenses 495,702.00 TOTAL DIRECT EXPENSES 495,702.00 INDIRECT EXPENSES Indirect Costs 1 !Indirect Costs 2 !Cost Allocation Plan / Other Other Cost Distributions-Nurse 0.0000 0.000 0.000 -22,031.00 TrainNFC/AFIX Health Adm Distribution 0.0000 0.000 0.000 51,767.00 Nursing Adm Distribution 0.0000 0.000 0.000 15,444.00 1Cost Allocation Plan 0.0000 0.000 0.000 29,732.00 I Notes : 11,91% Total for Cost Allocation Plan / Other 74,912.00 Total Indirect Costs 74,912.00 TOTAL INDIRECT EXPENSES 74,912.00 TOTAL EXPENDITURES 570,614.00 Local Health Department - 2018, Date: 08/2312017 Page: 102 of 186 Contract # Date: 06/23/2017 Program Budget Summary PROGRAM / PROJECT Local Health Department -2018 / Immunization ELPHS DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To: 9/30/2018 MAILING ADDRESS (Number and Street) 1200 NI. Telegraph Rd. 34 East BUDGET AGREEMENT R., Original 17 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 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. ErnplOyees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0,00 2 Cost Allocation Plan / Other 4,227,487.00 4,227,487.00 Total Indirect Costs 4,227,487,00 4,227,487.00 TOTAL INDIRECT EXPENSES 4,227,487.00 4,227,487.00 TOTAL EXPENDITURES 4,227,487.00 4,227,487.00 Local Health Department - 2018, Date: 0612312017 Page: 103 of 186 Contract # Date: 06123/2017 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 1,346,899.00 0.00 1,346,899.00 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 - NIDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 879,147.00 0.00 0.00 879,147.00 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 2,001,441.00 0.00 2,001,441.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 879,147.00_ 3,348,340.00 0.00 4,227,487.00 Local Health Department - 2018, Date: 06/23/2017 Page: 104 of 186 Contract # Date: 06/23/2017 3 Program Budget - Cost Detail Line Item I Qty( Rate' Units ri.I0M Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con, Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan / Other Other Cost Distributions Clinic 0,0000 0.000 0.000 2,880,588.00 Federally Provided Vaccines Notes : Used 201 4-15 budgetary figure/current not available yet. 0.0000 0.000 0.000 1,346,899.00 Total for Cost Allocation Plan / Other 4,227,487.00 Total Indirect Costs 4,227,487.00 TOTAL INDIRECT EXPENSES 4,227,487.00 TOTAL EXPENDITURES 4,227,487.00 Local Health Department - 2018, Date: 06/23/2017 Page: 105 01186 Contract # Pate: 06/23/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Infant Safe Sleep DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To: 9/30/2018 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 3,809.00 3,809.00 2 Fringe Benefits 2,617.00 2,617.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 9,995.00 9,995.00 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. Ernployees, Misc.) 5,625.00 5,625.00 Total Program Expenses 22,046,00 22,046.00 TOTAL DIRECT EXPENSES 22,046.00 22,046.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 3,332,00 3,332.00 Total Indirect Costs 3,332.00 3,332.00 TOTAL INDIRECT EXPENSES 3,332.00 3,332.00 TOTAL EXPENDITURES 25,378.00 25,378.00 Local Health Department - 201B, Date; 06/23/2017 Page: 106 of 186 Contract # Date: 0612312017 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 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 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 2,878.00 0.00 2,878.00 lnkind Match 0.00 0.00 0.00 0.00 N1DHHS Fixed Unit Rate Totals 22,500.00 2,878.00 1 0.00 25,378.00 Local Health Department - 2018, Date: 08123/2017 Page: 107 of 186 Contract # Date: 06/2312017 3 Program Budget - Cost Detail Line Item Qty Rate] UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Health Educator Notes : Step 4 GFGP 0.0601 44939.000 0.000 FTE 2,701.00 Chief Community Health Nursing Notes : Step 5 GFGP 0.0120 92300.000 0.000 FTE 1,108.00 Total for Salary & Wages 3,809.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Ins Retirement Ins Hospital Ins Life Ins Vision Ins Dental Ins Workers Comp Short/Long Terms Disability Ins 0.0000 68.710 3809.000 2,617.00 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 2,306.00 Client Support Materials 0.0000 0.000 0.000 3,375.00 Total for Supplies and Materials 9,995.00 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 22,046.00 Local Health Deportment- 2018, Date: 06/2312017 Page: 108 of 186 Contract # Date: 06/23/2017 1Line Item Qty Rate] Units' UOM Total TOTAL DIRECT EXPENSES 22,046.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 2,217.00 Nursing Adm Distribution 0.0000 0.000 0.000 66t00 Cost Allocation Plan Notes : 11.91% 0.0000 0.000 0.000 454.00 Total for Cost Allocation Plan / Other 3,332.00 Total Indirect Costs 3,332.00 TOTAL INDIRECT EXPENSES 3,332.00 TOTAL EXPENDITURES 25,378.00 Local Health) Department - 2018, Date: 0612312017 Page: 109 of 186 Contract # Date: 0612312017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Laboratory Services Bio DATE PREPARED 6/2312017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 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 Total Category An— Tit—lint DIRECT EXPENSES Program Expenses 1 Salary & Wages 16,871.00 16,871.00 2 Fringe Benefits 952.00 952.00 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.) 168.00 168.00 Total Program Expenses 17,991.00 17,991.00 TOTAL DIRECT EXPENSES 17,991.00 17,991.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 3,979.00 3,979.00 Total Indirect Costs 3,979.00 3,979.00 TOTAL INDIRECT EXPENSES 3,979.00 3,979.00 TOTAL EXPENDITURES 21,970.00 21,970.00 Local Health Department - 2018, Date: 08/2312017 Page: 110 of -186 Contract # Date. 06/2312017 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 H 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 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 1,970.00 0.00 1,970.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 20,000.00 1,970.00 0.00 21,970.00 Loca[ Health Department - 2018, Date: 06/23/2017 Page: 111 of 166 Contract # Date: 06123/2017 3 Program Budget - Cost Detail FLine Item 1 Qty Rate UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Technician Notes : Medical Technologist 0.3106 54322.000 0.000 FTE 16,871.00 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 5.640 16871.000 952.00 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 0.000 168.00 Total Program Expenses 17,991.00 TOTAL DIRECT EXPENSES 17,991.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 1,970.00 Cost Allocation Plan Notes :11.91% 0.0000 0.000 0.000 2,009.00 Total for Cost Allocation Plan / Other 3,979.00 Total Indirect Costs 3,979.00 Local Health Department- 2018, Date: 06/23/2017 Page: 112 of 186 Contract # Date: 06/2312017 Line Item I Qty Rate UnitslUOM Total TOTAL INDIRECT EXPENSES 3,979.00 TOTAL EXPENDITURES 21,970.00 Local Health Department - 2018, Date: 96/23/2017 Page: 113 of 166 Contract # Date: 06123/2017 1 Program Budget Summary PROGRAM I PROJECT Local Health Department -2018 / MI Health and Wellness 4x4 Plan - implementation DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET From : 1111 PERIOD 2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT rii 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 29,827.00 29,827.00 2 Fringe Benefits 1,219.00 1,219.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 9,007.00 9,007.00 5 Supplies and Materials 28,246.00 28,246.00 6 Travel 495.00 495.00 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.) 9,883.00 9,883.00 Total Program Expenses 78,677.00 78,677.00 TOTAL DIRECT EXPENSES 78,677.00 78,677.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 9,768,00 9,768.00 Total Indirect Costs 9,768.00 9,768.00 TOTAL INDIRECT EXPENSES 9,768.00 9,768.00 TOTAL EXPENDITURES 88,445.00 88,445.00 Local Health Department- 2018, Date: 0612312017 Page: 114 of 186 Contract # Date: 06/23/2017 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 65,000.00 0.00 0.00 65,000.00 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 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 7,195.00 0.00 7,195.00 lnkind Match 0.00 0.00 16,250.00 16,250.00 MDHHS Fixed Unit Rate Totals 65,000.00 7,195.00 . 16,250.00 88,445.00 Loca€ Health Department - 2018, Date: 06/2312017 Page: 115 of 186 1 Contract # Date: 0612312017 3 Program Budget - Cost Detail Line Item I Qty Rate Units UOM I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Health Educator 0.4808 44938.000 0.000 FTE 21,605.00 Supervisor Notes : MATCH 0.0240 78575,000 0.000 FTE 1,886.00 Health Educator Notes : MATCH 0.0817 66705.000 0.000 FTE 5,450.00 Chief CH1PIS Notes : MATCH 0.0096 92195.000 0.000 FTE 886.00 Total for Salary & Wages 29,827.00 2 Fringe Benefits Composite Rate Notes : No fringe on match salaries 0.0000 5.642 24605.000 1,219.00 3 Cap. Exp. for Equip & Fac. 4 Contractual Oakland University Notes : $3,520 MATCH 0,0000 0.000 0.000 9,007.00 5 Supplies and Materials Postage 0.0000 0.000 0.000 7,400.00 Printing Notes : $1008 MATCH 0.0000 0.000 0.000 3,515.00 Office Supplies 0.0000 0.000 0.000 900.00 Educational Supplies Notes : $1,500 MATCH 0.0000 0.000 0.000 6,000.00 Materials & Supplies 0.0000 0.000 0.000 5,431.00 Client Support Services 0.0000 0.000 0.000 5,000.00 Total for Supplies and Materials 28,246.00 6 Travel Mileage Notes : 738 miles @ .535 0.0000 0.000 0.000 395.00 Conferences 0.0000 0.000 0.000 100.00 Total for Travel 495.00 7 Communication 8 County-City Central Services 9 Space Costs Local Health Department - 2018, Date: 06/23/2017 Page: 116 of 186 Contract # Date: 06123/2017 Line Item I Qty Rate Units UOM I Total 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 180.00 Staff Training 0.0000 0.000 0.000 2,253.00 Advertising 0.0000 0.000 0.000 2,400.00 Educational Program Notes : 2000, MATCH 0.0000 0.000 0.000 4,500.00 Interpretation Fees 0.0000 0.000 0.000 550.00 Total for All Others (ADP, Con. Employees, Misc.) 9,883.00 Total Program Expenses 78,677.00 TOTAL DIRECT EXPENSES 78,677.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan I Other Health Adm Distribution 0.0000 0.000 0.000 7,195.00 Cast Allocation Plan Notes : 11.91% 0.0000 0.000 0.000 2,573.00 Total for Cost Allocation Plan I Other 9,768.00 Total Indirect Costs 9,768.00 TOTAL INDIRECT EXPENSES 9,768.00 TOTAL EXPENDITURES 88,445.00 Local Heath Department • 2018, Date: 06/23/2017 Page: 117 of 186 Contract # Date: 06/23/2017 1 Program Budget Summary PROGRAM I PROJECT Local Health Department - 20181Nurse Family Partnership Services DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 1011/2017 To : 9/30/2018 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 323,198.00 323,198.00 2 Fringe Benefits 225,611.00 225,611.00 3 Cap, Exp. for Equip & Fac. 0.00 0.00 4 Contractual 17,784.00 17,784.00 5 Supplies and Materials 4,772.00 4,772.00 6 Travel 7,675.00 7,675.00 7 Communication 4,680.00 4,680.00 8 County City Central Services 0.00 0.00 9 Space Costs 17,649.00 17,649.00 10 , All Others (ADP, Con. Employees, Misc.) 19,671.00 19,671.00 Total Program Expenses . 621,040.00 621,040.00 TOTAL DIRECT EXPENSES 621,040.00 621,040.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 79,440.00 79,440.00 Total Indirect Costs 79,440.00 79,440.00 TOTAL INDIRECT EXPENSES 79,440.00 79,440.00 TOTAL EXPENDITURES 700,480.00 700,480.00 Local Health Department - 2018, Date: 06/23/2017 Page: 118 of 186 Contract # Date: 06123/2017 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount 1 Cash . In kind 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 621,040.00 0.00 0.00 621,040.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private/Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 79,440.00 0.00 79,440.00 Inkind Match 0.00 0.00 0.00 0.00 MDEIHS Fixed Unit Rate Totals 621,040.00 79,440.00 0.00 700,480.00 Local Health Department - 2018, Date: 06/23/2017 Page: 119 of 186 Contract # Date: 06/23/2017 3 Program Budget - Cost Detail Line Item I QtYI Rate Units' UOIVI Total DIRECT EXPENSES Program Expenses '1 Salary & Wages Public Health Nurse Notes : Public Health Nurse III 1.0000 69410.000 0.000 FTE 69,410.00 Public Health Nurse Notes : Public Health Nurse III 1.0000 69410.000 0.000 FTE 69,410.00 Public Health Nurse Notes; Public Health Nurse II 1.0000 56557.000 0.000 FTE 56,557.00 Public Health Nurse Notes : Public Health Nurse III 1.0000 56557,000 0.000 FTE 56,557.00 Public Health Nurse Notes : Public Health Nurse ll 1.0000 69410.000 0.000 FTE 69,410.00 OVERTIME Notes : Overtime (PHNs) 0.0193 96075.000 0.000 FTE 1,854.00 Total for Salary & Wages 323,198.00 2 Fringe Benefits Composite Rate Notes : Fica Unemp Ins Retirement Hosp Ins Life Ins Vision Ins Dental Ins Work Comp Short/Long Term Disability 0,0000 69.806 323198.000 225,611,00 3 Cap. Exp. for Equip & Fac. 4 Contractual NFP National Office Program Support 0.0000 0.000 0.000 8,088.00 NFP Consultation 0.0000 0.000 0.000 9,696.00 Total for Contractual 17,784.00 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 1,842.00 Postage 0.0000 0.000 0.000 330.00 Printing 0.0000 0.000 0.000 1,400.00 Client Support Materials 0.0000 0.000 0.000 1,200.00 Total for Supplies and Materials 4,772.00 Local Health Department 2018, Date: 06/23/2017 Page: 120 of 186 Contract # Date: 0612312017 Line Item I Qtyl Rate! Units' UOM Total 6 Travel Client Transportation 0.0000 0.000 0.000 375.00 Mileage Notes : 13,644 miles @ .535 0.0000 0.000 0.000 7,300.00 Total for Travel 7,675.00 7 Communication Telephone Communications Notes : MCH BLOCK $ 0.0000 0.000 0.000 4,680.00 8 County-City Central Services 9 Space Costs Building Space Rental 0.00001 0.000 0.000 17,649.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 180.00 Translation & Interpretation 0.0000 0.000 0.000 100.00 Staff Training 0.0000 0.000 0.000 1,701.00 Copier 0.0000 0.000 0.000 3,690.00 IT Operations 0.0000 0.000 0.000 14,000.00 Total for All Others ADP, Con. Employees, Misc.) '19,671.00 Total Program Expenses 621,040.00 TOTAL DIRECT EXPENSES 621,040.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan 1 Other Health Adm Distribution 0.0000 0.000 0.000 61,186.00 Nursing Adm Distribution 0.0000 0.000 0.000 18,254.00 Total for Cost Allocation Plan 1 Other 79,440.00 Total Indirect Costs 79,440.00 TOTAL INDIRECT EXPENSES 79,440.00 TOTAL EXPENDITURES 700,480.00 Local Health Department - 2018, Date; 0612312017 Page: 121 of 186 Contract # Date: 06/23/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Medicaid Outreach DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To: 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p; Original r Amendment AMENDMENT # o CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 ----I Category Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & VVages 138,176.00 138,176.00 2 Fringe Benefits H 88,764.00 88,764.00 3 Cap. Exp. for Equip & Fac. H H 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 6,480.00 6,480.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 Total Program Expenses 233,420.00 233,420.00 TOTAL DIRECT EXPENSES 233,420.00 233,420.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 Cost Allocation Plan / Other 41,075.00 41,075.00 Total Indirect Costs 41,075.00 41,075.00 TOTAL INDIRECT EXPENSES 41,075.00 41,075.00 TOTAL EXPENDITURES 274,495.00 274,495,00 Local Health Department- 2018, Date; 06/2312017 Page: 122 of 186 Contract # Date: 0812312017 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 124,938.00 0.00 0.00 124,938.00 Required Match - Local 0.00 124,939.00 0.00 124,939.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.001 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 0.60 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 24,618.00 0.00 24,618.00 inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals I 124,938.00 149,557.00 0.00 274,495.00 Local Health Department- 2018, Date: 0612312017 Page: 123 of 186 Contract # Date 06/23/2017 3 Program Budget - Cost Detail Line Item _I Qty Ratel Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Multiple positons Notes : Amount determined based on time studies. 1.0000 138176.000 0.000 FTE 138,176.00 2 Fringe Benefits All Composite Rate Notes : FICA UNEM PLOY RETIREMENT HOSPITAL LIFE INSURANCE VISION DENTAL WORKERS COMP SHORT/LONG TERM DISABILITY 0.0000 64.240 138176.000 88,764.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication County-City Central Services 9 Space Costs Office Space Rental 0.0000 0.000 0.000 6,480.00 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses 233,420.00 TOTAL DIRECT EXPENSES 233,420.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 24,618.00 Cost Allocation Plan Notes : 11.91% 0.0000 0.000 0.000 16,457.00 Total for Cost Allocation Plan! Other 41,075.00 Total Indirect Costs 41,075.00 Local Health Department- 2018, Date: 06123/2017 Page: 124 of 186 Contract # Date: 06123/2017 Line Item Qty Rate Units UOM Total TOTAL INDIRECT EXPENSES 41,075.00 TOTAL EXPENDITURES 274,495.00 Local Health Department - 2018, Date: 0612312017 Page: 125 of 186 Contract # Date: 06123/2017 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Public Hlth Functions & Infratruct - MCH DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To: 9/30/2018 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 I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 89,875.00 89,875.00 2 Fringe Benefits 47,790.00 47,790.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 987.00 987.00 6 Travel 1,992.00 1,992.00 7 Communication 1,301.00 1,301.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, IVIlsc.) 5,700.00 5,700.00 Total Program Expenses 147,645.00 147,645.00 TOTAL DIRECT EXPENSES 147,645.00 147,645.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 5,091,138.00 5,091,138.00 Total Indirect Costs 5,091,138.00 5,091,138.00 TOTAL INDIRECT EXPENSES 5,091,138.00 5,091,138.00 TOTAL EXPENDITURES 5,238,783.00 5,238,783.00 Local Health Department- 2018, Date: 06/2312017 Page: 126 01 186 Contract # Date: 0612312017 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 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 158,349.00 0.00 0.00 158,349.00 Local Funds - Other 0.00 5,080,434.00 0.00 5,080,434.00 Inkind Match 0.00 0.00 0.00 0.00 MDEIHS Fixed Unit Rate Totals 168,349.00 5,080,434.00 0.00 5,238,783.00 Local Health Department - 2018, Date: 06123/2017 Page, 127 of 186 Contract # Date: 06123/2017 3 Program Budget - Cost Detail 'Line item I Qty Rate UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Coordinator 1.0000 73190.000 0.000 FTE 73,190.00 Public Health Nurse 0.2404 69405.000 0.000 FTE 16,686.00 Total for Salary & Wages 89,875.00 Fringe Benefits All Composite Rate Notes : FICA, LIFE INS, DENTAL, UNEMPLOYMENT, VISION, WORK COMP, RETIREMENT, HOSPITALIZATION, SHORT/LONG TERM DISABILITY 0.0000 53.174 89875.000 47,790.00 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0,000 500.00 P Printing 0.0000 0.0001 0,000 0.000 487.00 Total for Supplies and Materials 987.00 Travel Mileage Notes : 1854 miles @ .535 0.0000 0.000 0.000 992.00 Conferences 0.0000 0.000 0.000 1,000,00 Total for Travel 1,992.00 7 Communication Telephone 1 0.00001 0.0001 0.0001 1,301.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Info Tech Operations 0.0000 0.000 0.000 5,520.00 Insurance 0,0000 0.000 0.000 180.00 Total for All Others (ADP, Con. Employees, Misc.) 5,700.00 Total Program Expenses 147,645.00 TOTAL DIRECT EXPENSES 147,645,00 INDIRECT EXPENSES 1 Local Health Department - 2018, Date: 06/2312017 Page: 128 of 166 Contract # Date: 0612312017 'Line Item Qty Rate' Units UOM Total Indirect Costs I Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 15,601.00 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 71.42%. 0.0000 0,000 0.000 5,050,135.00 Nursing Adm Distribution 0.0000 0.000 0.000 4,654,00 Other Cost Distributions- Education Notes : This distribution takes total costs of Education and allocates them back to various cost centers by a time study. The % back to MCH for Education is .47%. 0.0000 0.000 0.000 10,044.00 Cost Allocation Plan Notes : 11.91% 0.0000 0.000 0.000 10,704.00 Total for Cost Allocation Plan /Other 5,091,138.00 Total Indirect Costs 5,091,138.00 TOTAL INDIRECT EXPENSES 5,091,138.00 TOTAL EXPENDITURES 5,238,783.00 Local Health Department - 2018, Date: 0612312017 Page: 129 of 186 Contract # Date: 0612312017 1 Program Budget Summary PROGRAM 1 PROJECT Local Health Department - 2018 / MDEQ On-site Wastewater Treatment DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9130/2018 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 -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 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 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 1,246,884.00 1,246,884.00 Total Indirect Costs 1,246,884.00 1,246,884.00 TOTAL INDIRECT EXPENSES 1,246,884.00 1,246,884.00 TOTAL EXPENDITURES 1,246,884.00 1,246,884.00 Local Health Department - 2018, Date; 06/23/2017 Page: 130 of 186 Contract # Date: 06/23/2017 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non 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 III 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 0.00 874,458.00 0.00 874,458.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 372,426.00 874,458.00 0.00 1,246,884.00 Local Health Department - 2018, Date: 06/2312017 Page: 131 of 186 Contract # Data: 06/23/2017 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 Cost Allocation Plan / Other Environmental Filth Mm Distribution 0,0000 0.000 0.000 1,246,884.00 Total Indirect Costs 1,246,884.00 TOTAL INDIRECT EXPENSES 1,246,884,00 TOTAL EXPENDITURES 1,246,884.00 1.0Cal Health Department -2018, Date: 0612312017 Page: 132 of 156 Contract # Date: 06/2312017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2018 / Sudden Unexplained Infant Death DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT iri- Original IT Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 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 Locaf Health Department - 2016, Date: 06/2312017 Page: 133 of 186 Contract 4 Date: 06/23/2017 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 III Federal Medicaid Outreach 0.00 0.00 0.00 0.00 III Required Match - Local 0.00 0.00 0.00 0.00 III Local Non-ELPHS 0.00 0.00 0.00 0,00 III 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 III 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 1111 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 III ELPHS - MDHHS Other 0.00 0.00 0,00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 II 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 1111 . MDHFIS 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 Heath Department - 2018, Date: 06/2312017 Page 134 of 186 Contract # Date: 0612312017 3 Program Budget - Cost Detail 'Line Item I Qty Rate' UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 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 Indirect Costs 2 Cost Allocation Plan / Other 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 - 2018, Date: 06/2312017 Page: 135 of 186 Contract # Date 06/23/2017 1 Program Budget Summary PROGRAM /PROJECT Local Health Department - 2018/ Sexually Transmitted Disease (STD) Control DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 1W1/2017 To : 9/30/2018 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 Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 48,121,00 48,121,00 2 Fringe Benefits 34,529.00 34,529.00 3 Cap. Exp. for Equip & Fac. 0.00 000 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 1 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 Cost Allocation Plan/Other 8,143.00 8,143.00 Total Indirect Costs 8,143.00 8,143.00 TOTAL INDIRECT EXPENSES 8,143.00 8,143.00 TOTAL EXPENDITURES 90,793.00 90,793.00 Local Health Department- 2018, Date: 06/23/2017 Page: 136 of 186 Contract # Date: 06/23/2017 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 Comprehensve 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 8,143.00 0.00 8,143.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 82,650.00 8,143.00 0.00 . 90,793.00 Local Health Department- 2018, Date: 0612312017 Page: 137 Of 186 Contract # Date: 06/2312017 3 Program Budget - Cost Detail 'Line Item I Qty Rate I UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Medical Technologist 0.7217 66677.000 0.000 FTE 48,121.00 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 71.755 48121.000 34,529.00 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.) Total Program Expenses 82,650.00 TOTAL DIRECT EXPENSES 82,650.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 8,143.00 Total Indirect Costs 8,143.00 TOTAL INDIRECT EXPENSES 8,143.00 TOTAL EXPENDITURES 90,793.00 Local Health Department - 2018, Date: 08123/2017 Page: 138 of 186 Contract # Date: 06/23/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Sexually Transmitted Disease (STD-ELPHS) DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 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 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 Cost Allocation Plan / Other 1,945,591.00 1,945,591.00 Total Indirect Costs 1,945,591.00 1,945,591.00 TOTAL INDIRECT EXPENSES 1,945,591.00 1,945,591.00 TOTAL EXPENDITURES 1,945,591.00 1,945,591.00 Local Health Department - 2018, Date: 00/23/2017 Page: 139 of 186 Contract # Date: 06/2312017 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 - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 597,292.00 0.00 0.00 597,292.00 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 1,348,299.00 0.00 1,348,299.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 597,292.00 1,348,299.00 0.00 1,945,591.00 Local Health Department - 2018, Date: 96/2312017 Page: 140 of 186 Contract # Date: 06/23/2017 3 Program Budget - Cost Detail 'Line Item QV' 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 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Nursing Adm Distribution 0,0000 0.000 0.000 18,243.00 Other Cost Distributions-Clinic & Lab distributions 0.0000 0.000 0.000 1,927,348.00 Total for Cost Allocation Plan / Other 1,945,591.00 Total Indirect Costs 1,945,591.00 TOTAL INDIRECT EXPENSES 1,945,591.00 TOTAL EXPENDITURES 1,945,591.00 Local Health Department - 2018, Date: 06/23/2017 Page: 141 of 186 Contract # Date: 06/23/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Tuberculosis (TB) Control DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd, 34 East BUDGET AGREEMENT g7. Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Mt ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 12,802.00 12,802.00 2 Fringe Benefits 722.00 722.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 52,903.00 52,903.00 6 Travel 13,060.00 13,060.00 7 Communication 800.00 800.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 39,867.00 39,867.00 Total Program Expenses 120,154.00 120,154.00 TOTAL DIRECT EXPENSES 120,154.00 120,154.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cast Allocation Plan / Other 1,369,387.00 1,369,387.00 Total indirect Costs 1,369,387.00 1,369,387.00 TOTAL INDIRECT EXPENSES 1,369,387.00 1,369,387.00 TOTAL EXPENDITURES 1,489,541.00 1,489,541.00 Local Health Department - 2018, Date: 06/23/2017 Page. 142 of 186 Contract # Date: 0612312017 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash In kind 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 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 / 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 1,440,863.00 0.00 1,440,863.00 lnkind Match 0.00 0.00 0.00 0,00 MDHHS Fixed Unit Rate Totals 48,678.00 1,440,863.00 0.00 1,489,541.00 Local Health DepartmentS 2018, Date: 06/23/2017 Page: 143 of 186 Contract # Date: 06/2312017 3 Program Budget - Cost Detail 'Line Item I QtYI Rate Units I UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Outreach Worker Notes : GRANT POSITION 0.3846 33286.000 0.000 FTE 12,802.00 2 Fringe Benefits All Composite Rate Notes : Social Security Unemployment Ins Retirement Hospital Ins Life Ins Vision Ins Dental Ins Work Comp 0.0000 5.640 12802.000 722.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Medical Supplies Notes : TB grant 0.0000 0.000 0.000 1,000.00 Office Supplies Notes : TB GRANT 0.0000 0.000 0.000 200.00 Client Support Materials Notes : TB GRANT 0.0000 0.000 0.000 1,453.00 Postage Notes : TB GRANT 0.0000 0.000 0.000 250.00 Drugs/Pharm - COUNTY BUDGET 0.0000 0.000 0.000 50,000.00 Total for Supplies and Materials 52,903.00 6 Travel Mileage Notes : 16,000 miles @ .535 TB GRANT 0.0000 0.000 0.000 8,560.00 Conferences Notes : TB GRANT 0.0000 0.000 0.000 4,000.00 Client Transporation Notes : TB GRANT 0.0000 0.000 0.000 500.00 Total for Travel 13,060.00 7 Communication Telephone Communications 0.0000 0.000 0,000 695.00 Local Health Department - 2018, Date: 06/23/2017 Page: 144 of 186 Contract # Date: 06/2312017 Line Item Qty Rate Units UOM Total Notes : TB GRANT Telephone Comm - COUNTY BUDGET 0.0000 0.000 0.000 105.00 Total for Communication 800.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance Notes : TB GRANT 0.0000 0.000 0.000 180.00 Lab Fees Notes : TB GRANT 0.0000 0.000 0.000 15,304.00 Translation/Interpretation Notes : TB GRANT 0.0000 0.000 0.000 817.00 Copier Notes : TB GRANT 0.0000 0.000 0.000 420.00 Equipment Repair Notes : TB GRANT 0.0000 0.000 0.000 250.00 Lab Fees, Membership-COUNTY BUDGET 0.0000 0.000 0.000 2,800.00 Prof Svcs, Copier-COUNTY BUDGET 0.0000 0.000 0.000 10,096.00 TB Cases/Outside - COUNTY BUDGET P.0000 0.000 0.000 10,000.00 Total for All Others (ADP, Con, Employees, Misc.) 39,867.00 Total Program Expenses H. 120,154.00 TOTAL DIRECT EXPENSES 120,154.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 11,988.00 Nursing Adm Distribution 0.0000 0.000 0.000 9,857.00 Other Cost Distributions-Misc 0.0000 0.000 0.000 1,346,017.00 Cost Allocation Plan Notes : 11.91% TB GRANT BUDGET 0.0000 0.000 0.000 1,525.00 Total for Cost Allocation Plan / Other 1,369,387.00 Total Indirect Costs 1,369,387.00 TOTAL INDIRECT EXPENSES 1,369,387.00 Local Health Department - 2018, Date: 06/23/2017 Page' 145 of 186 Contract # Date: 0612312017 [Line Item Qty Rate Units UOM Total TOTAL EXPENDITURES 1,489,541.00 Local Health Department - 2018, Date: 06/23/2017 Page: 146 of 186 Contract # Date: 06/23/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Local Tobacco Reduction DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9130/2018 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 I Amount 1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 22,859.00 22,859.00 2 Fringe Benefits 1,551.00 1,551.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 1,187.00 1,187.00 6 Travel 1,140.00 1,140.00 7 Communication 360.00 360.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 180.00 180.00 Total Program Expenses 27,277,00 27,277.00 TOTAL DIRECT EXPENSES 27,277.00 27,277.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 5,679.00 5,679.00 Total Indirect Costs 5,679.00 5,679.00 TOTAL INDIRECT EXPENSES 5,679.00 5,679.00 TOTAL EXPENDITURES 32,956.00 32,956.00 Local Health Department- 2018, Date: 06/23/2017 Page: 147 of 186 Contract # Date: 06/2312017 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total I 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 MDHFIS 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 --.---:. ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ell 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 2,956.00 0.00 2,956.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 34,000.00 2,956.00 0,00 32,956.00 Local Health Department - 2018, Date: 06/23/2017 Page: 148 of 186 Contract # Date: 0612312017 3 Program Budget - Cost Detail [Line Item I Qty Rate Units I UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Health Educator 0.3365 66688.000 0.000 FTE 22,441.00 Health Educator 0.0077 54322.000 0.000 FTE 418.00 Total for Salary & Wages 22,859.00 2 Fringe Benefits All Composite Rate 0.0000 6.785 22859,000 1,551.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials _ Printing 0.00001 0.000 0.000 1,187.00 6 Travel Mileage Notes : 2130 @ .535 0.0000 0.000 0.000 1,140.00 7 Communication Telephone Communications 0.0000 0.000 0.000 360.00 8 County-City Central Services 9 Space Costs 10 All Others pADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 180.00 Total Program Expenses 27,277.00 TOTAL DIRECT EXPENSES 27,277.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 2,956.00 Cost Allocation Plan Notes : 11.91% 0,0000 0.000 0.000 2,723.00 Total for Cost Allocation Plan / Other 5,679.00 Total Indirect Costs 5,679.00 TOTAL INDIRECT EXPENSES 5,679.00 TOTAL EXPENDITURES 32,956.00 Local Health Department - 2018, Date: 06/23/2017 Page: 149 of 186 Contract # Date: 06/2312017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Irnmunization Fixed Fees DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 1011/2017 To: 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT r.47: 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 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 Cost Allocation Plan / Other 22,031.00 22,031.00 Total Indirect Costs 22,031.00 22,031.00 TOTAL INDIRECT EXPENSES 22,031.00 22,031.00 TOTAL EXPENDITURES 22,031.00 22,031.00 Local Health Department - 2018, Date: 06/2312017 Page: 150 of 186 Contract # Date: 06/23/2017 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 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type 111 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 TODHHS Fixed Unit Rate IMM: VFC - AF1X Visits 22,031.00 0.00 0.00 22,031.00 Totals 22,031.00 0.00 0.00 22,031.00 Local Health Department - 2018, Date: 0612312017 Page: 151 of 186 Contract # Date: 06/23/2017 3 Program Budget - Cost Detail 'Line Item I QtYt Rate' Units I 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 Cost Allocation Plan / Other Cost Distributions for Fees-from IAP 0.0000 0.000 0.000 22,031.00 Total Indirect Costs 22,031.00 TOTAL INDIRECT EXPENSES 22,031.00 TOTAL EXPENDITURES 22,031.00 Local Health Department 2018, Date: 08123/2017 Page: 152 of 166 Contract # Date: 0612312017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Vision ELPHS DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 1, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 303,041.00 303,041.00 2 Fringe Benefits 95,050.00 95,050.00 3 Cap. Exp. for Equip & Fn. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 3,805.00 3,805.00 6 Travel 5,058.00 5,058.00 7 Communication 1,104.00 1,104.00 8 County-City Central Services 0.00 0.00 9 Space Costs 13,866.00 13,866.00 10 All Others (ADP, Con. Employees, Misc.) 6,439.00 6,439.00 Total Program Expenses 428,363.00 428,363.00 TOTAL DIRECT EXPENSES 428,363.00 428,363.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 167,334.00 167,334.00 Total Indirect Costs 167,334.00 167,334.00 TOTAL INDIRECT EXPENSES 167,334.00 167,334.00 TOTAL EXPENDITURES 595,697.00 595,697.00 Local Health Department - 2018, Date: 06/23/2017 Page: 153 of 186 Contract # Date: 0612312017 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 - MDHHS Vision 253,968.00 0.00 0.00 253,968.00 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 0.00 341,729.00 0.00 341,729.00 lnkind Match 0.00 0.00 0.00 0.00 MCHHS Fixed Unit Rate Totals 253,968.00 t 341,729.00 1 0.00 595,697.00 Local Health Department - 2018, Date: 06123/2017 Page: 154 of 186 Contract # Date: 06123/2017 3 Program Budget - Cost Detail 'Line Item I Qty Rate] Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Supervisor 1.0000 50118.000 0.000 FTE 50,118.00 Technician 0.6000 40351.000 0.000 FTE 24,211.00 Technician 0.4808 39323.000 0.000 FTE 18,905.00 Technician 0.6000 47685.000 0.000 FTE 28,611.00 Coordinator 0.5000 73190.000 0.000 FTE 36,595.00 Assistant 0.5000 41171.000 0.000 FTE 20,586.00 Technician 0.4808 33283.000 0.000 FTE 16,002.00 Technician 0.4808 33283.000 0.000 FTE 16,002.00 Technician 0.4808 33283.000 9.000 FTE 16,002.00 Technician 0.4808 33283.000 0.000 FTE 16,002.00 Technician 0.4808 33283.000 0.000 FTE 16,002.00 Technician 0.4808 33283.000 0.000 FTE 16,002.00 Technician 0,4808 33283.000 0.000 FTE 16,002.00 Technician 0,3606 33283.000 0.000 FTE 12,001.00 Total for Salary & Wages 303,041.00 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 31.365 303041.000 95,050.00 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 2,023.00 Total for Supplies and Materials 3,805.00 Local Health Department - 2018, Date: 05123/2017 Page: 155 of 186 Contract # Date: 06/23/2017 Line Item 1 QtYl Rate Units UOM Total 6 Travel Personal Mileage Notes : 9454.2 miles © .535 0.0000 0.000 0.000 5,058.00 7 Communication Telephone 0.0000 0.000 0.000 1,104.00 8 County-City Central Services 9 Space Costs Space/Rental Costs 0.0000 0.000 0.000 13,866.00 10 All Others (ADP, Con. Employees, Misc.) Staff Training 0.0000 0.000 0.000 2,650.00 Equipment Repair 0.0000 0.000 0.000 2,167.00 Copier 0.0000 -0.000 0.000 148.00 Insurance 0.0000 0.000 - 0.000 1,474.00 Total for All Others (ADP, Con. Employees, Misc.) 6,439.00 Total Program Expenses 428,363.00 TOTAL DIRECT EXPENSES 428,363.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Other Cost Distributions-Misc Distribution 0.0000 0.000 0.000 85,483.00 Health Adm Distribution 0.0000 0.000 0.000 45,759.00 Cost Allocation Plan Notes : 11.91% 0.0000 0.000 0.000 36,092.00 Total for Cost Allocation Plan / Other 167,334.00 Total Indirect Costs 167,334.00 TOTAL INDIRECT EXPENSES 167,334.00 TOTAL EXPENDITURES 595,697.00 Local Health Department- 2018, Date: 06/2312017 Page: 156 of 186 Contract # Date: 06123/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / Immunization Vaccine Quality Assurance DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT rv-: Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Amount 2,111,486.00 1,328,043.00 0.00 1,283,331.00 Total 2,111,486.00 1,328,043.00 0.00 1,283,331.00 0.00 0.00 6 Travel 6,680.00 6,680.00 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses TOTAL DIRECT EXPENSES INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan / Other Total Indirect Costs TOTAL INDIRECT EXPENSES TOTAL EXPENDITURES 27,636.00 27,636.00 0.00 0.00 157,530.00 157,530.00 467,400.00 467,400.00 5,382,106.00 5,382,106.00 5,382,106.00 5,382,106.00 0.00 0.00 -3,890,913.00 -3,890,913.00 -3,890,913,00 -3,890,913.00 -3,890,913.00 -3,890,913.00 1,491,193.00 1,491,193.00 Local Health Department- 2018, Date; 06/2312017 Page: 157 of 186 Contract # Date' 0612312017 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 1,109,012.00 0.00 1,109,012.00 Fees and Collections - 3rd Party 0.00 272,000.00 0.00 272,000.00 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 0.00 0.00 0.00 Local Non-ELPHS 0.00 , 0.00 0.00 0.00 Local Non-ELPHS 0.00L 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 110,181.00 0.00 0.00 110,181.00 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 MDFINS Fixed Unit Rate Totals 1 110,181.00 1,381,012.00 0.00 1,491,193.00 Local Health Department - 2018, Date: 08123/2017 Page: 158 of 186 Contract # Date: 0612312017 3 Program Budget - Cost Detail 1Line Item I Qty] Rate Units I UOM I Total DIRECT EXPENSES Program Expenses I Salary & Wages Coordinator 1.0000 40868,000 0.000 FTE 40,868.00 Coordinator Notes : Shared IAP 0.2500 47859.000 0.000 FTE 11,965.00 Overtime 0.0961 66585.000 0.000 FTE 6,399.00 PH Clinic Nurses-COUNTY BUDGET 1.0000 2052254.000 0.000 FTE 2,052,254.00 Total for Salary & Wages 2,111,486.00 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 57.393 59232.000 33,995.00 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 1294048.00 0 1,294,048.00 Total for Fringe Benefits 1,328,043.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Materials & Supplies Notes 1VQA budget 0.0000 0.000 0.000 7,721.00 Local Health Department - 2018, Date: 06/23/2017 Page: 159 of 186 Contract # Date 06/2312017 Line Item Qty Rate Units UOM Total Printing-COUNTY BUDGET 0.0000 0.000 0.000 3,250.00 DrugsNaccines-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 1,283,331.00 6 Travel Mileage Notes : 930 miles @ .535 VGA budget 0.0000 0.000 0,000 498.00 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 6,680.00 7 Communication Telephone-COUNTY BUDGET 0,00001 0.000 0.000 27,636.00 8 County-City Central Services 9 Space Costs Bldg Space Cost-COUNTY BUDGET 0.0000 0.000 0.000 157,530.00 10 All Others (ADP, Con. Employees, Misc.) Insurance Notes : VOA budget 0.0000 0.000 0.000 180.00 Insurance Notes : COUNTY BUDGET 0.0000 0.000 0.000 7,436.00 -, Prof Svcs - Smart Temps 0.0000 0.000 0.000 1,500.00 IT Oper-COUNTY BUDGET 0.0000 0.000 0.000 211,692.00 Copier $2083, Equip Rental $840 Notes : COUNTY BUDGET 0.0000 0.000 0.000 2,923.00 Staff Training Notes : COUNTY BUDGET 0.0000 0.000 0.000 200.00 Supporting Services Notes : Software support COUNTY BUDGET 0.0000 0.000 0.000 13,500.00 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 - 2018, Date: 06/2312017 Page: 160 of 186 Contract # Date: 06/23/2017 Line Item Qty Rate Units UOM Total IT Development-COUNTY BUDGET 0.0000 0.000 0.000 201,069.00 Total for All Others (ADP, Con. Employees, Misc.) 467,400.00 Total Program Expenses 5,382,106.00 TOTAL DIRECT EXPENSES 5,382,106.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0,000 2,010,581.00 Nursing Adm Distribution 0.0000 0.000 0.000 204,537.00 Other Cost Distributions-misc 0.0000 0.000 0.000 -6,357,509.00 Cost Allocation Plan Notes : 11.91% VQA BUDGET 0.0000 0.000 0.000 7,055.00 Cost Allocation Plan Notes : 11.91% COUNTY BUDGET 0,0000 0.000 0.000 244,423.00 Total for Cost Allocation Plan / Other -3,890,913.00 Total Indirect Costs -3,890,913.00 TOTAL INDIRECT EXPENSES -3,890,913.00 TOTAL EXPENDITURES 1,491,193.00 Local Health Department - 2018, Date: 06/23/2017 Page: 161 of 186 Contract # Date: 06/23/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / WIC Breastfeeding DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p": Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 77,456.00 77,456.00 2 Fringe Benefits 42,273.00 42,273.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 75,897.00 75,897.00 5 Supplies and Materials 5,597.00 5,597.00 6 Travel 2,200.00 2,200.00 7 Communication 3,816.00 3,816.00 8 County-City Central Services 0.00 0.00 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 2,735.00 2,735.00 Total Program Expenses 1 209,974.00 209,974.00 TOTAL DIRECT EXPENSES 209,974.00 209,974.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 30,821.00 30,821.00 Total Indirect Costs 30,821.00 30,821.00 TOTAL INDIRECT EXPENSES 30,821.00 30,821.00 TOTAL EXPENDITURES 240,795.00 240,795.00 Local Health Department - 2018, Date: 06/23/2017 Page. 162 of 186 Contract # Date: 06123/2017 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I 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 219,199.00 0.00 0.00 219,199.00 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 21,596.00 0.00 21,596.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 219,199.00 21,596.00 0.00 240,795.00 Local Health Department , 2018, Date: 08/2312017 Page: 163 of 186 Contract # Date: 06/2312017 3 Program Budget - Cost Detail ILine Item 1 . Qty Ratel UnitslUOM Total DIRECT EXPENSES Program Expenses Salary & Wages Lactation Specialist 1.0000 29260.000 0.000 FTE 29,260.00 Lactation Specialist 0.4808 29260.000 0.000 FTE 14,067.00 Lactation Specialist 0.4808 29260.000 0.000 FIE 14,067.00 Lactation Specialist 0.4808 29260.000 0.000 FTE 14,067.00 Nutritionist/Dietician 0.0899 66683.000 0.000 FTE 5,995.00 Total for Salary & Wages 77,456.00 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 54.577 77456.000 42,273.00 3 Cap. Exp. for Equip & Fac. 4 Contractual Subcontracting Agency-OLSHA 0.0000 0.000 0.0001 75,897.00 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 1,000.00 Printing 0.0000 0.000 0.000 1,000.00 Medical Supplies 0.0000 0.000 0.000 3,597.00 Total for Supplies and Materials 5,597.00 6 Travel Mileage Notes : 2243 miles @ .535 0.0000 0.000 0.000 1,200.00 Conferences 0.0000 0.000 0.000 1,000.00 Total for Travel 2,200.00 7 Communication Telephone Communications 0.0000 0.000 0.000 3,816.00 8 County-City Central Services 9 Space Costs Local Health Department - 2018, Date: 06/23/2017 Page: 164 of 186 Contract # Date: 06/2312017 Line Item I QtY I Rate Units UOM Total 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0,000 180.00 Advertising 0.0000 0.000 0.000 224.00 Staff Training 0.0000 0.000 0.000 2,331.00 Total for All Others (ADP, Con. Employees, Misc.) 2,735.00 Total Program Expenses 209,974.00 TOTAL DIRECT EXPENSES 209,974.00 INDIRECT EXPENSES Indirect Costs '1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 21,596.00 Cost Allocation Plan Notes : 11.91% 0,0000 0.000 0.000 9,225.00 Total for Cost Allocation Plan/Other 30,821.00 Total Indirect Costs 30,821.00 TOTAL INDIRECT EXPENSES • 30,821.00 TOTAL EXPENDITURES 240,795.00 Lepel Health Department - 2018, Date: 06/23/2017 Page: 165 of 186 Contract # Date: 06123/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 20181 WIC Resident Services DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT pf: Original I— 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 975,732.00 975,732.00 2 Fringe Benefits 620,038.00 620,038.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 430,560.00 430,560.00 5 Supplies and Materials i 41,725.00 41,725.00 Travel 5,829.00 5,829.00 7 Communication 14,200.00 14,200.00 8 County-City Central Services 0.00 0.00 9 Space Costs 101,320.00 101,320.00 10 All Others (ADP, Con. EMployees, Misc.) 129,716.00 129,716.00 Total Program Expenses - 2,319,120.00 2,319,120.00 TOTAL DIRECT EXPENSES . 2,319,120.00 2,319,120.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 462,998.00 462,998.00 Total Indirect Costs 462,998.00 462,998.00 TOTAL INDIRECT EXPENSES 462,998.00 462,998.00 TOTAL EXPENDITURES 2,782,118.00 2,782,118.00 Local Health Department - 2018, Date; 06/2312017 Page: 166 of 186 Contract # Date; 0612312017 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non 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 - 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 0.00 346,788.00 0.00 346,788,00 lnkind Match 0.00 0.00 0.00 0.00 MOH NS Fixed Unit Rate Totals 2,435,330.00 346,788.00 0.00 2,762,118,00 Local Health Department- 2018, Date 06/23/2017 Page' 167 of 186 Contract# Date: 06/23/2017 3 Program Budget - Cost Detail j Line Item I Qty Ratel UnitslIJONI I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Supervisor 1.0000 74712.000 0.000 FTE 74,712.00 Supervisor 1.0000 50186.000 0.000 FTE 50,186.00 Supervisor 1.0000 57847.000 0.000 FTE 57,847.00 Assistant 1.0000 30576.000 0.000 30,576.00 Outreach Worker 1.0000 41334.000 0.000 41,334.00 Outreach Worker 1.0000 43351.000 0.000 43,351.00 Outreach Worker 0.4808 35294.000 0.000 16,969.00 Outreach Worker 0.9616 43349.000 0.000 41,684.00 Outreach Worker 0.4808 35294.000 0.000 16,969.00 Outreach Worker 1.0000 37311.000 0.000 37,311.00 Outreach Worker 0.4808 33283.000 0.000 16,002.00 Outreach Worker 1.0000 35296.000 0.000 35,296.00 Nutritionist/Dietician 1.0000 45660.000 0.000 45,660.00 Nutritionist/Dietician 1.0000 39303.000 0.000 39,303.00 Nutritionist/Dietician 1.0000 37182.000 0.000 37,182.00 Nutritionist/Dietician 1.0000 45660.000 0.000 45,660.00 Nutritionist/Dietician 1.0000 35060.000 0.000 35,060.00 Nutritionist/Dietician 1.0000 45660.000 0.000 45,660.00 Nutritionist/Dietician 0.9101 66683.000 0.000 60,688.00 Nutritionist/Dietician 1.0000 60658.000 0.000 60,658.00 Nutritionist/Dietician 1.0000 60658.000 0.000 60,658.00 Nutritionist/Dietician 1.0000 66683.000 0.000 66,683.00 OVERTIME 0.2404 67735.000 0.000 16,283.00 Total for Salary & Wages 975,732.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Ins. Retirement Hospital Ins. Life Ins. Vision Ins. Hearing Ins. Dental Ins. 0.0000 63,546 _ 975732.000 620,038.00 Local Health Department -2018, Date: 06/23/2917 Page: 168 of 186 Contract # Date: 06123/2017 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 Oakland Co. 0.0000 0.000 0.000 430,560.00 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 8,000,00 Medical Supplies 0.0000 0.000 0.000 15,000.00 Educational Supplies 0.0000 0.000 0.000 7,000.00 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 8,000.00 Materials & Supplies 0.0000 0.000 0.000 1,525.00 Total for Supplies and Materials 41,725.00 6 Travel Mileage Notes : 8,750 miles @ .535 0.0000 0.000 0.000 3,611.00 Conferences 0,0000 0.000 0.000 2,218.00 Total for Travel 5,829.00 7 Communication Telephone 0,0000 0.000 0.000 14,20000 8 County-City Central Services 9 Space Costs Space/Rental Costs I 0.0000 0.000 0.000 101,320.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 180.00 Equipment Repair 0.0000 0.000 .-- 0.000 1,750.00 Convenience Copier 0.0000 0,000 0.000 10,170 00 IT Operatons 0.0000 0.000 0.000 95,616.00 Advertising 0.0000 0.000 0.000 18,000.00 Staff Training 0.0000 0.000 0.000 1,500.00 Prof svcs, interpretation, laundry 0.0000 0.000 0.000 2,000.00 Expendable Equipment 0.0000 0.000 0.000 500.00 Total for All Others (ADP, Con. Employees, Misc.) 129,716.00 Total Program Expenses 2,319,120.00 Local Health Department - 2018, Date; 0612312017 Page 169 of 166 Contract # Date: 06/2312017 Line Item I Qty Rate I UnitstUOM Total TOTAL DIRECT EXPENSES 2,319,120.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan I Other Health Adm Distribution 0.0000 0.000 0.000 239,934.00 Other Cost Distributions-Health Education 0.0000 0.000 0.000 106,854.00 Cost Allocation Plan Notes : 11.91% 0,0000 0.000 0.000 116,210.00 Total for Cost Allocation Plan / Other 462,998.00 Total Indirect Costs 462,998.00 TOTAL INDIRECT EXPENSES 462,998.00 TOTAL EXPENDITURES 2,782,118.00 Local Health Department- 2018, Date; 06/2312017 Page: 170 of 186 Contract # Date: 0612312017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2018 / West Nile Virus Community Surveillance DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT pi Original r Amendment AMENDMENT # o CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category 1 Amount] Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 3,620.00 3,620.00 2 Fringe Benefits 2,252.00 2,252.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual S 0.00 0.00 5 Supplies and Materials 850.00 850.00 Travel 847.00 847.00 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, MO 0.00 0.00 Total Program Expenses 7,569.00 7,569.00 TOTAL DIRECT EXPENSES 7,569.00 7,569.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 1,219.00 1,219.00 Total Indirect Costs 1,219.00 1,219.00 TOTAL INDIRECT EXPENSES 1,219.00 1,219.00 TOTAL EXPENDITURES 8,788.00 8,788.00 Local Health Department - 2018, Date: 0812312017 Page: 171 of 186 Contract # Date: 06/23/2017 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind 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 8,000,00 0.00 0.00 8,000.00 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 lii 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 0.00 788.00 0.00 788,00 Inkind Match 0.00 0.00 0.00 0.00 NIDHI-IS Fixed Unit Rate Totals 8,000.00 788,00 0.00 8,788.00 Local Health Department - 2018, Date: 05/23/2017 Page: 172 of 186 Contract # Date: 06/23/2017 3 Program Budget - Cost Detail Line Item Qty Rate Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Sanitarian 0.0461 78525.000 0.000 FTE 3,620.00 2 Fringe Benefits All Composite Rate Notes : FICA, UNEMP INS, RETIREMENT, HOSP INS, LIFE INS, VISION INS, HEARING INS, DENTAL INS, WORK COMP, SHORT/LONG TERM DISABILITY 0.0000 62.210 3620.000 2,252.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 0.0001 850.00 5 Travel Mileage Notes : 1058 miles x .535/mile 0.0000 0.000 0.000 566.00 Conferences 0.0000 0.000 0.000 281.00 Total for Travel 847.00 7 Communication 8 County-City Central Services Space Costs 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses 7,569.00 TOTAL DIRECT EXPENSES 7,569.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 788.00 Cost Allocation Plan Notes : 11.91% 0,0000 0.000 0.000 431.00 Total for Cost Allocation Plan / Other 1,219.00 Total Indirect Costs 1,219.00 TOTAL INDIRECT EXPENSES 1,219.00 Local Health Department - 2018, Date: 06/23/2017 Page: 173 of 186 Contract # Date: 06123/2017 'Line Item I Qty Ratel UnitslUOM Total TOTAL EXPENDITURES 8,788.00 Local Health Department - 2018, Date: 96/23/2017 Page: 174 of' 186 Contract # Date: 06/2312017 1 Program Budget Summary PROGRAM I PROJECT Local Health Department -2018 / MDEQ Private and Type III Water Supply DATE PREPARED 6123/20,17 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To: 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT pt. Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc,) 0,00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 1,584,353.00 1,584,353.00 Total Indirect Costs 1,584,353.00 1,584,353.00 TOTAL INDIRECT EXPENSES 1,584,353,00 1,584,353.00 TOTAL EXPENDITURES 1,584,353.00 1,584,353.00 Local Health Department - 2018, Date: 06/23/2017 Page: 175 of 186 Contract # Date: 0612312017 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 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 4.00 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 1,070,052.00 0.00 1,070,052.00 Inkind Match 0.00 0.00 0.00 0.00 MDEINS Fixed Unit Rate Totals 514,301.00 1,070,052.00 0.00 1,564,353.00 Local Health Department - 2018, Date: 06/23/2017 Page: 176 of 186 Contract # Date: 06123/2017 3 Program Budget - Cost Detail 1Line Item I QtYI Rate' Units I 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 Cost Allocation Plan / Other Environmental Hlth Adm Distribution 0,0000 0.000 0.000 1,448,125.00 Other Cost Distributions-Misc. Distribution 0.0000 0.000 0.000 136,228.00 Total for Cost Allocation Plan /.Others 1,584,353.00 Total Indirect Costs 1,584,353.00 TOTAL INDIRECT EXPENSES 1,584,353.00 TOTAL EXPENDITURES 1,584,353.00 Local Health Department - 2018, Date: 06/2312017 Page: 177 of 186 Contract # Date: 06123/2017 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2018 / ZIKA Virus Community Support DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT fb7 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 7,000.00 7,000.00 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.) 3,000.00 3,000,00 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 Cost Allocation Plan / Other 985,00 985.00 Total Indirect Costs 985.00 985.00 TOTAL INDIRECT EXPENSES 985.00 985.00 TOTAL EXPENDITURES 10,986.00 10,985.00 Local Health Department - 2018, Date: 06/2312017 Page: 178 of 186 Contract 1/ Data: 0612312017 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 Nori-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0,00 0.00 I Local 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 Comprehensive 10;000.00 0.00 0.00 10,000.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 I MDHHS 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 - Private / Type Ill Water Supply 0,00 0.00 0.00 0.00 I ELPHS 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 0.00 985.00 0.00 985.00 Match 0.00 0.00 0.00 0.00 I Inkind MDHHS Fixed Unit Rate Totals 10,000.00 986.00 0.00 10,985.00 Local Health Department- 2018, Date: 06/23/2017 Page: 179 of 186 Contract # Date: 06123/2017 3 Program Budget - Cost Detail Line Item I Qtyi 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 Postage 0.0000 0.000 0.000 304.00 Printing 0.0000 0,000 0.000 1,700.00 Educational Supplies Notes : Personal use mosquito repellant wipes to be disseminated in conjunction with educational literature about Zika prevention. This is a social marketing technique following the evidence-based best practices that health communications campaigns use,- 0.0000 0.000 0.000 5,000.00 Total for Supplies and Materials 7,000.00 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Advertising _ 0.0000 i 0.000 0.000 3,000.00 Total Program Expenses 10,000.00 TOTAL DIRECT EXPENSES 10,000.00 INDIRECT EXPENSES Indirect Costs Indirect Costs Cost Allocation Plan / Other Health Adm Distribution 1 0.0000 0.000j 0.000 985.00 Total Indirect Costs 985.00 TOTAL INDIRECT EXPENSES 985.00 TOTAL EXPENDITURES 10,985.00 Local Health Department - 2018, Date: osizatzoi 7 Page: 180 of 186 Contract # Date: 06/2312017 Program Budget Summary PROGRAM/PROJECT Local Health Department - 2018 / ZIKA Virus Mosquito Surveillance DATE PREPARED 6/23/2017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 17. Original ft- 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 3,959.00 3,959.00 2 Fringe Benefits 2,692.00 2,692.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 1,003.00 1,003.00 6 Travel 1,874.00 1,874.00 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 9,528.00 9,528.00 TOTAL DIRECT EXPENSES 9,528.00 9,528.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 1,457.00 1,457.00 Total Indirect Costs 1,457.00 1,457,00 TOTAL INDIRECT EXPENSES 1,457.00 1,457.00 TOTAL EXPENDITURES 10,985.00 10,985.00 Local Health Department - 2018, Date: 06/2312017 Page: 181 of 186 Contract Date: 06/23/2017 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 4 0.00 0.00 0.00 MDHHS Comprehensive 10,000.00 0.00 0.00 10,000.00 ELPHS - MDFIRS 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 0.00 985.00 0.00 985.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 10,000.00 985.00 0.00 10,985.00 Local Health Department - 2018, Date: 00/23/2017 Page: 182 of 186 Contract # Date: 06/23/2017 3 Program Budget - Cost Detail 'Line Item I Qty Rate' Units UOM I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Sanitarian 0.0558 70955.0001 0.000 FTE 3,959.00 2 Fringe Benefits All Composite Rate Notes : FICA, UNEMPL INS, RETIREMENT, HOSP INS, LIFE INS, VISION, HEARING, DENTAL WORK COMP, SHORT/LONG TERM DISABILITY 0.0000 68.000 3959.000 2,692.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 1,003.00 6 Travel Mileage Notes : 3503 X ,535 per mile H 0,0000 0.000 0.000 1,874.00 7 Communication 8 County-City Central Services . 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses 9,528.00 TOTAL DIRECT EXPENSES 9,528.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plant Other Health Adm Distribution 0.0000 0.000 0.000 985.00 Cost Allocation Plan Notes : 11.91% — 0.0000 0.000 0.000 472.00 Total for Cost Allocation Plan / Other 1,457.00 Total Indirect Costs 1,457.00 TOTAL INDIRECT EXPENSES 1,457.00 TOTAL EXPENDITURES 10,985.00 Loca[ Hearth Department - 2018, Date. 06/23/2017 Page: 183 of 186 Contract # Date' 06/2312017 Summary of Budget PROGRAM / PROJECT Local Health Department - 2018 / Local Health Department - 2018 DATEPREPARED 612312017 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2017 To : 9/30/2018 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 0432 48341- FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 15,541,678.00 15,541,678.00 2 Fringe Benefits 9,808,307.00 9,808,307.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 681,703.00 681,703.00 5 Supplies and Materials 1,966,989.00 1,966,989.00 6 Travel 400,528.00 400,528.00 7 Communication 248,001.00 248,001.00 8 County-City Central Services 0.00 0.00 9 Space Costs 1,274,797.00 1,274,797.00 10 All Others (ADP, Con. Employees, Misc.) 2,879,149.00 2,879,149.00 Total Program Expenses 32,801,152.00 32,801,152.00 TOTAL DIRECT EXPENSES 32,801,152.00 32,801,152.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 1,213,912.00 1,213,912.00 2 Cost Allocation Plan / Other 20,067,081.00 20,067,081.00 3 Other Costs Distributions -12,226,210.00 -12,226,210.00 Total Indirect Costs 9,054,783.00 9,054,783.00 TOTAL INDIRECT EXPENSES 9,054,783.00 9,054,783.00 Local Health Department - 2010, Date: 06123/2017 Page: 184 of 186 Contract # Date: 06/23/2017 TOTAL EXPENDITURES 41,856,936.00 41,855,935.00 SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Fees and Collections - 1st and 2nd Party 0.00 3,821,406.00 0.00 3,821,406.00 2 Fees and Collections - 3rd Party 0.00 383,928.00 0.00 383,928.00 3 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 4 Federal or State (Non MDHHS) 0.00 2,027,438.00 0.00 2,027,438.00 5 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 6 Federally Provided Vaccines 0.00 1,346,899.00 0.00 1,346,899.00 7 Federal Medicaid Outreach 672,361.00 0.00 0.00 672,361.00 Required Match - Local 0,00 687,575.00 0.00 687,575.00 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 5,515,470.0 0 0.00 0.00 5,515,470.00 15 ELPHS - MDHHS Hearing 253,969.00 0.00 0.00 253,969.00 16 ELPHS - MDHHS Vision 253,968.00 0.00 0.00 253,968.00 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 Ili 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 Local Health Department - 2418, Date: 06/23/2017 Page: 185 of 186 Contract # Date: 06/23/2017 22 Local Funds - Other 0.00 22,220,956.0 0.00 22,220,956.0 0 0 23 Inkind Match 0.00 0.00 40,351.00 40,351.00 24 MDHHS Fixed Unit Rate 312,927.00 0.00 0.00 312,927.00 TOTAL 11,327,382. 30,488,202.0 40,351.00 41,855,935.0 00 0 0 Local Health DepaTtment - 2018, Date: 0612312017 Page: 186 of 186 Version: Comprehenshie MICHIGAN DEPARTMEN T O F H E A L T H A N D H U M A N S E R V I C E S AGREEMENT ADDEN D U M A 1. This addendum adds t h e f o l l o w i n g s e c t i o n t o P a r t I a n d R e n u m b e r s e x i s t i n g 1 1 Special Certification to 1 2 a n d e x i s t i n g 1 2 S i g n a t u r e S e c t i o n t o 1 3 : Part I 11. Agreement Exception s a n d L i m i t a t i o n s Notwithstanding any ot h e r t e r m o r c o n d i t i o n i n t h i s A g r e e m e n t i n c l u d i n g , b u t not limited to, any pro v i s i o n s r e l a t e d t o a n y s e r v i c e s a s d e s c r i b e d i n t h e Annual Action Plan, an y G r a n t e e ( O a k l a n d C o u n t y ) s e r v i c e s p r o v i d e d pursuant to this Agree m e n t , o r a n y l i m i t a t i o n s u p o n a n y D e p a r t m e n t f u n d i n g obligations herein, the P a r t i e s s p e c i f i c a l l y i n t e n d a n d a g r e e t h a t t h e G r a n t e e may discontinue, withou t a n y p e n a l t y o r l i a b i l i t y w h a t s o e v e r , a n y G r a n t e e services or performan c e o b l i g a t i o n s u n d e r t h i s A g r e e m e n t w h e n a n d i f i t becomes apparent tha t S t a t e o r D e p a r t m e n t f u n d s f o r a n y s u c h s e r v i c e s w i l l be no longer available. N o t w i t h s t a n d i n g a n y o t h e r t e r m o r c o n d i t i o n i n t h i s Agreement, the Parties s p e c i f i c a l l y u n d e r s t a n d a n d a g r e e t h a t n o p r o v i s i o n i n this Agreement shall o p e r a t e a s a w a i v e r , b a r o r l i m i t a t i o n o f a n y k i n d , o n a n y legal claim or right th e G r a n t e e m a y h a v e a t a n y t i m e u n d e r a n y M i c h i g a n constitutional provision o r o t h e r l e g a l b a s i s ( e . g . , a n y H e a d l e e A m e n d m e n t limitations) to chall e n g e a n y S t a t e o r D e p a r t m e n t p r o g r a m f u n d i n g obligations; and, the p a r t i e s f u r t h e r a g r e e t h a t n o t e r m o r c o n d i t i o n i n t h i s Agreement is intended a n d n o s u c h p r o v i s i o n s h a l l b e a r g u e d t o s t a t e o r imply that the Grantee v o l u n t a r i l y a s s u m e d o r u n d e r t o o k t o p r o v i d e a n y services as described i n t h e A n n u a l A c t i o n P l a n , a n d t h e r e b y , w a i v e d a n y rights the Grantee ma y h a v e h a d u n d e r a n y l e g a l t h e o r y , i n l a w o r e q u i t y , without regard to whe t h e r o r n o t t h e G r a n t e e c o n t i n u e d t o p e r f o r m a n y services herein after a n y S t a t e o r D e p a r t m e n t f u n d i n g e n d s . 2. This addendum modifie s t h e f o l l o w i n g s e c t i o n s o f P a r t 1 1 , General Provisions: Part II Responsibilities-Gra n t e e J. Software Compliance . This section will be del e t e d i n i t s e n t i r e t y a n d replaced with the follo w i n g l a n g u a g e : Version: Comprehensive The Michigan Department of Health and Human Services and the County of Oakland will work together to identify and overcome potential data incompatibility problems. III. Assurances A. Compliance with Applicable Laws, This first sentence of this paragraph will be stricken in its entirety and replace with the following language: The Grantee 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: Grantee agrees that it will comply with the Health Insurance Portability and Accountability Act of 1996, and the lawfully enacted and applicable Regulations promulgated there under. IX. Liability. Paragraph A. will be deleted in its entirety and replaced with the following language. A. Except as otherwise provided by law neither Party shall be obligated to the other, or indemnify the other for any third party claims, demands, costs, or judgments arising out of activities to be carried out pursuant to the obligations of either party under this Contract, nothing herein shall be construed as a waiver of any governmental immunity for either party or its agencies, or officers and employees as provided by statute or modified by court decisions. 2 ATTACHMENT I MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES Local Health Department Agreement October 1,2017- September 30, 2018 Fiscal Year 2018 INSTRUCTIONS FOR THE ANNUAL BUDGET M DHHS/C0-2018 3/14/2017 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 Immunization 317 and VFC Allowable Expenditures 31 MDHHS/C0-2018 3/14/2017 Page 1 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. MINIMUM BUDGETING REQUIREMENTS A. Cost Principles - Types or items of cost which will be considered for reimbursement are generally consistent with definitions contained in Title 2 Code of Federal Regulations CFR, Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. B. Federal Block Grant Funds - Maternal & Child Health and Preventive Health Block Grant funds may not be used to: provide inpatient services; make cash payments to intended recipients of health services; purchase or improve land; purchase, contract or permanently improve (other than minor remodeling defined as work required to change the interior arrangements or other physical characteristics of any existing facility or installed equipment when the cost of the remodeling incident does not exceed $2,000) any building or other facility; or purchase major medical equipment (any item of medical equipment having a unit cost of over $10,000 and used in the diagnosis or treatment of patients, excluding equipment typically used in a laboratory); satisfy any requirement for the expenditure of non-federal funds as a condition for the receipt of Federal funds; or provide financial assistance to any entity other than a public or nonprofit private entity. C. Expenditure and Funding Source Breakdown - For purposes of development, analysis and negotiation activities must be budgeted at the individual expenditure and funding source category level on the Annual Budget for Local Health Services. D. Special Budget Requirements for Certain Categorical Program Elements - The Annual Budget for Local Health Services is completed in the MI E-Grants System through the application budget to include details for all program elements (excluding Administration and Grantee Support). MDHHS/C0-2018 3/14/2017 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: "I 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. III. REIMBURSEMENT CHART A. Program Element/Funding Source The Program Element/Funding Source column has been moved to Attachment III 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: MDHHS/CO-2018 3/14/2017 Page 3 of 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. MDHHS/C0-2018 3/14/2017 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 Mt E-Grants System sums the direct expenditures budgeted for each program element, project or service grouping and records in the Total Direct Expenditure line of the Budget Summary. L Indirect Cost — These cost categories are used to distribute costs of general administrative operations that have not been directly charged to individual subrecipient programs. The Indirect Cost expenditures distribute administrative overhead costs to each program element, project or service grouping. Two separate local rates may apply to the agreement period (i.e., one for each local fiscal year). Use Calendar Rate 1 to reflect the rate applicable to the first part of the agreement period and Calendar Rate 2 for the rate applicable to the latter part. Indirect costs are not allowed on programs elements designated as vendor relationship An indirect rate proposal and related supporting documentation must be retained for audit in accordance with records retention requirements. in addition, these documents are reviewed as part of the Single Audit, subrecipient monitoring visit, or other State of Michigan reviews. Following is further clarification regarding indirect rate and/or cost allocation approval requirements to distribute administrative overhead costs, in accordance with Title 2 CFR Part 200 (formerly Circular A- 87 2 CFR Part 225, Appendix E), for Local Health Departments budgeting indirect costs: 1. Local Health Departments receiving more than $35 million in direct Federal awards are required to have an approved indirect cost rate from a Federal Cognizant Agency. If your Local Health Department has received an approved indirect rate from a Federal Cognizant agency, attach the Federal approval letter to your MI E-Grants Grantee Profile. 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/C0-2018 3/14/2017 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. MDMHS/C0-2018 3/14/2017 Page 6 01 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 1st & 2n d Party- i. 1st party funds projected to be received from private payers, including patients, source users and any member of the general population receiving services. 2rld party funds received from organizations, private or public, who might reimburse services for a group or under a special plan. iii. Any Other Collections B. Fees & Collections _ 3rd Party — 3rd Party Fees - Funds projected to be received from private insurance, Medicaid, Medicare or other applicable titles of the Social Security Act directly related to the cost of providing patient care or other services (e.g., includes Early Periodic Screening, Detection and Treatment [EPSDT1 Screening, Family Planning.) C. Federal/State Funding (Non-MDHHS) - Funds received directly from the federal government and from any state Contractor other than MDHHS, such as the Department of Natural Resources and Environment (MDNRE). This line should also be used to exclude state aid funds such as those provided through the Michigan Department of Treasury under P.A. 264 of 1987 (cigarette tax). D. Federal Cost Based Reimbursement — Funds received for Federal Cost Based Reimbursement which should be budgeted in the program in which they were earned. E. Federally Provided Vaccines — The projected value of federally provided vaccine. F. Federal Medicaid Outreach — (Please note: to be used only for Medicaid Outreach, CSHCS Medicaid Outreach or Nurse Family Partnership Medicaid Outreach program elements.) Funds projected to be received from the federal government for allowable Medicaid Outreach activities. This amount represents the anticipated 50% federal administrative match of local contributions. G. Required Match - Local — Funds projected to be local contribution for programs that have a match contribution requirement (Please note: for Medicaid Outreach, CSHCS Medicaid Outreach, or Nurse Family Partnership Medicaid Outreach, this amount represents the 50% matching local contribution for allocable Medicaid Outreach Activities. Federal Medicaid Outreach and Required Local match amounts should equal each other.) H. Local Non-ELPHS - Local funds budgeted for the following expenditures; 1. Expenditures for services 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/C0-2018 3114/2017 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. 1. 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 — MDH HS Other. Vision allocations may only be spent on the Vision Program. N. ELPHS — MDHHS Other — This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS MDHHS Other program for eligible program elements. Please note: The MI E-Grants System validates the ELPHS MDHHS Other budgeted funds across the applicable program elements to assure the agreement does exceed the ELPHS — MDH HS Other allocation. O. 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-2018 3/14/2017 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. lnkind 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 U.S. Department of Agriculture, Food & Nutrition Service Family Planning U.S. Department of Health & Human Services, Public Health Service Breast and Cervical Cancer U.S. Department of Health & Human Services, Centers for Disease Control CSHCS Outreach & Advocacy Michigan Department of Health & Human Services Medicaid Outreach Activities Centers for Medicare and Medicaid Services In general, subgrantee budgets must provide sufficient budget detail to support grantee budget requests and be in a format consistent with grantor Contractor requirements. Certain types of costs must receive approval of the federal grantor Contractor and/or the grantee prior to being incurred. A. Public Health Emergency Preparedness (PHEP) Special Budget Requirements Local Health Departments will receive the initial FY 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/C0-2018 3/14/2017 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 MDH HS 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. MDHHS/C0-2018 3/14/2017 Page 100? 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 MDHHS. A. Alterations and Renovations - to change the interior arrangements or other physical characteristics of existing facilities or installed equipment, to the extent that such changes cost more than $1,000 each. B. Audiovisual Materials and Activities - acquired, produced, presented, or disseminated to the general public. C. Consultant Contracts for General Support Services - including equipment and supplies, that will cost in excess of $25,000 or 10% of the total direct cost budget (whichever is greater). D. Equipment - including general purpose and special equipment (e.g., air conditioning) costing $5,000 or more 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 Printing Costs - for the cost of publications. H. Capital Expenditures - for land or buildings. I. Indemnification Against Third Parties Costs - insurance against potential liabilities. MD-MS/CO-2018 3/14/2017 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.michigancancer.orq/BCCCNP. MDFIHS/C0-2018 3/1412017 Page 12 01 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 $250 per woman based on a target caseload established by MDH HS. 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 WISEWOMAN Program issued in August of each fiscal year. The above referenced documents are available at www.michigan.govicancer. E. Children's Special Health Care Services (CSHCS) Outreach and Advocacy - The program element, titled CSHCS Outreach and Advocacy should be used to budget costs associated with this program. I. Program Budget - Online Detail Budget Application Entry Complete the appropriate budget forms contained within the MI E-Grants System for each program element. An example of this form is attached (see Attachment 'I 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/C0-2018 3/14/2017 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 Ml 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. Frirme 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 subcontractors/subrecipient's address, amount by subcontractor/subrecipient and total of all subcontractor(s)/subrecipient(s). Multiple small subcontracts can be grouped (e.g., various worksite subcontracts). 5. Supplies and Materials - Enter amount by category. A description is required if the budget category exceeds 10% of total expenditures. 6. Travel - Enter amount by category. A description is required if the budget category exceeds 10% of total expenditures. 7. Communication - Enter amount by category. A description is required if the budget category exceeds 10% of total expenditures. 8. County-City Central Services - Enter amount by category and total for all categories. 9. Space Costs - Enter amount by category and total for all categories. 10. Other Expenses - Enter amount by category and total for all categories. A description is required if the budget category exceeds 10% of total expenditures. 11. Indirect Cost Calculation - Enter the base(s), rate(s) and amount(s). 12. Other Cost Distributions - Enter a description of the cost, percent distributed to this program and the amount distributed. 13. Total Exp. - MI E-grants totals the amount of all positions required and records it on the Budget Summary. MDMS/C0-2018 3/14/2017 Page 14 of 37 ARC. Z.. igpM111.11.4. ;97:61. • (1.61,10:*,:ii4. 44.4 AMotil 71-3 ra: I Eqoas0 . ........ : Top, 0,08E t- 41041^'•I tiOVISt,: • :44.:frAt : F. Program Budget-Cost Detail Schedule Preparation 61 Attachment B1-Program Budget Summary MDHHS/C0-2018 3/1412017 Page 15 of 37 = t:f 1(44.14,K. e-u•r!: 1,41411 1:-:;•;;;4i.0 • ".itikii4•1'1.1:11i*q.• • NJ. • • 5 tilltif.a, 1 1;Ee?. 0.1:•;;Jt; 40.711 ,:r-NPF 8 ••• 1111nIRN);n•11.q•e: Source of Funds MDHHS/CO-2018 3/14/2017 Page 16 of 37 Fir1 - . 4 1.1,4.--porf itroit-AL rA M S.-•Aty ••••.,,••v,-4,910,4 Pull9v.t NAO. • rn,s• ,r4641±::::•: 0:11Z!, ' • . . • VE.:30", 1.1E5. INt 'St .1 fi Q,; 4.4.1noi SV;C: •, •• •. .• •• • •• • &Ala rAmil E-:".; • • t:•a:itP,Pf• Vs, • NMI= MIN= f!wposlafac •::•::e401>6. fy.if .70.11 E<",=, !ff B2 Attachment B2-Program Budget Cost Detail MDHHS/C0-20113 3/14/2017 Page 17 of 37 Lioxt.c • iiitt.i...A4-01:11:104.. • :Pf.-•00.113 MDHHS/C0-2018 3/14/2017 Page 18 of 37 MDHHS/CO-2018 3/14/2017 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-09/30Nx. Reimbursable activities included in the budget must conform to the requirements as specified in the MSA Bulletin 05-29. Complete the MI E-Grants application and budget forms for this program. 1. Expenditure Category Tab Enter the expenditures budgeted for the fiscal year: 10/01/xx-09/30/xx. Expenses budgeted for each of the listed expenditure categories are allowable and must be specific to the Medicaid program as described in MSA Bulletin 05-29. 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-09/30/xx. MDHHS/CO-2018 3/14/2017 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: 10/1Nx-09/30/)(x. 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/CO-2018 3/14/2017 Page 21 of 37 4. Comprehensive CSHCS Outreach and Advocacy and Case Management/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. IL Financial Status Report (FSR) — LHDs seeking 50% federal administrative match should request reimbursement by submitting their actual expenses for allowable Medicaid Outreach activities on their quarterly FSRs through MI E-Grants. A. Medicaid Outreach Activities For Quarters 1-3, LHDs must reflect the actual Medicaid Outreach expenses incurred in a separate program element titled Medicaid Outreach. Actual expenses incurred for each of the listed expenditure categories are allowable, but must be specific to Medicaid Outreach as defined by the MSA Bulletin 05-29 and not part of a direct service. Expenses should be supported by an approved methodology 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. MD111-1S/C0-2018 3/14/2017 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 &Grants system after Comprehensive Agreement CSHCS Outreach and Advocacy funds have been expended. 1. Federal Medicaid Outreach Should be used to request the 50% federal administrative match. Match is determined by multiplying local contribution for the program by the percentage of Medicaid enrollees. This product is then multiplied by 50% in order to determine the eligible federal administrative match. 2. Required Match - Local Should be used to report the remaining portion of the local contribution for the Medicaid Outreach Match. Additional local contribution that is not eligible for the 50% federal match should be reported in Local Funds - Other. MDHHS/C0-2018 3/14/2017 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 I. 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. MDHEIS/C0-2018 3R4/2017 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 Ovtieach as follows: Salaries & Fringes: Distributed based on the actual*ndunt oftime-eacnemployee spends in each program for which they work. Vacation/sick/holiday pay is.allac,ated in the\eam0 mariner. , Supplies and Materials: Directly expensed 'to- thp,sRedifitiprogram(0\identifjed by the employee as needed. Costs that benefit all programs will bea116300 bed On'pertgrifa6taff in each program. „ Travel: All travel costs are charW dirqi-Opo't*proO'ram for,wnich the travel was incurred. Communications: Distribvted‘baseLl..,on.tho- qmenjAp ,b1 time staff worked in each program. Space Costs: Distribdtpd bas6:ti,priltle\scpe t96-tdge used by the FTE and the percentage of time they worked in each prObfa'm. C).mhr:On ai-ep\cittOe'footage is allocated based on percentage staff in each program. Indirect costs: distributed across all programs based on the salaries and fringes of staff in each program. \ ' All Others: (TranslatiOR s6rviaAs, miscellaneous services, insurances, dues, etc...) Costs are charged directly to the program for which the s,,ervice occurred. MDHHS/C0-2018 3/14/2017 Page 25 of 37 , as indirect costs havnottei?il accounted for ccin si'5tesitly bared asAirect costs. Similar types of costs have been Example 2 Orange County Health Department Medicaid Outreach Cost Allocation Methodology Certification This is to certify that I have reviewed the cost allocation plan and to the best of my knowledge and belief that: 1. All costs contained in this proposal to establish cost allocations or billings for Medicaid Outreach Activities are allowable in accordance with the requirements of Title 2 CFR Part 200, "Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards," and the federal and state award.sf to which they apply. Unallowable costs have been adjusted for in allocating costs,as. indicated in-the e.pst allocation plan. ,„ „ 2, All costs included in this proposal,`are mpe'rl....011c.igable tolhe MecijOid Outreach Activities Administration award on a tf.asii::::f-,p‘ b'opeficial Ou§at "relationship between the expenses incurred and the Medicaid Otitreabh AdministratiOn award to which they are allocated in accordance wit-Kapplicable:,e'cl:pie-qtr€61-* Further, the same costs that have been treated . , . 3. Thi's-ert.th.c.atfori\ wrq be -resubmitted if a significant change occurs that impacts the Medicaid 06ter-ich aCtiVities or upon a Department review that results in a finding of non-"' compliance›,...it.--ifeither of these conditions exists, the certification remains valid in subsequent fiscal years. I declare that the foregoing is true and correct: Health Department: Signature: Name of Official: Title: Date: An authorized official of the organization must certify that the plan has been prepared in accordance with authorizing legislation and regulations, and state or other applicable requirements. Every cost allocation plan must include a certification. MD-NS/CO-2018 3114/2017 Page 26 o137 Example 3 SAMPLE 3 ORANGE COUNTY HEALTH DEPARTMENT Budgeted Costs for Medicaid Outreach Activities Prckgrarn fautigerSumreary PROGRAM ( PROJECT Comprehensive Agreement - 201E1 Medicaid Outreach DATE PREPARED 08/17/2015 CONTRACTOR NAME Orange County Hearth Department BUDGET PEFU)D From : 1011/2015 To 9/3012016 ' 7 AMENDMENT • I° MAILING ADDRESS (Number end Streeti 123 Acme Rd, BUDGET AGREEMENT - '' Original AmearAment ,. CITY Orangegrove STATE Ml ZIP CODE 49555 FEDERAL ID NUMBER 38-5555555 , . Category Amount I Cash Intend ." Total DIRECT EXPENSES Program Expenses 1 Salary g, Wages 153,556.00 ;0.00 0.00 153,550.00 2 Fringe Benefits , `- 712C 50 - - 0.00 am 71,204.00 Cap, Exp. for Equip & Ric,' 14 . -0 00 . - Dm 0.00 ontractual 0,00 '-, --` 0m cum Q.00 5 Supplies and Materials'', . ' - ' 2 506.00 0.00 000 2,500L0 Travel - E40.00 0.00 0.0 500,00 7 Communication,- ' ' , • 5,000.00 000 0.00 5,000.00 County-City Central Set-vices' ' _ 4100 e.00 0.00 0.00 9 Space Costs . .800Q.00 0.40 0.00 6,090.00 ID All Others (ADP, Con. Employees, Miss 4,500.00 00 0.00 4,500.50 Total Program Expenses 246,260.00 DLO 0,00 245,260,00 TOTAL DIRECT EXPENSES 245,260.00 0.00 0.00 245,260.00 NDIRECT EXPENSES Indirect Costs 1 I 1rCoats 37,220.00 0.00 0.00 27,610.00 2 Other Costs Distributions 35,001100 0.00 0.04 35,900. Total Indirect Costs 72,220.00 0.00 0.00 72,220.00 TOTAL INDIRECT EXPENSES 72,220.00 0.00 0.00 72,220.90 TOTAL EXPENDITURES 311480,00 0.00 0,00 317,460,00 MOWS/CO-2018 3/14/2017 Page 27 of 37 2 Program Rudger- Source of Funds S tirce at Fends Category Amount Cash Inkind Total Fees and Co ctions - lstand2rid Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 , 0.00 0. El Federal or State (Non MDCH 0.00 0.00 ...-- -;., 0.00 4-- 0.00 M Federal Cost Based Reirriburaernent 0.00 0.D, apt) _ ago Federally Provided Vaccines 0.00 .. 0.130 , coO. aoo Federal Medicad Outreach 158,740.00 - - ' 1.00 ,. , ' ,, 158,740.00 III Local IIII Required Match - Local , -ii oo f',:11.7.4.1.60 ', .0 00 158,740.00 Non-ELPHS : t,po ol,po - ,.. -,, 0,00 0.00 Local Non-ELPHS 0,00 , - 0.00 CLOD El Local Non-ELPHS 0.00 0.00 0.00. 0.00 Other Non-ELPHS -. . b.0 , ', 000 0.00 0.00 .1 El MDCH Non Cornprehensi'Ve ':-., .",., .., , ,.. 0..01) '\ 1300 aoo DC1-I Convirenensiwa '„ `,, --4, -'. '.., toe' 000 000 aoo EL HS - MUCH Heaprig -. ,0 00 0.00 0.00 0.00 ELPHS - MDCKVisinp . 0.00 0.00 0 00 0.00 - MDCH 0 00 0.00 0,00 0.00 ELPHS - Food '---, . 0.00 . 0.00 0,01) ELPHS - Drinking Water 0.00 0.00 0_00 0.00 I ELPHS LPHS - On-Site Sewage .00 0.00 0.00 0.00 CH Funtling .0 0.00 0.0 0.00 Local Funds - Other r 0.00 0.00 0.00 0.00 III inkind Match 0.00 0.00 0.00 0.00 hi DCH Fixed Unit Rate Totals 1587'40..00 155740.00 0.00 317,4 0,00 _ Page 28 of 37 MDHHS/C0-2018 3/14/2017 3 Prclumsr Sudgrer - Coax Derail Line 1 en Rate 1.101e1 Amount J Ce Tote DIRECT EXPENSES Program Expenses I Salary & Wages Public Health Nome 1.037'0 54,545,00 FTE 50565.17 000 0.00 50,563 Social Worker 0_2000 1 STE.00 FTE 14,5 5.28 000 14,525 Tecanicyan 0.0650 40.650.00 FTE 23,1013..25 0.00 0.00 2 .7 Health Educator 0.5550 50,055.00 FTE 25 260 03 0.00 0.00 2.6250 Clerical 04550 34,071_00 FT,E 16,524.44 ., .. L , 0,00 0 . 00 1 .52 Supervisor 0 2200 63 1132..06 FTE 13,6152;i4 0.QU .-' 0.00 1 A52 Total for Salary 6 Wages '53,55E60 0.00 000 1 53 ,56e 2 Fringe Benefits , All Composite EateNotes _FICA, FUTA, urE, HEALTH, ' DENTAUVISION. , PENSION, UNEMPLOYMENT, WORXMANS COMP. P.0000 , 4Z.370, , , , 71,203.7'S 0.00 0.00 71,204 Car. Exp.. for Equip 4, Fee_ 4 Contractual Supplies and Materiola Printing 50,00 0.00 0.00 750. Office Supplies 1,250.00 0.00 0.00 1,250.00 Postage 500.00 0.00 0.00 S O. Travel 1 age SOO 00 o.00l 0.00 El 00 Communication Telephone, Cell 5,000.00 0.00 0.00 5,050.00 County-City Central Servicee Space Costs *-- ace Costs 6,000.00 000l O. On 13,000.00 0 All Otlera (ADP. Con, Employees, Misc.) Tra illation Services 4,000.00 0.00 0L00 4,0130.50 Miscellaneous 500.00 0.00 0.00 500.00 Tato! Program Expenses 245260.00 0.00 0.00 245,260.00 TOTAL DIRECT EXPENSES 245260.00 0.00 0.00 245,260,00 INDIRECT EXPENSES Indirect Costs I Indirect Coats 0000 16560 1 - --, ' , , • ''', 57 5 Fiscal Year Rate ..:7777 0.00. 0.00 37,220 Other Casts Distributions , - Nursing Acilmin Dislribution , , , --' `-p.lict ,.. '--- a -" 35,000.00 0.00 13. 0 .00 Total indirect Costs 7Z220.15 0.00 0.00 72220 TOTAL INDIRECT EXPENSES ,•,•)-, ‘i 72,220.15 0.00 0.00 72,22 TOTAL EXPENDITURES 77"--." , __,- 317,480.15 0.00 0.00 S317,460 Page 29 of 37 MDHHS/CO-2018 3/14/2017 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 MDH HS Cancer Prevention and Control Section. The LHD and/or direct service providers with contracts or letters of agreement with the LH D 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 MDHHS/C0-2018 3/14/2017 : VEC .ZHstrIbutlon , I : 0,fi.b4 with FPRF Allowable Uses of 317 and VFC FA Operations Funds PO B dmiopoi tIkt following table to assist awardees in preparing budgets that are in compliance with federal grants policies and CDC award requirements. The table was developed using a combination a OMB Circalar A-87, PHS (I113.4t5 Policy Statement 9505, and P08-identified program prioriti., tanis taiedotVII tipEOtinns: ::zAgn.*Ittlgel:::*110:10ble with ihV1C npratiwi ordering fund;fiutii Personnel geg Fin Compensationifringe b Local meetingv'coriferences (Ad hot) (excluding ineAls) .velgQ-St.S Out of state travel costs (e_g. NIC, Hep B Coordinator's Meeting, Program Managers/PHA Meeting, ACIP meetings, AFIX and VFC tralnings„ Program Managers Orientatian, and other CDC- : sponsored immunizatim program tneetingsr *ileum refer io Operations. Funding Categories, pgs, 10— I 1 for additional' _trtfortnaIon. OTC-rsiattra9 -f• OTC-reratat,i 15t20 16 Section lTh Basics. p2I 114014 2011 Object Class Category/ape-nu etilowable with 317 MlovOlkble 'fif rderifig ..::Afl,, . . with,with Pan cFC Thstributurn ith _ ," " ,• VPC-only site ViSitS rAF/X-Orily Site viitS 1- / Combined (AM. & VFC site visits) atal hospital,' reccprd reviews inment Fax rriachints for varxine ordeti 1 IVaccine storage equipment f vaccine , Copy machines *Eqt,t0tnent: at article pf tangible itattexpeadabl e personal property having !useful life of mare than one year and an acquisition cost r $5,000 or more per unit Ifeosi is below this threshold alnrnint, itEal Megi he imiuded s, Vaccine administration ,suppik$ , (including, but not limited to nasal pharyngeal. swabs„ syringes for ; emerRencY vaccination clinics' Office supplies-computers, genern1 •ck; (pens, paper, paper clips, etc.), it* Frtides calculators .1 Personal computers fl-aptops T VFC lets eiweigizirmpaW Pink Books, Red Printers ooks, Yellow 91161201k Section BASk8 p,22 IPOM 2017 - rp.R.F fwid Laboratory supplies (influenza. cultures' and PCPs,. cultures and molecular, lab ratcliA serotyphrk__ Dieitti data logger with valid certificate of calibratiothaIldationirestin re Vaccine sbipping supplies (stonge containersbubbk IN s-)crtC ontrat: I Statellocal toriferenctEs. Expenses (C-Onference sitn-,. materials printing, hotel accoffirnodafiors expenses, speaker fee) I Ma tat knot acrwabk, Itegicallocal =din Generai contactual serviCcS (e,g„ IAN, local health departments, contractual I staff, advisory committee media, larovicitisraini GSA Con 1„.TP41'..1 Other US contractual agreernen (support, enhAncemmt, upgrades) (CDC irFC-roged) sistanet Non-CDC Contract vaccines 317var--ene run& illitRt be requested in fiektfinz appliroation (e5rAT1S) under 3 t7 FA W1612016 Sertiell 1—The Basics p.23 TOM 2017 with tblat Allowable lowabl fun& 44g414217 ,Object Cia;i iihte 1317 '; Minim ble fiziat und :MI*414 A&wabfr Leillowable -Art* 4.11e*abiTil .:.;0710 iPol.:;;.. I !:-.MICalgribudeo Ira:v.11JF 1 NOs ftL11:: tindsjj. e#114.44 appifitetbk);: )bie‘i Clags CategorfElPensvi direct direct eo IOU Accounting se Advertising (restricted to recamitment of staff or trainees, procuremmt of goods and aervias, disposal of scrap or surplus maWrials) Audit Fees BRESS SurveV Committee meetings (room rev equipment rentaL Communication. (electronic/cornputer transmittal, messenger, postage. local and s, long distance telophone) onsuntr informadon aedvities .9perOlonit If If If nstnner I provider board partici* .Vavel -reimbursement) ory services (tests conducted immunization prozarns Local sekice delivety activities .s., Maintenanc o oft` Malpractice insurance for volunteer& Membersifinisubscriptions NIS Oversomplin2 Ragersleell phones Printing n of vaccine acwuntabiii 9/162016 Section I The Basics p:24 TOM 2017 •Object CCpc. pettes • Professional enice costs: direct!) related to immunization activities (limited term Istaff), Attorney General. Office s.traces iPubioMati0115 Pnblication/printing costs (all ober immunization related publication and. printing expenses) Rent (requires etplanation of why these costs are it included in the indirect cost rate agreement tar cost allocation plan) I Ihipping for materials (other than Nractne) :•1•1t1`..vcrre rwals (ORACLE, 0 end ReirribursernerAs .:40;otteatile : with 317 :Opci.iaTiO0f.5' Aliciwable With wITh.Pits : NPFC/41.iF.!7,N.:: AJkiwabIwith : , . , y-Fpf-nispipituotc, scith PEKE,: i",:r41.41.65:; (M* itmilkitbii) with VC with V) nperattnn.:, ordernt funds Toll-free phone lines for vaccine .oitCeeitixLrr thie .firsg'itit,t) (FA orly) torcalleerr VehicTe lease (t&cticted to awardees- wit policies the.mhibit loyal travel reimb VF ;tient le 1111111111111111111131111111111.11111 111111111111111111111MINIMMIIIIIIIIIIIIIIIM .-ready coDleS Lc lo ge abed Section Elasies p25 TOM 2017 Non-Allowable Expenses with Federal Immunization Funds t?c,perise • iOTaflowabkwthfdeit1 7, iilliklitaization funds lionorara i „ ,. , , „ Advertising costs (e,g„ eatmouiria*, &splays, exhibgv, tneeliope, .itit-9.7:rpterii:ei,,e.W.v, 'Ajt: ,r,f,,oiic beve_aEs Dui id inzyurchases, constwtion c:fipitalAntapveinents : .._......_..... — liond 0...trellases Le...1s1 at i Yeelobbyip&aetivities ATiciing. V V 1 V 7.;"-- V vl. — . f 1 ,. ireciadon on use c a ...,es esearch Fundraising V Interest on loans for the acquisition and/or modernization of ark existing [Tualatin: ( 1 in ical c.are (rrorr-hammtrizep 1 I V - - . 41 Paymont of bad debt Dq cleaning_ „. .__ _ : Vellici;iinrcliase , Promotional 41-27F IrleCilltIVe Ntiii6i44 (c.g.,, pfrquea, 41cithing on curnmvgnncarative Rona mreh -04 !Ports, intigsicroo, foldersefradiros, bockirds, ronforove bcogs.) Purchase of food (trifias pall of revriavd travel per diem cos14 Other restrictions -whiott must be taken into account while writing the budget • Funds may he spent only for activities and pemointel costs that are directly .related to the Immunization. and Vaccines tbr Children Cooperadve Agmement Funding requests not directly related to inuntinization activities are outside the scope of this cooperative agreement program and wit] not be funded. • Pre-award costs will not be reimbursed. 9,16/2 6 Section 1,—The Basics p,26 IPOM 2017 Page 36 of 37 MOMS/CO-2018 3/14/2017 ATTACHMENT III MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES LOCAL HEALTH DEPARTMENT AGREEMENT October 1 1 2017 — September 30 1 2018 Fiscal Year 2018 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/C0-2018 ATTACHMENT Iii Page 1 of 210 3/14/2017 For Fiscal Year 2018, 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) Screening 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 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 CHA Climate Health Adaptation CUSP Communities Uniting for Suicide Prevention CCCIP Comprehensive Cancer Control Community Implementation Project CCFIX-EB CSHCS Medicaid Elevated Blood Lead Case Mgmt 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 GTHML Getting to the Heart of the Matter — Lifestyle Change GTHMP Getting to the Heart of the Matter — Project Management GISP Gonococcal Isolate Surveillance Project (GISP) HEC Health Education Communication HIVDC HIV Data to Care HIVSTD HIV/STD Partner Services HIVPD HIV PrEP Data Collection HIVPREV HIV Prevention Services HIV-FIX HIV Prevention Non-Categorical HIVMHI HIV Ryan White Part B HIVRWM HIV Ryan White Part B MAI HIVSURV HIV Surveillance Support HALCP HIV/AIDS Linkage to Care HOPWA Housing Opportunities for Persons Living with HIV/AIDS IAP 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 MC1R Immunizations Michigan Care Improvement Registry (MCIR) Regional Michigan Care Improvement Registry Immunization - Vaccine Quality Assurance Program VQA ISS Infant Safe Sleep INCON-FIX Informed Consent LABBIO Laboratory Services MDHHS/CO-2018 ATTACHMENT III Page 2 of 210 3/14/2017 LACT Lactation Consultant LHDS Local Health Department (LHD) Sharing Support Local Maternal and Child Health (MCH) OTHER-MCH Direct Services Children — MCH OTHERMCHW Direct Services Women — MCH ESCMCH Enabling Services Children — MCH ESWMCH Enabling Services Women - MCH OTHERMCHV Public HIth Functions & I nfratruct - MCH TOBACCO Local Tobacco Reduction 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 BMHFAE Maternal Infant Childhood Home Visiting Program (MIECHVP) Healthy Families America Expansion 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 MIHWPI Michigan Health and Wellness 4x4 — Implementation NFP-MED Nurse Family Partnership Medicaid Outreach NFP-SEV Nurse Family Partnership (NFP)Services Nutrition and Physical Activity Self-Assessment for Child Care NPASCC 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 RPCS Regional Perinatal Care System SEAL SEAL! Michigan Dental Sealant STD Sexually Transmitted Disease (STD) Control STDGC STD Neisseria Gonorrhoeae Enhanced Surveillance Project RAPEPRE Sexual Violence Prevention (Rape Prey Ed) SIDS-FIX Sudden Unexplained Infant Death (SUID) and Other Fetal Infant Death TRIP Taking Pride in Prevention TCDC Tobacco Cessation — Dental Clinic TDT Tobacco Dependence Treatment TOBHIV Tobacco Reduction in People with HIV/AIDS TB Tuberculosis (TB) Control 340B Tuberculosis (TB) Control and Elimination WSVCS West Nile Virus Community Surveillance Women and Infant Children (WIC) WICBRST WIC Breasffeeding Peer Counseling WICMIG WIC Migrant WICRES WIC Resident Services WISEC Wise Choices West Niles Virus Community Surveillance WISEW Well-Integrated Screening and Evaluation for Women Across the Nation (VVISEWOMAN) WWHM Worksite Wellness — Getting to the Heart of the Matter MDHHS/CO-2018 ATTACHMENT III Page 3 of 210 3/14/2017 ZVCS Zika Virus Community Support ZVMS Zika Virus Mosquito Surveillance Essential Local Public Health Services (ELPHS) ADM-ELPHS Administration — ELPHS FOOD-ELPHS Food ELPHS GCD-ELPHS General Communicable Disease ELPHS HEAR-ELPHS Hearing ELPHS HIV-ELPHS HIV ELPHS DHIV-ELPHS HIV & STD Testing and Prevention IMM-ELPHS Immunization ELPHS SEW-ELPHS MDEQ On-site Wastewater Treatment VVTR-ELPHS MDEQ Private and Type III Water Supply VIS-ELPHS Vision ELPHS MDHHS/C0-2018 ATTACHMENT III Page 4 of 210 3/14/2017 FORMAT 1PROGRAM/ELEMENT) SPECIAL REQUIREMENTS I. Reimbursement Chart — a. Program Element: The Program Element indicates currently funded Department 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 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. M DH HS/C0-2018 ATTACHMENT in Page 5 of 210 3/14/2017 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 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. Subreciplent 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; MDHHS/C0-2018 ATTACHMENTIII Page 6 of 210 3/14/2017 c. Normally operates in a competitive environment; d. Provides goods or services that are ancillary to the operation of the Federal program; and e. Is not subject to compliance requirements of the Federal program as a result of the agreement, though similar requirements may apply for other reasons. In determining whether an agreement between a pass-through entity and another non-Federal entity casts the latter as a subrecipient or a contractor, the substance of the relationship is more important than the form of the agreement. All of the characteristics listed above may not be present in all cases, and the pass-through entity must use judgment in classifying each agreement as a subaward or a procurement contract. 3. Recipient A Recipient is for grant agreement with no federal funding. II. 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/C0-2018 ATTACHMENT Ifl Page 7 of 210 3/14/2017 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 instructions package for further explanation of applicability of these reimbursement methods. (3) Allocation to be reflected in individual programs during budgeting process. (4) Funding Source (not a single element). Hearing and Vision are single elements. (5) Subject to statewide maintenance of effort requirement for Title X. (6) State funding is first source (after fees and other earmarked sources). (7) Fixed unit rate subject to actual costs. (8) The performance reimbursement target will be the base target caseload established by the Department. (9) Subject to a match requirement (hard or in-kind) of $1 for each $3 of the Department agreement funding for coordination. (10) Fixed rate limited to contract amount. (11) Up to 6 visits per family. (12) Non-categorically funded Health Departments will be reimbursed at $11.00 per HIV test conducted up to a maximum of $2,000 annually. (13) Each delegate agency must serve a minimum percentage of Title X users to access their total allocated funds. Semi-annual FPAR data will be used to determine total Title X users. (14) Public Health Emergency Preparedness funding BPI must be expended by June 30, and is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHDs must submit a nine-month budget and a quarterly Financial Status Report (FSR) column for this program element. (15) Public Health Emergency Preparedness funding for October 1-June 30, and July 1-September 30, is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHD's must submit a three-month budget and a quarterly Financial Status Report (FSR) column for this program element. (16) Project meets the Research and Development Criteria as defined by Title 2 CFR Section 200.87. (17) Not Applicable. (18) Subject to match requirement as specified in Attachment III — Program Assurances and Specific Requirements. MDHHS/CO-2018 ATTACHMENT III Page 8 of 210 3/14/2017 Reimbursement Method Grant Start Date Grant Contract Administrator Contact Info (phone & email) 10/1/2017 Jennifer Linzmeier 517-241-5861; linzmeier@michigan.gov 9/30/2018 Subrecipient, Contractor, or Recipient (non-federal' Designation Subrecipient Staffing (6) Performance Level N/A Performance Target N/A QutpU Measure (if Applicable) ADOLESCENT SEXUALLY TRANSMITTED DISEASE (STD) SCREENING Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS N/A GRANTEE SPEC WIC REQUIREMENTS Project Summary: Individuals 15-24 years of age will be screened for chlamydia 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. MDHHS/C0-2018 ATTACHMENT UI Page 9 of 210 3/14/2017 5. Treat all positives on site if possible. 6. Contact positive clients that are released prior to treatment with treatment options in community. 7. Promote self-notification of partners. 8. Analyze and forward screening and treatment data to the Department quarterly: April 15, July 15, October 15, and January 15. 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-2018 ATTACHMENT lit Page 10 of 210 3/14/2017 10/1/2017 Grant End Date J Joseph Coyle 517-284-4915; coylej@michigan.gov .1 9/30/2018 Grant Start Date Grant Contrac Administrator. -- Contact Info (phone & email) Reimbursement Method Performance Level (If Applicable) Performance Target Output Measure N/A N/A Fixed Unit Rate (2) Subreciplent, Contractor, or Recipient (non-federal Designation 1 Recipient II BODY ART FACILITY LICENSING 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 13101-13111 of 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: $261.20 $130.60 $117.53 $261.20 $391.80 $26.12 Initial annual license for a Body Art Facility prior to July 1 50% of state fee Initial annual license for a Body Art Facility on or after July 1 50% of state fee Issue a temporary license for a Body Art Facility % of state fee License renewal prior to December 1 52.32% of state fee License renewal after December 1 50% of state fee ± 50% of penalty Duplicate License Payment will be made for those body art facilities that have applied and paid in full to the Department, following notification of a completed inspection and recommendation for issuance of license. GRANTEE REQUIREMENTS The Grantee is authorized to enforce PA 375 and conduct an inspection of all body art facilities under its jurisdiction, investigate complaints, and enforce licensing regulations and requirements. The Grantee must complete a Body Art Facility Inspection Report [DCH-1468 (07-09)], as provided by the MDHHS/C0-2018 ATTACHMENT III Page Li of 210 3/14/2017 Department, or other report form approved by the Department that meets, at minimum, all standards of the state inspection report Only body art facilities that have applied for licensure should be inspected. All body art facilities must be inspected annually. Licenses will only be released from the Department following notification of a completed inspection and upon recommendation by the Grantee. Completed inspection reports should be signed by the facility owner and recommendation for licensure should be forwarded to the Department within two to four weeks following the inspection. Reports should be entered via the online interface or can be sent to: HIV/STD and Body Art Section Division of Communicable Diseases 333 S. Grand Ave, 3rd Floor Lansing, Michigan 48933 DEPARTMENT REQUIREMENTS The Department will notify the Grantee by email when an applicant has paid for licensure or renewal. This will serve as the request to the Grantee to perform an inspection. The Department will issue a license to an applicant upon the recommendation of the Grantee performing the inspection. The Department will reimburse the Grantee according to this payment schedule to help offset the costs related to the licensing of the body art facility. Payments will be released quarterly based on the FSR submitted, The Department will provide a reporting template to be attached to the FSR. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MOHHS/C0-2018 ATTACHMENT III Page 12 of 210 3/14/2017 9/30/2018 Administrator Contact Info (phone & email) Reimbursement Method Performance Level • (if Applicable) Subreciplent, Contractor, or Recipient (non-federal) Designation Subrecipient 517-335-8814; siegle@michigan.gov Staffing (6) N/A N/A Ferforol:a•nce:T.a.rget i aptopt:Measued"• Gran Start Date 10/1/2017 Grant Contract E.J. Siegl BREAST AND CERVICAL CANCER CONTROL NAVIGATION PROGRAM (BCCCNP) Special Requirements 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 access to receiving breast and cervical cancer services. Program services are targeted to women in hard 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 reimbursed for uninsured and underinsured low-income women enrolled through the program that meet the following criteria: O 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/CO-2018 ATTACHMENT III Page 13 of 210 3/14/2017 The BCCCNP provides navigation services to low-income insured women, not enrolled in the program, to assist them in accessing the healthcare system so they can receive breast and/or cervical cancer screening, diagnostic, and/or treatment services through their insurance provider. For specific BCCCNP requirements, refer to the most current BCCCNP Policies and Procedures Manual (http://www.michiciancancer.orq/bcccp/). DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/CO-2018 ATTACHMENT ill Page 14 of 210 3/14/2017 Grant Start Date , I 10/1/2017 Staffing (6) I Reimbursement I Method I Performance Level N/A 1 (if Applicable) Grant Contract Administrator I• Contact Info (phone & email) Theresa Scorcia-Wilson 1 517-3M-8754; scorciawilsont@michigan.gov Grant End Date I 9/3012018 Performance .Tprgo. ! N/A Output .Measure , Subrecipient, Contractor, or I Recipient (non-federal Designation Subrecipient BUILDING HEALTHY COMMUNITIES - GETTING TO THE HEART OF THE MATTER .1 Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A 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 Building Healthy Communities (BHC) project and community settings. 5. Complete BHC 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, Submit progress and final reports according to the Department guidance. If the report due date falls on a weekend or holiday, you have until the next business day to submit, Progress Report Period Covered October 1 — December 31 January 1 — March 31 April 1 June 30 July 1 — September 30 Year End Report — Total Grant Period Report Due Dates January 30 April 30 July 30 October 30 November 15 8. Participate in grant conference calls/meetings, scheduled site visits, and training provided/supported by the Department. M DH HS/CO-2018 ATTACHMENT III Page 15 of 210 3/14/2017 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 Ml E-Grants system. 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/C0-2018 ATTACHMENT III Page 16 of 210 3/14/2017 Grant Start Date Grant Contrac Administrator 10/1/2017 Martha Stanbury nnnnnn Contact Info (phone & email) 517-284-4820; stanburym@michigan.gov Reimbursement Method Subrecipient, Contractor, or Recipient (non-federal Designation Subrecipient Staffing (6) N/A Performance Target • Output Measure N/A II CHILDHOOD LEAD POISONING EDUCATION & OUTREACH Special Requirements BUDGET AND AGREEMENT REQUIREMENTS The purpose of the project is to provide outreach and education to professionals interacting with families of children at risk of lead exposure to ensure that children are tested, elevated test results from capillary blood are confirmed with venous tests, and families and health care providers are knowledgeable about the prevention of lead exposure and elevated blood lead levels. GRANTEE REQUIREMENTS 1. Provide services described below in the Michigan "prosperity region" for which the grantee is designated. 2. Provide education, outreach, and training about blood lead testing and exposure prevention to Local Health Departments in their prosperity region and professionals that serve families of children at risk of exposure to lead, especially those living in geographical areas with a higher risk of lead exposure. Strategies, activities, and materials must address: a. Ensuring that providers include blood lead testing, as appropriate and as mandated by Medicaid policy, in patient visits; b. Ensuring that unconfirmed elevated blood lead capillary test results are followed up with confirmatory venous tests. c. Engaging parents/caregivers of children at risk for lead exposure and elevated blood lead in testing and lead exposure prevention activities. 3. Professionals, and organizations to which they belong, to target for outreach and training should include, but not be limited to: a. Agencies/organizations providing services to children, including • Great Start Collaborative partners MDHHS/C0-2018 ATTACHMENT 111 Page 17 of 210 3/14/2017 • Great Start Parent Coalition participants • Child care providers b. Agencies, organizations and professionals providing/overseeing clinical care and/or blood lead testing, including • Primary care providers • Medicaid Health Plans • WIC clinics • Local Health Department clinics 4. Distribute, through trainings and other means, educational materials that provide families and caregivers with information about lead poisoning prevention. 5. Participate in quarterly conference calls scheduled by the Department's Childhood Lead Poisoning Prevention Program. 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 Submit a work plan that identifies activities that will accomplish objectives of this project. Quarterly reports must include a description of accomplishments and challenges associated with each item in the work plan. REPORTING REQUIREMENT'S Required Reporting due 30 days after the end of each quarter and a final annual report due 90 days after the close of the fiscal year. Ftenorting Time Period Due Date October 1 — December 31 January 30 January 1 — March 31 April 30 April 1 — June 30 July 30 July 1 — Sept 30 October 30 MD HHS/C0-2018 ATTACHMENT III Page 18 of 210 3/14/2017 9/30/2018 Grant Sta Date :. 10/1/2017 N/A Performance Target' Output Measure N/A Performance Level (if Applicable) Contact Info (phone 84 email) 517-284-4820; stanburym@michigan.gov Reimbursement Method Staffing (6) Subrecipient Subrecipien Contractor, or Recipient (non-federal Designation Grant 'End Date • • Grant Contract Administrator Martha Stanbury II CHILDHOOD LEAD POISONING PREVENTION (CLPP) Special Requirements BUDGET AND AGREEMENT REQUIREMENTS Purpose: The primary purpose of this project is to conduct lead poisoning prevention interventions for children in high risk geographic areas of Michigan who have elevated blood lead levels (=>5 ug/dL) but are not eligible for services provided under the "CSHCS- Medicaid Elevated Blood Lead Nursing Case Management program" or where case management services are being provided by another agency. The second purpose of this project is to promote primary prevention of lead poisoning in high risk communities through outreach and policy development, focused on eliminating lead in homes and outdoor areas frequented by children. GRANTEE REQUIREMENTS 1) Lead poisoning prevention intervention services for children less than age 6 with elevated blood lead levels (EBL). • Services may include: o Education of the family about lead poisoning prevention provided in the child's home, in- person at another location, and/or by telephone. o Visual assessment of potential sources of lead in the child's home. o In-home nursing case management assessment and follow-up, using the Department Guidelines for Elevated Blood Lead Case Management. o Facilitation of an application to the Department Healthy Homes program to obtain an Environmental Investigation and, if appropriate, subsequent home lead abatement. o Coordination with the child's primary care provider and, where appropriate, Medicaid Health Plan to ensure the child is re-tested according to recommended schedule, including venous confirmatory re-testing of results from a capillary test. • In-home nursing case management services should not be provided under this program to children with EBL who are eligible for nursing case management services through the "CSHCS- Medicaid Elevated Blood Lead Nursing Case Management program". MDHHS/CO-2018 ATTACHMENT III Page 19 of 210 3/14/2017 • In jurisdictions where in-home nursing case management services are being provided under contract with the Department by another agency, the grantee shall not provide any services listed in this section. • In-home services shall not duplicate activities performed by Environmental Risk Assessors. • In-home services shall not include direct home mitigation activities such as cleaning, covering peeling paint etc. 2) Primary prevention activities • Activities to promote primary prevention may include, but are not limited to: o Identifying high risk areas, populations and activities associated with housing-based lead exposure, and use the data to motivate action for primary prevention. o Promoting public-private partnerships and academic and private sector collaborations to take actions to remove lead from housing stock, soil, and water. o Engaging in collaborative plans and programs with housing and related agencies. o Promoting awareness of the environmental assessment and home abatement services and resources managed by the Department's Healthy Homes program. o Working with local officials to improve housing code enforcement. o Working with local/regional members of the Rental Property Owners Association or other rental property owner professional associations to promote the benefits of lead abatement of rental properties. DEPARTMENT REQUIREMENTS Prohibited expenditures: 1. Screening or Testing for Blood Lead. 2. Services for children that are reimbursable under the "CSHCS- Medicaid Elevated Blood Lead Nursing Case Management program". 3. Case management services in a jurisdiction where another agency has been contracted by the Department to provide those services. 4. Childhood Lead Poisoning Prevention funds may not be used to fund other local public health operations. GRANTEE SPECIFIC REQUIREMENTS Grantees shall submit a work plan that identifies strategies, activities, and anticipated outcomes to accomplish project goals. Grantees should develop the work plan based on best practices. See: • "A Roadmap to Eliminating Child Lead Exposure" — a report from the Michigan Child Lead Poisoning Elimination Board; (https://www.michician.00v/documents/snvder/CLPEB Report— Final 542618 7.pdf • "Preventing Lead Exposure in Young Children: A Housing-Based Approach to Primary Prevention of Lead Poisoning" — a report from the CDC Advisory Committee on Childhood Lead Poisoning Prevention; https://www.cdc.00vinceh/lead/publications/primarvoreventiondocument.pdf • MDHHS materials posted on the CLPPP SharePoint site at https://public.mphi.oro/sites/lead/providers/Pacies/default.asox MDHHS/C0-2018 ATTACHMENT UI Page 20 of 210 3/14/2017 REPORTING REQUIREMENTS Reports are due 30 days after the end of each quarter Reporting Time Period October 1 — December 31 January 1 — March 31 April 1 — June 30 July 1 — Sept 30 Dpe Date January 30 April 30 July 31 October 31 Quarterly activity reports must include a description of accomplishments and challenges associated with each item in the work plan. All services provided to EBL children must be documented in the Department's HHLPSS database, and a spreadsheet with the name of each child who received services must be submitted quarterly to the secure the Department CLPPP FTP site .The spreadsheet should include HHLPSS ID, child name, date of activity and type of activity. MDHHS/C0-2018 ATTACHMENT III Page 21 of 210 3/14/2017 Grant Start Date Grant Contract Administrator Rebecca Start Subrecipient, Contractor, or Recipient (non-federal Designation Subrecipient Contact Info (phone & email) Reimbursement Method 517-241-7198; startr@michigan.gov Staffing (6) N/A N/A Performance Leve (if Applicable) Performance Target Output Measure CHILDREN'S SPECIAL HEALTH CARE SERVICES (CSHCS) OUTREACH AND ADVOCACY 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 M DH HS/CO-2018 ATTACHMENT I II Page 22 of 210 3/14/2017 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Program Management: Reporting Requirements The Grantee shall submit: 1. Annual Narrative Progress Report A brief annual narrative report is due by November 15 following the end of the fiscal year. The reporting period is October 1 — September 30. The annual report will be submitted to the Department and shall include: a. Summary of CSHCS successes and challenges b. Technical assistance needs the Grantee is requesting the Department to address c. Brief description of how any local MCH funds allocated to CSHCS were used (e.g. CSHCS salaries, outreach materials, mailing costs, etc.), if applicable d. The duplicated number of clients referred for diagnostic evaluations e. The unduplicated number of CSHCS eligible clients assisted with CSHCS enrollment f. The unduplicated number of CSHCS clients in the CSHCS renewal process. Duplicated Number of Clients Referred for Diagnostic Evaluation is defined as: Number of individuals the Grantee referred for and/or assisted in obtaining a diagnostic evaluations during the fiscal year. Those eligible for this service must have symptoms and medical history indicating the information. Individuals currently enrolled in a commercial Health Maintenance Organization (HMO), Medicaid Health Plan (MHP) or with other commercial insurance coverage must seek an evaluation by an appropriate physician sub- specialist through their respective health insurer. A diagnostic may be issued for insured persons to cover the cost of the evaluation that is by policy not covered by the health insurance (e.g. co-pay, deductible). Unduplicated Number of CSHCS Eligible Clients Assisted with CSHCS Enrollment is defined as: Number of CSHCS eligible clients the Grantee assisted in the CSHCS enrollment process during the fiscal year. This assistance includes but is not limited to helping the family obtain necessary medical reports to determine clinical eligibility, completing the CSHCS Application for Services, completing the CSHCS financial assessment forms, etc. "Assisted" refers to help provided either over the telephone or in person with the client. Unduplicated Number of CSHCS Clients Assisted in the CSHCS Renewal Process is defined as: Number of CSHCS enrollees the Grantee assisted in the completion and/or submission of the documents required for the Department to make a determination whether to continue/renew CSHCS coverage during the fiscal year. "Assisted" refers to help provided either over the telephone or in person with the client. MDHHS/CO-2018 ATTACHMENT III Page 23 of 210 3/14/2017 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. Quarter Reporting Time Period Quarterly...Logs Due Date 1 8t October 1 — December 31 January 30 2nd January 1— March 31 April 30 3rd April 1 — June 30 July 30 4th July 1 — September 30 October 30 Unless otherwise stated, all reports and information shall be submitted electronically via the secure electronic method of communication for sharing of 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 management and care coordination log audits on a quarterly basis. MDHHS/C0-2018 ATTACHMENT III Page 24 of 210 3/14/2017 10/1/2017 Lorraine L. Cameron Grant Contract Administrator I 517-284-4795; cameronL@michigan.gov Subrecipierd, Subrecipient Contractor, or Recipient (non-federal) Designation Performance Target Output Measure I N/A N/A CLIMATE HEALTH ADAPTATION Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS The Grantee will collaborate with the Department's Michigan Climate and Health Adaptation Program and partners to develop and conduct a needs assessment of Detroit communities which have been impacted by repeated flooding. The purpose of the needs assessment is to document the scope and nature of adverse health impacts in these communities, and to record local knowledge, needs and suggested remedies from these impacted citizens. This information is expected to be used to inform activities by the city and others to respond to this ongoing issue, and more generally, to build capacity for the Grantee to adapt to climate related health risks in the city. The following activities are required: 1, Develop a cross-sector working group led by the Grantee to leverage resources and information relevant to this issue. 2. Collaborate/engage with the working group and other partners to identify impacted communities to be targeted, and develop an advisory group to provide input into the project. The advisory group will include representatives from the impacted communities. 3. Develop needs assessment methodology with partners, and with technical assistance from the Department as stated below. 4. Engage members of the impacted communities in the needs assessment by recruiting interviewers from the communities and in other ways. 5. Field the needs assessment and collect the information, compile and analyze. 6. Summarize results and provide for review/feedback from advisory group/communities, and cross-sector working group. 7. Write final report incorporating feedback and recommendations. ATTACHMENT Itl Page 25 of 210 MDHHS/CO-2018 3/14/2017 DEPARTMENT REQUIREMENTS 1. The Departments - Michigan Climate and Health Adaptation Program (MICHAP) will provide technical assistance as needed, including reviews of methodology and data collection tools and quality assurance. 2. MICHAP will conduct at least one site visit to observe project activities and progress towards goals. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS A final report is required at the end of the project, to include a description of the needs assessment methodology, its results and conclusions/recommended next steps. MDHHS/C0-2018 ATTACHMENT III Page 26 of 210 3/14/2017 Performance Level (if Applicable) N/A N/A Grant Start Date Grant Contract Administrator Contact Info (phone & email) 10/1/2017 Patricia K. Smith Performance Target Output Measure Grant End Date 9/30/2018 517-335-9703; smithp40@michigan.gov Reimbursement Method Staffing (6) • Subrecipient, Contractor, or Recipient (non-federal) Designation Subrecipient II COMMUNITIES UNITING FOR SUICIDE PREVENTION (CUSP) Special Requirements 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 three, the grantee will 1. Continue to implement the plan of activities identified through the needs assessment. 2. Conduct a comprehensive community suicide prevention programs in two high-risk Marquette County communities with school-based health clinics, Gwinn and Ishpeming. 3. Continue the development and implementation of a seamless system of care for Marquette County youth and young adults identified at risk of suicide and those otherwise impacted by 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 outpatient primary care clinics. 5. Continue expansion of Dial Help's Suicide Risk Follow-Up Program to all 15 Upper Peninsula counties. 6. Continue implementation of Dial Help's Bereavement Support Follow-up Program for all 15 UP counties. 7. Conduct Applied Suicide Intervention Skills (AS1ST) trainings as needed. 8. Continue introduction of a youth focused suicide prevention app to youth and young adults in the Communities That Care catchment areas. 9. Begin or enhance suicide prevention work in 10 Communities That Care across the U.P. 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. MEM HS/CO-2018 ATTACHMENT III Page 27 of 210 3/14/2017 11. Continue expansion of the Marquette County Suicide Prevention Coalition membership. 12. Send at least one representative to 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-M12) 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 smitha40michioan.gov. The reports are due no later than 15 days after the end of each quarter. MDH HS/CO-2018 ATTACHMENT III Page 28 of 210 3/14/2017 Grant Start Date 10/1/2017 Grant Contract Administrator Contact Info (phone & email) Reimbursement Staffing (6) Method Polly Hager 517-335-9729; hagerp@michigan.gov Contractor, or Recipient (non-federa Designation Subrecipient, Subrecipient COMPREHENSIVE CANCER CONTROL (CCC) COMMUNITY IMPLEMENTATION PROJECT Special Requirements Performance Level N/A (if Applicable) Performance Target , N/A • Output Measure • • 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 and preferable two evidence-based strategies from the Cancer Plan for Michigan and/or the Community Guide. 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 NU58DP003921 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention." 3. Institutional Review Board approval must be considered for focus groups, surveys and other similar activities, This should be factored into the project timeline and the Department should be involved and kept apprised. DEPARTMENT REQUIREMENTS N/A MDH HS/CO-2018 ATTACHMENT Ill Page 29 of 210 3/14/2017 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Quarterly Progress Reports and one Final Report of Results and Program Issues, including the following information: Quarter is' 2ncl 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: Sandie Carmer, Section Secretary Cancer Prevention & Control Section P.O. Box 30195 Lansing, MI 48909 Phone: 517-335-8493 E-mail: carmersmichigan.cov MDHHS/C0-2018 ATTACHMENT I;1 Page 30 of 210 3/14/2017 Grant Start Date Grant Contract Administrator Martha Stanbury Contact Info (phone & email) 1 517-284-4820; stanburym@michigan.gov Fixed Unit Rate (2) Subrecipient, Contractor, or Recipient (non-federal Designation Subrecipient 1011/2017 CSHCS - MEDICAID ELEVATED BLOOD LEAD - CASE MANAGEMENT dal Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS All Local Health Departments in Michigan are eligible to participate in this program. The grantee will complete in-home elevated blood lead (EBL) case management (CM) services, with parental consent, for all children less than age 6 in their jurisdiction enrolled in Medicaid with a blood lead level equal to or greater than 5 micrograms per deciliter (=>5 pg/dL) as determined by a venipuncture test. EBL CM will be conducted according to the "Case Management Guide for Children with Elevated Blood Lead Levels" that is provided by the Department's Childhood Lead Poisoning Prevention Program (CLPPP). For each child eligible for EBL CM, efforts to contact the family to provide CM services and specific services provided must be documented in the child's electronic record in the Healthy Homes and Lead Poisoning Prevention (HHLPPS) database maintained by CLPPP-MDHHS. Enabling authority for this project is in the Department's Medicaid State Plan page 478 section A.1. MDH HS/CO-2018 ATTACHMENTlIl Page 31 of 210 3/14/2017 DEPARTMENT REQUIREMENTS CLPPP-MDHHS shall provide the Grantee with 1. Weekly list of children in their jurisdiction with a laboratory report received in the prior week and a faxed report for children with blood lead levels =>20 ug/dIthe day the report is received at MDHHS. 2. Written Case Management protocol. 3. Instructions for billing and documentation of services for participation in this project. 4. Spreadsheet template for log of CM activities. 5. Access to HHLPPS database. 6. Access to the CLPPP FTP site for secure file transfer. 7. Training in the basics of lead exposure and poisoning, conduct of CM, use of the HHLPPS database, and use of FTP site for transmission of confidential information. 8. On-going technical support and consultations from an MDHHS CLPPP nurse. GRANTEE SPECIFIC REQUIREMENTS The Grantee shall: 1. Have home case management conducted by a registered nurse trained by the Department's CLPPP. Training addresses general principals of lead poisoning and lead poisoning prevention, the Case Management protocol and the use of the HHLPPS database. 2. Sign up for the secure FTP site maintained by the Department's CLPPP, to be used for data sharing of confidential information. 3. Have an agreement with all Medicaid Health Plans in their jurisdiction that allows for sharing of Personal Health Information regarding the Plan's children with EBLLs. 4. Identify and Initiate contact with families of all Medicaid venous-confirmed EBLL children from the lists provided by the Department's CLPPP to the grantee. 5. Complete case management activities according to requirements in the Department's CLPPP Case Management Guide. 6. Document all case management activities in the child's electronic file in the HHLPPS database. 7. Provide quarterly summaries of case management activities for all eligible EBLL children using a spreadsheet template provided by the Department's CLPPP. 8. Submit request for reimbursement through the EGrAMS system based on the "fixed unit rate" method. The fixed rate for case management services is $201.58 per home visit, for up to 6 home visits. 9. Grantee maximum reimbursement: Allegan County Health Department 4,838 Barry-Eaton District Health Department $ 24,190 Bay County Health Department $ 21,771 Benzie-Leelanau District Health Department $ 2,419 Berrien County Health Department $ 30,237 Branch-Hillsdale-St. Joseph Community $ 14,514 Health Agency Calhoun County Health Department $ 62,893 Central Michigan District Health Department $ 4,838 Chippewa County Health Department 2,419 Detroit Health Department $ 1,423,558 MDH HS/CO-2018 ATTACHMENT III Page 32 of 210 3/14/2017 Dicidnson-lron District Health Department $ 2,419 District Health Department 10 $ 15,723 District Health Department 2 $ 2,419 District Health Department 4 $ 2,419 Grand Traverse County Health Department $ 8,466 Health Department of Northwest Michigan $ 2,419 Huron County Health Department $ 2,419 Ingham County Health Department $ 62,893 Jackson County Health Department $ 45,960 Kalamazoo County Health Department $ 33,865 Kent County Health Department $ 152,394 Lapeer County Health Department $ 2,419 Lenawee County Health Department $ 25,399 Livingston County Health Department $ 2,419 Macomb County Health Department $ 26,609 Marquette County Health Department $ 6,047 Midland County Health Department $ 3,628 Mid-Michigan District Health Department $ 2,419 Monroe County Health Department $ 3,628 Muskegon County Health Department $ 64,102 Oakland County Health Department $ 71,359 Ottawa County Health Department $ 8,466 Public Health Delta & Menomenee Counties $ 10,885 Saginaw County Health Department $ 21,771 Sanilac County Health Department $ 2,419 Shiawassee County Health Department $ 7,257 St. Claire County Health Department $ 13,304 Tuscola County Health Department $ 4,838 Van Buren-Cass District Health Department $ 14,514 Washtenaw County Health Department $ 18,142 Wayne County Health Department $ 183,841 Western Upper Penninsula District Health Department $ 18,142 REPORTING REQUIREMENTS The Grantee shall submit: 1. Annual Narrative Progress Report A brief annual narrative report is due by November 15 following the end of the fiscal year. The reporting period for FY18 is October 1 - September 30. The annual report shall include: a. Number of children eligible for EBL CM. b. Number of children provided CM. c. Summary of reasons why eligible but unserved children were not served. d. Summary of EBL CM successes and challenges. e. Technical assistance needs the Grantee is requesting the Department to address. f. Recommendations for changes in the program. MDHHS/C0-2018 ATTACHMENT III Page 33 of 210 3/14/2017 2. Quarterly Case Management (CM) Logs A log of CM activities for is due quarterly, submitted electronically through the CLPPP's secure File Transfer Site, using a spreadsheet template provided by CLPPP that specifies the information to be provided on each child for which reimbursement is being requested on the quarterly Supplemental Attachment to the CPBC FSR. The quarterly logs will be submitted no later than thirty (30) days after the close of the quarter. Quarter Reoortina Time Period Quarterly LOQS Due Date 1st October 1 — December 31 January 31 2nd January 1— March 31 April 30 3rd April 1 — June 30 July 30 4th July 1 — September 30 October 30 The CLPPP EBL CM Project Manager will review the logs for their completeness and adequacy and provide approval for payment within 30 days of receipt. CLPPP Statewide Medicaid EBL CM Project Manager: Angela Medina Childhood Lead Poisoning Prevention Program Division of Environmental Health, MDHHS MDHHS/CO-2018 ATTACHMENT III Page 34 of 210 3/14/2017 Grant Start Da Grant Contract Administrator I Contact Info (phone & email) 10/1/2017 Rebecca Start 517-241-7198; startr@michigan.gov 1i Reimbursement Method Performance Level (if Applicable) Staffing (6) N/A Subrecipient, Contractor, or Recipient (non-federal Designation Subrecipient Performance Target II CSHCS MEDICAID OUTREACH 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/C0-2018 ATTACHMENT 111 Page 35 of 210 3/14/2017 Grant Start Date 10/1/2017 Grant End Date I 9/30/2018 Grant Contract Administrator Contact Info (phone & email) Jennifer Gray 517-281-3483; grayj@michigan,gov Performance Target Output Measure N/A Performance Leve (if Applicable) N/A Subrecipient, Contractor, or I Recipient (non-federal) Designation Subrecipient Reimbursement Method Staffing (6) II EAT SAFE FISH Special Requirements BUDGET AND AGREEMENT REQUIREMENTS The Grantee will collaborate with the Department and the EPA Region V Saginaw Community Information Office to deliver a uniform message for the Saginaw River and connected waters regarding the fish and wild game consumption advisories within the tri-county area (Midland, Saginaw, and Bay), Bay County Health Department (BCHD) will develop a plan to distribute that message using existing health department programs, the medical community, special events, and community service providers to communicate with the at-risk population. BCHD will get approval from the Department program manager and for any changes to the Saginaw and Bay County Cooperative Agreement Scope of Work including budget and budget narratives. GRANTEE REQUIREMENTS The Grantee will provide appropriate staff to fulfill the following objectives and outputs as detailed: 1. Comply with the Saginaw and Bay County Cooperative Agreement budget and budget narratives as describe in the scopes of work provided to the BCHD program manager as applicable from October 1 to September 30, 2. Provide 30 hours of health education and community outreach per week. a. Conduct health education and community outreach in Saginaw, Midland, and Bay Counties. Activities will include, but not be limited to, internal BCHD distribution, health care provider outreach, and key event participation. b. Track hours to comply with cost recovery requirements. 3. Development, Printing, and Distribution of Outreach Materials and implementation of Display Booth. a. Identify, track, and record of materials distributed at additional locations within Midland, Bay, and Saginaw Counties. b. Make payment for the replacement of signage on the Tittabawasse and Saginaw Rivers. MDHHS/CO-2018 ATTACHMENT 111 Page 36 of 210 3/14/2017 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 MOHHS/C0-2018 ATTACHMENT III Page 37 of 210 3/14/2017 Grant Start Date 11011/2017 N/A :Performance Target :Output Measure' N/A Performance Level (if Applicable) MI Department of Health and Human Services (MDHHS) Vision Program Contact Info (phone & email) 517-335-6596 schumannr@michigartgov Subrecipient, Contractor, or Recipient (non- federal) Recipient i Designation MI Department of Health and Human Services (MDHHS) ELPHS Other Grant Contract Administrator Orlando Todd j Contact Info (phone & email) 517-284-4021 toddo@michigart.gov Reimbursement Method Performance Level N/A (if Applicable) Subrecipient, Contractor, or Recipient (non- federal) Designation Performance large N/A Output Measure Staffing (6) Recipient MI Department of Health and Human Services (MDHHS) HIV & STD Testing and Prevention (DHIV-ELPHS) Grant Contract I Administrator Contact Info (phone & email) 517-241-5861 linzmeierj@michigan.gov Staffing (6) Recipient Reimbursement Method Subrecipient, Contractor, or Recipient (non- federal) Designation M DH HS/C0-2018 ATTACHMENT III Page 38 of 21.0 3/14/2017 Jennifer Linzmeier Grant Contract Administrator Rachel Schumann Reimbursement Method Staffing (6) Grant End Date 9/30/2018 II ESSENTIAL LOCAL PUBLIC HEALTH SERVICES (ELPHS) Special Requirements 517-284-5706 christensona@miohigan.gov Grant Contract Administrator -- -- Reimbursement Method Recipient Subrecipient, Contractor, or Recipient (non- federal) Designation Staffing (6) Reimbursement Method Performance Level N/A (if Applicable) Performance Targe N/A Output Measure MI Department of Agriculture and Rural Development (MDARD) Food % of Food Service Licensees received required inspections MI Department of Agriculture and Rural Development (MDARD) Food and Water Lead Safety Inspections • •PerfOrrnanCe Target 1-Output Measure 1 ...: .. • Ml Department of Environmental Quality (MDEQ) Private & Type III Water Supply On-site Wastewater Treatment N/A Grant Contract Administrator Dana DeBruyn 517-930-6463 debruynd@michigan.gov Subrecipient, Contractor, or Recipient (non- federal) Designation Recipient Performance Target I N/A Output Measure MDH HS/CO-2018 ATTACHMENT ;II Page 39 of 210 3/14/2017 Subrecipient, Contractor, or Recipient (non- federal) Designation Recipient N/A BUDGET AND AGREEMENT REQUIREMENTS 1. State funding for ELPHS shall support and the Grantee shall provide for all of the following required services in accordance with P.A. 368, of 1978 and P.A. 92 of 2000, as amended, Part 24 and Act No. 336, of 1998 Section 909: Infectious/Communicable Disease Control Sexually Transmitted Disease Immunization On-Site Wastewater Treatment Management Drinking Water Supply Food Service Sanitation Hearing Vision State funding for ELPHS can support administrative cost for the eight required services including allowable indirect cost, or a Grantee's cost allocation plan. 2. ELPHS funding can also be used to fund other core health functions including: Community Health Assessment & Improvement, Public Policy Development, Health Services Administration, Quality Assurance, Creating & Maintaining a Competent Work Force and Local Public Health Accreditation. These services may be budgeted separately as part of the Administrative Budget element. 3. Net allowable expenditures are the authorized actual/allowable expenditures (total costs less specified exclusions). Available funding is also limited by state appropriations. 4. First and second party fees earned in each required service program may be used only in that required service program. 5. State ELPHS funding is subject to local maintenance of effort compliance. Distribution of state ELPHS funds shall only be made to agencies with total local general fund public health services spending in FY 16/17 of at least the amount expended in FY 92/93. To be eligible for any of the State funding increases from FY 94/95 through FY 17/18, the FY 92/93 Local Maintenance of Effort Level must be met. 6. A final statewide cost settlement will be performed to assure that all available ELPHS funds are fully distributed and applied for required services. GRANTEE REQUIREMENTS 1. Assure the availability and accessibility of services for the following basic health services: Prenatal Care; Immunizations; Communicable Disease Control; 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 process and schedule established by the Department for the required services to achieve full accreditation status, Grantees designated as "not accredited" may have their Department allocations reduced for Departmental costs incurred in the assurance of service delivery. The accreditation process is based upon the Minimum Program Standards and scheduled on a three-year cycle. The Minimum Program Standards include the majority of the required Department reviews. Some additional reviews, as mandated by the funding agency, may not be included in the Program Standards and may need to be scheduled at other times. MDHHS/C0-2018 ATTACHMENT UI Page 40 of 210 3/14/2017 DEPARTMENT REQUIREMENTS Whenever the Department delivers direct services within the Grantee's area, it shall give prior notification and provide summary reports of those activities upon the request of the Grantee health officer. GRANTEE SPECIFIC REQUIREMENTS Grantee Specific Re_auirements — HIV & STD Testina and Prevention 1. 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. Grantees should adhere to: a. All federal and Michigan laws pertaining to HIV/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. 2. 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. 3. Implement program standards and practices to ensure the delivery of culturally, linguistically, and developmentally appropriate services. Standards and practices must address sexual minorities. 4. Participate in technical assistance/capacity development, quality assurance, and program evaluation activities as directed by Division of HIV and STD Programs/Sexually Transmitted Disease Program (DHSP/STD). 5. 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 (MOUs) or letters of agreement related to the services in this agreement, d. If the subcontractor conducts HIV testing using rapid HIV testing, the Grantee will assure compliance with guidelines and standards issued by the Department and: i) 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: the Department's Quality Assurance for Rapid HIV Testing. ii) Ensure provision of current Clinical Laboratory Improvement Amendments (CLIA) certificate. iii) Report discordant test results to the Division of HIV and STD Programs, iv) Submit quality control, daily client logs, and test inventory on a monthly basis to Department staff. This information may be emailed to ctrsupolies@michidan.gov , faxed to MDHHS/C0-2018 ATTACHMENT III Page 41 of 210 3/14/2017 517-241-5922, or mailed via US Postal Service to: HIV Prevention Unit, 109W. Michigan Ave., 10th Floor, Lansing, MI 48913, ATTN: CTR Coordinator. v) 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 annual proficiency testing. vi) Ensure that all staff and site supervisors have completed, successfully, appropriate laboratory quality assurance training, blood borne pathogens training and rapid test device training and reviewed annually. vii) Develop, implement, and monitor protocol and procedures to ensure that patients receive confirmatory test results. 6. The Grantee and its subcontractors are required to use Evaluation Web (EvalWeb) to enter HIV client and service data into the centrally managed database on a secure server. 7. The Grantee will receive a condom and lubrication allowance. The Grantee must: a. Distribute condoms and lubrication b. Place orders for condoms/lubrication c. Order condoms/lubrication by emailing ctrsupplies@nnichigan.gov d. Report its condom distribution monthly using EvalWeb. 8. The Grantee will have 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 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. 9. 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. d. This information should be emailed to MDHHS-HIVSTDoperations@michigan.gov . 10. 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. Materials may be emailed to MDHHS-HIVSTDoperations@michigan.gov . 11. The Grantee will maintain, for a minimum of five (5) years after the end of the grant period, program, fiscal records, including documentation to support program activities and expenditures, under the terms of this agreement, for clients residing in the State of Michigan. Please refer to Michigan's Record Retention policies (htto://www.michigan.gov/documents/hal mhc rms local qs7 106287 7.pdf) for further details. MDHHS/CO-2018 ATTACHMENT III Page 42 of 210 3/14/2017 12. The Grantee will participate in monitoring site visits including review of fiscal and programmatic compliance with Department policies and contract requirements. 13. The Grantee will participate in the Department needs assessment and planning activities, as requested. 14. The Grantee will participate in regular Grantee meetings which may be: face-to-face, teleconferences, webinars, etc. The Grantee is highly encouraged to participate in other training offerings and information-sharing opportunities provided by the Department. 15. The Grantee must use the Department's standardized Technical Assistance (TA) Request Form when requesting TA. See Department website (http://www.michioan.00v/hivstd) to download the form. Department Requirements 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. The Department's standardized Technical Assistance (TA) Request Form is available online at httb://wvvw.michigan.gov/hivstd. 3. The Department will provide Grantees with a condom and lubrication allowance. The Department will: a. Notify the Grantee of its condom/lubrication allowance on or before January 1. b. Place all Grantees' condom/lubrication orders with the condom vendor between January and September 10 (the Grantee should email ctrsupolies(michigan.org to order condoms). c. Track the Grantees' orders. 4. The Department will monitor Grantee performance throughout the contract year, which may include a review of financial status reports (FSRs), EvalWeb data entries, quarterly progress reports, and site visits. For site visits: a. Monitoring will include a review of fiscal, program, administrative, quality assurance, and client 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. 5. The Department will review quarterly reports. Questions or clarifications, if any, will be requested within 30 calendar days of submission due date. 6. The Department will review EvalWeb data, on a quarterly basis, at minimum. Questions or clarifications, if any, will be requested within thirty (30) calendar days of submission due date, Reporting Requirements 1. The Grantee will adhere to reporting deadlines update progress toward the following: MDHHS/C0-2018 ATTACHMENT III Page 43 of 210 3/14/2017 Program Obiectives: 1. By April 30, complete a 3-year strategic planning process with community partners, to develop program focus areas and activities. 2. By April 30, review and update health threat to others (HTTO) policy and procedures, in conjunction with the Department's STD Program/DIS staff. 3. By September 30, provide at least six (6) community outreach forums to focus populations. 4. By September 30, develop and update the STD/HIV Prevention web page to include a section for consumers, and a section for health care providers. 5. By September 30, distribute $5,000 worth of condoms, lube, dental dams, and display equipment/materials. 6. By September 30, develop and begin distribution of PrEP advertising/marketing. Sub-Recipient Objectives: 1. By October 1, have sub-recipient contracts complete and active for fulfillment. 2. Henry Ford Health Systems STD Testing a. By September 30, provide STD education and testing for students at three (3) or more high schools located in Detroit. I. Report positive cases in Michigan disease surveillance system (MDSS) to include known information about the individual, specifically: demographics, site of specimen (urine), treatment, any known case management information, and co-infection when applicable, ii. Provide treatment for positives within one week of test for all students available for follow-up, and documentation of efforts for any that are lost to follow-up in MDSS. b. Provide monthly reports to the Detroit Health Department within ten (10) days into the following month, documenting: i. The number of tests performed, ii. The number of positive cases treated, The number of education activities completed, and iv. Narrative of successes/challenges or other relevant issues pertinent to the purpose of this funding. 3. Wayne State University School of Medicine Routine ER HIV Testing a. By December 31, finalize policies and procedures (including linkage for positives) for routine HIV testing in St. John Hospital and Medical Center's emergency room. b. Link 100% of newly and previously diagnosed persons with HIV to care within 30 days. c. Refer persons with HIV negative results, who are at increased risk for exposure to HIV, to STD screening/treatment, PrEP and other prevention services. d. By July 30, 2018, WSUSOM/St. John will have analyzed outcomes to determine successes/challenges and the feasibility/value of continuing the program over time. e. By September 1, 2018, based on item "c." above, WSUSOM/St. John will submit a sustainability plan to phase out of support from the Detroit Health Department based on known funding availability for FY2019 and estimated amounts for FY2020. f. Provide monthly reports to the Detroit Health Department within ten (10) days into the following month, documenting: i. The number of tests performed, The number of positives linked to care, iii. The number referred to prevention services, iv. Narrative of successes/challenges or other relevant issues pertinent to the purpose of this funding. MDHHS/C0-2018 ATTACHMENT III Page 44 of 210 3/14/2017 4. UNIFIED HIV Testing in DHealth Pop-Ups and Community a. Link 100% of newly and previously diagnosed persons with HIV to care within 30 days. b. Refer persons with HIV negative results, who are at increased risk for exposure to HIV, to STD screening/treatment, PrEP and other prevention services. 5. The Grantee and sub-recipients will enter condom distribution data in EvalWeb by the 10th day after the end of each calendar month. Grantee Specific Reauirements — Food Service Sanitation Budaet 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 licenses to the Grantee for each licensing year (May 1 through April 30) using previous year active license data. 2. Provide a count of all licenses sent to the Grantee titled "Record of Licenses Received." 3, Reprint any licenses requiring correction and send corrected copies to the Grantee. 4. Bill the local health department for state fees upon notification by Grantee that the license has been approved and issued. Temporary Food Service Establishment Licensing Furnish blank temporary food service license application forms (forms Fl-231, Fl-231A) and blank Combined License/Inspection forms (Fl-229) upon request from the local health department. a. Furnish a "Record of Licenses Received" with each order of Combined Licenses/Inspection forms. b. Periodically reconcile temporary food service establishment licenses sent to the Grantee with the licenses that have been issued (copy returned to MDARD). c. Bill the local health department for state fees upon notification by the Grantee that the license has been approved and issued. Grantee Specific Reauirements The Grantee agrees to: Food Service Establishment Licensing 1. Accept responsibility for all licenses specified in the "Record of Licenses Received." 2. Issue licenses in accordance with the Michigan Food Law 2000, as amended. 3. Provide updates to MDARD on the 1 st and 15th of each month, as necessary to: a. Provide a list of food service establishments approved for licensure/license issued. b. Provide a list of food service establishment licenses that have not been approved for licensure and are considered voided or deleted. c. Return the actual licenses to MDARD that are to be voided or deleted. d. Return renewal license applications and licenses that require correction. Mark the corrections on the renewal application. MDHHS/C0-2018 ATTACHMENT III Page 45 of 210 3/14/2017 Temporary Food Establishment Licensing 1. Upon receipt, sign and return the "Record of Licenses Received" to MDARD. 2, Issue licenses in accordance with the Michigan Food Law 2000, as amended. 3. Make every effort to issue temporary food establishment licenses in numerical order. 4. Provide updates to MDARD on the 1 st and 15th of each month, as necessary, to provide: a. A copy of each temporary food establishment license issued. b. A list of lost or voided licenses by license number. Grantee Specific Reauirements— Private and Tyne UI Drinkina Water Supply Requirements The Grantee shall perform the following services including but not limited to: 1. Perform water well permitting activities, pre-drilling site reviews, random construction inspections, and water supply system inspections for code compliance purposes with qualified individuals classified as sanitarians or equivalent. 2. Assign one individual to be responsible for quarterly reporting of the data and to coordinate communication with the assigned State staff. Reports shall be submitted no later than fifteen (16) days following the end of the quarter on forms provided by the State. The report form EQP 2057(8/2014) is available on the MDEQ website, All quarterly reports are submitted directly to the MDEQ address noted on the form. 3. Perform Minimum Program Requirements (MPRs) activities and associated performance indicators. These are available on the MDEQ website. Guidance regarding the MPRs and indicators in available in the "Local Health Department Guidance Manual for the Private and Type Ill Drinking Water Supply Program." The guidance manual is available online at www.michigan.00v/waterwellconstruction Grantee Specific Reauirements — Private On-Site Wastewater Treatment Management Program Reauirements The Grantee shall perform the following services for private single- and two-family homes and other establishments that generate less than 10,000 gallons per day of sanitary sewage: 1. Maintain an up-to-date regulation for on-site wastewater treatment systems (Systems). The regulation shall be supplemented by established internal policies and procedures. Technical guidance for staff that defines site suitability requirements, the basis for permit approval and/or denial, and issues not specifically addressed by the regulation shall be provided. 2. Evaluate all parcels to determine the suitability of the site for the installation of initial and replacement Systems in accordance with applicable regulation(s). These evaluations shall be conducted by a trained sanitarian or equivalent and shall consist of a review of the permit application for the installation of a System and a physical evaluation of the site to determine suitability. 3. Accurately record on the permit to install the initial or replacement System or on an attachment to the permit the site conditions for each parcel evaluated including soil profile data, seasonal high water table, topography, isolation distances, and the available area and location for initial and replacement Systems. The requirement for identifying a replacement System applies to issuance of new construction permits only, MDHHS/C0-2018 ATTACHMENT 111 Page 46 of 210 3/14/2017 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 also land divisions under one acre in size for site suitability according to the statutes and Administrative Rules of the Michigan Department of Environmental Quality (MDEQ). 9. Utilize the State's "Michigan Criteria for Subsurface Sewage Disposal" (Criteria) for Systems other than private single- and two-family homes that generate less than 10,000 gallons per day. Systems treating less than 1,000 gallons per day may be approved in accordance with the Grantee's regulation. Advise the State prior to issuance of a variance from the Criteria. Variances are only to be issued by the Director of Environmental Health of the Grantee after consultation with the State. Appeals of any decision of the Grantee pursuant to the Criteria including systems treating less than 1,000 gallons evaluated in accordance with the Grantee's regulation shall only be made to the State. 10. Maintain quarterly reports that summarize the total number of parcels evaluated, permits issued, alternative or engineered plans reviewed, and number of appeals, number of inspections during construction, number of failed systems evaluated, and number of sewage complaints received and investigated. The report form EQP 2067a 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. M DH HS/CO-2018 ATTACHMENT III Page 47 of 210 3/14/2017 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 & Vision Services as outlined in the Michigan Local Public Health Accreditation Program 2018 MPR Indicator Guide. Work Plan Requirements: 1. Upon initiation of the FY18 Agreement, Grantees must submit a School Based Hearing and Vision Screening work plan to MDCHHearinaVisionmichigan.gov The work plan must include: a. Outcome Objectives-a goal of program improvement (%) for screening services and follow-up b. The 6 pre-populated Activities as well as a minimum of 2 additional Activities, with corresponding comments describing how the activity was/is/will be accomplished by the school based Hearing Screening Program. c. The 6 pre-populated Activities as well as a minimum of 2 additional Activities, with corresponding comments describing how the activity was/is/will be accomplished by the school based Vision Screening Program. 2. Work plans must be approved by the Department Hearing & Vision Coordinator for their respective program. 3. Changes to the work plan throughout the year can occur with prior approval from the Department Hearing and Vision State Coordinators. Reporting Requirements: 1. All activities, as specified in the final approved work plan, shall be implemented and a six month and final narrative report submitted by the grantee to the Department. The reports are due 30 days after the six month and year end, and include the following timeframes: a. Initial Work Plan is dues August 1 b. Six month report, covering the reporting period of October 1 — March 31, is due April 30m. c. Final year-end report, covering the reporting period of April 1-September 30, is due October 301h. 2. The Department will provide specific instructions and a template for reporting on the work plan objectives and activities. 3. The Department staff shall evaluate the reports for their completeness and adequacy. MDHHS/C0-2018 ATTACHMENT Ill Page 48 of 210 3/14/2017 Grantee Specific Requirements - Food and Water Lead Safety Inspections Purpose Grantee activities funded by the Department are: $150,000 GF/GP for increased funding to Genesee County Health Department Food Safety Division for inspections of food service establishments for water sampling and safety, including restaurants, schools, hospitals, etc. The purpose is to assure safe water is being used in Flint food service establishments throughout the City of Flint, with special attention to areas identified with a medium to high lead in water risk. Continued funding is contingent 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 Environmental Health Director, Food Program Supervisor and one additional food safety Field Inspector. 2. Continue to conduct increased numbers of inspections, compliance assistance visits, water sampling and enforcement, as needed to assure Flint food service establishments are providing safe water to customers per Michigan Department of Agriculture and Rural Development (MDARD) requirements document date 1/13/16, or any subsequent updates. 3. Proactively provide information and respond to inquiries from public regarding the safety of the water in Flint food service establishments. 4. Train professional staff, as needed, in general food safety and in the specifics of addressing Flint lead in water compliance assistance for food service establishments. 5. Coordinate with MDARD and Michigan Department of Environmental Quality to assure seamless coordination of ongoing response and recovery efforts for both MDARD retail and food processing establishments and local health inspected food service establishments. 6. Required reporting due 30 days after the end of each six months: Reporting Time Period Due Date 10/1-3131 5/1 4/1-9/30 11/1 Reports shall include number of inspections, compliance visits, samples collected and field and administrative hours spent. 7. Prohibited expenditures a. These funds may not be used to fund other local public health operations. REPORTING REQUIREMENTS N/A MDHHS/CO-2018 ATTACHMENT III Page 49 of 210 3/14/2017 Grant Start Date Grant Contract Administrator t 10/1/2017 Steve Utter 517-241-0114; utters@michigan.gov 95% # Unduplicated Clinic Users Served FAMILY PLANNING SERVICES - PREGNANCY PREVENTION Special Requirements Subrecipient Subrecipient, Contractor, or Recipient (non-federal Designation BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS All Grantees must follow the program assurances and requirements, as prescribed below: Program Specific Assurances and Requirements 1. Grantee must serve a minimum of 95% of proposed Title X users to access its total amount of allocated funds. Semi-annual Family Planning Annual Reports (FPAR) data will be used to determine total Title X users. 2. Grantee will be required to adhere to Federal Statue and Regulations for Title X Family Planning Programs, including legislative mandates. 3. Grantee will be required to adhere to Michigan's Title X Family Planning Program 2017-2018 Standards and Guidelines Manual (http://www.michioan.00v/documents/mdhhs/StandardsandGuidelines2017FlNAL 549 238 7.pdf). 4. Grantee will be required to participate in program planning and evaluation, including the completion of a Family Planning Annual Plan, consisting of a needs assessment, health care plan, and work plan as detailed in the 2017-2018 Standards and Guidelines Manual. 5. Grantee will provide family planning clients (including adolescents) with a broad range of effective Food and Drug Administration approved family planning methods and services, including natural family planning methods, and temporary and permanent contraception either on-site or by referral. 6. Grantee will provide family planning services on a voluntary basis, without coercion to accept services or any particular method of family planning, and without making acceptance of services a prerequisite to eligibility for any other service or assistance in another program. MDHHS/CO-2018 ATTACHMENT LII Page 50 of 210 3/14/2017 7. Grantee will provide confidential family planning and related preventive health services to adolescents, written consent of parents or guardians for the provision of services to minors will not be required, and observe all state laws regarding mandated reporting. 8, Grantee will provide family planning services in a manner which protects the dignity of the individual. 9. Grantee will provide family planning services without regard to religion, race, color, national origin, creed, handicap, sex, number of pregnancies, marital status, age, sexual orientation, and contraceptive preference. 10. Grantee will not provide abortion as a method of family planning. Pregnant women will be offered the opportunity to be provided information and counseling regarding the following options: (A) Prenatal care and delivery; (B) Infant care, foster care, or adoption; and (C) Pregnancy termination. 11. Grantee will ensure that low-income clients are given priority to receive family planning services. 12. Grantee will have a sliding fee schedule, based on current Federal Poverty Guidelines, to determine a client's ability to pay for family planning services. 13. Grantee will have a schedule of fees designed to recover the reasonable cost of providing services to clients whose income exceeds 250% of poverty. 14. Grantee will be required to convene a Family Planning Advisory Council that will serve as their governing board, which will be broadly comprised of the population served and will meet at least once a year. 15. Grantee will be required to convene an Information and Education Committee comprised of five to nine members who are broadly representative of the population served or community that meets at least once a year to review and approve all informational and educational materials prior to their distribution. 16. Grantee will be required to have written clinical protocols that are in accordance with nationally recognized standards of care, signed and approved by the medical director overseeing family planning. 17. Grantee will be required to have a quality assurance system in place for ongoing evaluation of family planning services, including a tracking system for clients in need of follow-up or continued care, medical audits conducted quarterly, chart audits/record monitoring to determine the accuracy of medical records conducted quarterly, and a process to implement corrective actions for deficiencies. 18. Grantee will be required to have a current list of social services agencies and medical referral resources that is reviewed and updated annually. 19. Grantee will be required to offer education on HIV and AIDS, risk reduction information, and either on-site testing, or provide a referral for this service. 20. Grantee will be required to offer counseling services on-site or by referral and ensure that it is balanced, non-judgmental, and non-coercive. 21. Grantee will be required to have a separate budget for Title X funds and maintain a financial management system that meets the standards specified in 45 CFR 74.20 and 45 CFR 92.20 and is in compliance with federal standards. 22. Grantee will be required to comply with the Office of Population Affairs (OPA) FPAR requirements, as well as MDHHS required FPAR Tables, for the purposes of monitoring and reporting performance. 23. Grantee will be required to have a data collection system in place to assure accurate FPAR reporting, and will be responsible for updating their system, as needed, to be in compliance with OPA and the Department FPAR reporting standards. 24. 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). MDHHS/CO-2018 ATTACHMENT III Page 51 of 210 3/14/2017 Performance Expectation State Funded Minimum Performance Expected 25. Pursuant to Public Act (PA) 360 (2002) Section 333.1091, Grantees qualify as priority family planning providers who do not engage in any activities outlined in PA 360 (2002) Section 333.1091. 26. Grantee funding cannot be used to supplant funding for an existing program supported with another source of funds. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS 1. Each Grantee shall submit the required reportina on the followino dates: Report Time Period DUe Date to Department Submit To Work Plan October 1 — September 30 September 15 Judy Stiles Stilesa&michioan.gov Needs Assessment & Health Care Plan October 1— September 30 September 15 Judy Stiles StilesJgmichigan.00v FPAR Mid-Year Report January 1 — June 30 Jul 15 y Judy Stiles StilesJ@michigan.gov FPAR Year-End Report January 1 — December 31 Janua 13 ry Judy Stiles StilesJamichioan.gov 2. Each Grantee shall indicate the following project outputs: Unduplicated Percent Number Number of 95% Clinic Users REPORTING REQUIREMENTS N/A MDHHS/CO-2018 ATTACHMENT 11 Page 52 of 210 3/14/2017 9/30/2018 : :G rant:End. Date Subrecipient, Contractor, or Recipient (non-federal Designation N/A Performance Target Output Measure I Performance Leve 1 (if Applicable) FETAL ALCOHOL SPECTRUM DISORDER (FASD) COMMUNITY- BASED PROJECTS Special Requirements 517-335-8379; kimballdl@michigan.gov Subrecipient N/A BUDGET AND AGREEMENT REQUIREMENTS Objective', For the project period of October 1 to September 30, the Grantees will collaborate with the Department to assist local communities with evidence-based activities identified in the FASD Interagency Strategic Plan, to implement alcohol screening and prevent prenatal alcohol exposure among women of reproductive age and to refer affected children, birth to 18 years of age, and their families to an FASD Diagnostic Center for evaluation and intervention for the purpose of improving care and services for women, infants and families. GRANTEE REQUIREMENTS 1. FASD project coordinator (or designee) must participate/attend FASD Grantee Conference Calls provided/scheduled by the Department. 2. Implement the FASD Interagency Strategic Plan, activities as approved by the Department. 3. Produce quarterly and year-end reports using the Uniform Data Collection Evaluation Tool (UDCT) form provided by the Department that provides documentation of the types, numbers and demographic data including racial data of contacts for screening, motivational interviews and/or referrals from the Grantee's FASD community-based program. The UDCT form is available on the MI E-Grants system. The FASD UDCT quarterly reports are to be submitted via the MI E-Grants system attached to the FSR. The 4th quarter report, due October 15, will serve as the year-end report. DEPARTMENT REQUIREMENTS 1. Convene FASD Grantees conference calls to discuss progress toward community project goals outlined in the cooperative agreement and provide technical assistance questions/answers as outlined in the cooperative agreement. MDHHS/CO-2018 ATTACHMENT III Page 53 of 210 3/14/2017 2. Describe and provide resources and updates for the evidence-based interventions required by this contract. 3. Provide technical assistance for each requirement of this contract. 4. Provide reporting formats for data collection and deliverables. 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 2nd January 1— March 31 April 15 3rd April 1 — June 30 July 15 4th July 1 — September 30 October 15 2. The Grantee will collect data using the Uniform Data Collection Tool (UDCT) project evaluation/data tracking forms to monitor the FASD community program effectiveness. The Uniform Data Collection Tool (UDCT) is available on MI E-Grants. 3. The Grantee shall submit the following information electronically to the Department FASD Program via the MI E-Grants system attached to FSR a. The Grantee must provide documentation that FASD services are tracked for all individuals referred through the FASD community-based 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, MI 48909 Phone 517-335-8379 Fax 517-335-8822 Kimballdl@michigan.gov MOHHS/C0-2018 ATTACHMENT 111 Page 54 of 210 3/14/201.7 517-202-0675; tayor122@michigan.gov Su brecipient, Contractor, or Recipient (non-federal Designation N/A :.:.Performance Target Output Measure Subrecipient Fixed Unit Rate (2) N/A FETAL AND INFANT MORTALITY REVIEW (FIMR) CASE ABSTRACTIONS Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS MiaCtti.M. To assist local communities to learn from individual cases of fetal and infant death regarding what factors contribute to poor pregnancy outcome in their community, for the purpose of improving care and services for women, infants and families. Key Activities: Qualified individuals will perform medical record case abstraction for Fetal Infant Mortality Review to include the following: 1. Review of medical records involved in fetal and infant death to include but not limited to hospital records, pre-natal records, pediatric records, emergency and medical examiner's records. 2. interact with other agencies and service providers involved in infant's death (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 Fl MR 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. MDHHS/CO-2018 ATTACHMENTIll Page 55 of 210 3/14/2017 2. Department will provide ongoing technical assistance to local FIMR teams for medical record case abstraction, developing case summaries, maintaining a functioning Case Review Team, and facilitating moving recommendations to community action. 3. Department provides the statewide FIMR database, administered through MPHI. GRANTEE SPECIFIC REQUIREMENTS Maximum Project Reimbursement: Berrien County Health Department $ 4,050 Calhoun County Health Department 3,240 Detroit Health Department $ 5,940 Ingham County Health Department $ 3,240 Jackson County Health Department $ 3,240 Kalamazoo County Health and Community $ 6,840 Services Department Macomb County Health Department $ 4,050 Oakland County Department of Health and $ 6,840 Human Services/ Health Division Saginaw County Health Department $ 4,800 REPORTING REQUIREMENTS Quarterly progress reports following the template supplied by the FIMR State support program. Quarterly reports are due the 15th of the month following the end of the quarter and are submitted to the State coordinator. End of FY final report on cases completed and team findings are submitted to the State coordinator. Quarter Reportinq Time Period Due Date lst October 1 — December 31 January 15 2nd January 1— March 31 April 15 3rd April 1 — June 30 July 15 4th July 1 — September 30 October 15 ATTACHMENT III Page 56 of 210 MDH HS/CO-2018 3/14/2017 9/30/2018 iGeantEnd..Date. 10/1/2017 Richard Wimberley 517-335-8369; wimberleyr@michigan.gov (phone & email) Performance Level (if Applicable) Staffing (6) Subrecipient, Contractor, or Recipient (non-federal Designation Subrecipient Perforniance Targe N/A Output Measure N/A GETTING TO THE HEART OF THE MATTER — LIFESTYLE CHANGE Special 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 Complete Getting to the Heart of the Matter Lifestyle Change 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 Submit progress and final reports according to MDHHS guidance. If the report due date falls on a weekend or holiday, you have until the next business day to submit. Prowess Report Period Covered October 1 — December 31 January 1 - March 31 April 1 - June 30 July 1 - September 30 Year End Report — Total Grant Period Report Due Dates January 30 April 30 July 30 October 30 November 15 MDHHS/C0-2018 ATTACHMENT HI Page 57 of 210 3/14/2017 10/1/2017 Linda Scarpetta 517-373-3267; scarpettal@michigan.gov Grant Contract Administrator ....... . Contact Info Grant End: Dote Performance Level N/A (if Applicable) Performance Target N/A OutputiMeasure ... Subrecipient, Contractor, or Recipient (non-federal) Designation Subrecipient GETTING TO THE HEART OF THE MATTER - PROJECT MANAGEMENT Special 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 Complete project management for Getting to the Heart of the Matter initiative and comply with evaluation requirements, which may include periodic data collection and submission. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Submit progress and final reports according to MDHHS guidance. If the report due date falls on a weekend or holiday, you have until the next business day to submit. Progress Report Period Covered October 1 — December 31 January 1 - March 31 April 1 - June 30 July 1 - September 30 Year End Report — Total Grant Period Report Due Dates January 30 April 30 July 30 October 30 November 15 M DH HS/CO-2018 ATTACHMENT III Page 58 of 210 3/14/2017 Staffing (6) Reimbursement Method Subrecipient, Subrecipient Contractor, or Recipient (non-federal) Designation Grant Start Date 10/1/2017 Grant End Date 9/30/2018 Grant Contract Administrator Contact Info , (phone & email) Jennifer Linzmeier 517-241-5861; linzmeier@michigan.gov • Performance Level (if Applicable) Performance Target N/A Output Measure II GONOCOCCAL ISOLATE SURVEILLANCE PROJECT (GISP) Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Monitor trends in antimicrobial susceptibilities in Al. gonorrhoeae. 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. 4. Monitor trends in sexually transmitted N. Meningitidis DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC 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. Identify suspected cases of N. Meningitidis (positive growth of bacterial colonies of MTM, and negative urine nucleic acid amplification testing (NAAT); package and arrange for transport of these isolates to the Department's Bureau of Laboratories in Lansing for additional testing. 5. Assure monthly data reports are completed and submitted to CDC. REPORTING REQUIREMENTS N/A MDHHS/C0-2018 ATTACHMENT III Page 59 of 210 3/14/2017 Grant Start Date •; Grant Contract Administrator 10/1/2017 Orlando Todd 1 517-284-4021; toddo@michigan.gov Contact Info (phone & email) Reimbursement I Method • Performance Leve (if Applicable) Staffing (6) Subrecipient, Contractor, or Recipient (non-federal) Designation Performance Target Output Measure Subrecipient N/A HEALTH EDUCATION COMMUNICATION (HEC) Special Requirements BUDGET AND AGREEMENT REQUIREMENTS Funds for this project will be utilized to supplement cost for (1) F.T.E. (Health Educator) and (1) (Staff support) for health education activities. Eligible Activities include: a) Meeting activities, community presentations and travel costs b) Supplies and materials c) IT cost related to the function of the position GRANTEE REQUIREMENTS Submission of quarterly FSR's that detail cost allotment of funds. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Genesee Health Department will submit a final report of Activities and objectives that were completed by this position. Items of completion (Deliverables) can be listed in bulleted format and listed as "Accomplishments" or "Outcomes." The final report is due by October 31. Please submit the report to the Office Local Health Services at: MDHHS-Localhealthservices@michician.00v. MDHHS/C0-2018 ATTACHMENT III Page 60 of 210 3/14/2017 Grant Start Date Grant Contract Administrator Contact Info (phone & email) 9/30/2018 Reimbursement Method Performance Level • (if Applicable) Staffing (6) N/A II HIV DATA TO CARE Special Requirements 10/1/2017 Jennifer Linzmeier I Grant End Date 517-241-5861; linzmeierj@michigan.gov Subrecipient, Contractor, or Recipient (non- federal) Designation Performance Target N/A Output Measure Subrecipient BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Grantees must enter Not in Care (NIC) lists into CAREWare for sharing with agencies 2. Grantees must maintain password protected NIC lists on secure server locations and not in any portable storage devices 3. Grantees must store NIC lists on shared servers and not on desktop or personal computers 4. Grantees and Community-based Organizations must not email NIC lists or individual health information contained on NIC lists either internally or externally 5. Grantees must transmit updated surveillance data to MDHHS in pre-approved secure manners (e.g. DCH file transfer) 6. Grantees must keep all printed materials in locked storage cabinets in locked rooms 7. If NIC lists or partial lists are sent via US Mail, list size must not exceed 10 individuals in a given mailing and words indicated HIV infection must not be contained in the sent documents 8. Grantees and Community-based Organizations will document all data sharing agreements and share a copy with the Department. The data sharing agreements may be emailed to MDHHS- HIVSTDoperationsmichigan.00v. 9. Grantees and Community-based Organizations must provide written documentation of annual Security and Confidentiality training for all staff that have access to NIC lists 10. Grantees and Community-based Organizations will maintain the standards of CDC's Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs, https://www.cdc.00vinchhstp/proaraminteoration/docs/pcsidatasecurityguidelines.pdf MDHHS/CO-2018 ATTACHMENT III Page 61 of 210 3/14/2017 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 B 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. GRANTEE SPECIFIC REQUIREMENTS 1. 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 2. 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." 3. 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. 4. 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. 5. The Grantee will participate in the Department needs assessment and planning activities, as requested. 6. 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. MDHHS/C0-2018 ATTACHMENT III Page 62 of 210 3/14/2017 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. 7. If applicable, 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. 8. 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. 9. The Grantee must establish written procedures for protecting client information kept electronically or in charts or other paper records. Protection of electronic client-level data will minimally include: a. Regular back-up of client records with back-up files stored in a secure location. b. Use of passwords to prevent unauthorized access to the computer or Client Level Data program. c. Use of virus protection software to guard against computer viruses. d. Provide annual training to staff on security and confidentiality of client level data and sharing of electronic data files according to MDHHS policies concerning Sharing and Secured Electronic Data. 10. If using CAREWare to record program activities, the Grantee must include the following language in all Client Consent and Release of Information forms used for services in this agreement: "1 also understand that some limited information in the electronic data may be shared with other agencies if they also provide me with services and are part of the same care and data network. [AGENCY] is mandated to collect certain personal information that is entered and saved in a database system called CAREWare. CAREWare records are maintained in an encrypted and secure statewide database. The CAREWare database program allows for certain medical and support service information to be shared among providers involved with your care, this includes but is not limited to medical visits, lab results, medications, case management, transportation, substance abuse, and mental health counseling. MDHHS/CO-2018 ATTACHMENT Ili Page 63 of 210 3/14/2017 REPORTING REQUIREMENTS 1. The Grantee must assure that all CAREWare data is complete, cleaned, and entered into CAREWare by the 10th of the following month. 2. 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. c. The report should be emailed to MDHHS-HIVSTDoberations(&,michigan.gov on or before the due date: Report Period Covered Report Due Dates October 1 — December 31 January 31 January 1 - March 31 April 30 April 1 - June 30 July 31 July 1 - September 30 October 31 3. The Grantee must respond to any questions or clarifications of the quarterly progress report that the Department requests. MDHHS/CO-2018 ATTACHMENT IFI Page 64 of 210 3/14/2017 N/A Performance Level (if Applicable) Grant End Date Performance Target Output Measure 9/30/2018 Grant Start Date 1011/2017 Grant Contract Administrator Contact Info (phone & email) Jennifer Linzmeier 517-241-5861; linzmeier@michigan.gov Reimbursement Method Subrecipient, Contractor, or Recipient (non-federal) Designation Subrecipient Staffing (6) II HIV/STD PARTNER SERVICES PROGRAM Special 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 HIV/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; c. Use of virus protection software to guard against computer viruses; and MDHHS/CO-2018 ATTACHMENT III Page 65 of 210 3/14/2017 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. d. This information may be emailed to MDHHS-HIVSTDoperations@michigan.gov . 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 five (5) 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. Please refer to Michigan's Record Retention policies htto://www.michidan.00v/documents/hal mhc rms local gs7 106287 7.pdf) for further details. 10. The Grantee will maintain client records of HIV Positive or Negative with Syphilis diagnosis. MDHHS recommends that this information be retained indefinitely or until it is determined the client is deceased. Please refer to Michigan's Record Retention policies (http://www.michigan.gov/documents/hal_mhc_rms_local_gs7_106287_7.pdf) for further details. 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. MDHHS/C0-2018 ATTACHMENT lIl Page 66 of 210 3/14/2017 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. The Department's standardized Technical Assistance (TA) Request Form is available online at http://www.michigan.00v/hivstd. 2. The Department will monitor Grantee performance throughout the contract year, which may include a review of financial status reports (FSRs), EvalWeb, PSWeb, MDSS 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 MDSS 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 (MOSS) 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 MDHHS/CO-2018 ATTACHMENT 111 Page 67 of 210 3/14/2017 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 M MRS/CO-2018 ATTACHMENT III Page 68 of 210 3/14/2017 Grant Start Date 10/1/2017 Jennifer Linznneier Grant Contract Administrator 517-241-5861; linzmeier@michigan.gov Subrecipient, Contractor, or Recipient (non-federal) Designation Subrecipient Reimbursement Method Staffing (6) Performance Level (if Applicable) N/A Performance Target Output Measure N/A 9/30/2018 II HIV PREP DATA COLLECTION Spociai Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS The Grantee shall track referral to Pre-exposure Prophylaxis (PrEP) and report it monthly to the Department. DEPARTMENT REQUIREMENTS The Department will provide the agency with a MDHHS PrEP referral Excel spreadsheet. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 1, The Grantee shall submit monthly provider referral to PrEP by the 10th of the following month using the MDHHS PrEP referral spreadsheet. 2. The Grantee will email the PrEP referral spreadsheet to gtrsuj2a€,,&gr.nic, MDHHS/C0-2018 ATTACHMENT III Page 69 of 210 3/14/2017 Grant Start Date Grant Contract Administrator Contact Info (phone & email) Jennifer Linzmeier 617-241-5861; linzmeier@michigan.gov Categorical Reimbursement Staffing (6) :..Method:; Performance Level N/A (if Applicable) Non-Categorical Fixed Unit Rate (7) (12) Performance Level N/A (if Applicable) I Subrecipient, Contractor, or Recipient (non-fede Designation Performance Target Output Measure Subrecipient Reimbursement Method Subrecipient, Contractor, or Recipient (non-federal) Designation Recipient Performance Target N/A Output Measure il HIV PREVENTION PROGRAM Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Grantee Reauirements— Cateaoricat I. Grantees 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. MDHHS/C0-2018 ATTACHMENT III Page 70 of 210 3/14/2017 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. 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 (MOUs) or letters of agreement related to the services in this agreement. 5. The Grantee and its subcontractors are required to use Evaluation Web (EvalWeb) and, if applicable, Partner Services Web (PSWeb) to enter HIV client and service data into the centrally 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 c. Order condoms/lubrication by emailing 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 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 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. 8. 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. d. This information should be emailed to MDHHS-HIVSTDoperations@michigan.gov . MDH HS/CO-2018 ATTACHMENT III Page 71 of 210 3/14/2017 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. Please refer to Michigan's Record Retention policies (http://vvww.michigan.gov/documents/hal mhc rms local gs7 106287 7.edf) for further details. 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.The Grantee must use the Department's standardized Technical Assistance (TA) Request Form when requesting TA. See Department website (www.michigan.gov/hivstd) to download the form. Grantee Reauirements — Nan-Cateaoricat 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, DEPARTMENT REQUIREMENTS Deoartment Reauirements - Cateaorical 1. The Department will provide rapid HIV test devices and external controls in sufficient quantity to ensure that HIV testing is provided as a standard of care to dents 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. The Department's standardized Technical Assistance (TA) Request Form is available online at http://www.michigan.gov/hivstd. 3. The Department will provide Grantees with a condom and lubrication allowance. The Department will: a. Notify the Grantee of its condom/lubrication allowance on or before January 1. b. Place all Grantees' condom/lubrication orders with the condom vendor between January and September 10 (Grantee should email ctrsupplies@michieamorg to order condoms). c. Track the Grantees' orders. 4. The Department will monitor Grantee performance throughout the contract year, which may include a review of financial status reports (FSRs), EvalWeb data entries, PSWeb data entries (as applicable) quarterly progress reports, and site visits. For site visits: a. Monitoring will include a review of fiscal, program, administrative, quality assurance, and client records to ensure compliance with federal, Department, and contract requirements. MDHHS/CO-2018 ATTACHMENT III Page 72 of 210 3/14/2017 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. 5. The Department will review quarterly reports. Questions or clarifications, if any, will be requested within 30 calendar days of submission due date. 6. The Department will review EvalWeb data, on a quarterly basis, at minimum. Questions or clarifications, if any, will be requested within thirty (30) calendar days of submission due date. Department Rea uirements Non-Cateaorical 1. The Department will reimburse Grantees at a rate of $11.00 per test, not to exceed $2,000 for FY-18. 2. The Department will provide Grantee with a condoms and lubrication allowance. The Department will: a. Notify the Grantee of its condom/lubrication allowance by January 1. b. Place all Grantee's condom/lubrication orders with the condom vendor between January 1 and September 10 (Grantee should email ctrsuppliesmichiqan.qov to order condoms). c. Track the Grantees' allowance. GRANTEE SPECIFIC REQUIREMENTS Contract Specific Reauirements Categorical 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 Grantee'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 Department staff. This information may be emailed to ctrsupplies@michigan.gov , faxed to 517-241-5922, or mailed via US Postal Service to: HIV Prevention Unit, 109W. Michigan Ave., 10th Floor, Lansing, MI 48913, ATTN: CTR Coordinator. 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. MDF4HS/C0-2018 ATTACHMENT ILl Page 73 of 210 3/14/2017 f. Ensure that site supervisors have completed, successfully, appropriate laboratory quality assurance training, blood borne pathogens training and rapid test device training and reviewed annually. 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. 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. This information may be emailed to ctrsupplies@michioan.gov , faxed to 517-241-5922, or mailed via US Postal Service to: HIV Prevention Unit, 109W. Michigan Ave., 10 th Floor, Lansing, MI 48913, ATTN: CTR Coordinator. 3. The Grantee will submit EvalWeb and, if applicable, PSWeb data according to the following schedule: 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. d. Enter Linkage to Care and PS interview outcomes for reactive results within appropriate timeframe, i.e., client attended a medical care appointment within 90 days, and was interviewed by Partner Services within 30 days. 4. The Grantee will enter condom distribution data in EvalWeb by the 10th day after the end of each calendar month. Grantee Reporting-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 EvalWeb within seven days c. Clean-up missing data by the 10th day after the end of each calendar month. d. Enter Linkage to Care and PS interview outcomes for reactive results within appropriate timeframe, i.e., client attended a medical care appointment within 90 days, and was interviewed by Partner Services within 30 days. 3. The Grantee will enter condom distribution data in EvalWeb by the 10th day after the end of each calendar month. M OH HS/CO-2018 ATTACHMENT III Page 74 of 210 3/14/2017 Grant End Date 517-241-5861; linzmeier@michigan.gov Subrecipient, ' Contractor, or 1 Recipient (non-federal Designation Administrator Grant Start Date Grant Contract Contact info (phone & email) Reimbursement Method 10/1/2017 Jennifer Linzmeier Performance Target Output Measure N/A Subrecipient Staffing (6) Performance Level• (if Applicable) N/A 9/30/2018 HIV RYAN WHITE PART B HIV RYAN WHITE PART B MAI Special Requirements 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 HIV/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. MDH HS/CO-2018 ATTACHMENT III Page 75 of 210 3/14/2017 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. 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 (MOUs) 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: MDH HS/CO-2018 ATTACHMENT Ill Page 76 of 210 3/14/2017 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 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.michiqan.qov/hivstd) to download the form. 15. The Grantee must establish written procedures for protecting client information kept electronically or in charts or other paper records. Protection of electronic client-level data will minimally include: a. Regular back-up of client records with back-up files stored in a secure location. b. Use of passwords to prevent unauthorized access to the computer or Client Level Data program. c. Use of virus protection software to guard against computer viruses. d. Provide annual training to staff on security and confidentiality of client level data and sharing of electronic data files according to MDHHS policies concerning Sharing and Secured Electronic Data. 16. The Grantee must include the following language in all Client Consent and Release of Information forms used for services in this agreement: "I also understand that some limited information in the electronic data may be shared with other agencies if they also provide me with services and are part of the same care and data network. [AGENCY] is mandated to collect certain personal information that is entered and saved in a database system called CAREWare. CAREWare records are maintained in an encrypted and secure statewide database. The CARE Ware database program allows for certain medical and support service information to be shared among providers involved with your care, this includes but is not limited to medical visits, lab results, medications, case management, transportation, substance abuse, and mental health counseling. 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, MDHHS/CO-2018 ATTACHMENT III Page 77 of 210 3/14/2017 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, which may include a review of FSRs, CAREWare data entries, quarterly progress reports, and site visits. For 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 all CAP items have been successfully fulfilled. 3. The Department will review quarterly reports and provide written feedback within 30 calendar days of submission due date. 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. QIV1 Plans must contain the eleven required components: 1) Quality statement, 2) Quality infrastructure, 3) Annual quality goals, 4) Capacity building, 6) 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, MDHHS/C0-2018 ATTACHMENT II Page 78 of 210 3/14/2017 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. 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 FY17-18 Budget Administrator or designee. Allocation of Actual FY FY17-18 Attached to FSR April 30 Expenditures by Service Category Allocation of Actual FY17-18 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 RYAN WHITE MAI 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. MDHHS/CO-2018 ATTACHMENT III Page 79 of 210 3/14/2017 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. 11 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. 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 (MOUs) 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. 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. MDHHS/C0-2018 ATTACHMENT III Page 80 of 210 3/14/2017 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. 11. 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. 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. 13. The Grantee must use the Department's standardized Technical Assistance (TA) Request Form when requesting TA. See Department website (vvvvw.michiaan.qov/hivstd) to download the form. 14. The Grantee must establish written procedures for protecting client information kept electronically or in charts or other paper records. Protection of electronic client-level data will minimally include: a. Regular back-up of client records with back-up files stored in a secure location. b. Use of passwords to prevent unauthorized access to the computer or Client Level Data program. c. Use of virus protection software to guard against computer viruses. d. Provide annual training to staff on security and confidentiality of client level data and sharing of electronic data files according to MDHHS policies concerning Sharing and Secured Electronic Data. 15. If using CARE Ware to record program activities, the Grantee must include the following language in all Client Consent and Release of Information forms used for services in this agreement: "I also understand that some limited information in the electronic data may be shared with other agencies if they also provide me with services and are part of the same care and data network. [AGENCY] is mandated to collect certain personal information that is entered and saved in a database system called CAREWare. CAREWare records are maintained in an encrypted and secure statewide database. The CAREWare database program allows for certain medical and support service information to be shared among providers involved with your care, this includes but is not limited to medical visits, lab results, medications, case management, transportation, substance abuse, and mental health counseling. 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 B activities. Please see Grantee Specific Requirements, item 15 for information on how to request TA. MDHHS/CO-2018 ATTACHMENT III Page 81 of 210 3/14/2017 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. If applicable, 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. 2. 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. c. The report should be emailed to MDHHS-HIVSTDoperationsa,michloan.qov on or before the due date: Report Period Covered Report Due Dates October 1 — December 31 January 31 January 1 - March 31 April 30 April 1 - June 30 July 31 July 1 - September 30 October 31 3. The Grantee must respond to any questions or clarifications of the quarterly progress report that the Department requests. MDHHS/CO-2018 ATTACHMENT III Page 82 of 210 3/14/2017 I 517-284-4911; collins112@michigan.gov Subrecipient, Contractor, or Recipient (non-federal) Designation —I ----- ' Performance Level N/A (if Applicable) Subrecipient N/A II HIV SURVEILLANCE SUPPORT PROGRAM 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/C0-2018 3/14/2017 ATTACHMENT HI Page 83 of 210 Grant Contract Administrator Grant Start Date 10/1/2017 Jennifer Linzmeier 9/30/2018 Subreciplent, Contractor, or Recipient (non-federal Designation Subrecipient Staffing (6) Performance Target Output Measure N/A N/A 11 HIV/AIDS LINKAGE TO CARE Special Requirements Contact Info 517-241-5861; linzmeier@michigan.gov (phone & email) Reimbursement Method Performance Level (if Applicable) BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Grantee must enter Not in Care (NIC) lists into CAREWare for sharing with agencies 2. Grantee must maintain password protected NIC lists on secure server locations and not in any portable storage devices 3. Grantee must store NIC lists on shared servers and not on desktop or personal computers 4. Grantee and Community-based Organizations must not email NIC lists or individual health information contained on NIC lists either internally or externally 5. Grantee and Community-based Organizations must transmit updated surveillance data to MDHHS in pre-approved secure manners (e.g. DCH file transfer) 6. Grantee and Community-based Organizations must keep all printed materials in locked storage cabinets in locked rooms 7. If NIC lists or partial lists are sent via US Mail, list size must not exceed 10 individuals in a given mailing and words indicated HIV infection must not be contained in the sent documents 8. Grantee and Community-based Organizations will document all data sharing agreements and share a copy with MDHHS. The data sharing agreements may be emailed to MDHHS- HIVSTDocerations@michician.c101/. 9. Grantee and Community-based Organizations must provide written documentation of annual Security and Confidentiality training for all staff that have access to NIC lists. 10. Grantee and Community-based Organizations will maintain the standards of CDC's Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs, httbs://www.cdc.00vinchhstp/prociraminteQration/docs/bcsidatasecuritvguidelines.pdf MDHHS/CO-2018 ATTACHMENT III Page 84 of 210 3/14/2017 DEPARTMENT REQUIREMENTS 1. The Department will provide Technical Assistance (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 B 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. GRANTEE SPECIFIC REQUIREMENTS 1. 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 2. 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." 3. 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. 4. 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. 5. The Grantee will participate in the Department needs assessment and planning activities, as requested. 6. 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. MDHHS/CO-2018 ATTACHMENT lu Page 85 of 210 3/14/2017 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. 7. If applicable, 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. 8. 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. 9. The Grantee must establish written procedures for protecting client information kept electronically or in charts or other paper records. Protection of electronic client-level data will minimally include: a. Regular back-up of client records with back-up files stored in a secure location. b. Use of passwords to prevent unauthorized access to the computer or Client Level Data program, c. Use of virus protection software to guard against computer viruses. d. Provide annual training to staff on security and confidentiality of client level data and sharing of electronic data files according to MDHHS policies concerning Sharing and Secured Electronic Data. 10. If using CAREVVare to record program activities, the Grantee must include the following language in all Client Consent and Release of Information forms used for services in this agreement: "I also understand that some limited information in the electronic data may be shared with other agencies if they also provide me with services and are part of the same care and data network. [AGENCY] is mandated to collect certain personal information that is entered and saved in a database system called CAREWare. CAREWare records are maintained in an encrypted and secure statewide database. The CAREWare database program allows for certain medical and support service information to be shared among providers involved with your care, this includes but is not limited to medical visits, lab results, medications, case management, transportation, substance abuse, and mental health counseling. REPORTING REQUIREMENTS 1. The Grantee must assure that all CAREWare data is complete, cleaned, and entered into CAREWare by the 10t of the following month. 2. 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. MDHHS/C0-2018 ATTACHMENT III Page 86 of 210 3/14/2017 c. The report should be emailecl to MDHHS-1-11VSTDoperatiorismichidan.qov on or before the due dates: Report Period Covered Report Due Dates October 1 — December 31 January 31 January 1 - March 31 April 30 April 1 - June 30 July 31 July 1 - September 30 October 31 3. The Grantee must respond to any questions or clarifications of the quarterly progress report that the Department requests. MDHHS/C0-2018 ATTACHMENT III Page 87 of 210 3/14/2017 N/A Performance Level (if Applicable) N/A Performance Target Output Measure Grant Start Date Grant Contract Administrator Contact into (phone & email) 10/1/2017 Michelle Woolfe 517-335-1380; wollfm@michigan.gov Reimbursement Method Subrecipient, Contractor, or Recipient (non-federal) Designation Subrecipient Staffing (6) 9/30/2018 HOUSING OPPORTUNITIES FOR PERSONS LIVING WITH HIV/AIDS (HOPWA) Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS The grantee shall undertake, perform, and complete activities and services for the program as outlined in the Housing Opportunities for Persons with AIDS (HOPWA) Program Manual provided by the Department's Housing and Homeless Services Division. In addition, the grantee is expected to adhere to applicable federal laws, regulations, and notices including, but not limited to, the AIDS Housing Opportunity Act and 24 CFR Part 574 — Housing Opportunities for Persons with AIDS. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/CO-2018 ATTACHMENT III Page 88 of 210 3/14/2017 Grant Start Date 10/1/2017 Contact Info (phone & email) Reimbursement Staffing (6) Method Performance Level N/A (if Applicable) Robert Swanson 517-335-8159; swansonr@michigan.gov Subrecipient, Contractor, or Recipient (non-federal Designation N/A ,:•:: • : • :••= .:Grant:End.Date-. 9/30/2018 Subrecipient II IMMUNIZATION ACTION PLAN Special Requirements 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/CO-2018 ATTACHMENT flI Page 89 of 210 3/14/2017 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: M Di-INS/CO-2018 ATTACHMENT III Page 90 of 210 3/14/2017 I . 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 1. The department will develop templates for submission of IAP reports and the annual IAP plan, and provide feedback to the local health departments. 2. Provide technical assistance in establishing and operating immunization action plans. 3. Provide technical assistance in MCIR activities through regional coordinators. 4. Provide supportive services and resource identification when needed. 5. Provide financial support for Grantee and Community / Migrant Health Centers for Immunization in pocket of need (PON) areas. 6. Each LHD will have an annual VFC/AFIX site visit by the Department. 7. Develop pre-formatted tools including training for new initiatives and IAP reports I plan. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDH HS/CO-2018 ATTACHMENT III Page 91 of 210 3/14/2017 Administrator 517-3.35-8159; swansonr@michigan.gov Contact Info (phone & email) Reimbursement Method Subrecipient Fixed Unit Rate (7) Subrecipient, Contractor, or Recipient (non-federal Designation Performance Level 1 (if Applicable) Grant Start Date Grant Contract 10/1/2017 Robert Swanson Grant End Date 9/30/2018 Performance Targe Output Measure I N/A IMMUNIZATION ASSESSMENT FEEDBACK INCENTIVE EXCHANGE (AFIX) FOLLOW-UP SITE VISIT Special Requirements BUDGET AND AGREEMENT REQUIREMENTS The rate of reimbursement per AFIX follow-up visit is $100 for an on-site personal visit to the provider office or $50 for a follow-up phone call (with information mailed afterward) to the provider office. GRANTEE REQUIREMENTS 1. Conduct AFIX follow-up with all providers receiving an AFIX/VFC site visit with identified follow- up issues/activities. 2. AFIX follow-up visits are required to occur within 3 — 6 months from date of VFC/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/CO-2018 ATTACHMENT Ill Page 92 of 210 3/14/2017 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/C0-2018 ATTACHMENT III Page 93 of 210 3/14/2017 517-336-8159; swansonr@michigan.gov Contact Info (phone & email) Reimbursement Method Staffing (6) Subrecipient Subrecipient, Contractor. or Recipient (non-federal) Designation Performance Leve (if Applicable) N/A Performance Target Output Measure Grant End Date Grant Start Date Grant Contract Administrator 10/1/2017 Robert Swanson II IMMUNIZATION - FIELD SERVICE REPRESENTATIVES Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Field Representative Roles and Responsibilities- District #10. Marquette. and St. Clair Counties This position serves as a liaison, resource person and as a regional expert for local health jurisdictions regarding all the Department immunization programs and initiatives. 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. MOH HS/CO-2018 ATTACHMENT III Page 94 of 210 3/14/2017 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 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. M DH HS/CO-201.8 ATTACHMENT III Page 95 of 210 3/14/2017 GRANTEE SPECIFIC REQUIREMENTS District #10. Marauette and St. Clair Counties 1, Employ and oversee a full-time Immunization Field Representative for the Immunization Program who shall be acceptable to the Department and who shall be supported by this agreement, understanding that their full time is to be devoted for regional immunization related activities. 2. Provide the Immunization Field Representative with permanent office space and supplies, including, but not limited to: a telephone, general office supplies, a computer with high speed internet capabilities, a printer, a cellular telephone and a use of vehicle or reimbursement mechanism for transportation unless otherwise arranged. 3. Ensure the Immunization Field Representative will be available to all local health departments in the assigned regions to provide Immunization Program activities equitable and at the direction of the Department. Refer to field representative responsibilities as defined by the Department and distributed to the Grantee. 4. Provide for reimbursement for reasonable telephone charges incurred in the conduct of business by the Immunization Field Representative unless otherwise arranged. 5. Provide reasonable reimbursement for any travel and subsistence expenses incurred by the Immunization Field Representative necessary to the conduct of the Immunization Program. Travel could include the annual National Immunization Conference or other professional immunization related conferences, attendance at the Department Immunization staff meetings and trainings, and accreditation visits made in other areas of the state. Kent. Livingston and Monroe Countigs 1. Provide adequate office space, telephone connections, and high-speed internet access. Also provide access to fax and photocopiers. 2. Provide feedback to Division Director as needed, on employee work related conduct. REPORTING REQUIREMENTS N/A MDHHS/C0-2018 ATTACHMENT III Page 96 of 210 3/14/2017 10/1/2017 Grant End Date Robert Swanson 517-335-8159; swansonr@michigan.gov 9/30/2018 I Grant Start Date Grant Contract Administrator Contact Info (phone & email) Reimbursement Staffing (6) Method ., Performance Level N/A (if Applicable) Subrecipient, Subrecipient Contractor, or. Recipient (non-federal Designation Performance Target NIA Output Measure 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 of the Department to support the MCIR: 1. Promote and train providers and Health Care Organizations (HC0s) on all features of the MCIR Web application. 2. Support regional MCIR users by operating the regional help desk in accordance with Department approved procedures. 3. Monitor and develop strategies to increase private provider and HCO enrollment and participation in the MCIR which includes development of strategies to encourage all providers to fully participate with the MCIR, (such as sites of excellence awards). 4. Process all user/usage agreements, according to the Department's approved procedures, to create user accounts. 5. Implement and update marketing plans in support of increased provider and parent acceptance and use of the MGR, 6, Keep regional users updated on MCIR status and system changes. 7. Conduct ad hoc reporting and querying on behalf of MCIR users. 8. Work with local health departments to establish a mechanism and internal process to assure persons who have died within their county are appropriately flagged in the MCIR. 9. Maintain a listing of HCO private and public immunization providers. This listing should be as comprehensive as possible and should include all providers in the region. MDHHS/CO-2018 ATTACHMENT 111 Page 97 of 210 3/14/2017 10. Conduct regular de-duplication activities to assure that duplicate records are removed from the MCIR as quickly as possible. 11. Process user petitions to change MCIR data according to Department approved procedures. 12. Monitor ongoing immunization data submission for all local health departments and private providers. 13. Conduct training functions as needed to assure that local health department staff can train and educate providers on how to access and submit data into MCIR. 14. Maintain a policy/procedure manual, approved by the Department. 15. Process and file all "opt out" forms according to the Department approved procedures. 16. Attend regular MCIR regional Grantee/coordinator meeting. 17. Conduct Onboarding activities as required for providers submitting immunization data via HL7 messaging to MCIR. 18. Perform quality assurance checks on the MCIR data for the region as prescribed by the Department. A. Assist local health departments and private providers with methodologies to "clean up" their data. B. Provide assistance to the Department on User Acceptance Testing (UAT) when required to verify MC1R system releases of bug fixes and enhancements. C. Attend all UAT training sessions as required by the Department. 18. The Grantee shall provide to the MCIR Regional Coordinator: a) permanent office space; b) general office supplies; c) a land based telephone; d) a computer with high speed internet capabilities; e) a printer; f) a cellular telephone; and g) use of a vehicle or in the alternative reimbursement mechanism for transportation unless otherwise arranged. 19. When sufficient funding is available, provide to the MCIR Regional Coordinator reimbursement for travel to attend the National Registry related meetings if approved by the Department. This includes travel related expenses concerning air fare, lodging, baggage processing, taxi services, etc. 20. Consult with the Department on any personnel or performance issues that could affect the above mentioned contract requirements. 21. Facilitate the Department's attendance in the interview process for hiring of a MC1R Regional Coordinator / MCIR staff. This process includes consultation with the Department regarding selection of interview candidates as well as participation in the hiring determination. 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 MDH HS/CO-2018 ATTACHMENT III Page 98 of 210 3/14/2017 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: Report Period Covered Report Due Dates October 1 — December 31 January 31 January 1 - March 31 April 30 April 1 - June 30 July 31 July 1 - September 30 October 31 2. Final quarterly report shall be an annual report. The annual report will be distributed to the Department and shall include: A. Summary of provider enrollment (breakdown by role); B. The amount of data submitted to the region during the fiscal year; C. Summary of staff resources; D. Sites of excellence award recipients. 3. Any other information as specified in the special requirements shall be developed and submitted by the Grantee as required by the Department. Reports and information should be submitted to: Bea Salada, MCIR Coordinator Michigan Department of Health & Human Services Immunization Division P.O. Box 30195 Lansing, MI 48909 Phone: (517) 335-9340 The Grantee shall permit the Department or its designee to visit and to evaluate on an as- needed basis. MDH H5/CO-2018 ATTACHMENT Ill Page 99 of 210 3/14/2017 poot . Contract Administrator Contact Info (phone & email) Performance Level (if Applicable) N/A Grant End Date 9/30/2018 ; Subrecipient N/A Grant Start Date 10/1/2017 Robert Swanson 517-335-8159; swansonr@michigan,gov Fixed Unit Rate (2) (7) Subrecipient, Contractor, or Recipient (non f' Designation .)P.orfeithinaoce Target .. ...:Output Measure. ii 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 INE Provider Contact and Report Forms for eligible sessions. Payment will be based on submission of the quarterly FSR that should include all sessions conducted during that quarter with detail of the sessions documented on the spreadsheet that is provided by the Department. 2. The Department will provide two (2) sessions per calendar year for Grantee Immunization Nurse Educators. MDHHS/C0-2018 ATTACHMENT Ill Page 100 of 210 3/14/2017 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/CO-2018 ATTACHMENT III Page 101 of 210 3/14/2017 Staffing (6) Reimbursement I. Me. hold ,: N/A Performance Level (if Applicable) .Grant-End Date ' Contact Info 517-335-8159; swansonr©nnichigan.gov (phone & email) 9/30/2018 Performance Target N/A Output Measure Grant Start Date 10/1/2017 I Grant Contract I Administrator Robert Swanson Subrecipient, Contractor, or Recipient (non-federal Designation Recipient II IMMUNIZATION - VACCINE QUALITY ASSURANCE PROGRAM SoKlal 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 Grantees. 2. Monitor and approve vaccine orders for Grantees. 3. Consult with Local Health Departments on vaccine losses and assist as needed. 4. Act as the PPOC to Grantees. 5. Assist Grantees on education and intervention on the inappropriate use of publicly purchased vaccine. MDHHS/C0-2018 ATTACHMENT III Page 102 of 210 3/14/2017 6. Assist Local Health Departments on issues related to MC1R functionality and operation. 7. Assist Grantees with the redistribution of short dated vaccine. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/C0-2018 ATTACHMENT III Page 103 of 210 3/14/2017 Grant Start Date 10/1/2017 I Grant End Date 9/30/2018 Robert Swanson 517-335-8159; swansonr@michigan.gov Fixed Unit Rate (2) (7) Subrecipient, Contractor, or Recipient (non-federal Designation Subrecipient , Performance Level N/A I (if Applicable) Performance Target Output Measure N/A Reimbursement Method II IMMUNIZATION VFC/AFIX SITE VISIT Special Requirements BUDGET AND AGREEMENT REQUIREMENTS 1. The rate of reimbursement is $150 for a VFC Enrollment or a VFC Only visit, $350 for a combined VFC/AFIX or birthing hospital visit. An enrollment visit is required for all new VFC enrolled provider sites. All LHD staff involved with any 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 (QAS) contractual obligations. Combined VFC/AFIX site visits will be conducted using registry based AFIX reports and AFIX tools developed by the Department. Follow-up of outstanding issues must be completed within CDC guidelines. 3. All reimbursement requests should be submitted on the quarterly Comprehensive Financial Status Report (FSR). The submission should include, as an attachment, detail all of the visits during the quarter using the spreadsheet information provided by the Department. The format of the site visit will be based on the complete site visit questionnaire and AFIX Online Tool reviewed at the most recent Fall lAP 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/C0-2018 ATTACHMENT HI Page 104 of 210 3/14/2017 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 AFIXNFC 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/CO-2018 ATTACHMENT In Page 105 of 210 3/14/2017 -.Grant:Start:Date • 10/1/2017 Grant End Date.. 9/30/2018 Grant Contract Administrator Patti Kelly 517-335-5911; kellyp2©michigan.gov 1. Contact Info (phone & email) Reimbursement Method Subrecipient, Contractor, or Recipient (non-federal) Designation Subrecipient Staffing (6) I Performance Leve (if Applicable) N/A Performance Target Output Measure N/A II INFANT SAFE SLEEP Special Requirements BUDGET AND AGREEMENT REQUIREMENTS Objective: Provide funding to select Grantees to support promotion and awareness of infant safe sleep best practices in their communities. Funding must be expended by September 30. GRANTEE REQUIREMENTS 1. Grantee personnel will provide educational activities, conduct community outreach efforts and/or expand community awareness of infant safe sleep. These efforts must adhere to the updated policy statement titled "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment" issued by the American Academy of Pediatrics in October, 2016. 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. Grantee 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 including: 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. M Dhi HS/CO-2018 ATTACHMENT III Page 106 of 210 3/14/2017 DEPARTMENT REQUIREMENTS Provide technical assistance for infant safe sleep through Infant Safe Sleep Program Coordinator. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 1. Grantee will attach completed "Infant Safe Sleep Mini-Grant Work Plan" to the indirect cost line of the budget for review and approval by the Infant Safe Sleep program. 2. Prior to the submission of the proposed work plan, Grantee will participate in a meeting (by person or phone) with all mini-grantees facilitated by the Infant Safe Sleep Program to review current data, discuss infant safe sleep best practices and answer any questions related to mini grant requirements. 3. Grantee will attach "Infant Safe Sleep Mini-Grant Work Plan" with reporting column completed and completed "Infant Safe Sleep Mini-Grant Report Grid" to the indirect cost line of the 2nd quarter FSR (January-April). 4. Grantee will participate in a TA call with the Infant Safe Sleep Program (if requested) by May 15 to review progress to date. 5. Grantee will attach "Infant Safe Sleep Mini-Grant Work Plan" with reporting column completed and completed "Infant Safe Sleep Mini-Grant Report Grid" to the indirect cost line of the final FSR. MDHHS/CO-2018 ATTACHMENT 111 Page 107 of 210 3/14/2017 Grant Contract Administrator Orlando Todd Performance LeVet Appiicabie).: N/A Contact Info (phone & emai HI 517-284-4722; toddo@michigan.gov Performance Target Output Measure Subrecipient, Contractor, or Recipient (non-federal Designation 1:.;.Grant E Start Date 10/1/2017 (Oa OW Date . 9/30/2018 Fixed Unit Rate (2) (7) II INFORMED CONSENT Special Requirements 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 MDHHS/C0-2018 ATTACHMENT lIl Page 108 of 210 3/14/2017 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 MI E-Grants system. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDH HS/CO-2018 ATTACHMENT III Page 109 of 210 3/14/2017 • Reimbursement • • Method Performance Target Output Measure Performance Level ' (if Applicable) N/A N/A Staffing (6) Subrecipient Grant Start 10/1/2017 Grant End Date Stabrecipient, Contractor, or Recipient (non-fede Designation 9/30/2018 Date. I Grant Contract Administrator Contact Info ; (phone & email) Mahad Adawe 517-336-8058; adawern@michigan.gov ISLAB.Ol RRAegTORY. SERVICES BUDGET AND AGREEMENT REQUIREMENTS 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 LAMS 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. MDHHS/C0-2018 ATTACHMENT III Page 110 of 210 3/14/2017 DEPARTMENT REQUIREMENTS Department Requirements -All Grantees: A. The Department will provide notifications and explicit instruction for stop and start days to Grantee laboratory regarding this contractual arrangement prior to its implementation. B. The Department will provide access to LIMS, support for LI MS hardware and software, user training for LIMS utilized for testing performed under contract, advanced training for LIMS liaisons for test master and Grantee specific data. The Department will maintain the sole contract with LIMS vendor, Backups and maintenance of all module(s)/customization(s) will be performed by the Department staff. C. Analyze data from reports submitted from Grantee. Supply timely feedback of statistical analysis and other data related to ongoing program activities. D. Assist in technical training of personnel and computer software utilization. E. Supply Grantee with a copy of the contracts associated with this program. 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 CLIA 1988. 2. Laboratory Directors will: a. Sign the appropriate CMS paperwork for CUA 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 M ATTACHMENT II I Page 111 of 210 3/14/2017 Grant Start Date 1 10/1/2017 Grant Contract Administrator Contact Info (phone & email) Marji Cyrul 517-373-6486; cyrulm@michigan.gov Grant End Date Reimbursement Method Performance Level (if Applicable) Staffing (6) Subrecipient, Contractor, or Recipient (non-federal Designation 1 Recipient Performance Target Output Measure N/A 1 N/A II LACTATION CONSULTANT Spc:Tiat Requirements 9/30/2018 BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Upon initiation of the FY18 contract, grantees must submit a Lactation Consultant work plan to CyrulMmichician.qov. The work plan must include: a. Outcome objectives (a minimum of 2) for improved breastfeeding rates in Genesee County. b. Activities (a minimum of 3 per objective) that include names and numbers of specific populations targeted for interventions. C. The estimated cost, person responsible and deliverable quantifiable outcomes for each activity. 2. Work plans must be approved by the Department State Breasffeeding Coordinator. 3. Changes to the work plan throughout the year can occur with prior approval from the Department State Breastfeeding Coordinator. 4. All activities, as specified in the initial approved work plan, shall be implemented. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS The Department's Women Infant Children (WIC) program will collaborate with the Genesee County Health Department to increase breasffeeding 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. M DH HS/CO-2018 ATTACHM ENT 111 Page 112 of 210 3/14/201.7 REPORTING REQUIREMENTS 1. Work plan narrative reports must be submitted quarterly. The reports are due 30 days after the quarter and year-end and include the following timeframe: Report Period Covered Report Due Dates Initial work plan August 1 October 1 — December 31 January 30 January 1 - March 31 April 30 April 1 - June 30 July 30 July 1 - September 30 October 30 2. The Department will provide specific instructions and a template for reporting on the work plan objectives and activities. 3. The Department State Breastfeeding Coordinator will evaluate the reports for their completeness and accuracy. MD1-I HS/CO-2018 ATTACHMENT III Page 113 of 210 3/14/2017 • grant start pate . Grant Contract Administrator (phone & email) Reimbursement Method 10/1/2017 Orlando Todd 9/30/2018 Grant End Date 517-284-4021; toddo@michigan.gov Staffing (6) Subreciplent, Contractor, or Recipient (non-federal) Designation Subrecipient LOCAL HEALTH DEPARTMENT (LHD) SERVICE SHARING SUPPORT Special Requirements Performance Level (if Applicable) N/A Performance Target N/A Output Measure BUDGET AND AGREEMENT REQUIREMENTS Grantees participating in the project will utilize funds to support activities pertinent to the exploration, preparation, planning, implementing, and improving sharing of local health department services, programs or personnel. GRANTEE REQUIREMENTS Grantees must submit a continuation work plan and budget for continuation funding of the project "Local Health Department Collaboration and Exploration of Shared Approach to Delivery of Services," Eligible Activities: A. Meeting activities, including time and travel costs Cost of research activities C. Supplies and presentation materials D. Legal fees and other professional services related to the project E. 11- cost related to service sharing (grant funds may not be used to reimburse equipment costs) DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A M DH HS/CO-2018 ATTACH M ENT HI Page 114 of 210 3/14/2017 REPORTING REQUIREMENTS The first update project report is due on December 31. The final report will be due on November 30. Report templates will be provided prior to report submission. Reporting will be submitted to the Office of Local Health Services and will not have to be entered in the Mi EGrants System. MDHHS/CO-2018 ATTACHMENT III Page 115 of 210 3/14/2017 ------ Grant Start Date' 10/1/2017 Grant End Date 9/30/2018 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 Subrecipient, Contractor, or Recipient (non-federal Designation Performance Target Output Measure Subrecipient N/A Reimbursement Staffing (6) Method Performance Level N/A (if Applicable) II LOCAL MATERNAL AND CHILD HEALTH (MCH) PROGRAM Special 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 & lnfrastruct — MCH 2. The Local MCH Plan submission and due date will be communicated with the Local MCH Plan through a notification mailing. The department will provide the format for the LMCH Plan, The Local MCH Plan, approved by the department, is to be uploaded with the budget application. 3. Local MCH funding source cannot be used under the WIC element, except in extreme circumstances where a waiver is requested in advance of the expenditures and evidence is provided that the expenditures satisfy all funding requirements. 4. 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. 5. 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. MDHHS/C0-2018 ATTACHMENT !II Page 116 of 210 3/14/2017 GRANTEE REQUIREMENTS LOCAL MATERNAL AND CHILD HEALTH A. Local MCH funds are available to support one or more of the Title V Maternal Child Health Block Grant national and state performance measures, B. Grantees are to follow the FY 2018 Local MCH Plan I nstructions to prepare the agency's Local MCH Plan. C. Grantees are to follow the FY 2018 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 The FY18 LMCH Year-End Report is due at the time of the final FSR submission for FYI 8. The department will provide the format for the LMCH Year-End Report. MOH HS/CO-2018 ATTACHMENT III Page 117 of 210 3/14/2017 Grant Start Date Grant Contract Administrator 989-619-1304; cotantm@michigan.gov Sul3recipient, Contractor, or Recipient (non-federal Designation Performance Target Output Measure Subrecipient N/A II LOCAL TOBACCO PREVENTION Special Requirements 9/30/2018 I Reimbursement Staffing (6) 1 Method Performance Level N/A (if Applicable) 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 M NHS/CO-2018 ATTACHMENT III Page 118 of 210 3/14/2017 REPORTING REQUIREMENTS Reports are due on a quarterly basis. Submit reports by the 15th of the month following the end of the quarter via email to Consultant (email to be provided) and a hard copy to MDHHS Tobacco Section (address listed below). Report Period: October 1 — December 31 January 1 — March 31 April 1 — June 30 July 1 — September 30 Complete a narrative final report Due Date: January 15 April 15 July 15 October 15 November 1 Mail a hard copy of the Report to: MDHHS Tobacco Control Program Washington Square Building, 8th Floor 109 West Michigan Avenue Lansing, MI 48913 M DH HS/CO-2018 ATTACHMENT III Page 119 of 210 3/14/2017 Grant End Date 517-335-4663; kosteiect@michigan.gov Staffing (6) i Administrator Contact Info (phone & email) Reimbursement Method i Performance Level N/A 1. (if Applicable) Subrecipient, Contractor, or Recipient (non-federal Designation :Performance Target • • Output.MeaS4re.... Subrecipient N/A MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING INITIATIVE (MIECHV) LOCAL HOME VISITING LEADERSHIP GROUP (MIECHVLLG) Special Requirements Grant Start Date 10/1/2017 Grant Contract Tiffany Kostelec BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Comply with MHVI Program Requirements: The Grantee shall operate the program with fidelity to the requirements of the Department, as outlined in the Michigan Home Visiting Initiative (MHVI) Guidance Manual. 1. The Local Leadership Group (LLG) will work with the MDHHS contractors: Early Childhood Investment Corporation (ECIC) and the Michigan Public Health Institute (MPHI). See the MHVI Guidance Manual for details related to working with ECIC and MPHI. 2. The LLG will continue efforts started in years one, two and three. a. Continue to ensure recruitment and participation of both required and strongly encouraged LLG representatives. b. Continue to implement one strategy from the respective community's local home visiting continuum of models project plan c. Continue to participate in the LLG Quality Improvement Learning Collaborative to identify strategies and activities for the purposes of improving outreach and enrollment in evidence-based home visiting. 3. In year four, the LLG will begin to develop a sustainability plan. See the MHVI Guidance Manual for requirements related to LLG membership/participation, development of a continuum and CQI as well as development of a sustainability plan. M DH HS/CO-2018 ATTACHMENT Page 120 of 210 3/14/2017 Funding Requirements: The funding can be used to: 1. Enable the LLG to pay for staff support. 2. Financially support LLG members, including parent leaders, to be a part of the LLG. 3. Carry out the MIECHV activities, as specified in this agreement. Promotional Materials If the LLG wishes to produce any marketing, advertising or educational materials, using contract funds, they must follow the requirements, as outlined in the MHVI Guidance Manual. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS The Grantee shall submit the following reports: 1. All activities as specified in the work plan shall be implemented and quarterly narrative reports submitted to the MHVI Mailbox at MDHHS-HVInitiativ©michigan.gov. See the MHVI Guidance Manual for specific detail about what must be provided in the reports. 2. Any such other information as specified in the work plan shall be developed and submitted by the Grantee, as required by the Contract Manager. 3. See the MHVI Guidance Manual for specific CQI reporting requirements, to include: monthly data tracking and Plan, Do, Study, Act (PDSA) cycle updates (due the 15th of each month), Story Board and Team Charter submissions. 4. Any other required reports or information are to be submitted electronically to the MHVI MHVI Mailbox at MDHHS-HVI nitiativ@michigan.gov. 5. The Contract Manager shall evaluate the reports submitted as described for their completeness and adequacy. 6. The Grantee shall permit the Department or its designeed to visit and to make an evaluation of the project, as determined by the Contract Manager. MDHHS/C0-2018 ATTACHMENT III Page 121 of 210 3/14/2017 Performance Level N/A (if Applicable) Tiffany Kostelec 517-335-4663; kostelect@michigan.gov Staffing (6) Grant Contract Administrator Contact Info (phone & email) Reimbursement Method Subreciplent, Contractor, or Recipient (non-federal Designation Subrecipient Performance Target N/A Output Measure 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) Special Requirements Grant Start Date I 10/1/2017 I Grant End Date I 9/30/2018 BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Comply with MHVI Program Requirements: The subcontracting agency shall operate the program with fidelity to the requirements of the Department, as outlined in the Michigan Home Visiting Initiative (MHVI) Guidance Manual. 1. The Local Leadership Group (LLG) will work with the Department contractors: Early Childhood Investment Corporation (ECIC) and the Michigan Public Health Institute (MPHI). See the MHVI Guidance Manual for details related to working with ECIC and MPHI. 2. The LLG will continue efforts started in years one, two and three. a. to ensure recruitment and participation of both required and strongly encouraged LLG representatives. b. Continue to implement one strategy from the respective community's local home visiting continuum of models project plan c. Continue to participate in the LLG Quality Improvement Learning Collaborative to identify strategies and activities for the purposes of improving outreach and enrollment in evidence-based home visiting. MDHFIS/C0-2018 ATTACHMENT III Page 122 of 210 3/14/2017 3. In year four, the LLG will begin to develop a sustainability plan. See the MHVI Guidance Manual for requirements related to LLG membership/participation, development of a continuum and CQI as well as development of a sustainability plan. Funding Requirements: The funding can be used to: 1. Enable the LLG to pay for staff support. 2. Financially support LLG members, including parent leaders, to be a part of the LLG. 3. Carry out the MIECHV activities, as specified in this agreement. Promotional Materials If the LLG wishes to produce any marketing, advertising or educational materials, using contract funds, they must follow the requirements, as outlined in the MHVI Guidance Manual. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS The Contractor shall submit the following reports: 1. All activities as specified in the work plan shall be implemented and quarterly narrative reports submitted to the MHVI mailbox at MDHHS-HVInitiativeemichiqan.gov . See the Guidance Manual for specific detail about what must be provided in the reports. 2. Any such other information as specified in the work plan shall be developed and submitted by the Contractor, as required by the Contract Manager. 3. See the MHVI Guidance Manual for specific CQI reporting requirements, to include: monthly data tracking and Plan, Do, Study, Act (PDSA) cycle updates (due the 15th of each month), Story Board and Team Charter submissions. 4. Any other required reports or information are to be submitted electronically to the MHVI mailbox at MDHHS-HVI nitiativea.michiaan.gov . 5. The Contract Manager shall evaluate the reports submitted as described for their completeness and adequacy. 6. The Grantee shall permit the Department or its designee to visit and to make an evaluation of the project, as determined by the Contract Manager. MIDI-INS/CO-2018 ATTACHMENT III Page 123 of 210 3/14/2017 Grant Start Date 10/1/2017 Grant End Date Reimbursement Staffing (6) Method Sul3recipient, Contractor, or Recipient (non-federal) Designation Subrecipient 9/30/2018 Grant Contract Administrator Contact Info (phone & email) Tiffany Kostelec 517-335-4663; kostelect@michigan.gov Performance Level N/A (if Applicable) Performance Target N/A Output Measure MATERNAL INFANT CHILDHOOD HOME VISITING PROGRAM (MIECHVP) HEALTHY FAMILIES AMERICA EXPANSION (BMHFAE) Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Maintain Fidelity to the Model The Grantee shall adhere to the Healthy Families America (HFA) Best Practice Standards. P.A. 291 The Grantee shall comply with the provisions of Public Act 291 of 2012. See the Michigan Home Visiting Initiative (MHVI) Guidance Manual for requirements related to PA 291. Staffing The Grantee HFA home visiting staff will reflect the community served. The Grantee will provide documentation to demonstrate due diligence if unable to fully meet this requirement, within 90 days of a MHVI site visit in which this was a finding. See the MHVI Guidance Manual for requirements related to program staffing. Comply with MHVI Program Requirements The Grantee shall operate the program with fidelity to the requirements of the Department, as outlined in the MHVI Guidance Manual. MDHHS/CO-2018 ATTACHMENT II; Page 124 of 210 3/14/2017 Program Monitoring. Assessment, Support and Technical Assistance (TA): The Grantee shall fully participate with the Department and the Michigan Public Health Institute (MPHI) with regards to program development and monitoring (including annual site visits), training, support and technical assistance services. See the MHV1 Guidance Manual for requirements related to program monitoring, assessment, support and TA. Professional Development and Training: All of the Grantee's HFA program staff associated with this funding will participate in professional development and training activities, as required by both HFA and the Department. All Grantee HFA program staff must receive HFA-specific training from a Michigan-based approved HFA training entity. See the MHVI Guidance Manual for requirements related to professional Development and Training Activities. Supervision: The Grantee 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. Engage and Coordinate with Community Stakeholders: The Grantee shall assure that there is a broad-based community advisory committee that is providing oversight for HFA. The Grantee shall build upon and maintain diverse community and target population collaboration and support. The Grantee shall participate in the Local Leadership Group (LLG) (if not the HFA community advisory committee) or, if none, at the Great Start Collaborative. See the MHVI Guidance Manual for requirements related to engagement and coordination with community stakeholders. Maintain Fidelity to the Model The Grantee shall adhere to the Healthy Families America (HFA) Best Practice Standards. P.A. 291 The Grantee shall comply with the provisions of Public Act 291 of 2012. See the MHVI Guidance Manual for requirements related to PA 291. Staffing, The Grantee HFA home visiting staff will reflect the community served. The Grantee will provide documentation to demonstrate due diligence if unable to fully meet this requirement, within 90 days of a MHVI site visit in which this was a finding. See the MHV1 Guidance Manual for requirements related to program staffing. MDHHS/CO-2018 ATTACHMENT HI Page 125 of 210 3/14/2017 Comply with MHVI Program Requirements The Grantee shall operate the program with fidelity to the requirements of the Department, as outlined in the MHVI Guidance Manual, Program Monitoring, Assessment, Support and Technical Assistance (TM: The Grantee shall fully participate with the Department and the Michigan Public Health Institute (MPHI) with regards to program development and monitoring (including annual site visits), training, support and technical assistance services. See the MHVI Guidance Manual for requirements related to program monitoring, assessment, support and TA. Professional Development and Training: All of the Grantee's HFA program staff associated with this funding will participate in professional development and training activities, as required by both HFA and the Department. All LIA HFA program staff must receive HFA-specific training from a Michigan-based approved HFA training entity. See the MHVI Guidance Manual for requirements related to professional Development and Training Activities. Supervision: The Grantee 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. Engage and Coordinate with Community Stakeholders: The Grantee shall assure that there is a broad-based community advisory committee that is providing oversight for HFA. The Grantee shall build upon and maintain diverse community and target population collaboration and support. The Grantee shall participate in the Local Leadership Group (LLG) (if not the HFA community advisory committee) or, if none, at the Great Start Collaborative. See the MHVI Guidance Manual for requirements related to engagement and coordination with community stakeholders. Data Collection: The Grantee shall comply with all HFA and MDHHS data training, collection, entry and submission requirements. See the MHVI Guidance Manual for requirements related to data collection. Continuous Quality Improvement (CQI): The Grantee shall participate in all HFA quality initiatives including: research, evaluation and continuous quality improvement. The Grantee shall participate in all State and local Home Visiting CQI activities as required by MDHHS. Required activities include, but are not limited to: MOHHS/C0-2018 ATTACHMENT lh Page 126 of 210 3/14/2017 a. Qi team participates in one Quality Improvement (QI) Learning Collaborative per fiscal year, with all required training, reporting requirements and deliverables. b. Conduct and complete two Grantee specific Plan, Do, Study, Act (PDSA) cycles per fiscal year, with all required reporting and deliverables. See the MHVI Guidance Manual for requirements related to CQI. Work Plan Requirements: Upon initiation of the FY18 contract, the Grantee must submit a work plan (outlining all program activities) to the MHVI mailbox at MDHHS-HVInitiativeAmichioan.gov . See the MHVI Guidance Manual for requirements related to the work plan. Promotional Materials: If the Grantee wishes to produce any marketing, advertising or educational materials, using contract funds, they must follow the requirements outlined in the MHVI Guidance Manual. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS The Grantee shall serve the target population approved by the MDHHS, which supports the findings of their community's Needs Assessment. a. The Kalamazoo County Health and Community Services Dept. HFA program will serve 60 families with children who are at high risk in the areas of Comstock Township, City of Kalamazoo-Arcadia, Vine, Eastside neighborhoods, Richland Township, City of Portage, Texas Township, Oshtemo and Galesburg. b. The Wayne County Babies HFA program will serve 50 families who are young parents, through age 24, living in the Cities of Hamtramck, Highland Park, Redford, Inkster, Taylor, Romulus, Van Buren Township and Westland. See the MHVI Guidance Manual for requirements related to development of an outreach plan and timeframe for reaching full caseloads. REPORTING REQUIREMENTS The Grantee shall submit all required reports in accordance with the Department reporting requirements. See MHVI Guidance Manual for details about what must be included in each report. 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. Family Stories: at a minimum, one home visiting experience, as told from the perspective of a currently enrolled family, within 30 days of the end of each quarter (see below reporting schedule). MDHHS/CO-2018 ATTACHMENT III Page 127 of 210 3/14/2017 d. Work Plan Reports: must be submitted within 30 days of the end of each quarter and include detailed and specific activities that have taken place during the quarter. Biannually (April 30 and October 30) the work plan reports must include information about outreach activities and caseload population status. Report Period Covered Report Due Dates October 1 — December 31 January 30 January 1 - March 31 April 30 April 1 - June 30 July 30 July 1 - September 30 October 30 All reports (a-d) and information shall be submitted electronically to the MHVI mailbox at MDHHS- HVInitiative(&_michician.dov. e. Implementation Monitoring Date and HRSA data collection requirements on the 5th business day of each month. f. Continuous Quality Improvement reporting for the Learning Collaborative due on the 15th of each month. g. Continuous quality Improvement reporting for LIA specific projects due by the 15th of the next month following the end of the quarter: Report Period Covered Report Due Dates October 1 — December 31 January 15 January 1 - March 31 April 15 April 1 - June 30 July 15 July 1 - September 30 October 15 All reports (e-g) shall be submitted to the appropriate MPHI staff, as designated in the MVHI Guidance Manual. MDHHS/C0-2018 ATTACHMENT III Page 128 of 210 3/14/2017 Reimbursement Method Performance Leve (if Applicable) Grant Start Date Grant Contract Administrator Contact Info (phone & email) 10/1/2017 Tiffany Kostelec 517-335-4663; kostelect@michigan.gov Subrecipient Contractor, or Recipient (non-federal Designation Performance Target Output Measure Staffing (6) N/A Subrecipient N/A Grant End Date 9/30/2018 MI HOME VISITING INITIATIVE RURAL EXPANSION GRANT (MHVIRE) MI HOME VISITATION INITIATIVE RURAL EXPANSION GRANT REGION 3 (MHVIRE3) Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Maintain Fidelity to the Model The Grantee shall adhere to the Healthy Families America (HFA) Best Practice Standards. P.A. 291 The Grantee shall comply with the provisions of Public Act 291 of 2012. See the Michigan Home Visiting Initiative (MHVI) Guidance Manual for requirements related to PA 291. Staffing The Grantee's HFA home visiting staff will reflect the community served. The Grantee will provide documentation to demonstrate due diligence if unable to fully meet this requirement, within 90 days of a MHVI site visit in which this was a finding. See the MHVI Guidance Manual for requirements related to program staffing. MDH HS/CO-2018 ATTACHMENT III Page 129 of 210 3/14/2017 Comply with MHVI Program Requirements The Grantee shall operate the program with fidelity to the requirements of the Department, as outlined in the MHVI Guidance Manual. Program Monitoring, Assessment, Support and Technical Assistance (TA): The Grantee shall fully participate with the Department and the Michigan Public Health Institute (MPHI) with regards to program development and monitoring (including annual site visits), training, support and technical assistance services. See the MHVI Guidance Manual for requirements related to program monitoring, assessment, support and TA. Professional Development and Training: All of the Grantee's HFA program staff associated with this funding will participate in professional development and training activities, as required by both HFA and the Department. All Grantee HFA program staff must receive HFA-specific training from a Michigan-based approved HFA training entity. See the MHVI Guidance Manual for requirements related to professional Development and Training Activities. Supervision: The Grantee 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. Engage and Coordinate with Community Stakeholders: The Grantee shall assure that there is a broad-based community advisory committee that is providing oversight for HFA. The Grantee shall build upon and maintain diverse community and target population collaboration and support. The Grantee shall participate in the Local Leadership Group (LLG) (if not the HFA community advisory committee) or, if none, at the Great Start Collaborative. See the MHVI Guidance Manual for requirements related to engagement and coordination with community stakeholders. Data Collection: The Grantee shall comply with all HFA and Department data training, collection, entry and submission requirements. See the MHVI Guidance Manual for requirements related to data collection. Continuous Quality Improvement (CQI): The Grantee shall participate in all HFA quality initiatives including: research, evaluation and continuous quality improvement. The Grantee shall participate in all State and local Home Visiting CQI activities as required by the Department. Required activities include, but are not limited to: MDHHS/CO-2018 ATTACHMENT III Page 130 of 210 3/14/2017 a. QI team participates in one Quality Improvement (Q1) Learning Collaborative per fiscal year, with all required training, reporting requirements and deliverables. b. Conduct and complete two Grantee specific PDSA cycles per fiscal year, with all required reporting and deliverables. See the MHV1 Guidance Manual for requirements related to Ca. Work Plan Requirements: Upon initiation of the FY18 contract, the Grantee must submit a work plan (outlining all program activities) to the MHVI mailbox at MDHIS-HVInitiative@michican.gov . See the MHVI Guidance Manual for requirements related to the work plan. Promotional Materials: If the Grantee wishes to produce any marketing, advertising or educational materials, using contract funds, they must follow the requirements outlined in the MHVI Guidance Manual. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS The LIA shall serve the target population approved by the MDHHS, which supports the findings of their community's Needs Assessment. a. The Health Department of NWMI HFA Program (Region 2) will serve 20 families with pregnant women per 1.0 FTE home visitor. b. The Health Department of NWM1 HFA Program (Region 3) will serve 20 families with pregnant women per 1.0 FTE home visitor. c. The Luce-Mackinac-Alger-Schoolcraft Health Department HFA Program (Region 1) will serve 20 families with pregnant women per 1.0 FTE home visitor. See the MHVI Guidance Manual for requirements related to development of an outreach plan and timeframe for reaching full caseloads. REPORTING REQUIREMENTS The Grantee shall submit all required reports in accordance with the Department reporting requirements. See MHVI Guidance Manual for details about what must be included in each report. 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. Family Stories: at a minimum, one home visiting experience, as told from the perspective of a currently enrolled family, within 30 days of the end of each quarter (see below reporting schedule). d. Work Plan Reports: must be submitted within 30 days of the end of each quarter and include detailed and specific activities that have taken place during the quarter. Biannually (April 30 MDHHS/CO-2018 ATTACHMENT III Page 131 of 210 3/14/2017 and October 30) the work plan reports must include information about outreach activities and caseload population status. Report Period Covered Rs. ..,p-t Due E:s., October 1 — December 31 January 31 January 1 - March 31 April 30 April 1 - June 30 July 31 July 1 - September 30 October 31 All reports (a-d) and information shall be submitted electronically to the MHV1 mailbox at MDHHS- HVInitiative@michician.qov. e. Implementation Monitoring Date and HRSA data collection requirements on the 5th business day of each month, . Continuous Quality Improvement reporting for the Learning Collaborative due on the 15th of each month. g. Continuous quality Improvement reporting for L1A specific projects due by the 15th of the next month following the end of the quarter: Report Period Covered Report Due Dates October 1 — December 31 January 15 January 1 - March 31 April 15 April 1 - June 30 July 15 July 1 - September 30 October 15 All reports (e-g) shall be submitted to the appropriate MPHI staff, as designated in the MVH1 Guidance Manual. MDH HS/CO-2018 ATTACHMENT III Page 132 of 210 3/14/2017 Performance Target N/A Output Measure N/A Performance Level if Applicable) Grant Start Date Grant Contract Administrator Contact Info (phone & email) 517-335-8976; orsbornr@michigan,gov Reimbursement Method Staffing (6) Subrecipient, Contractor, or Recipient (non Designation Subrecipient ederal) Robin Orsborn 10/1/2017 I Grant II MEDICAID OUTREACH Special Requirements BUDGET AND AGREEMENT REQUIREMENTS See Attachment I for instructions. MDHHS/C0-2018 ATTACHMENT III Page 133 of 210 3/14/2017 10/1/2017 Robyn Corey Grant Start Grant Contract Administrator Contact Info (phone & email) Reimbursemen Method Performance Level (if Applicable) 517-355-9526; Coreyrl@michigan.gov Performance (8) (18) Subrecipient, Contractor, or Recipient (non-federal Designation Performance Target : Output Measure : 90% Subrecipient Number of unduplicated youth to be served Grant End Date I 9/30/2018 II MICHIGAN ABSTINENCE PROGRAM (MAP) 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. lf 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-2018 ATTACHMENT Page 134 of 210 3/14/2017 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 1, The Grantee shall submit program narrative reports on the following dates: Type of Renort 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. lst 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/CO-2018 ATTACHMENT III Page 135 of 210 3/14/2017 ::•Grant Contract Administrator Contact Info (phone & email) Reimbursement Method Performance Level (if Applicable) Hillary Turner 517-335-5928; turnerh@michigan.gov Subrecipient, Contractor, or Recipient (non-federal Designation Subrecipient Staffing (6) • • Performance,,Targe N/A N/A Grant End Date I 9/30/2018 MICHIGAN ADOLESCENT PREGNANCY & PARENTING PROGRAM (MI-AF'PP) Special Requirements Grant Start Date 10/1/2017 Output Measure BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 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, rViDHHS/C0-2018 ATTACHMENT III Page 136 of 210 3/14/2017 9. Programs must administer, following the approved implementation guidelines, the MI-APPP youth intake and exist forms and enter required information into MI-APPP database and submit to MPHI quarterly. 10. Pregnancy prevention education must be delivered separate and apart from any religious education or promotion. MI-APPP funding cannot be used to support inherently religious activities including but not limited to, religious instruction, worship, prayer or proselytizing (45 CFR Part 87). 11. Family planning drugs and/or devices cannot be prescribed, dispense or otherwise distributed on school property as part of the pregnancy prevention education funded by MI-APPP as mandated in the Michigan School Code. 12. Abortion services, counseling and/or referrals for abortion services cannot be provided as part of the pregnancy prevention education funded under MI-APPP. 13. MI-APPP funding cannot be used to supplant funding for an existing program supported with another source of funds. 14. All program and financial reports must be submitted by the deadlines specified by the Department in the report face sheet. DEPARTMENT REQUIREMENTS 1. Provide administrative professional and technical consultation to the program. 2. Provide two, two-day MI-APPP sponsored learning 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 109W. Michigan Ave., 8th Floor P.O. Box 30195 Lansing, MI 48913 4. The Contract Manager shall evaluate the reports submitted for their completeness and adequacy. 5. The Grantee shall permit the Department or its designee to visit and to make an evaluation of the projects as determined by the Contract Manager, M HS/CO-2018 ATTACHMENT HI Page 137 of 210 3/14/2017 Grant Start Date Grant Contract Administrator Contact Info (phone & email) Reimbursement Method :Performance Target. • •OutpU.tiMeatire:•... Number of women and men that complete a screen test 90% 517-335-9729; hagerp@michigan.gov Performance Level (if Applicable) Performance (8) Subrecipient, Contractor, or Recipient (non-federal) Designation Subrecipient -1-- - - Polly Hager [ 9/30/2018 Grant End Date 10/1/2017 II MICHIGAN COLORECTAL CANCER EARLY DETECTION PROGRAM 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 60-64 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 260% of the Federal poverty level) 6. Who have inadequate or no health insurance For specific MCRCEDP requirements please refer to the most current MCRCEDP manual available at htto://wINw.michioancancer.oro/Colorectal/. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/CO-2018 ATTACHMENT IU Page 138 of 210 3/14/2017 Administrator Contact Info (phone & email) ......... ...... . • ' Staffing (6) Subrecipient, Contractor, or I Recipient (non-federal Designation Subrecipient MI HEALTH AND WELLNESS 4X4 PLAN - IMPLEMENTATION Special Requirements Grant Start Date 10/1/2017 Grant Contract Scott Bell Grant End :Date:: • 9/30/2018 517-335-9300; bells1©michigan.gov N/A N/A Performance Target . • g .Output:Measure::: .• BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Develop, submit and implement an approved work plan and budget which will be maintained on file at the Department. 2. Develop and implement an evaluation process, as appropriate and approved by MDHHS staff. A copy of all evaluation reports and data collection must be provided to the MDHHS consultant. 3. Maintain an active coalition, to support the funded project, interventions and activities. 4. Attend required meetings. 5. The Grantee shall collaborate with the program consultant to schedule and participate in site visits (as required). 6. Provide interventions and strategies to support physical activity or healthy eating and include a community wide public awareness campaign that incorporates the 4x4 health messages and recognizes the grant support of Grantee and the Ml Health and Wellness 4x4 Plan. 7, 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. 8. Each Grantee will have a 25% required match. ATTACHMENT III Page 139 of 210 MDHHS/C0-2018 3/14/2017 9. 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 The Grantee will submit a progress report to the project evaluator as prescribed in the evaluation plan. Period Covered Report Due Dates October 1 — December 31 January 31 January 1 — March 30 April 30 April 1 — June 30 July 31 July 1 — September 15 September 30 MOM-IS/CO-2018 ATTACHMENT Ill Page 140 of 210 3/14/2017 Grant Contract ; Administrator • Contact Info (phone & email) Tiffany Kostelec 517-335-4663; kostelect@michigari.gov Reimbursement Method Performance Level (if Applicable) Subrecipient, Contractor, or Recipient (non-federal Designation Performance Target Output Measure Subredpient Staffing (6) N/A N/A ; Grant Start Date I 10/1/2017 NURSE FAMILY PARTNERSHIP (NFP) SERVICES NURSE FAMILY PARTNERSHIP MEDICAID OUTREACH Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Maintain Fidelity to the Model: The Grantee shall adhere to the Nurse Family Partnership (NFP) National Service Office (NSO) program standards and operate the program with fidelity to the NSO Application Review Team approved Implementation Plan. P.A. 291: The Grantee shall comply with the provisions of Public Act 291 of 2012. See the Michigan Home Visiting Initiative (MHVI) Guidance Manual for requirements related to PA 291. Comply with MHVI Program Requirements: The Grantee shall operate the program with fidelity to the requirements of the Department as outlined in the MHVI Guidance Manual. Staffing: The Grantee's NFP home visiting staff will reflect the community served. The Grantee will provide documentation to demonstrate due diligence if unable to fully meet this requirement, within 90 days of a MHVI site visit in which this was a finding. See the MHVI Guidance Manual for requirements related to program staffing. MDHHS/C0-2018 ATTACHMENT III Page 141 of 210 3/14/2017 Target Population: 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 pre-term births (based on the Kitagawa analysis provided by the Department). This specialized service strategy is a focused way of using limited resources, directing them to the most at-risk populations. The Grantee will conduct outreach activities to the population group identified in their Kitagawa analysis, in order to enroll families from those outreach efforts. See the MHVI Guidance Manual for requirements related to development of an outreach plan and timeframe for reaching full caseloads. Program Monitoring, Assessment, Support and Technical Assistance (TA): The Grantee shall fully participate with the NFP NSO, the Department and the Michigan Public Health Institute (MPHI) with regards to program monitoring (including annual site visits), assessment, support and technical assistance services. See the MHVI Guidance Manual for requirements related to program monitoring, assessment, support and TA. Professional Development and Training: All of the Grantee's NFP staff associated with this funding will participate in professional development and training activities, as required by both NFP and the Department. See the MHVI Guidance Manual for requirements related to professional development and training activities. Supervision: The Grantee shall adhere to the NFP supervision requirements. Engage and Coordinate with Community Stakeholders: The Grantee shall assure that there is a broad-based community advisory committee that is providing oversight for NFP. The Grantee shall build upon and maintain diverse community and target population collaboration and support. The Grantee shall participate in the Local Leadership Group (LLG) (if not the NFP community advisory body) or, if none, at the Great Start Collaborative. See the MHVI Guidance Manual for requirements related to engagement and coordination with community stakeholders. Data collection: The Grantee shall comply with all NFP and the Department data training, collection and entry, and submission requirements. See the MHVI Guidance Manual for requirements related to data collection. Continuous Quality Improvement (CQI): The Grantee shall participate in all NFP quality initiatives including: research, evaluation and continuous quality improvement. MDH HS/CO-2018 ATTACHMENT HI Page 142 of 210 3/14/2017 The Grantee shall participate in all State and local Home Visiting CQI activities, as required by the Department. Required activities include, but are not limited to: 1. QI team participates in one Quality Improvement (QI) Learning Collaborative per fiscal year, with all required training, reporting requirements and deliverables. 2. Conduct and complete two Grantee specific PDSA cycles per fiscal year, with all required reporting and deliverables. See the MHVI Guidance Manual for requirements related to CQI. Work Plan Requirements: Upon initiation of the FY18 contract, the Grantee must submit a work plan (outlining all program activities) to the MHVI mailbox at MDHHS-HVInitiative@michidan.00v . See the MHVI Guidance Manual for requirements related to work plans. Promotional Materials: If the Grantee wishes to produce any marketing, advertising or educational materials, using contract funds, they must follow the requirements outlined in the MHVI Guidance Manual. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS The Grantee shall submit all required reports in accordance with the Department reporting requirements. See the MHVI Guidance Manual for details about what must be included in each report. 1. Staff Roster: within 30 days of the beginning of each fiscal year and within 30 days of a staffing change. 2. NFP Community Outreach Plan: within 30 days of the beginning of each fiscal year. 3. Family Stories: at a minimum, one home visiting experience, as told from the perspective of a currently enrolled family, within 30 days of the end of each quarter (reporting schedule below). 4. Medicaid Outreach Report (Berrien, Calhoun, Kalamazoo and Kent only): within 30 days of the end of each quarter (reporting schedule below). 5. Work Plan Reports: must be submitted within 30 days of the end of each quarter and include detailed and specific activities that have taken place during the quarter. Biannually (April 30 and October 30) the work plan reports must include information about outreach activities and caseload population status. Report Period Covered October 1 — December 31 January 1 - March 31 April 1 - June 30 July 1 - September 30 Report Due Dates January 31 April 30 July 31 October 31 MDRHS/C0-2018 ATTACHMENT III Page 143 of 210 3/14/2017 All reports (1-5) and information shall be submitted electronically to the MHVI mailbox at MDHHS- HVInitiativea.michigan.gov . 6. Implementation Monitoring Date and HRSA data collection requirements on the 5th business day of each month. 7. Continuous quality Improvement reporting for the Learning Collaborative due the 15'h of each month. 8. Continuous Quality Improvement reporting for Grantee specific projects due by the 15 1hof the next month following the end of the quarter: Report Period Covered October 1 — December 31 January 1 - March 31 April 1 - June 30 July 1 - September 30 Report Due Dates January 15 April 15 July 15 October 15 All reports (6-8) shall be submitted to the appropriate MPHI staff, as designated in the MHVI Guidance Manual. MDH HS/CO-2018 ATTACHMENT III Page 144 of 210 3/14/2017 'Grant ptart Date:, 10/1/2017 Performance Level (1 Applicable) Subrecipient, Contractor, or Recipient (non-federal) Designation Subrecipient NUTRITION AND PHYSICAL ACTIVITY SELF-ASSESSMENT FOR CHILD CARE Special Requirements Scott Bell 517-335-9300; bells1 ©michigartgov Staffing (6) N/A 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. The Grantee will utilize the tool provided by MDHHS to measure progress and success. 3. The Grantee will attend required meetings. 4. The Grantee shall collaborate with the program consultant to schedule and participate in site visits. 5. 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. 6. 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 MDIIHS/C0-2018 ATTACHMENT ill Page 145 of 210 3/14/2017 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS The grantee will submit monthly progress report, to Department no later than 15 days after the close of each calendar month. Reports will be submitted electronically to: GILMOREL@Michigan.gov MDHHS/C0-2018 ATTACHMENT III Page 146 of 210 3/14/2017 517-335-8150; GuyskyP1 @rnichigan.gov Staffing (6) (14) (18) Subrecipient, Contractor, or Recipient (non-federal Designation Contact Info (phone & email) Reimbursement Method Subrecipient Performance Level N/A Performance Target N/A (if Applicable) Output Measure II PUBLIC HEALTH EMERGENCY PREPAREDNESS (PHEP) Special Requirements 1 9/30/2018 Grant Start Date 10/1/2017 .Grant..End ,Date • Grant Contract Administrator Patrick Guysky BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Grantee Reauirements (Base/ CRI) The Public Health Emergency Preparedness section of Attachment III is effective from October 1, 2017 through June 30, 2018. Funds are provided by the Department for nine months based on the Department's fiscal year. As a Grantee 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 Grantee 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 2017-2018 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 Budget Period 5 (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 (EPC), as a point of contact. In addition to the Grantee health officer, the EPC shall participate in collaborative capacity building activities of the HPP/PHEP Cooperative Agreement, all required reporting and exercise requirements and in regional Healthcare Coalition (HCC) initiatives. 2. Under the alignment of the HPP and PHEP cooperative agreements, Grantee's must partner with the Regional Healthcare Coalition (HCC) and support HCC initiatives to ensure that healthcare organizations receive resources to meet medical surge demands. Working well MDHHS/CO-2018 ATTACHMENT III Page 147 of 210 3/14/2017 together during a crisis is facilitated by meeting on a regular basis. To this end, EPCs, supported by CDC PHEP are required to participate in and support regional HCC initiatives. In addition, the EPC or designee is required to attend regional HCC planning or advisory board meetings. 3. There are a number of special initiatives, projects, and/or supplemental funding opportunities 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 — Division of Emergency Preparedness and Response (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 Ito Sept 30) for both Base PHEP and CRI) funding, including the 10 percent (10%) MATCH for those periods (see #14 below for detail regarding Match). Submitted to MDHHS- BETP-DEPR-PHEP(a_nnichigan.gov by May 1, 2017. 5. ALL activities funded through the PHEP cooperative agreement must be completed between July 1, and June 30, and all BPI -2017 funding must be obligated by June 30, 2018 and completed by the August 15, 2018 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 Patrick Guysky at guyskypamichigan.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, 2018. 8, 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. Grantees may not use funds for fund raising activities or lobbying. b. Grantees may not use funds for research. c. Grantees may not use funds for construction or major renovations. d. Grantee may not use funds for clinical care. e. Grantees 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. Grantees may not use funds for reimbursement of pre-award costs, MD HH S/C0-2018 ATTACHMENT III Page 148 of 210 3/14/2017 g. Grantees may supplement but not supplant existing state or federal funds for activities described in the budget. h. Payment or reimbursement of backfilling costs for staff is not allowed. 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, 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 (NI MS) compliance as detailed in the LHD work plan and submit annually to the Department — DEPR per the LHD BP1-2017 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. Grantees provide the required 10 percent MATCH for July 1,2017 through September 30, 2017 and October 1, 2017 through June 30, 2018. 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 BP1-2017, 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. MDHHS/CO-2018 ATTACHMENT III Page 149 of 210 3/14/2017 16. The Pandemic and All Hazards Preparedness Reauthorization Act (PAHPRA) of 2013 requires the withholding of amounts from entities that fail to achieve PHEP benchmarks, The following PHEP benchmarks have been identified by CDC and the Department -DEPR for the Fiscal Year: a. Demonstrated adherence to all PHEP application and reporting deadlines. Grantees must submit required PHEP program data and reports by the stated deadlines. This includes, but is not limited to, progress reports, performance measure data reports, National Incident Management System (NI MS) 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 Grantee BPS work plan. b. Demonstrated capability to receive, stage, store, distribute, and dispense medical countermeasures (MCM) I during a public health emergency, per the BPI-2017 Grantee Work Plan. c. Pandemic Influenza Preparedness plans: Further guidance will be included in the Grantee PHEP Work Plan. 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 Grantee 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. Regional Epidemiology Support: 1. For those Grantees receiving additional funds to provide workspace for Regional Epidemiologists, the grantee must provide adequate office space, telephone connections, and high-speed Internet access. The position must also have access to fax and photocopiers. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A MDHHS/CO-2018 ATTACHMENT111 Page 150 of 210 3/14/2017 Grant start Grant Contract Administrator Contact Info (phone & email) Reimbursement Method Performance Level (if Applicable) N/A Subrecipient, Contractor, or Recipient (non- federal) Designation Performance Target Contractor Lucie Taylor l 517-202-0675; tayor122@michigan.gov I Staffing (6) 10/1/2017 Grant End Date 9/30/2018 N/A Output Measure REGIONAL PERINATAL CARE SYSTEM Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS 1. At minimum, the quality improvement area of focus, as determined by the department, must be addressed. In addition, the regional project may choose additional quality improvement areas of focus. 2. All quality improvement efforts must be inclusive of addressing equity and specifically the social determinants; 3. Regional efforts must be comprised of a multi-stakeholder membership; GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 1. Report on the status of both grantee and department determined key process or outcome measures on a quarterly basis; 2. Report on outcomes/performance goals, as identified by the grantee and department on a quarterly basis; 3. Reports shall be submitted to the Contract Manager, Dawn Shanafelt, at Shanafelin Ylichippn.goy, MDHHS/CO-2018 ATTACHMENT III Page 151 of 210 3/14/2017 L9/30/2018 Contact Info (phone & email) Reimbursement Method 517.-373-4943; MooreJ14@Michigan.gov Performance Target N/A Output Measure N/A T- S ubrecipient, Contractor, or Recipient (non-federal Designation Staffing (6) Subredpient M SEAL! MICHIGAN DENTAL SEALANT PROGRAM Special Requirements Performance Level (if Applicable) 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 schools that have a minimum of 50% students participating in the Free and Reduced Lunch Program. Families will not be charged for sealant applications, as sealants, screenings, and education are provided free. All applicable insurances (Medicaid, Healthy Kids Dental, Healthy Kids, private insurances etc.) must be billed for services rendered. 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, 2018 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. MDHHS/C0-2018 ATTACHMENT III Page 152 of 210 3/14/2017 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. 9. Provide details on how the program is working toward sustainability beyond the grant. Grantees must provide documentation on how sustainability is taking place, for example: Medicaid, 3rd party billing protocols or in-kind contributions. 10. Grantees must utilize experienced and competent staff to accomplish program goals. 11. Grantees must track separately the amount of schools they serve, how many children received dental sealants, and how many dental sealants have been placed separately from SEALS and be able to provide this information upon request 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. Any time that retention does not meet the program goals (90% occlusal or 65% buccal pits) then the Department will be immediately notified. 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. 14. At least one member of sealant program will attend the annual SEAL! MI Workshop, and any other trainings offered. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A MDHHS/C0-2018 ATTACHMENT III Page 153 of 210 3/14/2017 REPORTING REQUIREMENTS The Grantee shall submit the following reports within 15 days as stated on the following dates: Quarter End Date Report Due Date 1st Quarter (December 31) January 15 2nd Quarter (March 31) April 15 3rd Quarter (June 30) July 15 4th Quarter (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 amended according to program outcomes throughout the year according to work plan 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 Ml 48909 Phone: (517) 373-4943 Fax: (517) 335-9461 MooreJ14@michiqan,dov MDHHS/C0-2018 ATTACHMENT III Page 154 of 210 3/14/2017 N/A if Applicable) Performance .Level:': 9/30/2018 Performance Target Output Measure 517-241-5861; linzmeier@michigan.gov • Reimbursement Method Staffing (6) Subrecipient Subrecipient, Contractor, or Recipient (non-federal Designation SEXUALLY TRANSMITTED DISEASE (STD) CONTROL Special Requirements 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 Division of HIV and STD Programs/Sexually Transmitted Disease (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/C0-2018 ATTACHMENT III Page 155 of 210 3/14/2017 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-2018 ATTACHMENT III Page 156 of 210 3/14/2017 Grant Start pate•:: 'TO-M/2017 .... ..... Jennifer Linzmeier 517-241-5861; linzmeier@michigan.gov 'Grant. End Date'.... I 9/30/2018 Grant Contract Administrator Contact Info (phone & email) Reimbursemen Method STD NEISSERIA GONORRHOEAE ENHANCED SURVEILLANCE PROJECT Special Requirements Staffing (6) Performance Level N/A (if Applicable) Subrecipient, Contractor, or Recipient (non-federal) Designation Performance Target N/A Output Measure Subrecipient BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1, To monitor trends in antimicrobial susceptibilities in N. gonorrhoeae. 2. To characterize patients with gonorrhea (GC), particularly those infected with N. gonorrhoeae that are not susceptible to recommended antimicrobials. 3. To phenotypically characterize antimicrobial-resistant isolates to describe the diversity of antimicrobial resistance in N. gonorrhoeae. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS 1. Assess each STD patient presenting Monday Wednesday for possible gonococcal infection. 2. For each STD clinic patient suspected of having GC (symptoms, known partner etc.), collect a urogenital sample using a Modified Thayer Martin (MTM) plate. 3. For each male STD clinic patient who reports same sex partners, collect sample using a MTM plate from all sites of exposure (rectal, pharyngeal, urethral), regardless of symptoms. MDHHs/co-2018 ATTACHMENT Ili Page 157 of 210 3/14/2017 4. For clients with positive isolates, submit specimen to MDHHS Bureau of Laboratories for susceptibility testing. 5. For clients with samples with decreased susceptibility to recommended GC treatment, conduct DIS services to locate patient and conduct test of cure and additional treatment if necessary. REPORTING REQUIREMENTS 1. Complete detailed case report form in the Michigan Disease Surveillance System (MDSS) for patients diagnosed with GC in the County STD Clinic. 2, On a quarterly basis, extract from StarLIMS, and submit to MDHHS, the number of culture specimens collected and number of presumptive positive GC specimens sent to MDHHS for susceptibility testing. a. Report due dates: April 15, July 15, October 15, December 15 MDHHS/C0-2018 ATTACHMENT ill Page 158 of 210 3/14/2017 517-335-8627; grzywaczj©michigan.gov Subrecipient N/A Reimbursement . Staffing (6) Method Performance Level N/A (if Applicable) Recipient (non-federal Designation SEXUAL VIOLENCE PREVENTION Special 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 indirect, research, or clinical care. b. Recipients may only expend funds for reasonable program purposes, including personnel, travel, and supplies. c. Awardees may not generally use funding to purchase of furniture or equipment. Any such proposed spending must be identified in the budget. d. Recipients may not use funds for fund-raising activities or lobbying, construction or major renovations, or of pre-award costs. e. Recipients may supplement but not supplant existing state or federal funds. f. Payment or reimbursement of backfilling costs for staff is not allowed. DEPARTMENT REQUIREMENTS N/A MDHHS/C0-2018 ATTACHMENT III Page 159 of 210 3/14/2017 GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS The Grantee will submit the following reports to Jessica Grzywacz at: grzwaczj@michigan.gov Report 1st Quarter (October 1 through December 31) 2nd Quarter (January 1 through March 31) 3rd Quarter (April 1 through June 30) 4th Quarter (July 1 through September 30) Due Date January 17 April 17 July 17 October 16 MDHHS/C0-2018 ATTACHMENT Ill Page 160 of 210 3/14/2017 Performance Target': : OUtpUt ..Measure: N/A N/A ' Performance Level (if Applicable) Grant Start Date Grant Contract Administrator Contact Info (phone & email) 10/1/2017 Lucie Taylor 517-202-0675; tayor122@michigan.gov 9130/2018 Reimbursement Method Fixed Unit Rate (2) (11) Subrecipient, Contractor, or Recipient (non-federal Designation 7—Contractor Grant End Date SUDDEN UNEXPLAINED INFANT DEATH (SUID) AND OTHER FETAL INFANT DEATH Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 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 fetaVinfant death risk reduction information and interconception care education and/or counseling. I nterconception 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 &AD diagnosis. MOI-11-1S/C0-2018 ATTACHMENT III Page 161 of 210 3/14/2017 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-2018 ATTACHMENT III Page 162 of 210 3/14/2017 Grant Contract Administrator i Grant End Date I 9/30/2018 Grant Start Date 10/1/2017 1 Kara Anderson Contact Info (phone & email) 517-373-3864; a ndersonk10@michigan.g ov Reimbursement Method I Performance (8) (18) Subreciplent, Contractor, or Recipient (non-federal Designation Performance Target Output Measure Performance Level (if Applicable) 90% II TAKING PRIDE IN PREVENTION (TPIP) Special Requirements Subrecipient Number of unduplicated youth who complete at least 75% of the i 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 Online Data Entry (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. MOHHS/C0-2018 ATTACHMENT III Page 163 of 210 3/14/2017 6. Pregnancy prevention programming must be delivered separate and apart from any religious education or promotion. TP1P funding cannot be used to support inherently religious activities including, but not limited to, religious instruction, worship, prayer, or proselytizing (45 CFR Part 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 TPIPTIPPI 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. TP1P funding cannot be used to supplant funding for an existing program supported with another source of funds. 10. TP1P 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: ,Report Time Period Due Date Submit T October 1 - December 31 Program January 1 - March 31 April 15 Email to Contract Narrative Manager July 31 July 1 - September 30 October 15 MDHHS/C0-2018 ATTACHMENT III Page 164 of 210 3/14/2017 Work Plan October 1 - December 31 January 31 Email to Contract Manager January 1 - March 31 April 15 April 1 - June 30 July 31 July 1 - September 30 October 15 Local Match Report October 1 - December 31 January 31 - Email to Contract Manager January 1 - March 31 April 15 April 1 - June 30 July 31 July 1 - September 30 October 15 Program & Participant Data October 1 - December 31 January 31 ODE https://tpia mihealth.orq January 1 - March 31 April 15 April 1 - July 31 August 5 August 1 - September 30 October 15 Fidelity Checklists January 1-31 February 28 Email to Contract Manager May 1-31 June 30 Youth Surveys October 1 - December 31 January 31 ODE https://tbip.mihealth.orq January 1 - March 31 April 30 April 1 - July 31 August 5 August 1 - September 30 October 31 Structure & TA Survey October 1 - September 30 August 15 - Qualtrics Survey link will be sent to grantees in late July/early August 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. MDHHS/C0-2018 ATTACHMENT HI Page 165 of 210 3/14/2017 Performance Level (if Applicable) N/A Performance Target I N/A Output Measure ' Grant Start Date Grant Contract Administrator 10/1/2017 Chris Farrell 517-335-8388; farrellc@michigan.gov Staffing (6) Subrecipient, Contractor, or Recipient (non-federal Designation Contact Info (phone &email) Reimbursement Method Subrecipient II TOBACCO CESSATION - DENTAL CLINIC Special 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 Complete Dental Clinic Tobacco Cessation Project 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 Submit progress and final reports according to MDHHS guidance. If the report due date falls on a weekend or holiday, you have until the next business day to submit. Progress Report Period Covered October 1 — December 31 January 1 - March 31 April 1 - June 30 July 1 - September 30 Year End Report — Total Grant Period Report Due Dates January 30 April 30 July 30 October 30 November 15 MDH HS/CO-2018 ATTACHMENT III Page 166 of 210 3/14/2017 9/30/2018 517-335-9407; kilerygmichigan.gov 4 Staffing (6) Performance : Level: N/A • (if Applicable) [ Subrecipient, Designation Contractor, or Recipient (non-feder Subrecipient .. Grant, End Date ... Grant Contract Administrator Contact Info (phone & email) 11 TOBACCO DEPENDENCE TREATMENT Special 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 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 Submit progress and final reports according to MDHHS guidance. If the report due date falls on a weekend or holiday, you have until the next business day to submit. Period Covered Quarterly Report (October 1 — December 31) Quarterly Report (January 1 — March 31) Quarterly Report (April 1 — June 30) Quarterly Report (July 1 — September 30) Final comprehensive report (October 1 — September 30) Report Due Dates January 30 April 30 July 30 October 30 November 15 MDHHS/C0-2018 ATTACHMENT III Page 167 of 210 3/14/2017 Grant Start Date 10/1/2017 1 Grant End Date Lynne Stauff Grant Contract Administrator Contact Info (phone & email) 517-335-1818; stauffi@michigan.gov Performance Level (if Applicable) N/A : Reimbursement Method Staffing (6) Subrecipient, Contractor, or Recipient (non-federal Designation Subrecipient . PeilcirMariceTarget:- .:Output Measure • N/A II TOBACCO REDUCTION IN PEOPLE LIVING WITH HIV/AIDS Special Requirements 9/30/2018 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 HIV/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: MDHHS/CO-2018 ATTACHMENT III Page 168 of 210 3/14/2017 a. Monitoring may include a review of fiscal, program, administrative, quality management, and client health 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. 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 may 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 (MOUs) 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. MDHHS/CO-2018 ATTACHMENT III Page 169 of 210 3/14/2017 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 HIV Office 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. 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. Submit Quarterly Progress Reports to the contract manager. Period Covered October 1, 2017 — December 31 January 1, 2018— March 31 April 1, 2018 — June 30 July 1, 2018— September 30 Report Due Dates January 12 April 13 July 13 October 15 The grantee will collaborate with the Tobacco Section staff to accomplish goals through, at the most, MDH HS/CO-2018 ATTACHMENT III Page 170 of 210 3/14/2017 monthly calls, one annual site visit, and other grant monitoring tools and technical assistance activities. 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 1. The Department will monitor Grantee performance throughout the contract year, which may include a review of FSRs, CAREWare data entries, quarterly progress reports, and site visits. For 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 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. GRANTEE SPECIFIC REQUIREMENTS 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/C0-2018 ATTACHMENT III Page 171 of 210 3/14/2017 10/1/2017 Grant End Date Peter Davidson 517-335-8173; davidsonP@michigan.gov •1 9/30/2018 Grant Contract Administrator Subrecipient, Contractor, or Recipient (non-federal Designation Performance Target Output Measure N/A TUBERCULOSIS CONTROL AND ELIMINATION Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS Each Grantee 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.gov/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). MDH HS/CO-2018 ATTACHMENT III Page 172 of 210 3/14/2017 2. Document in Michigan Disease Surveillance System ( 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 RVCT pages 1 - 6 in MDSS within one month of diagnosis. 7. Unallowable Costs per federal guidelines: Funds cannot be used for procurement of anti-tuberculosis medications. Funds cannot be used for research. Funds cannot 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" htto://www.cdcsiovinchhstp/prooraminteqration/docs/PCSIDataSecurityGuidelines.pdf REPORTING REQUIREMENTS DOT Logs are maintained on site and available if needed. All other data must be entered into MDSS as stipulated in contract specific requirements. MDHHS/C0-2018 ATTACHMENT III Page 173 of 210 3/14/2017 517-284-4961; fostere@michigan.gov 517-284-4951; signsk@michigan.gov Staffing (6) Subrecipient, Contractor, or Recipient (non-federal Designation Subrecipient Performance Level (if N/A Applicable) Performance Target Output Measure N/A Grant Start Date Grant Contract Administrator Contact Info (phone & email) I Reimi3Ursement Method 3/1/2018 Erik Foster; Kimberly Signs II WEST NILE VIRUS COMMUNITY SURVEILLANCE Special Requirements BUDGET AND AGREEMENT REQUIREMENTS This agreement is intended to support the development of a low cost surveillance system for the early detection of West Nile virus in mosquitoes at the community level, for the purpose of educating the public and healthcare providers, and preventing outbreaks. This information can be utilized by participating local health departments to notify its citizens and healthcare providers of any local transmission risk using education campaigns, press-releases and other means, and to potentially work with local municipalities to conduct mosquito population mitigation activities such as drain management, scrap-tire campaigns, breeding site removal, larviciding, and adulticiding. Requirements for participation in this program include providing for the placement of a minimum number of mosquito traps, operating for at least two "trap nights" per week, identifying mosquitoes, and weekly reporting to the Department of surveillance results ($8,000). GRANTEE REQUIREMENTS Each Grantee as a sub-recipient of the Centers for Disease Control and Prevention (CDC) Epidemiology and Laboratory Capacity Cooperative Agreement shall conduct activities for the purposes of West Nile virus (WNV) surveillance among mosquito populations in their jurisdiction. Funds may be used to support personnel, to purchase equipment and supplies related to conducting mosquito surveillance in areas of historically high incidence of WNV, and to produce and/or distribute educational and other materials related to West Nile virus prevention and control. DEPARTMENT REQUIREMENTS The Department's Emerging & Zoonotic Infectious Diseases (EZID) Section will provide the Grantee with the following support: Training for staff associated with the project (Spring 2018) MDHHS/C0-2018 ATTACHMENT III Page 174 of 210 3/14/2017 2. Trapping equipment necessary to collect mosquitoes (traps, batteries, chargers) 3. VecTOR test kits for the rapid, field detection of WNV 4. Entomologic and epidemiologic support to guide trapping efforts GRANTEE SPECIFIC REQUIREMENTS Mosquito Surveillance ($10,000): 1. Minimum recommended mosquito traps for this project is 5 traps utilized per county, operating 2 nights per week for a total of 10 "trap nights" per week for approximately 16 weeks. 2. Provide weekly reporting of surveillance results to the Department EZID Section (see contact information below). 3. Use surveillance data to notify the public and healthcare providers of any risk related to WNV in mosquitoes in the jurisdiction. 4. The total funds ($8,000) allocated for this project to participating local health departments must be utilized prior to September 30. REPORTING REQUIREMENTS Quarterly financial status reports (FSR's) will be required for this new project. Due dates and periods covered are listed below: Activity Period: FSR Due: Jan 1 March 31 April 15 April 1 — June 30 July 15 July 1 Sept 30 October 15 The Grantee shall submit weekly tables of surveillance data (template provided) documenting trap rates and disease detections to Erik Foster (fostere@michigan.gov ) and Kim Signs (signsk@michigan.gov) at the MDHHS EZID Section, MDHHS/CO-2018 ATTACHMENT III Page 175 of 210 3/14/2017 517-335-1178; robertsr6@michigan.gov 10/1/2017 Robin Roberts Grant End Da 9/30/2018 Grant Contract Administrator Contact Info (phone & email) Performance Targe Output Measure -:Performance Level : 95% (if Applicable) Performance (8) (9) Subrecipient, Contractor, or Recipient (non-federal Designation Reimbursement Method WISEWOMAN: WELL-INTEGRATED SCREENING AND EVALUATION FOR WOMEN ACROSS THE NATION PROJECT Special tI;N,!quirements • Grant Start Date BUDGET AND AGREEMENT REQUIREMENTS N/A Subrecipient # Clients Screened I for Cardiovascular Disease Risk Factors 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 Entrepreneurial Gardening Project The W1SEWOMAN 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 MOHHS/C0-2018 ATTACHMENT Ii Page 176 of 210 3/14/2017 and supplies based on appropriated project budget, and coordinate trainings that strengthen participants understanding of sales and marking skills at area farm markets for greatest impact. The WISEWOMAN Entrepreneurial Gardening Project will be subject to a 100% performance requirement. 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 WISEWOMAN 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. Community Advancement Project Through the WISEWOMAN Community Advancement project, agencies are required to conduct one low cost systems, environmental change, or health equity/social justice intervention that will benefit WISEWOMAN participants and the communities where they live. The WISEWOMAN Community Advancement 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. Entrepreneurial Gardening Program Grantees: Monthly calls as needed to discuss program requirements. Final progress report (May 1 — September 30) due October 20 (template provided) Entrepreneurial Gardening Program Coordinator Grantees: Monthly calls to report on activities, discuss problems, and brainstorm solutions. Final Progress Report (October 1 — September 30) due October 20 (template provided) Community Advancement Project Grantees: Quarterly Progress Reports Covering: Period Covered Report Due Dates October 1 — December 31 January 15 January 1 — March 31 April 15 April 1 — June 30 July 15 MOH HS/CO-2018 ATTACHMENT 111 Page 177 of 210 3/14/2017 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 - WISEVVOMAN Program P.O. Box 30195 Lansing, MI 48909 Phone: 517-335-1178; E-mail: robertsr6@michigan.gov MDHHS/CO-2018 ATTACHMENT III Page 178 of 210 3/14/2017 9/30/2018 Grant Date ''' ' Performance Level (if Applicable) Patricia Brookover 517-335-9620; brookoverp@michigan.gov Subrecipient, Contractor, or Recipient (non-federal) Designation Performance Target N/A Output Measure Subrecipient N/A 11 WISE CHOICES 9ecial 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 Complete Wise Choices 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 Submit progress and final reports to the Department. if the report due date falls on a weekend or holiday, you have until the next business day to submit. Report Period Covered October 1 — December 31 January 1 - March 31 April 1 - June 30 July 1 - September 30 Year End Report — Total Grant Period Due Dates January 30 April 30 July 30 October 30 November 15 MDHHS/C0-2018 ATTACHMENT ii Page 179 of 210 3/14/2017 ...Grant EEnd , Date,' Contact Into (phone & email) 517-335-8625; larueb@michigan.gov WIC — Breastfeeding and WIC - Migrant Grant Start Date 10/1/2017 Grant Contract Administrator Brittany LaRue 1 9/3012018 WIC - Resident Staffing (6) N/A PerfOrmancaTorgot:- Output Reimbursement Method Performance Level Staffing (6) Subrecipient, Contractor, or Recipient (non-federal Designation Subrecipient Reimbursement Method Performance Level (if Applicable) N/A Contractor, or Recipient (non-federal Designation •Performance Target • • .Output•Measure::.: Subrecipient WOMEN INFANT CHILDREN (WIC) 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)]. MOH HS/Co-2018 ATTACHMENT III Page 180 of 210 3/14/2017 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 Special Reaturements for the WIC Breastfeedina Peer Counselina Proaram 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 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 Breasffeeding Coordinator. Reports are due by the 15th day of: January, March, July and October. Allowable Expenses The primary purpose of these funds is to provide breastfeeding support services through peer counseling to WIC participants. Expenses may include: 1. Supervisor and/or mentor staff time 2. Materials that educate/advertise to WIC clients about the Peer Counseling Program 3. Educational resources for Peer 4. Voicemail, cell phones or phone-line expenses MDHHS/C0-2018 ATTACHMENTIU Page 181 of 210 3/14/2017 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. Breasffeeding Basics Training 2. State WIC Peer Counselor Meetings 3. Annual WIC Conference Staff Training and Education for WIC Resident Services Designated Grantee staff (at minimum the agency WIC Coordinator or designated WIC agency representative) are required: 1. To attend Annual WIC Training & Educational Conference. 2. To attend the Michigan WIC Coordinator Summit. Other Grantee Obligations The following requirements apply to the Grantee receiving a special allocation for the Breasffeeding Peer Counseling Program. USDA and the Department WIC program requires the Grantee to comply with the following nine components: 1. Hire staff that meet the definition of Peer Counselor. 2. Designate a Breasffeeding 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 breasffeeding peer counseling program procedures at the local level as part of the Grantee's WIC Nutrition Services Plan. 7. Supervise and monitor the peer counselor(s). Establish community partnerships to enhance the effectiveness of the WIC peer counseling program. 8. To include designated State Lactation Consultants (LC) as part of the peer counselor recruitment and applicant interview team. MDH HS/CO-2018 ATTACHMENT III Page 182 of 210 3/14/2017 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 breasffeeding 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 regular WIC funds should be reflected on this supplemental form. Grantees shall report nutrition education and breastfeeding promotion and support expenditures by completing the WIC Nutrition Education and Breastfeeding Time Study as required by the Department. Breasffeeding Peer Counseling Program expenditures are not to be included. The1/6 th 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. Breasffeeding Allowable Nutrition Education (NE) Expenses are: 1. Costs for procuring equipment for NE (as approved by the State WIC Program). 2. Interpreter or translator services to facilitate NE. 3. Evaluation or monitoring of NE. 4. NE material costs. 5. Costs of training nutrition educators, including costs related conducting training sessions and purchasing & producing training materials. 6. Costs for clinic space devoted to NE activities. 7. Travel and related expenses incurred by WIC staff to conduct any NE activity. 8. Costs of reimbursable agreements with other organizations, public or private, to provide NE to WIC participates. M DH HS/CO-2018 ATTACHMENT III Page 183 of 210 3/14/2017 Allowable Breastfeedina (BF) Promotion & Support Expenses are 1. Peer counseling if supported with funds allocated through the WIC funding formula (Report as time study data.) 2. Cost of procuring BF educational materials. 3. interpreter or translator services to facilitate BE promotion and support. 4. Costs of training BF 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 BE WIC infants. 6. BE aids which directly support the initiation and continuation of BF, as purchased with WIC funds allocated through the funding formula. 7. Costs of documenting, monitoring and/or evaluating BF promotion and support staff, activities, methods and materials. This includes the cost of collecting, analyzing and evaluating data concerning WIC participant's opinions on the effectiveness of the BF promotion and support they received. (Report as time study data) 8. Travel and related expenses incurred by WIC staff to conduct any BF promotion and support activity. 9. Costs of reimbursable agreements with other organizations, public or private, to undertake training and direct service delivery to WIC participants concerning BE promotion and support. The examples above are not all inclusive. In-kind support can also be included, if other non-WIG 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-2018 ATTACHMENT III Page 184 of 210 3/14/2017 Staffing (6) Reimbursement Method Grant Start Date Grant Contract Administrator Contact Info (phone & email) 10/1/2017 I rapt Enil Date Theresa Scorcia-Wilson 517-335-8754; scorciawilsont@michigan.gov Performance Leve (if Applicable) N/A Performance Target Output Measure I N/A Subrecipient, Subrecipient Contractor, or I Recipient (non-federal I Designation WORKSITE WELLNESS — GETTING TO THE HEART OF THE MATTER 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. Submit progress and final reports according to MDHHS guidance. If the report due date fills on a weekend or holiday, you have until the new business day. Period Covered October 1 — December 31 January 1 — March 31 April 1 — June 30 July 1 — September 30 Year End Report — Total Grant Period 4. The Grantee will attend required meetings. Report Due Dates January 30 April 30 July 30 October 30 November 15 5. The Grantee shall collaborate with the program consultant to schedule and participate in site visits. 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. MDHHS/CO-2018 ATTACHMENT III Page 185 of 210 3/14/2017 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 NIDHHS/CO-2018 ATTACHMENT III Page 186 of 210 3/14/2017 Grant Start Da Grant Contract :• Administrator 3/1/2018 Erik Foster; Kimberly Signs Contact Into : (phone 8.4E 1 517-284-4961; fostere@michigan.gov 517-284-4951; signsk©michigan.gov 9/30/2018 Performance Target Output Measure .1 N/A Subrecipient, Contractor, or Recipient (non-federa Designation Subrecipient Reimbursement Method Performance Level fit Staffing (6) 1 N/A ZIKA VIRUS COMMUNITY SUPPORT Special Requirements • :Appiitable)••• BUDGET AND AGREEMENT REQUIREMENTS This agreement is intended to support the development of community programs aimed at reducing Zika virus and other mosquito-borne disease. Categories include education, community "clean up" or breeding site reduction, and support for the development of vector control programs ($10,000). GRANTEE REQUIREMENTS For community-level mosquito education/abatement projects, funds may be used to support the development of targeted educational materials, fund community "cleanup" projects to reduce mosquito breeding, and assist communities to develop vector-control plans and programs. DEPARTMENT REQUIREMENTS The Department Emerging & Zoonotic Infectious Diseases (EZID) Section will provide the Grantee with the following support: • Training for staff associated with the project (Spring 2018) • Entomologic and epidemiologic support to guide community support activities GRANTEE SPECIFIC REQUIREMENTS Community Projects ($10,000): 1. Provide concept of support and detailed budget for community-level projects to the Department staff for approval a. Projects must be measureable b. Project summaries must be submitted upon completion 2. Funds must be used in the following categories: a) development and dissemination of targeted educational materials; b) community "cleanup" projects including mosquito breeding site MDHHS/C0-2018 ATTACHMENT III Page 187 of 210 3/14/2017 reduction or elimination, scrap tire drives, and other methods to reduce mosquito populations; c) assist communities in developing vector-control plans and programs. 3. The total funds ($10,000) allocated for this project to participating local health departments must be utilized prior to September 30. REPORTING REQUIREMENTS Quarterly financial status reports (FSR's) will be required for this new project. Due dates and periods covered are listed below: Activity Period: FSR Due: Jan 1 — March 31 April 15 April 1 — June 30 July 15 July 1 — Sept 30 October 15 The Grantee shall submit Community Project budget requests to Erik Foster (fostere@michigan.gov ) and Kim Signs (signsk@michigan.gov) at the Department EZID Section. Within 30 days of the end of the grant period, grantee must submit a final activity report to the Department. MDHRS/C0-2018 ATTACHMENT III Page 188 of 210 3/14/2017 Grant Start Date 9/30/2018 j 3/1/2018 I Erik Foster; Kimberly Signs Grant Contract Administrator Contact info (phone & email) 517-284-4961; fostere@michigan.gov 517-284-4951; signsk@michigan.gov Staffing (6) Subrecipient Reimbursement Method Performance Level (if Applicable) N/A ; Subrecipient, Contractor, or Recipient (non-federal I Designation 1 Performance Target Output Measure II ZIKA VIRUS MOSQUITO SURVEILLANCE Special Requirements BUDGET AND AGREEMENT REQUIREMENTS This agreement is intended to support the development of a low cost surveillance system for the early detection of Zika virus vectors at the community level, for the purpose of preventing potential local transmission. This information can be utilized by participating local health departments to notify its citizens of any local transmission risk using education campaigns, and to potentially work with local municipalities to conduct mosquito population mitigation activities such as drain management, scrap- tire campaigns, breeding site removal, larviciding, and adulticiding. Requirements for participation in this program include providing for the placement of a minimum number of mosquito traps, operating for at least two "trap nights" per week, identifying mosquitoes, and weekly reporting to the Department of surveillance results ($10,000). GRANTEE REQUIREMENTS Each Grantee as a sub-recipient of the Centers for Disease Control and Prevention (CDC) Epidemiology and Laboratory Capacity Cooperative Agreement shall conduct activities for the purposes of Zika virus vector surveillance among mosquito populations in their jurisdiction. For mosquito surveillance, funds may be used to support personnel, to purchase equipment and supplies related to conducting mosquito surveillance, and to produce and/or distribute educational and other materials related to mosquito-borne disease prevention and control. DEPARTMENT REQUIREMENTS The Department Emerging & Zoonotic Infectious Diseases (EZID) Section will provide the Grantee with the following support: • Training for staff associated with the project (Spring 2018) • Trapping equipment necessary to collect mosquitoes (traps, batteries, chargers) MDHHS/CO-2018 ATTACHMENT III Page 189 of 210 3/14/2017 • Entomologic and epidemiologic support to guide trapping efforts GRANTEE SPECIFIC REQUIREMENTS Mosquito Surveillance ($10,000): 1. Minimum recommended mosquito traps for this project is 5 traps utilized per county, operating 2 nights per week for a total of 10 "trap nights" per week for approximately 16 weeks. 2. Provide weekly reporting of surveillance results to the CDC MosquitoNET website and to the Department EZID Section (see contact information below). 3. Any suspect Zika vectors must be confirmed by experts at the Department and/or Michigan State University. 4. Use surveillance data to notify the public of any risk related to Zika virus in mosquitoes in the jurisdiction. 5, The total funds ($10,000) allocated for this project to participating local health departments must be utilized prior to September 30. REPORTING REQUIREMENTS Quarterly financial status reports (FSR's) will be required for this new project. Due dates and periods covered are listed below: Activity Period: FSR Due: Jan 1 March 31 April 15 April 1 June 30 July 15 July 1 Sept 30 October 15 The Grantee shall submit weekly tables of surveillance data (template provided) documenting trap rates and disease detections to Erik Foster (fostere@michigan.gov ) and Kim Signs (signsk@michigan.gov) at the Department EZID Section. MOHHS/C0-2018 ATTACHMENT III Page 190 of 210 3/14/2017 ADDENDUM "I Dissemination LicenseAgreement forlflothers 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 (NIH), grant number 1R18-DK083934-01A2 ("Grant'). WHEREAS, Licensor isthe owner of certain rights, title and interest in the 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 N I H grant, desires to grant such license to Licensee on the terms and conditions herein. WHEREAS, Licenseewishes to obtain this Agreement in orderto carry out the 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 the form 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 hereunder orother rights that are relevant to using the Sublicenseable Materials. AGR2015-0I 146 TEC2015-0036 MDH HS/CO-2018 ATTACHMENT III Page 191 of 210 3/14/2017 f. "Sublicensee" means any entity to which a Sublicense is granted. 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 conform to the technical format of Sublicensee's website platform; the content, however, shall not be modified. Sublicensee is not permitted to sell or receive consideration for the Sublicenseable Materials in any format. Any content created solely by Sublicensee that supports the implementation of the Sublicensable Materials shall be owned by Sublicensee. Ufa 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 Licensors 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 Licensor's endorsement of Licensee or its goods or services, (0) 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. AGR2015-01 146 2 TEC2015-0036 MDHHS/C0-2018 ATTACHMENT II Page 192 of 210 3/14/2017 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. Licensors 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 Licensors 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 Su blicensee. AG R2015-01146 3 TEC2015-0036 MIDI-INS/CO-2018 ATTACHMENT HI Page 193 of 210 3/14/2017 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 after the end of the five (5) year term. The reports shall be sent to Mci-Wel.Chang@.ht.msu.edu and msulagrr@msu.edu . 5. 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 event that either Party 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 Licensor's 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 NONINFRINGEMENT. LICENSEE ASSUMES THE ENTIRE RISK AGR2015-01 146 4 TEC1015-0036 MDHHS/CO-2018 ATTACHMENT UI Page 194 of 210 3/14/2017 AND RESPONSIBILITY FOR THE SAFETY, EFFICACY, PERFORMANCE, DESIGN, MARKETAB1LITY 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 IT IS ERROR-FREE OR THAT LICENSOR IS UNDER ANY OBLIGATION TO CORRECT SUCH ERRORS. S. 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. AGR2015-01 146 5 TEC2015-0036 MDHHS/C0-2018 ATTACHMENT 111 Page 195 of 210 3/14/2017 12. Entire Agreement 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. U 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 Agreement, 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: MS1J Technologies Attention: Agreement Coordinator A0R2015-01146 325 E. Grand River Suite 350 City Center Building East Lansing, MI 48823 517-884.1605 rnsutagr@.msu.edu AGR201 5-01146 6 TEC2015-0036 MDHHS/CO-2018 ATTACHMENT III Page 296 of 210 3/14/2017 If to Licensee: Michigan Department of Health and Human Services, WIC Division Attn: Kristen Hanulcik Manager, Consultation and Nutrition Services Unit 320 S. Walnut, Lewis Cass Bldg., 6th Floor Lansing, MI 48913 517-335-8545 hanulcikk@michigan.gov 17. Article Headings The Parties have carefully considered thisAgreement and have determined that ambiguities, if any, shall not be construed or enforced against the drafter. Furthermore, the headings 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, covenants orconditions of this Agreement i n any manner. 18. Relationship of Pa tiles 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 Of 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 MDHH5/C0-2018 ATTACHMENT III Page 197 of 210 3/14/2017 IN WITNESS WHEREOF, the Parties have executed this Agreement by their respective, duly authorized representative as of the date first above written. LICENSOR: Michigan State University Signature on file Date: '10115115 By: Dr. Richard W. Chylla Executive Director, M SU Technologies LICENSEE: State of Michigan Department of Health and Human ServicesWomen; Infants & Children Signature on file BY: Kim Stephen Date: 10116115 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. Wain ut, Lewis Cass Bldg., 6th Floor Lansing, MI 48913 biens@michigangov 517-335-8448 AGRZ015-QI 146 8 TEC2QI 5-0036 MDHHS/CO-2018 ATTACHMENT III Page 198 of 210 3/14/2017 Schedule A 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 11Iessons) 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. H. 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-2018 ATTACHMENT III Page 199 of 210 3/14/2017 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 (NI H-NIDDK, 1R18-DK083934-01A2) 111. 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 (N1H-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(NIH-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. Grantnumber(NIH-NIDDK, 1R18-DK083934-01A2) iii. Acknowledgement section iv. Video/DVD Contents v. Copyright notice b. Label on Disks* 1. MSU and Mothers in Motion logo ii. Grant number (NI H-N I DDK, 1R18-DK083934-01A2) iii. Title of each lesson iv. Copyright notice A0R2015-01 146 10 TEC2015-0036 NAM-INS/CO-2018 ATTACHMENT III Page 200 of 210 3/14/2017 *WIC is allowed to duplicate DVDswithout label orgrant number onthedisks, if necessary. I Sublicensee may create contentthat supportsthe 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 Sublicensee shall be owned in accordance with Section 1.2 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 inW1C"Videos/DVD shall be in accordance with Section 1.2. A0R2015-01146 11 TEC2015-0036 MI:MINS/CO-2018 ATTACHMENT III Page 201 of 210 3/14/2017 l ADDENDUM 2 1'1 OtA, i ri Agree for "Com ate to Motivate" Among Micitigae Vete Oaten*. %to Stole lonovellon Foundaden gen Department Of Health mad HOMO &Oita This License Agree Agreement"), effective at or any 1, 2017 EfThtwe Date is in 1)1143 MkbhillnSlate University, having offices DA 32$ S. Crand River, Suite 350, East Iansmg, 411321, ("MU"), lo Soto itasovittion Foundation, having dikes at :524 n liigh nett, Columbus, au 412o1 .osir) (together 'Llama) and Stale of Michigan Depertment of Herd* and Human Services Women, Infants and Children, having offices at 32* S. %drat Lansing, Mt 4913 rLicenseel (Individua)ly a "Nay" and collectively. tho"Fartien EMS, Licensor hes intellectual property rights in the "Cannormica(e to ntdtnatothLe tyska Metsrials"). MSU reference number TSC2016-01 It, OSU reference number T2017- &Moped (Aline Rinds from a pent flora the National instintat of Health MIK goad Rl8-Dit-08393441 WHEItEAS, LiettlIOr is the o ant Seams theteundere. interestIn the Physicai Malachi end has Licensee wishes!. lioan ii to rant such Nemec to Licensee o dissemination purposes end Licensor coalitions herein, NOW THEItEfORE, the ParSet agree L DafiektOru Pltys cai °Wawa*: Meted*" shalt mean one ót4.ió -. of the Physle 14 knish iviodifloadon Olthail moan the speoiflestkaneouillnedi DsriVM1VO Work** means nfl worksdee1opMby Uconsee or Sublime** which would be seterized as 4411VIMIVO worts of dm hysiatl Materials andfor Sublictosable Meted& coder the United States Copyright Act of 1976, or subsequent revisions thereof, specifically including, bet not limited to translations, abridgments, condensations, meadow, snutsibk-siretioss, or adiguations Mated, or works consithog of editorial revitions, annotattorts, eiaborsiions, or other modifications thereof. The it Derivative Atork* stud not Include those derivative works which= developed hy Licensor. 'Sublicense mesas. an averment wideb may take the form of, but is not thrilled to, a sublicense agreement, menterandtan of tiodentemditsg. or special provisions added anen emendmatit to an (listing egmemeot between :Acmee and a Sublicensas in Web Lirensee grants or otherwise towline any ofthe rights licensed to tAliffies hereunder or othsrilghss that 4110 relevant busing the Subliceneablo Mated Sublicense*manna any entity to which a OSU M DHHS/CO-2018 3/14/2017 ATTACHMENT III Page 202 of 210 Grant of License LI SUbj4d to the this Agreement, iAcate ights to Physical MaedaIs as a mull ceators grant of rights to the }WOW 0014 ea in accordance with dm terms and condidnos of the Omen are iroufficient for Liactsee's activities hereunder. Licensor hereby volts to Licensee a ttonesolusive„ nentransfemble, imridtVide, ileum to use, perform, reproduce, pablically diaplisy the Physical Materials, Licensee is granted the limited right to creme Derivative Works of the Physical Wisterias, spaineelly Licensee sintil have the right to cteate Derivative Works which OM (11) companion giddence handouts to the Physical Materials for educational InstrooMrs in the mune of employing Phyalcal Materials, (b) materials for promotion of the lity of odUcational opportunities employing the Physicei Materiels, end (0) connoting eminences and feedback flora comae participants. NOILYWIsualding the forogolug. .L conoe may only distribute the Physical Materials within Licensee.n,ansged locations vAntin the snUe of Michigan, Licensee it not permitted to sell or receive ronsidera ion Sx any of the Physical Materials or reproduction of the Physical Materials. Licensor gams Llotintas the deg to grant ub1kcnser of hi tights trador 8.041104 I.1 of the limesable Nleterinla to Sublicenseo for the sole purpose of placing tho content comniesd in the Sublicansable Mandeb (including the videos) on e 14404 that is controlled by Sublicense* sad dot is mom limited, password protected, Any Subfleanatt shall be its accordant:a with Article 3 below, Stbileatatee it not porminall to sell or receive couldotstion fbr the Sublieensabbt Matadi& In any L Any content created solely by Sublicensee that torments the implcatennaion of the Sean shall be owned by Subli 1.3 In such incidence" whoa, for financial reatons, Licensee Is not able to repro we the label displayed on dor original master copy of the DVO portion of the Physical Malone% Licensee must ensure that the entire content of the DVD portion of the Physicol Metedsis two reproduced in he eititety so that the inclusion of the copyright notireA grant number information, title of each lesson, 4.041 acknowledgements are nesintainark L Licensor or The approtnli or Liontser. 15 Licensor shell pawl e Physic/4 Materials to Licensee by May 1, 2dt1 Licensor moo tesponeihility for distributing Physical Materiels to the Mato othliclagen Liam i0414i044. Notwithstanding rIte rights ventett in Atticiei her acknowledges that end interest hr the Physical Memdals, holed* any copyright a teabisi thereto. shall remilt prornty of Licentor, Licensee or Sahliormee shall he Interest is the Priyalcal Materiels including any copyright appileible thereto, Opt iy tat in this Aymara rights ii4 lice 3,4 (a) Any * Unmet rig)* than (lose seti ACM20174003 TEC2010114 2 contain toms no less protecti ve shall not he In conflict with Ode Olt) A20174112 sod shall requhv iblicertacee university ("Min in pouchy or *OM using the own g wttttoitt the prior mitten M DH HS/CO-2018 ATTACHMENT III Page 203 of 210 3/14/2017 This Agreement SUB OnMMerten unless earlier terminated needed 'monitored with A 1 a for period of live (5) . Agreerneat rimy be !evolves of Licensor end it) shall itientifY Licorice as sa ótcndtdthird petty berieficiary of the *ell ;milk Licensoe with a complete electronic or paper copy of mit Stehlicenm imthn thirty (30) days eller emersion of the Sublicense. Liter/seashell provide Licenser with © of each moon terchoed by Licensee pertinent to any data pmdeeed by Sublicensee that would paste to the report due under Section at Licensee shall be fully responsible to Uctimer for thy breach of tho terms of this Agreement by o Subiteernee, (b) Upon termindon of this Agreement for any retain aft Sublicensce aheft ferralnetc. if a SUblieensea was hi compliance with the leans of Its Sublicenee in *Met on the termimelloo. Licensor may great such Sittlicernes that to requestr, a licenit with Units end use rights as ere neeeptebte to Licensor In no event shall licensor have any obligations of arty moms whatsoever with respect to (I) arty psst, current or Mute obligations that Licensee may have had, or may in the future hen, for the perreet of any *mounts owing to any Snislicensee, (0) any pot oblIgations whatsoever, and (Hi) any Arum obligations to any Sublicense* beyond those set Onth in the OW lieemeo between Licensor and such Subilanees. coesideration of the s granted herein Licensee lI poovide to Lir,eneer two effectivenese and titillation data mows based on the use of the Phrical teitrieriels. One dais report shall include; a) mini= niche* vitie anerin the Physical Moak& lessons; b) number ordmos spool fie lessons are completed; c) ember of unique users; d) client perceptions kir useffilliess and helpfulness of lessons; and e elle* beliefs in relation to ability to mike *Mgt* baud on lesson completion and ehall be due to years from the Effective Date and one dam report containiag the UM* data as described shriv shell be due thirty (30) dayi after the and erase live (5) year term: Such date roma shall the trifornietion provided ma-c by CM (distilleme and aeries) or htaireffeeding peer reports shell bests to 00057 edo mwvatlon@ontrd u and do. Ihidgenes Literates shell use its ressoarible efforts It d ssemitrate the Phytical Materials ins Widen that Licensee dutsndaesallpaswith its/nisi= in onierto provide pubiie benefit. Tenn sad Toads*** 6.2. In the mar that a Petty believes that amber Petty has materially bombed any obligation under this Agreement, such Party Medd to not the haseiting Party in whin& The breaching Patty shall have !MY (30) day, from the receipt of notice in care the alleged broach end to notify dtc son-branch 'a writiag that said WM has been effected lithe houtch is not owed within said peri0d, the sten ; Party; shall have the eight to terminate the Ave meat without kith r notice, WHHS/C0-2018 ATTACHMENT HI Page 204 of 210 3/14/2017 disoi atiog end dieplaying the Physical• Materhds, dam the Physical Meterials hews clew been interned to Licensor discrer 14), MI Sublicense* shall terminate assainetion n, the Ibl wilt provns hall survive $*.t TI5fl ht Act: 23; runt %triodes Icen*oi represents thst to the knowledge of The tXdo Slate Universi 's oid MSU's transfer offices thet h hes KM right, power and authority to nor Into this Ag.meitt sad cop ese of 44 is granted ander This Agreentent. 71 LICENSOR AND OSU, fl4CLUDRIO THEIR CREATORS, TRUSTEES. OFFICERS, EMPLOYEES, AGENTS OR AFFILIATED NTER,PREIES MAKE NO REPIIESENTATIONS OR WARRANTIES OF ANY KIND CONCERNtNO THE PHYSICAL MATERIALS AND SUBLICENSABLE MATERIALS AND HEREBY DISCLAIM ALL REPRESENTATIONS AND WARRANTIES. EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, ANY Anonms OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOS NONDIFRINOEMENT, SAFETY, EFFICACY, APPROVABILITY BY REGULATORY AUTHORITIES, TIME AND COST OF DEVELOPMENT, OR PAIENTABILITY, LICENSEE ASSUMES THE ENTIRE RISK AND RESPONSIBILITY FOR THE SAFETY, EFFICACY, PERFORMANCE, DEMON. MARKETABILITY AND QUALITY OF WE PHYSICAL MATERIALS AND SUBLICENSABLE MATERIALS WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, THE PARTIES, INCLUDING THEIR OFFICERS AND EMPLOYEES, AMOWLEDGE THAT (A) THE PHYSICAL MATERIALS AND SUBLICENSABL MATERIALS ARR PROVIDED "AS IS"; 03) NEITHER THE. PHYSICAL MATERIALS NOR SUBL10ENSAEILE MATERIALS MAY BE FUNCTIONAL ON EVERY MACHINE OR IN EVERY ENVIRONMENT AND (C) THE PHYSICAL MATERIALS AND SUBLICENSABLE MATERIALS ARE PROVIDED WITHOUT ANY WARRANTIES THAT IT IS ERROR-FREE OR THAT L ENSOR IS UNDER ANY OBLIGATION TO CORRECT SUCH silos of Ltsbally Enc./thirty acknowledges and represents that It will be reopens% for any claim for personal roped7 donne asserted by a NM petty rod robin out of or Wool to its sets or omissions rn the room Ohs oblivalons hereunder to the extent Usst scoot of eonvetern Jurisdiction - Fatty to best fault broth-utilise Itgelly reeponsibla for nab aloha, Nothing Agreement stud be wool or framed** any ,ndeer of say Partys sovereign trantunity or i esse lawt elYtal"b1 la nes. hslIaPsiiy be liable to snotherPsetyorioanythkd pay, wheth rundsr thety of eestru4 tort or ethane*, far any indirect, inelderdid, porutive, consequentird, or spode, damages, %haw foresotsble or not and whether such Party is.dvked of the postibility aflanik darner 4 OSU 17-117: MDHHS/CO-2018 ATTACHMENT!!! Page 205 of 210 3/14/2017 oftitis Agreemant the validity or enfteccab H out anther action by the Patio hereto messy to mehe such proition valid - enforceable under spittle ow, it the tem of this Age C reformed to the uthdrnwn tXtCOt le. Dispute Resoletion 10,1 in the event of any dispute or controversy stung out of or relating ib tMe the metier hereof, the Wks AA nse their test titans to eel** the thtpule at soon aa poesb1e The Parties Ala WithOlift kir*, MAWS to preform their respective obligations under th13 AgteerMa which sto not effected by the dispute. IL force Maj No Party shall be lishk for damages or subject to injunctive or ether mftef or have the right to terminate this Artemis% lbr rely detety or default in performance hereunder if such delay or doiloit is caused by conditions heyond its control including, but not !belied to Acts or God or throe rerdesee. govenunetu restrictions (including the &nisi or osocolistiOn of any eecessery keno), ware ) insurrections and/or any thee cause beyond Oat mons* cotrot of the Party whose porformriiee i$ Wet the en re toireeincot tithe PirreitS and supersedes all pe g to dos sultject metterbettor, whether oral or vni Pivot of any provision herein shill not to doomed waiver of any other provision herein waiver of any breach of die Avosetta be construed as a contirtutag waiver of other lamer other provisiote of this Arum All notices evert pursue* to di. Agreement sitall he in welting and may be band delivered, or eheti be doomed received within three (3) days after mailing if sent by tcligerod or testified snaft. return receipt reqiictrd, grow notice is gent by ficeirelie. sonfirmadon copies must be sent by midi or heed de to the 7ipecif1ed address. Either patty may from thnesto-rinte chop its notice address by wit to Om other Patty AOS2.11,004S1 013U-A2017.1172 TEC2016.01111 MDHHS/CO-2018 ATTACHMENT 111 Page 206 of 210 3/14/2017 If to L mason MU Tochnolo Attention: Agr 325 E. Orend River Suitt 350 City Ctmer Building EOM Lansing+Ml 41823 517484- /605 grigmagmadg natot AGR2017-004 3 Ohio Stet 1flDOYat4W4 roandatiort 1524W 111011 Street Columbus. OH 41201 414,292.1315 El to UtCONM irlichigan Deportment of Health and 14 AM; Kristen Henuielk Manager, Consultation and Nutrition Semites Ii 320S. Walnut, Lewis CAS, Bldg,. 6th Ploi Lansing, Mt 0913 517-1334545 hanuleikk@miehl Arad* Head owe easefully cosiodated this Agreemon and ha ibotaMguides, 'any, shalt not ha conn*cd or enthrood against the drititer. FOrthettlIO ings of Artie/et have bean 01WOhiCKO of Merely* only and shrill not control or meaning or nuestniction of any of the efscef'icnis, leans, tovenanK orcondition of lids Agreement y minuet ationship of Partite t1iser and Lleruste •mit acknowledge and agree that the other Went conirottor in *onnertte of each and every pan of this Agttentent and is solely remponsible ibr all of Its eniployves ta and such Petty's labor tom and expenses Mains in connection therewith. The Parties are not panstara,:foint venturers or otherwise altliated, and neither has any right or authority to make any Statement% orpreseinutions or commitments of any kind, or to take any action, which shall be hincilit on the other Party, without the polar mitten consent of:nth other Pony. Ariten '140433 OSUAN n00164171 MDHHS/CO-2018 ATTACHMENT III Page 207 of 210 3/14/2017 W1C Oivh ona Dow wrirtiss H$attor, tht .1Htve excixict! Agre•Pnicni by iht-h . kik Wheal Zt1:1 ivi n. f tho: !tato ffmt IACENS011:: Mhn Sigo Unile6-zity ic Rithald NV. t,*.ilyiitk ,',"IccttLtive i)ire5101. MSU'rtutinoffA4ivs, LICENSER; iitutt. M iaiLtt Dtpottmeat D Ktidlittn-taki. WoIrtim, Jear.zite icster .Direotor- ;*vants rhosion, Bureau of PorOasing Sian .Binn, ChNc•Or WIC Diviiion Midiivo.Depaii:sitent 41(171cilt1 ;1106. Stfrtittx 520 E. 'iItte,„ (jib neCsr 1.1:1VISig, MI 413913 .1,t11,213:1.7,04$:) 05U,kaari -1 'MN:Yid-Ph% MDHHS/C0-2018 ATTACHMENT iii Page 208 of 210 3/14/2017 foMoEtuvIdeos-p toJO*eIn.DVDimnt lessons: 12 video iàon rnJfldetefi1 ;wend dp lesson, intro sod who we thinkml respond is WIC video 650 copies(cók,r i'nt, hotonsted and oft) D. Cm thM cnnndn the raliow1ig materials eøe1 to Cornettist les): llp Sim% Power point slides dell 12 WWII r end encm tip lesson; itunroory of key paints in each video lemon; in*tiDns for Wit of the villa*. anal Nod drive (2) that contain ttt Cootenorleme in ilfotteate vIdeag Rethinkhg what we think old rts Idea; Tip Sheets in PDF; 4. Power point a tk,efnIt 12 tempt, rentioder end tip P e. Summary alley points in oath video it4I04 InKIR C Inshuerions for uso of the video in PDF. OSt.i 17. I MDH HS/CO-2018 ATTACHMENT III Page 209 of 210 3/14/2017 fictkodule Michnials Modification GuMo ittooept provided inflection 1.1, contfification of Mo: J1 ad ponnitted, AOK2011-4043 9 URlM26111 tfl TEC20164174 MDH HS/CO-2018 ATTACHMENT Ill Page 210 of 210 3/14/2017 FOOTNOTES: FY 2017/2018 (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. (0) Negotiated starting from the average of the past two complete years' actual number where available. (d) Calculated by multiplying the 'Total Performance Expectation" column by the ratio of the elements total State funding (DCH 0410, Line 24) to "Total Expenditures" DCH 0410, Line 17). Prior to calculation, adjustments will be made for unallowable cost, equipment funded by local funds and MDHHS reimbursement not performance based (I.E., fixed unit rate, staffing). (e) Calculated by multiplying the "State Funded Element Target Performance" column by the "Percent" column. (f) Refer to master comprehensive agreement and budget instructions package for further explanation regarding these designations. (1) CSHCS Care Coordination 1. Case Management A. Maximum of six (6) services per year B. Reimbursement - $201.58 per service provided face-to-face in the home setting. 2. CARE COORDINATION A. LEVEL I PLAN OF CARE 1. Annual Plan of Care in the home or home-like setting that requires the Care Coordinator to travel to a non-LHD site $150 2. Annual Plan of Care over the telephone $100 B. LEVEL ll CARE COORDINATION 1. Level li Care Coordination is reimbursed at $30.00 per unit 2. A maximum of 10 units per beneficiary per eligibility year will be reimbursed. (2) Reimbursement Chart for Fixed Rates AIDS/HIV Prevention Non- Categorical $11.00 per blood draw for non-categorical health departments. Limited annually to $2,000 Biomonitoring of Toxic Substances in Michigan Urban Fisheaters $500 per clinic date Body Art $261.20/appl. annual license prior to 7/1; $130.60/appl. annual license after 7/1; $117.53/appl, temporary license; $261.20/appl. renewal prior to 12/1; $391.80/appl. renewal after 12/1; $26.12/duplicate license CSHCS-Medicaid Elevated Blood Lead Case Management $201.58 per home visit, for up to 6 home visits FDA Tobacco Retailer (A&L) Inspections - Oakland only $325.20 per inspection Fetal Infant Mortality Review (FIMR) Case Abstractions $270.00 per case, not to exceed the maximum set for each Grantee Immunization Assessment Feedback Incentive Exchange (AFIX) Follow-up $100 per personal visit or $50 for a phone call (with information mailed afterward) to the provider office, not to exceed the maximum set for each individual contractor. Immunization Nurse Education $200 per session except Vaccines Across the Lifespan, which is to be reimbursed at $250 per session, upon completion and submission of Provider Contracts and Report Forms. Reimbursement can only be made for one in-service module session per physician clinic site per year. Immunization VFC (only) Provider Site Visits $150 per site visit, not to exceed the maximum set for each individual Grantee Immunization VFC/AFIX Combined Provider Site Visits $350 per site visit, not to exceed the maximum set for each individual Grantee Informed Consent $50 per woman served, for each woman that expressly states that she is seeking a pregnancy test or confirmation of a pregnancy for the purpose of obtaining an abortion and is provided the services. Laboratory Services & STD See contract language for gonorrhea and chlamydia testing reimbursement performance requirements, AIDS SIDS $125 for each family support visit. A maximum of six (6) visits per infant death is reimbursable Original Notes FY 2018 3/14/2017 (3) Allocation to be reflected in individual programs during budgeting process. (4) Funding Source (not a single element). Hearing and Vision are single elements. (5) Subject to Statewide Maintenance of Effort requirement for Title X. (6) State funding is first source (after fees and other earmarked sources). (7) Fixed unit rate subject to actual costs. (8) The performance reimbursement target will be the base target caseload established by MDHHS. (9) Subject to a match requirement (hard or in-kind) of $1 for each $3 of MDHFIS agreement funding for Coordination. (10) Fixed rate limited to contract amount. (11) Up to six (6) visits per family. (12) Non-categorically funded Health Departments will be reimbursed at $11.00 per HIV test conducted up to a maximum of $2,000 annually. (13) Each delegate agency must serve a minimum percentage of Title X users to access their total allocated funds. Semi-annual FPAR data will be used to determine total Title X users. (14) Public Health Emergency Preparedness (PHEP) funding BP1 must be expended by June 30, 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 October 1—June 30, and July 1—September 30, is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHDs must submit a three-month budget and a quarterly Financial Status Report (FSR) column for this program element. (16) Project meets the Research and Development criteria as defined by Title 2 CFR, Section 200.87. (17) Not Applicable (18) Subject to match requirement as specified in Attachment Ill - Program Assurances and Specific Requirements. NOTE: Some footnotes may not apply to this agency. Original Notes FY 2018 3/14/2017 REQUEST: 1. To accept the 2017/2018 Comprehensive Planning, Budget and Contracting (CPBC) Grant Agreement. 2. To continue sixty-three (63) SR positions included in Schedule B. 3. To delete fourteen (14) SR positions included in Schedule C and listed below.. BOARD/COMMITTEE ACTION: General Government Committee: Human Resources Committee: Finance Committee: Board of Commissioners: 08/14/2017 08/16/2017 08/17/2017 08/23/2017 PROPOSED FUNDING: Michigan Department of Health and Human Services CPBC 201712018 Grant OVERVIEW: The Michigan Department of Health and Human Services CPBC Grant funds several programs administered by the Health Division. The amount of this grant is $10,342,094, which is an increase of $102,310 from the previous year grant agreement. This agreement begins October 1, 2017 through September 30, 2018. The grant agreement and anticipated fiscal year 2018 contract amendments include sufficient funding for the sixty-three (63) positions listed in Schedule B. The fourteen (14) special revenue (SR) positions (listed below) are requested to be deleted. These positons are all currently vacant and will not be filled during the 2017/2018 CPBC grant period. SPECIAL REVENUE POSITIONS TO BE DELETED Position # Status (FTE or PINE) Classification 05492 Full-Time Eligible Public Health Nurse Ill 07412 Full-Time Eligible Public Health Nurse Ill 07558 Full-Time Eligible Public Health Nurse III 06514 Part-Time Non-Eligible @ 1,000 hours Public Health Nurse III 06515 Part-Time Non-Eligible @ 1,000 hours Public Health Nurse Ill 09552 Part-Time Non-Eligible @ 1,000 hours Public Health Nurse Ill 10902 Part-Time Non-Eligible @ 1,000 hours Public Health Nurse III 00515 Full-Time Eligible Office Assistant II 01234 Full-Time Eligible Office Assistant II 02636 Full-Time Eligible Office Assistant II 04738 Full-Time Eligible Office Assistant II 05135 Full-Time Eligible Office Assistant II 07383 Full-Time Eligible Office Assistant II 02740 Full-Time Eligible Clerk This grant agreement has been submitted through the County Executive's Contract Review Process and is recommended for approval. Acceptance of this grant does not obligate the County to any future commitment and continuation of the special revenue position in the grant is contingent upon continued future levels of grant funding. COUNTY EXECUTIVE RECOMMENDATION: Recommended as Requested PROJECTED PERTINENT SALARIES 2018 Class Gr Pey.l00 , .-Base..: 1: Year 2-1(0 Year .Y 3,Ypar - 4 Y:ear,: 5:Year . Public Annual $ 53,347 $ 56,557 $ 59,774 $ 62,982 $ 66,196 $ 69,410 Health exc Bi-wkly 2,051.81 2,175.26 2,299.01 2,422.40 2,546.00 2,669.60 Nurse Ill Hourly 25.6476 27.1910 28.7376 30.2799 31.8248 33.3698 Annual $31,608 $33,518 $35,431 $37,344 $39,256 $41,171 Office Assistant 11 5 Bi-wkly Hourly 1,215.69 15.1961 1,289.15 16.1144 1,362.73 17.0341 1,436.28 17.9536 1,509.85 18.8732 1,583.49 19.7936 Annual $26,004 $27,638 $29,375 $31,117 $32,857 $34,600 $36,334 Clerk exc Bi-wkly 1,000.17 1,062.99 1,129.80 1,196.81 1,26373 1,330.76 1397.46 Hourly 12.5021. 13.2874 14.1224 14.9602 15,7966 16.6345 17.4683 *Note: Annual rates are shown for illustrative purposes only. SALARY AND FRINGE BENEFIT COST: **Note: FYI 8 Fringe benefit rates displayed are County averages. Annual costs are shown for illustrative purposes only. Actual costs are reflected in the fiscal note. Delete three (3) FTE Public Health Nurse III Salary at 1 year step Fringes @ 38.29% Direct Contract Charge Savings one (1) Position Savings Three (3) Positions Delete four (4) PTNE 1,000 hours/year Public Health Nurse Ill Salary at 1 year step @ $27.1910 per hour Fringes @ 5.64% Savings one (1) Position Savings Four (4) Positions Delete six (6) FTE Office Assistant IF Salary at 1 year step Fringes @ 38.29% Direct Contract Charge Savings one (1) Position Savings Six (6) Positions Delete one (1) Clerk FTE Salary at 1 year step Fringes @ 38.29% Direct Contract Charge Savings one (1) Position Annual Savings ($ 56,557) (21,655) (15,881) ($ 94,093) ($282,279) ($27,191) (1,534) ($ 28,725) ($114,900) ($33,518) (12,834) (15,881) ($ 62,233) ($373,398) ($ 27,638) (10,583) (15,881) ($54,102) Total Savings Fourteen (14) Positions ($824,679) FISCAL NOTE (MISC. #1.7237) August 23, 2017 BY: Commissioner Tom Middleton, Chairperson, Finance Committee IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION —2017/2018 COMPREHENSIVE PLANNING, BUDGETING AND CONTRACTING (CPBC) AGREEMENT ACCEPTANCE To The Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: Pursuant to Rule XII-C of this Board, the Finance Committee has reviewed the above referenced resolution and finds: 1. The Michigan Department of Health and Human Services (MDHHS) has awarded Oakland County funding in the amount of $10,342,094 for the period October 1, 2017 through September 30, 2018. 2. The initial FY 2018 award reflects an increase in the amount of $102,310 from the initial Fiscal Year 2016/2017 award amount of $10,239,784. 3. The FY 2018 award amount for the General Fund Revenue is $4,587,817. 4. The FY 2018 amount for the Grant Fund Revenue is $5,978,845, which also includes $224,568 for fees and collections. 5. Details of the total General Fund Revenue are as follows: Michigan Dept. of Health & Human Svcs. $2,251,290 Food Protection 859,213 MDEQ Private Drinking Water 514,301 MDEQ Private Sewage 372,426 Hearing 253,969 Vision 253,968 Sexually Transmitted Disease 82,650 Total General Fund $4,587,817 6. Details of the total Grant Fund Revenue are as follows: Adolescent Screening Immunization Action Plan Gonococcal Isolate WIC WIC Breastfeeding Peer Council TB Control Aids Prevention HIV Surveillance Vaccine Replacement/Handling Maternal Child Health Block CSHCS Outreach and Advocacy Infant Safe Sleep Public Health Emergency Preparedness BT Lab Program Cities Readiness Initiative Tobacco Reduction West Nile Virus Surveillance ZIKA Virus Community Support ZIKA Virus Mosquito Surveillance MI Health & Wellness 4x4 Nurse Family Partnership Total Grants $ 73,000 503,403 39,000 2,435,330 219,199 48,678 518,900 39,071 110,181 321,457 285,000 22,500 222,390 20,000 152,128 30,000 8,000 10,000 10,000 65,000 621,040 $5,754,277 Total Program $10 342 094 FINANCE COMMITTEE VOTE: Motion carried unanimously on a roll call vote. 7. The General and Grant Fund Revenue Budgets are amended per the attached Schedule A, to reflect the FY 2018 grant award of $10,342,094. 8. Schedule A also reflects revenue totaling $224,568 to recognize generated program fees and collections for CSHCS Outreach and Advocacy - $202,537 and Immunization Action Plan - $22,031. 9. The grant continues funding sixty-three (63) special revenue (SR) positions as reflected on Schedule B. 10. Fourteen (14) vacant special revenue (SR) positions as reflected on Schedule C to be deleted. ComMissioner Tom Middleton, District #4 Chairperson, Finance Committee Resolution #17237 August 23, 2017 Moved by Tietz supported by Zack the resolutions (with fiscal notes attached) on the Consent Agenda be adopted (with accompanying reports being accepted). AYES: Crawford, Dwyer, Fleming, Gershenson, Hoffman, Jackson, Kochenderfer, KowaII, Long, McGillivray, Middleton, Quarles, Spisz, Taub, Tietz, Weipert, Woodward, Zack, Berman, Bowman. (20) NAYS: None. (0) A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the Consent Agenda were adopted (with accompanying reports being accepted). tVRETC,;(13Ridiffitre TM btpury coutoY exedutivt STATE OF MICHIGAN) 439woPorissiwrFe Me4dist,Sak(±4 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 August 23, 2017, 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 23 1 day of August, 2017. Xad Lisa Brown, Oakland County //7