HomeMy WebLinkAboutResolutions - 2017.09.28 - 23116MISCELLANEOUS RESOLUTION /17267 September 28, 2017
BY: Commissioner Christine Long, Chairperson, General Government Committee
IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION — INTERLOCAL
AGREEMENT WITH THE OAKLAND COMMUNITY HEALTH NETWORK FOR SUBSTANCE USE
DISORDER PREVENTION SERVICES
To the Oakland County Board of Commissioners
Chairperson, Ladies and Gentlemen:
WHEREAS Oakland County has received an Interlocal Agreement from the Oakland Community Health
Network (OCHN), formally known as the Oakland County Community Mental Health Authority
(OCCMHA), to reflect the change in name and update work plan objectives for substance use disorder
prevention services; and
WHEREAS the new Agreement includes total Fiscal Year (FY) 2017 funding in the amount of $182,898
which consists of $166,271 in grant funding with a required local match of $16,627; and
WHEREAS the funding is sufficient to cover two (2) Special Revenue (SR) Full-Time Eligible (FTE) Public
Health Educator III positions (#1060233-00960 and #1060233-07497) within the Health Division for FY
2017; and
WHEREAS the Agreement is effective upon approval and will remain in effect until terminated by either of
the parties; and
WHEREAS an increase in funding for FY 2018 is expected in a future amendment; and
WHEREAS this Interlocal 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
approves the Interlocal Agreement between the County of Oakland and the Oakland Community Health
Network including total FY 2017 funding of $182,898 which consists of $166,271 in grant funding and a
required local match of $16,627.
BE IT FURTHER RESOLVED to continue two (2) SR FTE Public Health Educator III positions (#1060233-
00960 and #1060233-07497) within the Health Division.
BE IT FURTHER RESOLVED that the Chairperson of the Board of Commissioners is authorized to
execute the agreement and to approve any extensions or changes, within fifteen percent (15%) of the
original award, which are consistent with the original agreement as approved.
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 future
levels of grant funding.
Chairperson, on behalf of the General Government Committee, I move the adoption of the foregoing
resolution.
1(7-1 \ I
Commissioner Christine Long, Disirr #7
Chairperson, General Government Co1imittee
GENERAL GOVERNMENT COMMITTEE VOTE:
Motion carried unanimously on a roll call vote with Kochenderfer absent.
Federal Operating Grants
Revenue Total
$166,271
$166,271
Salaries Regular $ 75,728
Fringe Benefits $ 53,911
Education Programs $ 2,000
Indirect Costs $ 9,019
Interpreter Fees $ 500
Licenses and Permits $ 1,000
Personal Mileage $ 2,675
Printing $ 2,000
Training $ 2,500
Travel and Conference $ 3,000
Incentives $ 4,500
Materials and Supplies $ 1,508
Metered Postage $ 250
Office Supplies $ 500
Training-Educational Supplies $ 7,000
Insurance Fund $ 180
Total Expenditures $166,271
FISCAL NOTE (MISC . #17267) September 28, 2017
BY: Commissioner Thomas Middleton, Chairperson, Finance Committee
IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION — INTERLOCAL
AGREEMENT WITH THE OAKLAND COMMUNITY HEALTH NETWORK FOR SUBSTANCE USE
DISORDER PREVENTION SERVICES
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. Resolution authorizes the Interlocal Agreement between Oakland County and Oakland
Community Health Network (OCHN) formally known as the Oakland County Mental Health
Authority (OCCMHA) for substance use disorder prevention services.
2. The Agreement includes FY 2017 funding in the amount of $182,898 which consists of $166,271
in grant funding and a local match of $16,627 for the period October 1,2016 through September
30, 2017.
3. The $16,627 local match, which is budgeted in the general fund, includes salaries, educational
supplies, telephone communications, and IT operations.
4. The Agreement continues funding for two (2) Special Revenue (SR) Full-Time Eligible (FTE)
Public Health Educator III positions (1060233-00960 and 1060233-07497) within the Health
Division.
5. The FY 2017 budget is amended as follows:
HEALTH MDPH OSAS FUND #28249
GR0000000203 Bud Ref: 2017 Analysis: GLB Activity GLB
FY 2017
Revenues
1060261-134795-610313
Expenditures
1060261-134795-702010
1060261-134795-722740
1060261-134795-730555
1060261-134795-730926
1060261-134795-730982
1060261-134795-731115
1060261-134795-731346
1060261-134795-731388
1060261-134795-731941
1060261-134795-732018
1060261-134795-750245
1060261-134795-750294
1060261-134795-750392
1060261-134795-750399
1060261-134795-750567
1060261-134795-774677
CO missioner Thomas IVUddleton, District #4
Chairperson, Finance Committee
FINANCE COMMITTEE VOTE:
Motion carried unanimously on a roll call vote.
GRANT REVIEW SIGN OFF — Health Division
GRANT NAME: Interlocal Agreement with Oakland Community Health Network for Substance Use
Disorder Prevention Services
FUNDING AGENCY: Oakland Community Health Network (OCHN)
DEPARTMENT CONTACT PERSON: Rachel Shyrnkiw /452-2151
STATUS: Grant Acceptance
DATE: August 30, 2017
Pursuant to Misc. Resolution 417194, please be advised the captioned grant materials have completed
internal grant review. Below are the returned comments.
The captioned grant materials and grant acceptance package (which should include the Board of
Commissioners' Liaison Committee Resolution, the grant agreement/contract, Finance Committee Fiscal
Note, and this Sign Off email containing grant review comments) may be requested to be placed on the
appropriate Board of Commissioners' committee(s) for grant acceptance by Board resolution.
DEPARTMENT REVIEW
Department of Management and Budget:
Approved. — Laurie Van Pelt (8/23/2017)
Department of Human Resources:
FIR Approved (No Committee) — Lori Taylor (8/23/2017)
Risk Management and Safety:
Approved by Risk Management. — Robert Erlenbeck (8/23/2017)
Corporation Counsel:
APPROVAL — there are no legal issues that need to be addressed at this time. — Mary Ann Jerge
(8/30/2017)
OAKLAND COUNTY INTERLOCAL AGREEMENT
BETWEEN
OAKLAND COUNTY
AND
OAKLAND COMMUNITY HEALTH NETWORK
2017-0016
This Agreement ("Agreement") is made and entered into between the County of Oakland,
("County") (DUNS # 136200362), a Michigan Constitutional and Municipal Corporation, a
political subdivision of the state of Michigan, and the designated Coordinating Agency per MCL
333.6201 et seq., whose address is 1200 North Telegraph, Pontiac, Michigan 48341 and the
OAKLAND COMMUNITY HEALTH NETWORK (hereafter "OCHN"), a Michigan Statutory
Public Governmental Entity (MCL 330.1100a(12), Federal Employer I.D. #38-3437521), created
pursuant to the Michigan Mental Health Code (P.A. 1974, No. 258, MCL 330.1100, et seq.,
hereafter "Mental Health Code"), whose address is 5505 Corporate Drive., Troy, MI 48098. In this
Agreement, either the OCHN or the County may also be referred to individually as a "Party" or
jointly as the "Parties."
PURPOSE OF AGREEMENT. The OCHN is seeking to purchase services or provide funds for
programs to Oakland County. The Parties agrees, subject to the terms and conditions set forth in
this Agreement, to provide funds and/or services as described in Exhibits I and Exhibit II.
The Parties are authorized to enter into this Agreement pursuant to P.A. 1967, No. 7 (MCL 124.501
et seq.).
In consideration of the mutual promises, obligations, representations, and assurances in this
Agreement, the Parties agree as follows:
1. DEFINITIONS. In addition to any other defined terms in this Agreement (e.g.,
"Agreement," "County," "Mental Health Code," "OCHN," "Party," or "Parties," etc.), the
Parties agree that for all purposes, and as used throughout this Agreement, the following
words and expressions used throughout this Agreement, whether used in the singular or
plural, within or without quotation marks, or possessive or nonpossessive, shall be defined,
and interpreted as follows:
1.1. Agreement Documents mean the following documents, which this Contract includes
and incorporates:
1.1.1. Exhibit I: Financial Obligations
1.1.2. Exhibit H: Scope of Services
OCHN Contract #2017-0016-SUD Page 1 of 41
1.1.3. Exhibit 111: Business Associate Agreement, Requirements for Contracts
Involving the Health Insurance Portability and Accountability Act, if
applicable
1.1.4. Exhibit IV: Attachments C and D
1.2. Claim(s) means any loss; complaint; demand for relief or damages; lawsuit; cause of
action; proceeding; judgment; penalty; costs or other liability of any kind which is
imposed on, incurred by, or asserted against the County or for which the County may
become legally or contractually obligated to pay or defend against, whether
commenced or threatened, including, but not limited to, reimbursement for reasonable
attorney fees, mediation, facilitation, arbitration fees, witness fees, court costs,
investigation expenses, litigation expenses, or amounts paid in settlement..
1.3. OCHN as defined on the first page of this Agreement, and shall be further defined to
include any and all "CMH Agents" as defined herein.
1.4. OCHN Agent shall be defined to include, any and all OCHN Contractor(s)'
employees, officers, directors, board members, concurrent board members, managers,
departments, divisions, trustees, volunteers, licensees, concessionaires, subcontractors,
vendors, subsidiaries, joint ventures or partners, and/or any such OCHN Contractor(s)'
successors or predecessors and any such successors' or predecessors' employees
(whether such persons act or acted in their personal, representative or official
capacities), and/or any and all persons acting by, through, under, or in concert with any
OCHN Contractor(s) "OCHN Agency" shall also include any person who was a OCHN
Agent any time during the term of this Agreement but, for any reason, is no longer
employed, appointed, or serving as a OCHN Agent, without limitation, any and all
employees, officers, directors, members, managers, departments, and divisions of the
OCHN (whether such persons act or acted in their personal, representative or official
capacities but shall NOT include the County or "Concurrent Board Member" as defined
herein.
1.5. Concurrent Board Member shall be defined as any Oakland County Commissioner
who is also serving as a member of the Oakland Community Health Network Board.
1.6. County As this term may be used in this Agreement, "County" shall be further defined
to include any and all "County Agents," as defined herein.
1.7. County Agent shall be defined as any and all elected officials, appointed officials,
directors, board members, council members, commissioners, authorities, other boards,
committees, commissions, employees, third-party contractors, departments, divisions,
volunteers, representatives, and/or any such persons' successors (weather such persons
act or acted in their personal representative or official capacities), and/or "County
Agents" shall also include any person who was a County Agent any time during the
term of this Agreement but, for any reason, is no longer employed, appointed, or elected
and serving as an County Agent, and shall include the any "Concurrent Board
Member."
1.8. pla shall be defined as any calendar day, which shall always begin at 12:00:00 a.m.
and end at 1 1:59:59 p.m.
OCHN Contract #2017-0016-SUD Page 2 of 41
2. COUNTY SERVICES FOR THE OCHN. Subject to the terms and conditions in this
Agreement, and except as otherwise provided by law, the County shall provide those services
for the OCHN as described in Exhibit TI and Exhibit IV attached to this Agreement and hereby
incorporated and made part of this Agreement. The Parties intend, agree, and acknowledge
that no services, other than those services described in this Agreement, shall or are otherwise
required to be provided by the County for or to the OCHN. Additional services may be
contracted by mutual agreement between the Parties.
3. OCHN PAYMENT OBLIGATION FOR COUNTY SERVICES.
3.1. Subject to the terms and conditions of this Agreement the OCHN agrees to pay to the
County on a monthly basis the dollar amount described in Exhibit I. This amount shall
be paid to the County within the thirty days of the OCHN receiving the expenditure
report from the County, via a wire transfer to a bank account designated by the County.
3.2. The Parties agree that the dollar Amount in Exhibit I is subject to change. The OCHN
will notify the County via a written notice at least 30 days in advance of any such
change, and the notice shall detail the change in the dollar amount. Furthermore, if the
dollar amount described in Exhibit I should change either by increase or decrease the
level of services provided by the County will change accordingly to match that increase
or decrease in funds. At no time will the County be required to perform services for
which it will not be paid or reimbursed.
3.3. Notwithstanding any references in the Exhibits to this Agreement, the Parties agree that
any and all references to "capitation," "Per Eligible Per Month (PEPM) payments,"
"shared-risk," "risk" of any sort, or any maximum payment obligation shall be
completely void and without any effect in interpreting this Agreement.
3.4. Unless there is a termination as provided for herein, the OCHN's obligations set forth
in this Section, shall be absolute and unconditional and shall not be affected by the
occurrence of either Party's default of any term or condition of this Agreement, nor
shall any other occurrence or event relieve, limit, or impair the obligation of the OCHN
to pay any such amount due to the County.
3.5. In the event that any amount due and owing from the OCHN is not paid to the County
as otherwise required in this Agreement, the OCHN agrees that the County may, at its
sole option, recover any and all such amounts determined by the County to be then due
and owing by the OCHN by and through any combination of reduced payments, set-
off, and/or withholding of any OCHN funds then in the possession of the County that
would otherwise have been paid to the OCHN by the County pursuant to the Mental
Health Code and/or any prior County funding commitment.
3.6. This Section shall not be interpreted as prohibiting, limiting or preventing the Parties
from mutually recognizing and agreeing that any amount invoiced by and/or received
or paid to the County in connection with this Agreement was in error and voluntarily
agreeing to correct same.
3.7. The Contract Amount per the Exhibit I for the applicable fiscal year represents a Not
To Exceed Amount (NTE) and is the maximum financial obligation of the OCHN to
the County for that fiscal year. If the Contractor projects their expenses will exceed
the NTE the County will submit to OCHN in writing a request for additional funds as
OCHN Contract #2017-0016-SUD Page 3 of 41
soon as projections indicate a potential overage but no later than September 30th of the
current fiscal year. Upon this notification the County and OCHN will discuss potential
adjustments to the NIB.
3.8. Cost Settlement & Audit: For each fiscal year (October 1 through September 30), cost
settlement will be based on a comparison of the Exhibit I categorical amounts, as
amended by OCHN, to the County's actual, allowable, net expenses incurred and
reported for the period.
4. ASSURANCES AND WARRANTIES.
4.1. The OCHN agrees to comply with the provisions of any and all laws relating to
nondiscrimination and conflict of interest with governmental employees and,
specifically, any County Agent. The OCHN warrants to avoid any conflict of interest,
whether real or perceived.
4.2. Any and all County services set forth in this Agreement are provided on an "as-in" and
"as-available" basis, without any warranty of any kind, to the maximum extent
permitted by applicable law. The County hereby expressly further disclaims any and
all warranties, of any kind, whether express or implied, including, without limitation,
any implied warranties of merchantability, fitness for a particular purpose, non-
infringement, and/or that any County services under this Agreement will meet any
OCHN's needs or requirements, will be uninterrupted, timely, secure, error or risk
free/or that any deficiencies in any County service. The entire risk arising out of the
use of any and all County services herein remains at all times, with the OCHN to the
maximum extent permitted by law.
5. NO INDEMNIFICATION.
5.1. Each Party shall be responsible for any Claims made against that Party and for the acts
of its Employees or Agents.
5.2. In any Claim that may arise from the performance of this Agreement, each Party shall
seek its own legal representation and bear the costs associated with such representation
including any attorney fees.
5.3. Except as otherwise provided in this Agreement, neither Party shall have any right
under any legal principle to be indemnified by the other Party or any of its employees
or Agents in connection with any Claim.
5.4. This Agreement does not, and is not intended to, impair, divest, delegate or contravene
any constitutional, statutory, and/or other legal right, privilege, power, obligation, duty
or immunity of the Parties. Nothing in this Agreement shall be construed as a waiver
of governmental immunity for either Party.
6. LIMITS AND EXCLUSIONS ON COUNTY SERVICES.
6.1. In no event and under no circumstances in connection with or as a result of this
Agreement shall the County be liable to the OCHN, or any other person, for any
consequential, incidental, direct, indirect, special punitive, or other similar damages
whatsoever (including, without limitation, damages for loss of business, profits,
business interruption, or any other pecuniary loss or business detriment) arising out of
this Agreement for any County services hereunder or any OCHN use or inability to use
OCHN Contract #2017-0016-SUD Page 4 of 41
any County services, even if the County has been advised of the possibility of such
damages.
7. NO IMPLIED WAIVER. Except as otherwise expressly provided for in this Agreement:
7.1. Absent a written waiver, no act, failure, or delay by a Party to pursue or enforce any
rights or remedies under this Agreement shall constitute a waiver of those rights with
regard to any existing or subsequent breach of this Agreement.
7.2. No waiver of any term, condition, or provision of this Agreement, whether by conduct
or otherwise, in one or more instances, shall be deemed or construed as a continuing
waiver of any term, condition, or provision of this Agreement.
7.3. No waiver by either Party shall subsequently affect its right to require strict
performance of this Agreement.
8. MONITORING.
8.1. The OCHN will perform regular monitoring and reporting on the County's
performance and the County agrees to cooperate with the monitoring.
8.2. The OCHN shall complete on-site reviews and/or audits of the County at least
annually and has the right to investigate alleged compliance violations by the County.
8.3. The OCHN shall prepare a report summarizing the findings from the on-site review
and/or audit and shall forward a copy of the report to the County within 60 days of
completion of the review and/or audit.
AUDITING. The County agrees that financial records will be available upon request for
review or audit by OCHN or other appropriate officials.
10. AGREEMENT INTERPRETATION. The Parties agree that performance under this
Agreement will be conducted in compliance with all federal, Michigan, and local laws and
regulations. This Agreement is made and entered into in the County of Oakland and in the
State of Michigan. The language of all parts of this Agreement is intended to and under all
circumstances to be construed as a whole according to its fair meaning and not construed
strictly for or against any Party.
ii. EFFECTIVE DATE AND DURATION OF THE AGREEMENT.
11.1. The Parties agree that this Agreement, and/or any subsequent amendments thereto,
shall not become effective prior to the approval by the Oakland County Board of
Commissioners and the OCHN. The approval and terms of this Agreement, and/or any
possible subsequent amendments thereto, shall be entered in the official minutes and
proceedings of the Oakland County Board of Commissioners and the OCHN Board
and shall also be filed with the office of the Clerk of the County.
11.2. The Parties further agree that this Agreement, and/or any subsequent amendments
thereto, shall not become effective prior to the filing of this Agreement, and/or any
possible subsequent amendments with the Michigan Secretary of State (MCL 124.510).
11.3. This Agreement shall remain in effect until it is cancelled or terminated by either of
the Parties as provided herein.
OCHN Contract #2017-0016-SUD Page 5 of 41
11 INDEPENDENT CONTRACTOR. The Parties agree that at all times and for all purposes
under the terms of this Agreement, the County's and/or any and all County Agents' legal status
and relationship to the OCHN shall be that of an Independent Contractor. Except as expressly
provided herein, each Party will be solely responsible for the acts of its own employees,
agents, and servants during the term of this Agreement. No liability, right or benefits arising
out of an employer/employee relationship, either express or implied, shall arise or accrue to
either Party as a result of this Agreement.
13. TERMINATION OR CANCELLATION OF AGREEMENT. Either Party may terminate
and/or cancel this Agreement upon ninety (90) Days written notice to the other Party. The
effective date of termination and/or cancellation shall be clearly stated in the written notice.
Termination of this Agreement does not release any Party from any obligations that Party has
pursuant to any law.
13.1. The Parties agree and acknowledge that either Party's decision to terminate and/or
cancel this Agreement, or any one or more individual County Services identified
herein, shall not relieve the OCHN or any OCHN payment obligation for any County
Services rendered prior to the effective date of any termination or cancellation of this
Agreement. The provisions of this Subsection shall survive the termination,
cancellation, and/or expiration of this Agreement.
14. DISCRIMINATION. The Parties shall not discriminate against their employees, agents,
applicants for employment, or another person or entities with respect to hire, tenure, terms,
conditions, and privileges of employment, or any matter directly or indirectly related to
employment in violation of any federal, state or local law.
15. RECORD RETENTION. The Parties agrees to maintain records in accordance with state
law. All records relative to this Agreement shall be available at any reasonable time for
examination or audit by personnel authorized by OCHN or law.
16. CORPORATE COMPLIANCE. The County shall have a Corporate Compliance Plan
and/or Policy. The Plan shall advance the prevention of fraud, abuse and waste providing
health care and to detect misconduct or wrongdoing. The OCHN shall monitor the
implementation of the Plan. The County shall investigate any reported allegations of fraud
and abuse related to the purchase of services funded through this Agreement. The County
shall notify the OCHN within 48 hours of becoming aware of any such allegation(s). The
County shall also notify the OCHN of the outcome of the investigation completed by the
County.
17. DELEGATION/SUBCONTRACT/ASSIGNMENT. Neither Party shall delegate,
subcontract, and/or assign any obligations or rights under this Agreement without the prior
written consent of the other Party.
18. FORCE MAJEURE. Each Party shall be excused from any obligations under this
Agreement during the time and to the extent that a Party is prevented from performing due to
causes beyond the Party's control, including, but not limited to, an act of God, war, fire, strike,
labor disputes, civil disturbances, reduction of power source, or any other circumstances
beyond the reasonable control of the affected Party. Reasonable notice shall be given to the
other party of any such event.
OCHN Contract #2017-0016-SUD Page 6 of 41
19. SEVERABILITY. If a court of competent jurisdiction finds a term, or condition, of this
Agreement to be illegal or invalid, then the term, or condition, shall be deemed severed from
this Agreement. All other terms, conditions, and provisions of this Agreement shall remain
in full force.
20. CAPTIONS. The section and subsection numbers, captions, and any index to such sections
and subsections contained in this Agreement are intended for the convenience of the reader
and are not intended to have any substantive meaning. The numbers, captions, and indexes
shall not be interpreted or be considered as part of this Agreement. Any use of the singular
or plural number, any reference to the male, female, or neuter genders, and any possessive or
nonpossessive use in this Agreement shall be deemed the appropriate plurality, gender or
possession as the context requires.
21. NOTICES. Notices given under this Agreement shall be in writing and shall be personally
delivered, sent by express delivery service, certified mail, or first class U.S. mail postage
prepaid, and addressed to the person listed below. Notice will be deemed given on the date
when one of the following first occur: (1) the date of actual receipt; (2) the next business day
when notice is sent express delivery service or personal delivery; or (3) three days after
mailing first class or certified U.S. mail.
21.1. IfNotice is sent to the County, it shall be addressed and sent to: 1200 North Telegraph,
Pontiac, Michigan 48341.
21.2. if Notice is sent to the OCHN, it shall be addressed and sent to: 5505 Corporate Drive,
Troy, Michigan 48098.
21.3. Either Party may change the address and/or individual to which Notice is sent by
notifying the other Party in writing of the change.
22. GOVERNING LAW. This Agreement shall be governed, interpreted, and enforced by the
laws of the State of Michigan without giving effect to its conflict of law principles.
23. JURISDICTION AND VENUE. Except as otherwise required by law or court rule, any
action brought to enforce, interpret, or decide any Claim(s) arising under or related to this
Agreement shall be brought in the Sixth Judicial Circuit Court of the State of Michigan, the
50th District Court of the State of Michigan, or the United States District Court for the Eastern
District of Michigan, Southern Division, as dictated by the applicable jurisdiction of the court.
Except as otherwise required by law or court rule, venue is proper in the courts set forth
above. The choice of forum set forth above shall not be deemed to preclude the enforcement
of any judgment obtained in such forum or taking action under this Agreement to enforce
such judgment in any appropriate jurisdiction.
24. AGREEMENT MODIFICATIONS OR AMENDMENTS. Any modifications,
amendments, rescissions, waivers, or releases to this Agreement must be in writing and
executed by both Parties. The Parties agree that no such modification, rescission, waiver,
release or amendment of any provision of this Agreement shall become effective against the
County unless signed for by the Oakland County Board of Commissioners. The Parties further
agree that this Agreement shall not be changed, supplemented, or amended, in any manner,
except as provided for herein, and no other act, verbal representation, document, usage or
custom shall be deemed to amend or modify this Agreement in any manner.
OCHN Contract #2017-0016-SUD Page 7 of 41
25. ENTIRE AGREEMENT. This Agreement sets forth the entire agreement between the
Parties along with the Agreement Documents. In entering into this Agreement, OCHN
acknowledges that it has not relied upon any prior or contemporaneous agreement,
representation, warranty, or other statement by the County and/or any County Agent that is
not expressly set forth in this Agreement, and that any and all such possible, perceived or
prior agreements, representations, understandings, statements, negotiations, understandings
and undertakings, whether written or oral, in any way concerning or related to the subject
matter of this Agreement are fully and completely superseded by this Agreement.
25.1. If there is a contradicting term or condition in any Exhibit to this Agreement, the
Agreement controls.
25.2. It is further agreed that the terms and conditions of this Agreement are contractual and
binding and are not mere recitals. The Parties acknowledge that this Agreement
contains certain limitations and disclaimers of liability.
OAKLAND COMMUNITY HEALTH NETWORK:
BY: DATE:
Kathleen Kovach,
Deputy Executive Director
BY: DATE:
Anya Eliassen,
Chief Financial Officer
THE COUNTY OF OAKLAND
BY: DATE:
Michael J. Gingen,
Chairperson, Oakland County Board of Commissioners
OCHN Contract #2017-0016-SUD Page 8 of 41
OAKLAND COUNTY INTERLOCAL AGREEMENT
BETWEEN
OAKLAND COUNTY
AND
OAKLAND COMMUNITY HEALTH NETWORK
EXHIBIT I: Financial' and Reporting Obligations
Health Education SUD Prevention Services
October 1, 2016 — September 30, 2017
Description Budget
FY17 Travel 5,675
Supplies & Materials 19,266
Contractual 142,201
Other 15,756
OCHN Funding 166,271
Local Match 16,627
Total Budget 182,898
The County shall submit an invoice to the OCHN on a monthly basis, which shall itemize all
amounts due and or owing by OCHN. The monthly invoice must reflect total actual program
expenditures by category. The invoices shall be submitted in a form and format agreed upon by
the Parties.
Some or all of the funds provided by OCHN are federal funds. Department of Health and Human
Services/Substance Abuse and Mental Health Services Administration (SAMHSA), CFDA NO, 93.959, Block Grant
for Prevention and Treatment of Substance Abuse, Grant NO. 13 B1 MT SAPT, award phase 2016. Title SAPT
Block Grant sub-recipient relationship, non-research and development project.
OCHN Contract #2017-0016-SUD Page 9 of 41
OAKLAND COUNTY INTERLOCAL AGREEMENT
BETWEEN
OAKLAND COUNTY
AND
OAKLAND COMMUNITY HEALTH NETWORK
EXHIBIT II: Scope of Services
SUPPORTS AND SERVICES:
A. The County shall assure for the provision of services for eligible individuals
pursuant to the Contract and this Scope of Services.
B. Federal Award Project Description: Support projects for the development and
implementation of prevention activities directed to the diseases of alcohol and drug
abuse.
C. The County agrees to provide Health Education Substance Use Prevention Services
and will comply with the Management by Objective requirements in Attachment C
and the terms and conditions in Attachment D.
IL ADMINISTRATIVE RESPONSIBILITIES
A. Required Staff Training(s): The County understands that various federal and state
rules and regulations impose specific training requirements on the Parties. The
County agrees that its entire staff will receive all required training(s) as applicable.
The County also agrees to document the completion of applicable training in the
personnel file of each staff.
B. Cultural Competency: The County must assure meaningful service for persons with
diverse cultural backgrounds (including, but not limited to religious, ethnical,
geographical, geriatric, socioeconomic, and/or disability). The County shall assess
the population(s) it serves, collaborating with other community agencies (e.g.,
Council on Aging) and training staff on any identified cultural issues.
C. Relationship with Other Providers (Contractors): The County when practicable shall
collaborate with agencies in the community to the benefit of the consumer. Such
agencies include but are not limited to hospitals, intermediate school district, local
schools, faith based organizations, courts, law enforcement, community corrections,
substance abuse, Indian Health Services and Tribal Health Centers, Early On and
OCHN Contract #2017-0016-SUD Page 10 of 41
other early intervention programs that are essential to positive outcomes to our
community.
D. Customer Services:
Orientation: The County will provide orientation to newly enrolled
Consumers. Orientation will include information about benefits and
services provided by Oakland County's Office of Substance Abuse Services.
2. The County will acknowledge receipt of support and for Federal and State
funds from the Michigan Depai tinent of Health and Human Services
(MDHITS) and/or Oakland Community Health Network (OCHN) in any
articles or publications that are produced utilizing any such funding.
3. Grievance: The County will have a policy, procedures and a process to
document the number and nature of grievances and complaints brought to
the County.
E. Recipient Rights:
1. The County will, and will require its subcontractors to, at every service site,
make readily available to all employees and staff, and if applicable, will post
in a conspicuous place and/or make available, the following:
a. A summary of all recipient rights guaranteed by the Public Health Code;
b. Post the MDDHS/Office of Recipient Rights (ORR) Reporting
Requirements poster for staff;
F. Service Cost Tables Reporting: The County agrees to cooperate with and
participate in OCHN's cost integrity process. The County agrees to develop and
submit to OCHN Service Cost Tables upon request by the OCHN. The County
agrees that the rates it establishes for all procedures listed in the Service Cost Table
are based on actual costs and are representative of current costs incurred and paid
by the County.
III. DATA MANAGEMENT:
A. As to the extent provided for by law the OCHN is the owner of all data
related to consumers pursuant to this agreement including all data entered
into the County's management information system(s), such as, all eligibility
and demographic data, utilization data, claims data, and any other service,
administrative or financial information that has passed through the OCHN's
or the County's operation that resides with the County. Notwithstanding the
foregoing, the County is not precluded from maintaining and utilizing the
data identified in this section in support of the services provided to the
consumer and internal County operations.
OCHN Contract #2017-0016-SUD Page 11 of 41
B. The County shall implement tools to prevent unauthorized access and virus
protection to its internal transaction and office system using planning,
management, and system monitoring tools.
C. The Parties agree that when transmitting information electronically the
national ANSI and HIPAA compliant standards shall be utilized.
OCHN Contract #2017-0016-SUD Page 12 of 41
OAKLAND COUNTY INTERLOCAL AGREEMENT
BETWEEN
OAKLAND COUNTY
AND
OAKLAND COMMUNITY HEALTH NETWORK
EXHIBIT III
BUSINESS ASSOCIATE AGREEMENT
(Health Insurance Portability and Accountability Act Requirements)
Exhibit H is a Business Associate Agreement between Contractor ("Business Associate") and the
County ("Covered Entity"). This Exhibit is incorporated into the Contract and shall be
hereinafter referred to as "Agreement." The purpose of this Agreement is to facilitate
compliance with the Privacy and Security Rules and to facilitate compliance with HIPAA and
the HITECH Amendment to HIPAA.
1. DEFINITIONS. The following terms have the meanings set forth below for purposes of
the Agreement, unless the context clearly indicates another meaning. Terms used but not
otherwise defined in this Agreement have the same meaning as those terms in the Privacy
Rule.
1.1 Business Associate. "Business Associate" means the Contractor.
1.2 CFR. "CFR" means the Code of Federal Regulations.
1.3 Contract. "Contract" means the document with the Purchasing Contract
Number:
1.4 Contractor. "Contractor" means the entity or individual defined in the Contract
and listed on the first page of this Contract.
1.5 Covered Entity. "Covered Entity" means the County of Oakland as defined in
the Contract.
1.6 Designated Record Set. "Designated Record Set" is defined in 45 CFR 164.501.
1.7 Electronic Health Record. "Electronic Health Record" means an electronic
record of health-related information on an individual that is created, gathered,
managed, and consulted by authorized health care clinicians and staff.
1.8 HIPAA. "HIPAA" means the Health Insurance Portability and Accountability
Act of 1996.
1.9 HITECH Amendment. "HITECH Amendment" means the changes to HIPAA
made by the Health Information Technology for Economic and Clinical Health
Act.
OCHN Contract #2017-0016-SUD Page 13 of 41
1.10 Individual. "Individual" is defined in 45 CFR 160.103 and includes a person who
qualifies as a personal representative in 45 CFR 164.502(g).
1.11 Privacy Rule. "Privacy Rule" means the privacy rule of HIPAA as set forth in the
Standards for Privacy of Individually Identifiable Health Information at 45 CFR
part 160 and part 164, subparts A and E.
1.12 Protected Health Information. "Protected Health Information" or "PHI" is
defined in 45 CFR 160.103, limited to the information created or received by
Business Associate from or on behalf of Covered Entity.
1.13 Required By Law. "Required By Law" is defined in 45 CFR 164.103.
1.14 Secretary. "Secretary" means the Secretary of the Department of Health and
Human Services or his or her designee.
1.15 Security Incident. "Security Incident" is defined in 45 CFR 164.304.
1.16 Security Rule. "Security Rule" means the security standards and implementation
specifications at 45 CFR part 160 and part 164, subpart C.
2. OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATE. Business
Associate agrees to perform the obligations and activities described in this Section.
2.1 Business Associate understands that pursuant to the HITECH Amendment, it is
subject to the HIPAA Privacy and Security Rules in a similar manner as the rules
apply to Covered Entity. As a result, Business Associate shall take all actions
necessary to comply with the HIPAA Privacy and Security Rules for business
associates as revised by the HITECH Amendment, including, but not limited to,
the following: (a) Business Associate shall appoint a HIPAA privacy officer and
a HIPAA security officer; (b) Business Associate shall establish policies and
procedures to ensure compliance with the Privacy and Security Rules; (c)
Business Associate shall train its workforce regarding the Privacy and Security
Rules; (d) Business Associate shall enter into a privacy/security agreement with
Covered Entity; (e) Business Associate shall enter into privacy/security
agreements with its subcontractors that perform functions relating to Covered
Entity involving PHI; and (f) Business Associate shall conduct a security risk
analysis.
2.2 Business Associate shall not to use or disclose PHI other than as permitted or
required by this Agreement or as required by law.
2.3 Business Associate shall use appropriate safeguards to prevent use or disclosure
of the PHI. Business Associate shall implement administrative, physical, and
technical safeguards (including written policies and procedures) that reasonably
and appropriately protect the confidentiality, integrity, and availability of PHI that
it creates, receives, maintains, or transmits on behalf of Covered Entity as
required by the Security Rule.
2.4 Business Associate shall mitigate, to the extent practicable, any harmful effect
that is known to Business Associate of a use or disclosure of PHI by Business
Associate in violation of law or this Agreement.
OCHN Contract #2017-0016-SUD Page 14 of 41
2.5 Business Associate shall report to Covered Entity any known Security Incident or
any known use or disclosure of PHI not permitted by this Agreement.
2.6 Effective September 23, 2009 or the date this Agreement is signed, if later,
Business Associate shall do the following in connection with the breach
notification requirements of the HITECH Amendment:
2.6.1 If Business Associate discovers a breach of unsecured PHI, as those terms
are defined by 45 CFR 164.402, Business Associate shall notify Covered
Entity without unreasonable delay but no later than ten (10) calendar days
after discovery. For this purpose, "discovery" means the first day on
which the breach is known to Business Associate or should have been
known by exercising reasonable diligence. Business Associate shall be
deemed to have knowledge of a breach if the breach is known or should
have been known by exercising reasonable diligence, to any person, other
than the person committing the breach, who is an employee, officer,
subcontractor, or other agent of Business Associate. The notification to
Covered Entity shall include the following: (a) identification of each
individual whose unsecured PHI has been breached or has reasonably
believed to have been breached and (b) any other available information in
Business Associate's possession that the Covered Entity is required to
include in the individual notice contemplated by 45 CFR 164.404.
2.6.2 Notwithstanding the immediate preceding subsection, Business Associate
shall assume the individual notice obligation specified in 45 CFR 164.404
on behalf of Covered Entity where a breach of unsecured PHI was
committed by Business Associate or its employee, officer, subcontractor,
or other agent of Business Associate or is within the unique knowledge of
Business Associate as opposed to Covered Entity. In such case, Business
Associate shall prepare the notice and shall provide it to Covered Entity
for review and approval at least five (5) calendar days before it is required
to be sent to the affected individual(s). Covered Entity shall promptly
review the notice and shall not unreasonably withhold its approval.
2.6.3 Where a breach of unsecured PHI involves more than five hundred (500)
individuals and was committed by the Business Associate or its employee,
officer, subcontractor, or other agent or is within the unique knowledge of
Business Associate as opposed to Covered Entity, Business Associate
shall provide notice to the media pursuant to 45 CFR 164.406. Business
Associate shall prepare the notice and shall provide it to Covered Entity
for review and approval at least five (5) calendar days before it is required
to be sent to the media. Covered Entity shall promptly review the notice
and shall not unreasonably withhold its approval.
2.6.4 Business Associate shall maintain a log of breaches of unsecured PHI with
respect to Covered Entity and shall submit the log to Covered Entity
within thirty (30) calendar days following the end of each calendar year,
so that the Covered Entity may report breaches to the Secretary in
accordance with 45 CFR 164.408. This requirement shall take effect with
respect to breaches occurring on or after September 23, 2009.
OCHN Contract #2017-0016-SUD Page 15 of 41
2.7 Business Associate shall ensure that any agent or subcontractor to whom it
provides PHI, received from Covered Entity or created or received by Business
Associate on behalf of Covered Entity, agrees in writing to the same restrictions
and conditions that apply to Business Associate with respect to such information.
Business Associate shall ensure that any such agent or subcontractor implements
reasonable and appropriate safeguards to protect Covered Entity's PHI.
2.8 Business Associate shall provide reasonable access, at the written request of
Covered Entity, to PHI in a Designated Record Set to Covered Entity or, as
directed in writing by Covered Entity, to an Individual in order to meet the
requirements under 45 CFR 164.524.
2.9 Business Associate shall make any amendment(s) to PHI in a Designated Record
Set that the Covered Entity directs in writing or agrees to pursuant to 45 CFR
164.526.
2.10 Following receipt of a written request by Covered Entity, Business Associate shall
make internal practices, books, and records reasonably available to the Secretary
in order to determine Covered Entity's compliance with the Privacy Rule. The
afore mentioned materials include policies and procedures and PHI relating to the
use and disclosure of PHI received from Covered Entity or created or received by
Business Associate on behalf of Covered Entity.
2.11 Business Associate shall document disclosures of PHI and information related to
such disclosures, to permit Covered Entity to respond to a request by an
Individual for: (a) an accounting of disclosures of PHI in accordance with 45
CFR 164.528 or (b) effective January 1, 2011 or such later effective date
prescribed by regulations issued by the U.S. Department of Health and Human
Services, an accounting of disclosures PHI from an Electronic Health Record in
accordance with the HITECH Amendment.
2.12 Following receipt of a written request by Covered Entity, Business Associate shall
provide to Covered Entity or an Individual information collected in accordance
with Section 2 to permit Covered Entity to respond to a request by an Individual
for: (a) an accounting of disclosures of PHI in accordance with 45 CFR 164.528
or (b) effective as of January 1, 2011 or such later effective date prescribed by
regulations issued by the U.S. Department of Health and Human Services, an
accounting of disclosures of Protected Health Information from an Electronic
Health Record in accordance with the HITECH Amendment.
3. PERMITTED USES AND DISCLOSURES BY BUSINESS ASSOCIATE. Business
Associate may use and disclose PHI as set forth in this Section.
3.1 Except as otherwise limited in this Agreement, Business Associate may use or
disclose PHI to perform functions, activities, or services for or on behalf of
Covered Entity as specified in the underlying service agreement between Covered
Entity and Business Associate, provided that such use or disclosure shall not
violate the Privacy Rule if done by Covered Entity or the minimum necessary
policies and procedures of the Covered Entity. If no underlying service
agreement exists between Covered Entity and Business Associate, Business
Associate may use or disclose PHI to perform functions, activities, or services for
or on behalf of Covered Entity for the purposes of payment, treatment, or health
OCHN Contract #2017-0016-SUD Page 16 of 41
care operations as those terms are defined in the Privacy Rule, provided that such
use or disclosure shall not violate the Privacy Rule if done by Covered Entity or
the minimum necessary policies and procedures of the Covered Entity.
3.2 Except as otherwise limited in this Agreement, Business Associate may use PHI
for the proper management and administration of the Business Associate or to
carry out the legal responsibilities of the Business Associate.
3.3 Except as otherwise limited in this Agreement, Business Associate may disclose
PHI for the proper management and administration of the Business Associate or
to carry out the legal responsibilities of the Business Associate, provided that
disclosures are Required by Law or Business Associate obtains reasonable
assurances in writing from the person to whom the information is disclosed that:
(a) the disclosed PHI will remain confidential and will be used or further
disclosed only as Required by Law or for the purpose for which it was disclosed
to the person and (b) the person notifies the Business Associate of any known
instances in which the confidentiality of the information has been breached.
3.4 Except as otherwise limited in this Agreement, Business Associate may use PHI
to provide data aggregation services to Covered Entity as permitted by 45 CFR
164.504(e)(2)(i)(B).
3.5 Business Associate may use PHI to report violations of law to appropriate federal
and state authorities, consistent with 45 CFR 164.502(j)(1).
4. OBLIGATIONS OF COVERED ENTITY.
4.1 Covered Entity shall notify Business Associate of any limitation(s) of Covered
Entity in its notice of privacy practices in accordance with 45 CFR 164.520, to the
extent that such limitation may affect Business Associate's use or disclosure of
PHI.
4.2 Covered Entity shall notify Business Associate of any changes in or revocation of
permission by an Individual to use or disclose PHI, to the extent that such changes
may affect Business Associate's use or disclosure of PHI.
4.3 Covered Entity shall use appropriate safeguards to maintain and ensure the
confidentiality, privacy and security of PHI transmitted to Business Associate
pursuant to this Agreement, the Contract, and the Privacy Rule, until such PHI is
received by Business Associate, pursuant to any specifications set forth in any
attachment to the Contract.
4.4 Covered Entity shall manage all users of the services including its qualified
access, password restrictions, inactivity timeouts, downloads, and its ability to
download and otherwise process PHI.
4.5 The Parties acknowledge that Covered Entity owns and controls its data.
4.6 Covered Entity shall provide Business Associate with a copy of its notice of
privacy practices produced in accordance with 45 CFR Section 164.520, as well
as any subsequent changes or limitation(s) to such notice, to the extent such
changes or limitations may effect Business Associate's use or disclosure of PHI.
Covered Entity shall provide Business Associate with any changes in or
OCHN Contract #2017-0016-SUD Page 17 of 41
revocation of permission to use or disclose PHI, to the extent the changes or
revocation may affect Business Associate's permitted or required uses or
disclosures. To the extent that the changes or revocations may affect Business
Associate's permitted use or disclosure of PHI, Covered Entity shall notify
Business Associate of any restriction on the use or disclosure of PHI that Covered
Entity has agreed to in accordance with 45 CFR Section 164.522. Covered Entity
may effectuate any and all such notices of non-private information via posting on
Covered Entity's web site.
5. EFFECT OF TERMINATION.
5.1 Except as provided in Section 5, upon termination of this Agreement or the
Contract, for any reason, Business Associate shall return or destroy (at Covered
Entity's request) all PHI received from Covered Entity or created or received by
Business Associate on behalf of Covered Entity. This provision shall apply to
PHI that is in the possession of subcontractors or agents of Business Associate.
Business Associate shall retain no copies of PH1.
5.2 If Business Associate determines that returning or destroying the PH1 is
infeasible, Business Associate shall provide to Covered Entity written notification
of the conditions that make return or destruction infeasible. Upon receipt of
written notification that return or destruction of PHI is infeasible, Business
Associate shall extend the protections of this Agreement to such PHI and shall
limit further uses and disclosures of such PHI to those purposes that make the
return or destruction infeasible, for so long as Business Associate maintains such
PHL which shall be for a period of at least six (6) years.
6 MISCELLANEOUS.
6.1 This Agreement is effective when the Contract is executed or when Business
Associate becomes a Business Associate of Covered Entity and both Parties sign
this Agreement, if later. However, certain provisions have special effective
dates, as set forth herein or as set forth in H1PAA or the HITECH Amendment.
6.2 Regulatory References. A reference in this Agreement to a section in the Privacy
Rule or Security Rule means the section as in effect or as amended.
6.3 Amendment. The Parties agree to take action to amend this Agreement as
necessary for Covered Entity to comply with the Privacy and Security
requirements of HIPAA. If the Business Associate refuses to sign such an
amendment, this Agreement shall automatically terminate.
6.4 Survival. The respective rights and obligations of Business Associate and
Covered Entity under this Agreement shall survive the termination of this
Agreement and/or the Contract.
OCHN Contract #2017-0016-SUD Page 18 of 41
OAKLAND COUNTY INTERLOCAL AGREEMENT
BETWEEN
OAKLAND COUNTY
AND
OAKLAND COMMUNITY HEALTH NETWORK
EXHIBIT IV: Attachments
ATTACHMENT C
Management by Objective
ATTACHMENT C
Oe1dand Community Heaith Network!Substance Use Disorder Services
Management by Objective
FY 2016 - 2017
Program Name: SLID Prevention. Health Education
Agency/Organization. Oakland County Health Division
Prepared By: Trish Zizumbo/ Kathleen Altman
Program Goal:
Date Prepared. 9/21/2010
evised 6112/17
To delay the onset/ prevent the use of alcohol, tobacco and other drugs by youth in Oakland County
with particular emphasis on high risk populations
Specific Activity and Objective (s)
(Number consecutively and use separate page for each
Pnavention Activity)
Estimated
Total
Recipients
(12 months)
Number of Direct Service Hours (outputs)
P = Planned / A = Delivered .
let Orr. 2nd Ohm. 3rd Ohm, 4th Otr, TOTAL
p lin A E I A DIE F la
Activity #1 Engage in education and recruitment activities 111111111111111 10 IIII 10 11111111:1111111 40 0 with personnel In schools, youth-serving agencies and =1.111111111111111011111111.= 0 0
other community organizations in order to implement 11111111111111111111111111111111111111111111111111111111111111111 0 0
Botviris Life Skills Training, Elotvin Parenting Program, IIIIIIIIIIIIINIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 0 0
PhotoVoice, WITS. and Safe Dates Programs. Particular 111111111111111111111111111111111111111.1.111111111.111111111111111111111111111111 o
emphasis in recruiting will be placed on high risk IIIIIIII. .1111.1= 0 0 goopgraphic areas. Outcomes= (1) number of agencies 11....111111111111.11111111111.111111111111111.1111111111111111 o 0
receiving education, {2) the number, names and location of MI MENEM 0 0
successfuly recruited organizations IIIIIIIIIIIIIIIIIIII MOM 0 0
11111111111111.111111111111111111.111111..1111 0
=MO= 1/11111111111 WEB
11111111111111111111111111111111111111111111111
Shale 1st Sub Total 11,2 01 0 0 0
A Alternative Total
C Community-Based
E Education
N.=.1nfortnation dissemination .
P Problem ID & Referral
3 Environmental
OCHN Contract #2017-0016-SUD Page 19 of 41
ATTACHMENT C
Oakland Community Health Network/Substance Use Disorder Services
Management by Objective
FY 2016 - 2017
Program Name: SLJD Prevention Health Education
Agency/Organization: Oakland County Health Division
Prepared By: Trisha Zizumbo/ Kathleen Altman
Program Goal'
Date Prepared; 9/21/2016
Revised 6-12-2017
To delay the onset/ prevent the use of alcohol, tobacco and other drugs by youth In Oakland County
with particular emphasis on high risk populations
Specific Activity and Objective (s)
(Number consecutively and use separate page for each
Prevention Activity)
Estimated
Total
Recipients
(12 montfa)
Number of Direct Service Hours (outputs)
P = Planned / A = Delivered
1 Qtr. 2nd Qtr. 3rd Qtr, 4th Qtr. TOTAL
p P A P AP AP A
Activity #2 Provide a minimum of 5 (five) series of Botvin's 25 50 10 0 85 0
Life Skills Training to middle school age students. A series 111111111111111111111111110. umusfinnini
consists of 15 (fifteen) hour-long lessons plus an additional Millillim 111111111111111111111111111111 0 0
2 sessions for pretesting and orientation and posttesting 11.1111111111111.11111111111 0 0
and celebratory activity. Outcomes to be delivered include MINEIlimimilliemmii IN 0 0
the pre/post testing results of the LST indicators of 1111111111111111111111111111111111111111111111111111111111111111111 0 0
knowledge, attitude and skills: including individual and IIIIIIIIINIMIIIIIIMIIIIIIIIIIIIIIIIIIIIIIIIInllIl 0 0
group scares, A 5% (five percent) increase is expected in MIIIIIIIIII 11/1.11111111111111111111111 0 0
he overall group score from pre to post testing. 111111111Mill IIII== MI 0
111111111111111111111111111111111111111111111111111111111111111 0 0
IIIIIIIIIIIIIIIIIII 11111111011111 IIIII 0 0
Strategy; (list)
A = Alternative
C = Community-Based
E. Education
N = Information dissemination
P Problem 10 & Referral
V = Environmental
Sub Totail 2
Total
OCHN Contract #2017-0016-SUD Page 20 of 41
ATTACHMENT C
Program Name:
Agency/Organization:
Prepared By:
Program Goal:
Oakland Community Health Network/Substance Use Disorder Services
Management by Objective
FY 2016 - 2017
SUB Prevention Health Education Date Prepared 9/21/2016
Oakland County Health Division evised 612-2017
Trisha Zizurnbo/ Kathleen Altman
To delay the onset/ prevent the use of alcohol, tobacco and other drugs by youth in Oakland County
with particular emphasis on high risk populations
Specific Activity and Oblective (s)
(Number 000sedutively and use separate page for each
Prevention Activity)
Estimated
Total _ ec.pi . ients Fk
(12 nx:otha)
Number of Direct Service Hours (outputs)
P = Planned / A = Delivered
1st Qtr, 2nd Ott rd Qtr. rituriurin h Qtr. TOTAL CI GI
Activity #3 Provide a minimum of 15 (fifteen) series of IIIIIIIIIIII 30 alIl 50 MI 50lIlIl 20 III 50 CI
,otvin's Life SKills Training to elementary school age 11111111111111M MOM 111111 0 0
students in Oakland County, A series consists of 8 (eight) MI MEM. =ME 0 0
hour-long lessons plus an additional 2 (two) sessions for IIIIIIIIIIIIIIIIIINIIIINIIIIIIIIIIIIIIIIIII MI 0 0
pretesting and orientation arid posttesting and celebratory 11111111111111111111111111111111111111111111111111111 0 0
activity. Outcomes to be delivered include the pre/post IIIII MN IIIIIIMMIMIIIII 0 0
testing results of the -LSI indicators of knowledge, attitude IIIInEMMIIIIIIIImmm 0 0
and skills, including individual arid group scores. A 5% (five NIIIIIIMMIIII /1111111111. 0 0
percent) increase is expected In the overall group score IIIIIIIIIIIIMIIIIIIIBIIIIIIIIIII.NuuoM 0 0
from pre to post testing. IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 0
1111.11.1111111111== Mi
Strategy: (list)
A = Alternative
C CoMmunity-ased
E Education
N = Information dissemination
P Problem ID & Referral
V = Environmental
UP Ota}
Total
0
iso
OCHN Contract #2017-0016-SUB Page 21 of 41
ATTACHMENT C
Oakland Community Health Network/Substance Use Disorder Services
Management by Objective
Pi' 2010 2017
Program Name:
Agency/Organization
Prepared By:
Program Goal!
,SUD Prevention Health Education
Oakland County Health Division
Trisha Zizumbo/ Kathleen Altman
Date Prepared; 0/2112016
Revised 6-12-2017
To delay the onset/ prevent the use of alcohol, tobacco and other drugs by youth in Oakland County
with particular emphasis on high risk populations
Specific Activity and Objective (s) (Number corksecutivety and use separate page for each Prevention Activity)
Estimated
Reci
Toter
en (12mo n t I m)
Number of Direct Service Hours (outputs)
P -4,- Planned I A ,=-- Delivered
151 51 2nd Qtr, 3rd Qtr. 4th Qtr, IOTA 111111111111111111 A 111 A
Activity 44 Provide a minimum of 2 (two) series of Botvin's
Life Skills Training Parent Program to Oakland County
families. A series consists of 7 weekly', 1 hour-long
lessons. Outcomes to be provided Include the results of
attitude and behavior change from pm to post testing,
including group as well as individual behavior change
scores,
0
= == =Ell 0 0
111111.111
11111111111111011111111
1111.111 MEM 0 0
==
111111111111111111.111111111111111.111111111111111.
==
O11111111111.1111111111
=
0 0 C 0
0 0
IIIIIIIIIIINNN IIIIIIIIIIIIIIIIIIII MINI
INININIMINIIIIIII
1111111111111111111
0 0
0 0
•111111111111111111111 Mal IIIIIIIIIIIIIIIII o
1111111 MIMI MIll 0 0
IMIIIIIIIIIIIII =MINIM=
Strategy: (list)
A = Alternative
• Community»Based
E. Education
N Information dissemination
P = Problem ID & Referral
3 Environmental
Sub Total
Total
OCHN Contract #2017-0016-SUD Page 22 of 41
ATTACHMENT 0
Oakland Community Hearth Network/Substance Use Disorder services
Management by Objective
FY 2016 - 2017
Date Prepared' 9/21/2016
Revised 6A22017
Program Name: SUD Prevention Health Education .
Agency/Organization -Oakland County Health Division
Prepared By: Trisha Zizumboi Kathleen Altman
Program Goal:
To delay the onseU prevent the use of alcohol, tobacco and other drugs by youth in Oakland County
with particular emphasis on high risk populations
Specific Activity and Objective (s)
(Number consecutively and use separate page for each
Prevention Activity)
Estimated
T l
Reooents
(12 frionth)
Number of Direct Service Hours (outputs)
P = Planned I A 7 Delivered
1st Qtr. 2nd Qtr. 3rd Qtr. Ith Qtr. TOTAL
1111111 Alil A PIIP A
Activity #5 Provide training and technical assistance in the 16 20 0
completion of 2 (two) PhotoVoice projects related to the IIIIIIIIIIII M1111111111111. =MI 0 0
prevention of the non-medical use of prescription drugs by IIIIIIIIIIIIIIIIIOIIIIIIIIIIIIIOIIIINNINNNNINNI 0 0
youth. Outcomes to be reported: demographics/ description 1111111111111111Ensuilimmiimin.
of the populations involved; summary of ideas generated; wilimmmiallilimm NB 0 0
examples of photos, soreenshots of postings, exhibits IIIIIIIIIIIIIIIIIIIMIIIIIMIIIIIIIIIMIIIIBIIIII 0 0
produced by the project, 0 0 11.1111111110111111M1.11111111111111ME 11111111111111111111=m111111111111111111=
IIIMIIIIIIII•INIIIIMIIIII = 0 0
111111111111111111111M11111=1111111111111111111111111 111111=11111111111111111111111111111111 0 0
Strategy: (list)
A = Alternative
C = Community-Based
E = Education
N Information dissemination
P = Problem ID & Referral
V = Environmental
Sub Iota
Total
OCHN Contract #2017-0016-SUD Page 23 of 41
ATTACHMENT C
Oakland Community Health Network/Substance Use. Disorder Services
Management by Objective
FY 2018 - 2017
Program Name: SUD Prevention- Health Education
Agency/Organization: Oakland County.Health. Division
Prepared By: Trisha Zizurnbo/ Kathleen Altman . . Program Coal:
Date Prepared! 9/21/2016
Revised 6-12-2017
To delay the onset/ prevent the use of alcohol, tobacco and other drugs by youth in Oakland County
with particular emphasis on high risk populations
Specific Activity and Objective (a)
(Number consecutively and use separate page for each
Prevention Activity)
Estimated
Total Recipients
(V months)
Number of Direct Service Hours (outputs)
P =,' Pianned IA ,-• Delivered
1st Qtr.
121111111:11
2nd Qtr. 3rd Car. 4th Qtr. TOTAL
P A PIMP A
Activity #6 (a) Promote and provide technical assistance to Milimmill111111111111111.2.111E1111 10 0
prescription and over-the counter drug disposal and take MII=11/IIIIIIIIIIIIIIIIIIIIIIIII MIN 0
back programs in Oakland County. Outcomes to be MI M 0 reported: number, locations and types of events, number of 1111111111111111 al MIN= 0 0
pounds collected, report on results of senior survey re: IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII In 0 0
barriers to disposal; (b) support the Scope of Pain training 11111111111111.1111Millmummimummi
and continue providing evidence-based training regarding IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIINI IIIIIIIIIIII 0 0
safe prescribing practices to health care and medical ......11 WM 1.11111111111111111111111111 0 0 professional. Outcomes to be reported include: training 1111111111111111 um mum no mom .... 0 0
tools and number and types of professional trained. IIIIIIIIIIIII NI NM 11111111111111111.111111111 =MINI MI == 0 0
MININIIII 111111011111 MINN 11111111111111111
Strategy: (list)
A = Alternative
C Community‘,Based
E = Education
N = Information dissemination
P = Problem ID & Referral
V Environmental
Sub Total
Total
OCHN Contract #2017-0016-SUD Page 24 of 41
ATTACHMENT C
Oakland Community Health Network/Substance Use Disorder Services
Management by Objective
FY 2016- 2017
Program Name! SUD Prevention Health Education Date Prepared 9/21/2016,
Agency/Organization: Oakland County Health Division Revised 6-12-2017
Preparedl3y; Trisha Zizumbot Kathleen Altman
Program Goal,
To delay the onset/ prevent the use of alcohol, tobacco and other drugs by youth in Oakland County
with particular emphasis on high risk populations
Specific Activity and Objective (s)
(Number consecutively and use separate page for each
Prevention Activity)
Estimated
Total Recipients
(12 mouths)
Number of Direct Service Hours (outputs)
P= Planned /A= Delivered
1st r 2nd 01r 3rd Qtr 4th Qtr, TOTAL
p A p A p A P A P A
Activity #7 Provide a minimum of 2 (two) series of the Safe
Dates Program to middle school and/or high school
students in Oakland County. A series consists of 10 ten)
hour-long lessons which includes pretesting and orientation
and posttesting plus a celebratory activity. Outcomes to be
delivered include the results of the evaluation tool
accompanying the program,
10 10 20 0
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
1111..11111111.11.111111111111==
III 0
11111111111111111111111=
IIIIIIIIIIIIIIIIIIIIIIII
111.111111111111.111mummuummon.
IIIIIIIIIIIIMIIIMIIMIIMIIIIIIIIIMIIIMIMIMIM
IMIIIIIIIIIMIIIIIIIIMI=IN III
IIIIIIIIIIIMIIII1
11111111111111111111111
0
0 0
0 0 0 0
IIIIIIIIIIIIIIIIIIIIIIIIIII IMIMIIIIIIIMIIIIIIIIIIIIIIIIIIIIIIIIIIIIMMI
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIMMIIIIMMg 11111111111111111M
0
0 0
Strategy: (list)
A Alternative
Sub Total 01 0 1 01 DI 101 01 10 01 20 01
Total .
C Community-Based
E Educlrltori
N +-= Information dissemination
P = Problem ID & Referral
V = Environmental
OCHN Contract #2017-0016-SUD Page 25 of 41
ATTACHMENT C
Oakland Community Health Network/Substance Use Disorder Services
Management by Objective
FY 2ole. 2017
Program Name: SUD Prevention- Health Education Date Prepared W2112010
Agency/Organization: Oakland County Health Division Revised 6-12-2017
Prepared By Trisha Zizumbof Kathleen Altman
Program Goal:
To delay the onset/ prevent the use of alcohol, tobacco and other drugs by youth in Oakland County
with particular emphasis on high risk populations
Specific Activity and Objective (s)
(Number consecutively and use separate page for each
Prevention Activity)
Estimated
T l ota
Recipents
02 months)
Number of Direct Service Hours (outputs)
P = Planned !A = Delivered
lot Qtr. 2nd Qtr 3rd Citr 4th Qtr T TA
p Emma an
Activity a Pr vi e 1 (one) pilot of VV,l.T,S. consisting of 5-
10 lessons of the anti-bullying prevention program for
primary students. Outcomes to be reported include the
results of the evaluation tool accompanying the program.
1.1111.111MMIIM=IM
111111111101111111111111111111iimaimini
=
mu
immilimimminiumino 0 0
OMNI= MI MIMEIMMIII 0 0
111111111111111111111111111111111111111111111111111111 iilliMMOMMIUMMME 0 0 0 0
ONOMMMMINO iiiiiiiiiilill IIIIIIIiiiiii
=MB MOHNIE MO Nig IIIIIIIMIIIIIIII IIIIIIIIIMINIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 11111111MIIIIM = == = 0
0 0 MENEM MINI •1111111111111111111 IIIIIIIIIIIIIIIIIIIIIIIINIINIIIIIIIMINMIIIIMIIM 0 o
Strategy: (list)
A = Alternative
C= Community-Based
.E = Education
14= information dissemination
P Problem ID Referral
V = Environmental
Sub Total
Total
OCHN Contract #2017-0016-SUD Page 26 of 41
ATTACHMENT 0
Oakland Community Health Network/Substance Use Disorder Services
Management by Objective
FY 201e. 2017
Program Name: BUD Prevention- Health Education Date Prepared 9/2112016
Agency/Organization: Oakland County Health Division Revised 6-12-2017
Prepared By Trisha Zizumbo/ Kathleen Altman
Program Goal.
To delay the onset/ prevent the use of alcohol, tobacco and other drugs by youth in Oakland County
with particular emphasis on high risk populations
—
Specific Activity and Obiective O.)
(number consecutivety and use separate page for each
Preve Activ ntion ity)
Estimated
Total
Recipients
02 0/0103)
Number or Direct Service Hours (outputs)
. P= Planned / A = Delivered . . .
1st Qtr, 2nd Qtr. rd Qtr. 4th Qtr, IOTA
P AP A P EU A E A
Activity #9 Provide a minimum of 2 (two) series of Botvin's 11 =1111111111111115•1•11 0 Life Skills Training Transitions Program to Oakland County 111111.1111111111111111.1.1111111111Momm. 0
families. A series consists of six, 1 hour-long lessons that 1111111111111111111.1.001. siminii 0 0
can be down over the course of 2, 3, or 6 weeks. 1111111111111111111111111111111111111111111.11111111111 0 0
Outcomes to be provided include the results of attitude and .11111111111111111111 0 0
behavior change from pre to poet testing, including group 11111111111111111111111111111111.111.1.0muim 0
as well as individual behavior change scores. 1111111111111111111111111111111111111111111M.11111 0 0 11111111111111111111111111111111111111mm11111 0
=.1111111111111111111111. 0 0
IMIMMMIIIIIIIIIIIIIIOMMMIIIIIIM 0 0 111111111111111111111111111111111111111111111111111111111111111 0 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 0
Strafe ist)
Sub Total
A = Alternative Total
C = Community-Based
E = Education
N Information dissemination
P -z Problem ID & Referral
V -= Environmental
Total Activities 1-0 0 0
OCHN Contract #2017-0016-SUD Page 27 of 41
ATTACHMENT D
OAKLAND COMMUNITY HEALTH NETWORK
SUBSTANCE USE DISORDER SERVICES
PURCHASE OF SERVICE POLICIES
For
PREVENTION PROVIDERS
FY 2016-2017
FY 2016- 2017 OCHN Contract Prevention Attach D
TABLE OF CONTENTS
I. BUDGETS 2
Prevention Budget 2
Program Local Match 2
II. BILLING AND PAYMENT 2
Prevention Billing Summary Form 2
Billing Summary Page 2
Bill Due Date 2
Reimbursements 2
Performance Requirement
III. AMENDMENTS AND ALLOCATIONS 2
Request an amendment 2
Budget amendment 2
Request for Amendment Form 2
IV. DATA AND REPORTING .3
Evidence-Based Services
Prevention Management by Objectives (MBO) 3
Reimbursement 3
Reporting Requirements 3
Electronic Submission 3
V. STAFF' CREDENTIALS .4
Prevention Credential Requirements 4
Criminal Background Checks 4
VI. CULTURAL COMPETENCY .4
VII. CONFIDENTIALITY 5
VIH. CHOICE POLICY AND PROCEDURE .5
The Federal Register 5
Charitable Choice Regulations 5
IX. REQUIRED DISCLAIMERS 6
Funding Sources Statement 6
OCHN Logo Requirements 6
X. OCHN PREVENTION REVIEW 6
Programmatic and On-Site Reviews 6
Bi-annual Financial Review 6
FY 2016- 2017 OCHN Contract Prevention Attach])
FY 2016/2017
OCHN Prevention Program Policies and Procedures
I. Budget
A. Prevention programs will submit an annual budget for OCHN-administered funds that
include revenue sources for total substance use disorder prevention programming using
the following forms: Prevention Budget/ Billing Summary and Budget/Billing Pages
(Exhibit I.)
B. Programs will provide a 10% local match for all OCHN funding and submit as part of
budget.
II. Billing and Payment
A. The Prevention Billing Summary Form along with the Prevention Budget Billing Pages
are the source document for billing the OCHN for actual expenditures related to
prevention services provided each month.
B. Payment for services will be based on actual expenses incurred for service delivery. The
Billing Summary page must include the total amount expended for each category
(Travel, Supplies & Materials, Contractual, and Other) for the invoiced month, as well as
a breakout by funding source (i.e., OCHN funds and/or Local Match) The Billing Pages
must contain the monthly charges by line item in each category as identified in the
original budget.
C. Bills are due to OCHN no later than 10 days after the close of each service month; those
received after the 10th will not be processed for payment until the following month.
D. Reimbursements will be based on the understanding that a certain level of performance,
measured by outputs (face-to-face or direct service hours engaged with the service
population- ATTACHMENT C) must be met in order to receive full reimbursement of
costs up to the contracted amount at the end of the contract year.
E. For this agreement, the performance requirement is defined as 100% of the OCHN-
funded share of total direct service hours.
III. Amendments and Adjustments to Allocations
A. A program can request an amendment at any time up to the OCHN amendment
deadline of May 15, 2017.
B. A budget amendment with revised budget pages is required when there is a
change in a budget category over $2,000 or 15% of the category whichever constitutes
the greater amount. The deviation allowance does not authorize new categories or line
items within the category.
C. A Request for Amendment Form (Attachment D-1) must be completed and approved by
OCIIN before requested changes can be implemented. In order to move 15% or $2,000
(whichever is greater) from one budget category to another, it is necessary to complete
the Request for Amendment Form, including a detailed explanation of the changes,
updated billing summary and billing pages — (fax or email to Janet Selberg at
EY 2016- 2017 OCHN Contract Prevention Attach D 2
248.975.9768, selbergi@oaklandchn.org, or by mail to her attention at 2011 Executive
Hills Blvd., Auburn Hills, MI 48326. For questions call 248.758.1981.) You will receive
a determination of approval, disapproval or pending status along with comments if
further direction is required within 10 business days.
IV. Data and Reporting
A. Prevention contractors must provide evidence-based prevention services (as defined in
the Research-based Prevention Protocol of their proposal).
B. A Prevention Management by Objectives (1030) Form (Attachment C) describing
specific measurable objectives and number of outputs for each is submitted as part of the
contract and will be reviewed for compliance during the contract year.
C. All OCHN-funded program grantees are required to participate in the collection of state-
required prevention data elements by utilizing the Michigan Prevention Data System
(MPDS) (http://mpds.sudpds.com), a web-based system- including but not limited to:
• the number of direct hours (defined as face to face or output hours),
• the collection of strategies employed (Information Dissemination, Education,
Community-Based, Problem Identification and Referral, Environmental, or
Alternative),
• population code,
• service population, type and domain,
• service population demographics,
• evidence-based practice, and
• funding source(s).
Outputs delivered during the invoiced month must be entered into the Michigan Data
Prevention System (MPDS) by the 10 th of the month following the service month for on-
time reimbursement.
D. Reimbursements will be based on the understanding that a certain level of performance,
measured by outputs (face-to-face or direct service hours engaged with the service
population) must be met in order to receive full reimbursement of costs up to the
contracted
amount at the end of the contract year.
E. OCHN grantees must submit a Mid-Year and End-of-Year Prevention Program Report
(Attachment D-2) that includes a narrative and tables with data and outcome evaluation
results for all programs/services - no later than 10 days following the end of the reporting
period (e-mail to altmanW,oaklandchn.org .)
F. OCHN grantees must incorporate tobacco prevention activities into their programming.
A report of tobacco prevention activities is to be submitted biannually, using the
Tobacco
Activity Report Form (Attachment D-3) - no later than 10 days following the end of
Mid- and End-of-Year reporting periods (e-mail to altmank(&oaklandchn.org.)
G. All forms and reports must be submitted in electronic form. Failure to submit required
reports in a timely manner to OCHN will result in withholding of payment for services.
FY 2016- 2017 OCHAT Contract Prevention Attach I)
3
V. Staff Credentials and Requirements
A. During the period covered by this contract, the provider agency that directly employs or
contracts with the OCHN to provide prevention services is responsible for verifying the
ongoing certification status of the employee. This includes verification of the
credential(s), monitoring staff development plans, and compliance with continuing
education requirements.
B. As a condition of the contract, Prevention Professionals (commonly described as Program
or Prevention Coordinators, Prevention Specialist, or Consultants i.e., those responsible
for the planning, coordination and or oversight of program implementation) must be
certified by the Michigan Certification Board for Addiction Professional (MCBAP) as
one of the following:
• Certified Prevention Specialist M (CPS-M)
• Certified Prevention Specialist R (CPS-R)
• Certified Prevention Consultant M (CPC-M)
• Certified Prevention Consultant R (CPC-R)
• Certified Health Educator Specialist (CHES)
OR
• Must file a certification "Development Plan" with Michigan Certification Board
for Addiction Professionals (MCBAP) within 60 days of the contract start date.
Information on filing a Plan may be found at www.mcbap.com
Failure to comply with credentialing requirement may result in termination of contract.
C. All providers must conduct yearly criminal background checks on all employees (and
potential employees) employed in programs funded by the OCHN as a condition of
employment.
VI. Cultural Competency and a Trauma Informed Approach to Prevention
Providers must submit a cultural competency plan to the OCHN addressing the following
elements and be able to document same at their annual program review:
• The program must identify and assess the cultural needs of potential and active
clients based on population served
• The program must identify how access to services is facilitated for persons with
diverse cultural backgrounds and Limited English Proficiency (LEP) and hearing
impairment
I. The program must identify standards for the recruitment and hiring of culturally
competent staff members
2. The program must document cultural competency training for provider staff upon
hire and bi-annually (every two years) thereafter for all staff
3. The program must document staff training in a trauma-informed approach to
prevention. The training must include: an understanding of the critical nature of
trauma in the development of SUD; an understanding of the dimensions of
resiliency; building community capacity, and learning strategies to change
community conditions to support individuals, families and communities affected
FY 2016- 2017 OCI1N Contract Prevention Attach D
4
by trauma/adverse experiences.
VII. Confidentiality
The provider will comply with all Federal requirements contained in 42 CFR, Part 2,
Confidentiality of Alcohol and Drug Abuse Patient Records, Final Rule, June 9, 1987, as well as
any information about alcohol and other drug use obtained by a "program" (42 CFR2.11),
(42CFR2.12b). Information may be disclosed in summary, statistical, or other form which does
not directly identify particular individuals.
VIII. Charitable Choice Policy and Procedure
A. The Federal Register (45 CFR part 96) contains federal Charitable Choice SAPT block
grant regulations that apply to prevention and treatment providers/programs. The
regulations require: (1) that the designation of religious (faith-based) organizations as
such be based on the organization's self-identification as religious (or faith-based) and (2)
that a program beneficiary receiving services from such an organization who objects to
the religious character of a program has a right to notice, referral and alternative services
which meet standards of timeliness, capacity, accessibility and equivalency — and
ensuring contact to this alternative provider.
B. The program is required to comply with all applicable requirements of the Charitable
Choice regulations. If the program identifies itself as a religious or faith based
organization it must provide the federally mandated model notice to all clients. Providers
who are faith-based must notify participants of their right by providing the following
model notice:
"No provider of substance abuse services receiving Federal funds from
the U.S. Substance Abuse and Mental Health Services Administration,
including this organization, may discriminate against you on the basis of
religion, a religious belief, a refusal to hold a religious belief, or a refusal
to actively participate in a religious practice.
If you object to the religious character of this organization, Federal law
gives you the right to a referral to another provider of substance abuse
services. The referral, and your receipt of alternative services, must occur
within a reasonable period of time after you request them. The alternative
provider must be accessible to you and have the capacity to provide
substance abuse services. The services provided to you by the alternative
provider must be of a value not less than the value of the services you
would have received from this organization"
FY 2016. 2017 OCHN Contract Prevention Attach 1)
5
IX. Required Statement of Funding Sources and Statement of Recipient Rights
Prevention programs that maintain records that include both the recipient's name and information
regarding his or her substance use, shall provide the recipient with a summary of recipient rights
protected by state or federal laws and promulgated rules. Any program announcement, brochure,
or other written communication that describes the program's substance abuse prevention services
shall state the following:
"Recipients of substance abuse prevention services have rights protected by state and
federal laws and promulgated rules". For information contact the OCHN Substance Use
Disorder Services, Recipient Rights Coordinator, Sherrie Kilpatrick, 2011 Executive
Hills Blvd., Auburn Hills, MI 48326 or call 248.858.1210
Providers must assure that any program reports, articles and publications that result from
information gathered through the use of state, federal or county funds acknowledge receipt of
that support from the OCHN and/or the appropriate federal agencies by use of the following
statement:
"Federal, State, and/or County Funding has been provided through the Oakland
Community Health Network (OCHN) Substance Use Disorder Services to support the
project costs".
In addition to the above disclaimer the promotion of any program, activity, training, or
meeting funded in whole or in part by the OCHN must contain the OCHN logo.
X. Programmatic and Financial Review
OCHN grantees are subject to an annual site review as well as annual scheduled program review
by the OCHN Clinical Analyst. The site review affords OCHN an opportunity to experience the
staff and program in action. The program review looks at compliance with contractual
requirements: progress toward meeting output and outcome goals, process and outcome
evaluation, certification and background checks on employees, timeliness and accuracy of billing
and reporting, etc.
Grantees are also subject to a complete financial review on a bi-annual basis by the OCHN Fiscal
Analyst. The objectives of the financial review are:
• To verify the reported expenditures have supporting documentation and were allowable
expenses;
• To determine whether an agency's internal controls are adequate to provide reasonable
assurance that funds are managed in compliance with applicable laws and regulations
and/or provisions of the contract;
• Confirm the billing was consistent with the contract budget;
• Review the agency's financial audit to deteimine if there were any significant audit
findings.
Prevention contract questions may be addresses to Kathleen Altman, Prevention Coordinator for OCHN
altmanlaoaklandchn.org or (248)452-9850.
FY 2016- 2017 OCHN Contract Prevention Attach D 6
ATTACHMENT 0-1
REQUEST FOR AMENDMENT OAKLAND COMMUNITY HEALTH NETWORK Substance Use Disorder Services
Agency
AmendIn Bud et . Date Re•uested: Re•uested • :
Purpose of Amendment:
Ex dives Current Bud• et pro osed Bud et Increase/Decrease
EINIIIIIIIIIMMI111111111111111111
EEMIIIIIINIIIIMIIIIIIIIIIIIMII=
Contractual IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
Other 11111111111111111111111101111.11111111111111111111 IIIIIIIIII. 11.111111111111111
11111111111.1111111111111111111.1111111111111111.
111111.M1 .111111111.1111
MEMEMIIIIIIII
11.11111.11111.11111111111111111111111111111111
TOTAL EXPENDITURES
Source of Funds
Local Match
OCHN Fundin.
TOTAL FUNDING
0 Approved 0 Not Approved Fended:
Pere
Comments:
Date
ATTAMMENT172
Agency Name
OAKLAND COMMUNITY IIEALTII NETWORK
Substance Use Disorder Services
Mid- Year/K tut-of-Year
Prevention Program Report
0 Mid-Year— Due April 10, 2017
0 End of Year Due October 10,2017
Note: The mid-year report should reflect activity fi'orn October thru Afarch, The end-of-year report should contain a
summation of activity/Or the ento.e year. Slowly type your responses beneath each question.
1) Describe your service population for the reporting period. Indicate how suecessful you werrs in recruiting your
target population. h is not necessary to provide exact numbers however, please describe what risk categories von
intended to target and if different from your original plan- describe the actual population served. What impact did
this change have on programiservice delivery or outcomes?
2) Refer to your MBO (ManaRenteurBy Objcqive) form and comment on any services that were not provided as
planned (explain either why you were not able to complete the activity and/or why you did something different
from the original plan.)
FY 20115 1.7W .7 (X ON -Cmrtrart Prrs, from C.2 ftihnend N v Irina; Rermi
ATTACHMENT D-2
3) Describe your program's overall process evaluation method(s) and the results of your evaluation. (In a process
evaluation items commonly include recruitment procedures and retention rate; number of participants; participants'
risk for substance use: staff processing of program activity; participant comments or results of satisfaction surveys.)
Describe any ways in which your process evaluation results will be used to improve the program in the future.
4) Outcome Evaluation: Complete the Attached Outcome Tables for each service/activity listed on your kl110 Form.
State your measurable indicator(s) and provide supporting data to show if the outcome was achieved. Use as many
tables as you need to present results in an organized and logical manner (please number if using multiple tables.)
For activities/services that are implemented as series at multiple locations - you may choose to state outcomes by
grade, school. city, etc+ hut the provider must include a table with an overall result for a particular program.
For Alliance of Coalition for Healthy Communities (ACHC) ONLY: in replacement of -the Outcome Tables at mid.
year and end-of-year, the ACM is required to submit an MPDS summary of activity by ACHC staff and by
individual coalition and as well as complete its 1. 2, 3 and 5 of this report form, The end-ofyea Report includes
deliver), of an Annual Report by the end of the calendar year.
Provide supporting documentation.
• Actual data used to calculate outcome results and a docription Vhow the results were determined
• Progt-am,flyers or letters used to recruit participants
• Outline or brier description of the program or curriodum
• A copy of evaluation instruments
• Letters ofsupport or news articles generated by the program
Call or email Kathleen Altman at alintanktivalaandelmarg jar assivtanee in collecting, calculating, analyzing
and reporting data.
0610, Comm, ?me. Form c°,2 Orld?ati Year Haat Ylopmi
AT1ACTMTNT D=2
OAKLAND COMMUNITY HEALTH NETWORK
Substance Use Disorder Services
Prevention Activities FY 201G/2017
Outcomes Table 4 example
Program Name Example Group Designation'
MBO
Activity Target Population Indicator 5tatement Outcome Results
CMI-1
Use
Only
# Hispanic parents living in
the Pontiac and Auburn
Hills areas
Hispanic parents who
participate in the Love &
Logic Program (3 hours
per week for 8 weeks) will
experience (a) 7%
increase in positive
parenting attitudes and
interaction with their
children and (la) a 10%
Increase in knowledge of
positive parenting
techniques as measured
by the Love & Logic Pre
Post Test that
accompanies the
program
Auburn Hill Elem Group 41
(a) 15% I
(b) 12% •
1 EXAM P
COMMerlis;
please Note! For activities/services that are implemented in series at multiple locations you may choose to state
outcomes by grade, school location, city, etc., but please also include a table with an overall result Copy and create
as many tables as you deem necessary to accurately report your results. Attach supporting dataispreadsheets to
table or at end of report.
,20017 °um ootracy p.oc.;° Mierbui Yem Novi itapOrf
ATTACHMENT D-2
OAKLAND COMMUNITY HEALTH NETWORK
Substance Use Disorder Services
Prevention Activities FY 201612017
Outcomes Table If I
Program Name: Group Designation:
MBO
Activity Target Population Indicator Statement
MH Outcome Results
C
Use
Only
#___
Comments:
Please Note: For activitiesIservices that are implemented in series at multiple locations - you may choose to
state outcomes by grade, school location, city, etc., but please also include a table With an overall result. Copy
and create as many tables as you deem necessary as you deem necessary to accurately report results. Attach
supporting data/spreadsheets to table or at end of report,
',3(1111,Z111., X INContrad Ptr•, Farm Moroi iteprr
ATTACHMENT 1),2
OAKLAND COMMUNITY HEALTH NETWORK
Substance Use Disorder Services
Prevention Activities FY 201812011
Outcomes Table # 2
Program Name. Group Designation:
MBO
Activity Target Population indicator Statement Outcome Results
CMH
Use
Only
Comments:
Please Note; For activities/services that are implemented in series at multiple locations - you may choose to
state outcomes by grade, school location, city, etc., but please also include a table with an overall result. Copy
and create as many tables as you deem necessary to accurately report results. Attach supporting
date/spreadsheets to table or at end of report.
Fy 20.16,7017 only contrad riv. Y07172 (1:',2 Afitand Year Final Repoi
ATTACHMENT D-3
OAKLAND COMMUNITY HEALTH NETWORK
Substance Use Disorder Services
PROGRAM
TOBACCO ACTWITY REPORT FY 201612017
6 Month 0 Year End
Instructions: Please briefly describe any tobacco use prevention activities your group or organization has
undertaken in the Oast six-month reporting period in each of the following strategies
information Dissemination
Specific topic of information
Description of population distributed to
Estimated Outputs
Education
Type of format (class, series of classes, video, speaker, skills training, etc.)
Description of audience
Estimated outputs
Community-Baaed Activity (Describe activity: examples may include assessing community needs
regarding tobacco use; accessing services and funding fQr tobacco use prevention; providing trainings on
tobacco use prevention, etc.)
Estimated outputs
Environmental Strategies (Describe activity: examples include any activity undertaken to change
the physical, legal, economic, and social processes of a community that are associated with tobacco use,
i.e,, establishing tobacco free policies, preventing underage sale of tobacco products to minors, vendor
education, changing codes, ordinances, or regulations regarding sale and use )
Estimated outputs
FY 2016-2017 00 IN Contract Prevention C,3 Midlind Yr Tob Report
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
LHD PROGRAM BUDGET - COST DETAIL
DCH 0387 7198
Replaces Fin-121 Page 1 of 4
Program
OCHN Substance Abuse Prevention Healh Ed
Code Budget Period 10/1/2016 to 9/30/2017 Date Prepared
8/18/2017
Local Agency
OAKLAND COUNTY HEALTH DIVISION
Original Amended Amendment
Budget Number Budget
POSITION DESCRIPTION POSITIONS
REQUIRED
TOTAL
SALARY
COMMENTS
Public Health Educator II 1.00 $22,158.
Public Health Educator II 1.00 $53,570
0 0.00 $0
0 0.00 $0
CHPIS Administrator 1.00 $1,362 ..,
Health Education Supervisor 1.00 $5,456
0 0.00 $0
0 0.00 $0
0.00 $0
0 0.00 $0
0 0,00 $0
0 0.00 $0
TOTAL 4.00 $82,546
FRINGE BENEFITS:
(Specify) FICA
UNEMPLY INS,
RETIREMENT
HOSP. INS.
X LIFE INS. X DENTAL INS. X
X VISION INS. X WORK. COMP. X
X HEARING INS.
OTHER: Short and Long Term Disability
COMPOSITE
RATE
AMOUNT
65,31%
$53,911
EQUIPMENT (Specify):
See Attached Budget Detail
TOTAL EQUIPMENT $0
SUB-CONTRACTS (Specify):
See Attached Budget Detail
TOTAL SUB-CONTRACTS
OTHER EXPENSES (Specify if any item exceeds 10% of Total Expenditures)
SUPPLIES AND MATERIALS
TRAVEL
COMMUNICATIONS
SPACE COST
OTHER: (see attached budget detail)
$15,758
5 675
0
0
6,180
$27,613
OTHER COST DISTRIBUTIONS INDIRECT COST CALCULATION
Description of cost being distributed: Percent distributed
to this program:
Amount
Distributed:
2016/17 $75,728 x RATE 11.910% $9.019
PROGRAM GRAND TOTAL EXP.
$182,898
COMPLETION IS A CONDITION OF FUNDING (MIK PA. 3S OF 1975)
PROGRAM BUDGET SUMMARY
Page 2 of 4
DCH 0387 7198 0 Contract No.
Program
OCHN Substance Abuse Prevention Heaih Ed
Code Budget Period
10/01/16 to 09/30/17
Date Prepared
8/18/2017
Local Agency
OAKLAND COUNTY HEALTH DIVISION
Amended Amendment
Budget Number
Original El
Budget
Address City State Zip Code
1200 North Telegraph Road Pontiac, MI 48341-0432
Employer Identification No.
P38-6004876W
CATEGORY
AGREEMENT BUDGET LOCAL BUDGET
TOTAL
BUDGET
CURRENT YEAR
PORTION
SUBSEQUENT
YEAR PORTION
CURRENT
YEAR 20XX
SUBSEQUENT
YEAR 20XX
1 Salaries & Wages $75,728
2 Fringe Benefits 53,911
3 Travel 5,675
4 Supplies & Materials 15,758
5 Communications 0
Office Space Rental 0
7 Contractual (Subcont) 0
8 Equipment 0
9 Other Expenses:
Liability Insurance (774677) 180
Interpretation Fees (730982) 500
Educational Programs 2,000
Training 2,500
Advertising f730072) 0
License & Permits (731115) 1,000
Convenience Copier (770667) 0
IT Operations (774636) 0
Workshops & Meetings (732165) 0
8 TOTAL DIRECT $157,252
9 Indirect Costs 2016/17 11.91% 9,019
10 Other Cost Distributions
11 TOTAL EXPENDITURES $166,271
12 Fees & Collections ,Less: 0
13 FUNDS REQUIRED $166,271
SOURCE OF FUNDS
14 State Agreement 100% $165,271
15 Local Match 103/0 16,627 16,627
15 Federal 0% 0
17 Other 0% 0
18 TOTAL FUNDING $182,898
CERTIFICATION:
administration
expenditures.
NAME:
I certify that I am authorized to sign on behalf of the local agency. This budget represents cost necessary for the
and operation of the program. Adequate documentation and records will be maintained to support all required program
TITLE: DATE:
Completion is a Condition of Funding.
PROGRAM BUDGET - POSITION SCHEDULE
007-10387 750 Page 3014
Program
OCHN Substance Abuse Prevention Healh Ed
Code Budget Period
10101116 To 09/30/17
Date Proparod
811812017
Local Agency
OAKLAND COUNTY HEALTH DIVISION
oritanal
1....3 Budget
Arnended
Budget
Amendment D
Number
POSITION DESCRIPTION POSITIONS x ANNUAL . TOTAL
REQUIRED SALARY SALARY
COMMENTS
PulKic Health Educator II 1.00 641,150 522,158 Budgeted 1120 Ho WS D
PubIlc Health Educator II 1.00 53,670 63,570 Budgeted 2002, Hours 0
0 0.00 0 0 Budgeted 0 Hours 0
0 0.00 0 0 Budgeted 0 Hours 3
OHMS Adrulniltrator 1.20 94,456 1,362 Budgeted 33 Hour, 0
Neagh Education Supervisor 1.00 75,167 5,406 BOdgOted 140 HOUEs 0
0 0.00 0 0 Budgeted 6 Hours 3
0 0.00 0 0 Budgeted 0 Hours 0
0 0.00 0 0 Budgeted 0 H01116 D
0 0.00 0 0 Budgeted 0 Flours a
0 0.00 0 0 Budgeted 0 Hours 0
0 0,00 0 0 Budgeted 0 Hours 0
Budgeted Hours
Budgeted Hours
Budgeted Hours
TOTAL 4.00 $75,7213
CompletIon15 a Condition of Funding.
0
180
500
2,000
2,500
0
1,000
0
0
0
5,421
DCH 0387 7198
PROGRAM BUDGET - COST DETAIL SCHEDULE
0 Page 4 of 4
Program
OCHN Substance Abuse Prevention Heal) Ed
Local Agency
OAKLAND COUNTY HEALTH DIVISION
Code Budget Period Date Prepared
10101/16 To 09/30/17 8118/2017
Original Lii-,j, iiniiinn-iii L HiriiIiIlltrir
Budget Budget Number
DESCRIPTION QUANTITY
SUB-CATEGORY/
ITEM TOTAL CATEGORY
TOTAL
FRINGE BENEFITS (722740)
TRAVEL
Personal Mileage (731346) - 5,000 Miles @ 0.535
Travel and Conference (732018)
TOTAL
SUPPLIES AND MATERIALS
Postage (750448)
Printing (731388)
Office Supplies (750399)
Material & Supplies - (750294)
Educational Supplies (750567)
Incentives (750245)
TOTAL
COMMUNICATIONS
Telephone Communications (778675)
TOTAL
OFFICE SPACE
Building Space Rental (770631)
Rent (731626)
TOTAL
CONTRACTUAL (730373)
TOTAL
EQUIPMENT (750168)
TOTAL
OTHER EXPENSES
Liability Insurance (774677)
Interpretation Fees (730982)
Educational Programs (730555)
Training (731941)
Advertising (730072)
License & Permits (731115)
Convenience Copier (770667)
IT Operations (774636)
Workshops & Meetings (732165)
$53,911
2,675
3,000
5,675
250
2,000
500
1,508
7,000 2,516
4,500
15,758
0
1,872
0
0
0
TOTAL 6,180
INDIRECT COSTS
2016/17 11,91% on Salaries & VVages of
$75,728 9,019
9,809 Match
Completion is a Condition of Funding.
PROGRAM BUDGET - POSITION SCHEDULE INTERNAL INFORMATION Program OCHN Substance Abuse Prevention Healh Ed Code Budget Period 10101/16 Date Prepared To 09130/17 8118/2017 Local Agency OAKLAND COUNTY HEALTH DIVISION Original D Budget Amended 0 Amendment Budget Number POSITION NUMBER EMPLOYEE NAME OR VACANT p OSITION DESCRIPTION POSITIONS X REQUIRED ANNUAL = SALARY TOTAL SALARY TOTAL FRINGES COMMENTS 00960 Mary McClain Public Health Educator 11 1.00 41,150 22,158 $16,466 Budgeted 1,120 Hours 54% 07497 Melanie Stone Public Health Educator II 1.00 53,570 53,570 $37,445 Budgeted 2,080 Hours 100% Budgeted Hours $0 Budgeted Hours Lisa McKay -Chiasson CHPIS Administrator 1.00 594,456 41,362 Budgeted 30 Hours Trisha Zzumbo Health Education Supervisor 1.00 $76,167 95456 Budgeted 149 Hours $0 Budgeted Hours Budgeted Hours Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours 0 Budgeted HMIS 0 Budgeted HMIS Budgeted Hours Budgeted Hours 0 Budgeted Hours 0 Budgeted Hours TOTAL 2.00 $75,728 $53,911 $6.818
Resolution #17267 September 28, 2017
Moved by Hoffman Supported by Quarles the resolutions (with fiscal notes attached) on the amended
Consent Agenda be adopted (with accompanying reports being accepted).
AYES: Crawford, Dwyer, Fleming, Gershenson, Gingell, Hoffman, Kochenderfer, KowaII, Long,
McGillivray, Middleton, Quarles, Taub, Tietz, Weipert, Woodward, Zack, Berman, Bowman. (19)
NAYS: None. (0)
A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the amended
Consent Agenda were adopted (with accompanying reports being accepted).
7/9-1A 7
I HEREBY APPROVE THIS RESOLLIT
CHIEF DEPUTY COUNTY EXECUTI
ACTING PURSUANT TO MCL 45.559A (7)
STATE OF MICHIGAN)
COUNTY OF OAKLAND)
I, Lisa Brown, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and
accurate copy of a resolution adopted by the Oakland County Board of Commissioners on September 28,
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 28th day of September, 2017.
Lisa Brown, Oakland County