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Resolutions - 2018.09.05 - 23763
REPORT (MISC. #18309) September 5, 2018 BY: Bob Hoffman, Chairperson, Human Resources Committee IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION — 2018/2019 COMPREHENSIVE PLANNING, BUDGETING AND CONTRACTING (CPBC) AGREEMENT ACCEPTANCE To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: The Human Resources Committee, having reviewed the above-referenced resolution on August 29, 2018, reports with the recommendation that the resolution be adopted. Chairperson, on behalf of the Human Resources Committee, I move the acceptance of the foregoing report. Commissioner Bob Hoffman, District #2 Chairperson, Human Resources Committee HUMAN RESOURCES COMMITTEE VOTE: Motion carried unanimously on a roll call vote. MISCELLANEOUS RESOLUTION #18309 September 6, 2018 BY: Commissioner Christine Long, Chairperson, General Government Committee IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION - 2018/2019 COMPREHENSIVE PLANNING, BUDGETING AND CONTRACTING (CPBC) AGREEMENT ACCEPTANCE To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: WHEREAS the Michigan Department of Health and Human Services (MDHHS) has awarded the Oakland County Health Division funding through the Comprehensive Planning, Budgeting, and Contracting (CPBC) Agreement for the period October 1, 2018 through September 30, 2019; and WHEREAS the 2017/2018 CPBC Agreement included total funding of $10,342,094; and WHEREAS the 2018/2019 CPBC Agreement reflects grant funding in the amount of $10,206,073, a decrease of $136,021 from the previous year; and WHEREAS the grant agreement and anticipated fiscal year 2019 contract amendments include sufficient funding for the fifty-nine (59) Special Revenue (SR) positions listed in Schedule B; and WHEREAS four (4) SR positions listed in Schedule C to be deleted are vacant and will not be filled during the 2018/2019 CPBC grant period; and WHEREAS the budget detail for the various programs is a matter of negotiation between the Health Division and MDH HS; amendments will be recommended to the FY 2019 Budget when details are finalized; and WHEREAS the CPBC Agreement has completed the Grant Review Process in accordance with the Board of Commissioners Grant Acceptance Procedures and is recommended for approval. NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners hereby accepts the 2018/2019 Comprehensive Planning, Budgeting, and Contracting (CPBC) agreement for funding in the amount of $10,206,073 for the period of October 1, 2018 through September 30, 2019. BE IT FURTHER RESOLVED to continue fifty-nine (59) SR positions included in Schedule B. BE IT FURTHER RESOLVED to delete four (4) SR positions included in Schedule C (#1060284-02091, 1060291-04737, 1060284-07564, 1060212-10012). BE IT FURTHER RESOLVED that acceptance of this grant does not obligate the county to any future commitment and continuation of the Special Revenue positions in the grant is contingent upon continued future levels of grant funding. BE IT FURTHER RESOLVED that the Board Chairperson is authorized to execute this agreement and to approve any grant extensions or changes, within fifteen percent (15%) of the original award, which is consistent with the agreement as originally approved. BE IT FURTHER RESOLVED that the Oakland County Board of Commissioners authorizes its Chairperson to execute this Agreement subject to the following additional condition: That the County's approval for entering into this Agreement is specifically conditioned and premised upon the acceptance, approval and execution of the Agreement containing Addendum A, by the Michigan Department of Health and Human Services, and that the failure of the Michigan Department of Health and Human Services to execute the Agreement as specified shall, without any further act of the Oakland County Board of Commissioners, automatically negate and void the County's approval and/or acceptance of this agreement as provided for in this resolution. Chairperson, on behalf of the General Government Committee, I move the adoption of the foregoing resolution. Commissioner Christine Lon Chairperson, General Govern GENERAL GOVERNMENT COMMITTEE VOTE: Motion carried unanimously on a roll call vote with Hoffman and Kochenderfer absent. GRANT REVIEW SIGN OFF — Health Division GRANT NAME: FY 2019 Comprehensive Planning, Budgeting, and Contracting Agreement FUNDING AGENCY: Michigan Department of Health & Human Services DEPARTMENT CONTACT PERSON: Rachel Shymkiw, 2-2151 STATUS: Grant Acceptance DATE: August 16, 2018 Pursuant to Misc. Resolution #17194, 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 (8/13/18) Department of Human Resources: HR Approved (Needs HR Committee) — Lori Taylor (8/15/18) Risk Management and Safety: Approved by Risk Management. R.E. — Robert Erlenbeck (8/13/18) Corporation Counsel: We regards to the above referenced grant Corporation Counsel Approves. — Brad Benn (8/16/18) 702011, 0 722740 730 26 731346 731368 7503b1 750399 750 7 77436 774 61511 702010 722740 General Fund (#10100). Revenue 10100 1060283 133930 10100 1060220 134000 10100 1060220 134080 10100 1060220 134200 10100 1060237 133300 10100 1060237 133310 10100 1060283 133930 10100 1060201 133150 Total Revenues Sexually Transmitted Disease Food Protection Private Sewage Private Water Hearing Vision Sexually Transmitted Disease Health Administration 6103 615571 615571 615571 615571 615571 616571 615675 Expenditures Total Expenditures Gonococcal Isolate (#28310) GR0000000689 Bud Ref: 2019 Activity: GLB Analysis: GLB Revenue 28310 1060234 133120 Lab 610313 28310 1060234 133120 Lab 615571 Total Revenues Expenditures 28310 1060234 133120 Lab 28310 1060234 133120 Lab Total Expenditures Adolescent Screening (#28310) GR0000000467 Bud Ref: 2019 Activity: GL,B Analysis: OLD Revenue 28310 1060234 133930 Sexually Transmitted Disease Total Revenues 750280 7746177 610313 Expenditures 28310 1060234 133930 28310 1060234 133930 28310 1060234 133930 28310 1060234 133930 28310 1060234 133930 28310 1060234 133930 28310 1060234 133930 28310 1060234 133930 29310 1060234 133930 28310 1060234 133930 Total Expenditures Sexually Transmitted Disease Sexually Transmitted Disease Sexually Transmitted Disease Sexually Transmitted Disease Sexually Transmitted Disease Sexually Transmitted Disease Sexually Transmitted Disease Sexually Transmitted Disease Sexually Transmitted Disease Sexually Transmitted Disease Local Tobacco Prevention (#28315) GR0000000740 Bud Ref: 2019 Activity: GLB Analysis: GLB Revenue 28315 1060233 133490 HENS - Tobacco Total Revenues Expenditures 28315 1060233 133490 HENS Tobacco 26315 1060233 133490 HENS Tobacco Federal Operating Grants State Operating Grants State Operating Grants State Operating Grants State Operating Grants State Operating Grants State Operating Grants Health State Subsidy Federal Operating Grants State Operating Grants Laboratory Supplies Insurance Fund Federal Operating Grants Salaries Regular Fringe Benefits Indirect Costs Personal Mileage Printing Medical Supplies Office Supplies Training-Educational Supplies Info Tech Operations Insurance Fund State Operating Grants Salaries Regular Fringe Benefits $0 40,135 859,213 372,426 514,301 253,969 253,968 42,515 2,251,290 $4,587,817 $0 40,135 859,213 372,426 514*301 253,959 253,968 42,515 2,251,290 $4,587,817 0 0 0 0 0 40,135 859,213 372,426 614,301 253,969 253,968 42,615 2,251.290 $4,587,817 40,135 859,213 372,426 514,301 253,969 253,968 42,515 2,251,290 $4,587,817 40,135 859,213 372,426 514,301 253,969 253,968 42,515 2,251,290 $4,587,817 40,135 859,213 372,426 514,301 253,969 253,968 42,515 2,251,290 $4,587,817 $0 $0 39,000 0 $39,000 $0 12,167 36,500 $48,667 $0 (26,833) 36,500 69,667 $0 39,000 $39,000 $0 12,167 36,500 $48,667 $0 (26,833) 35,500 $9,667 $0 39,000 0 $39,000 $0 12,167 36,500 $48,667 $0 (26,833) 36,500 $9,667 39,000 0 $39,000 48,595 72 $48,667 9,595 72 $9,667 39,000 0 $39,000 48,595 72 $48,667 9,595 72 69,667 39,000 0 $39,000 48,595 72 $48,667 9„595 72 $9,667 0 73,000 73,000 $0 $73,000 $73,000 0 73,000 73,000 $0 $73,000 $73,000 73,000 73,000 $73000 $73.000 $0 41,896 42,732 836 41,896 42,732 836 41,896 42,732 836 16,273 15,635 (638) 16,273 15,635 (538) 16,273 15,635 (638) 4,990 5,465 475 4,990 5,465 475 4,990 5,465 475 669 681 12 669 681 12 669 681 12 300 300 0 300 300 0 300 300 0 1,000 1,099 99 1,000 1,099 99 1,000 1,099 99 392 392 0 392 392 0 392 392 0 4,600 3,564 (936) 4,500 3,564 (936) 4,500 3,564 (936) 2,800 3,024 224 2,800 3,024 224 2,800 3,024 224 180 108 (72) 180 -108 (72) 180 108 (72) $73,000 $73,000 $0 $73,000 $73,000 $0 $73,000 $73,000 $0 30,000 20,000 (10,000) 30.000 20.000 (10,000) 30,000 20,000 (10.000) $30,000 $20,000 ($10 000) $30,000 820,000 ($10.000) $30,000 $20,000 ($10,000) 22,859 14,836 (8,023) 22,859 14,836 (8,023) 22,859 14,836 (8,023) 1,551 817 (734) 1,551 817 (734) 1,551 817 (734) Page 1 OAKLAND COUNTY, MICHIGAN COMPREHENSIVE PLANNING, BUDGETING AND CONTRACTING (CPBC) AGREEMENT FY2019, FY2020, AND FY2021 BUDGET AMENDMENTS SCHEDULE A FY 2019 FY 2020 FY 2021 Revised Increase/ Bud Rec (Decrease) Fund Dept ID Prog Frog Desc Fund Op Acct Aff Unit Account Desc Co. Exec Revised Rec Bud Rec Increase/ Co. Exec Revised Encreasel (Decrease) Ran Bud Rec (Decrease) Co Exec Rec 730072 730926 731346 731 750$7 774 77 778675 702010 7227,40 730072 730373 730555 730926 730982 731346 731388 731941 732018 7321165 7505 7544 750 92 75099 75077 77477 422 1,898 1,161 200 300 30 336 $20,000 (825) 21 (987) 300 (150) (24) ($10,000) (825) 21 (987) 300 (150) (24) ($10,000) (65,000) 65,000 $0 ($65,000) 656,000 (20,15)) 20,151 0 (1,137) 1,137 (6,000) 6,000 (6,000) 6,000 (1,070) 1,070 (2.400) 2,400 (1,550) 1,550 0 (428) 428 (3,694) 3,694 (4,000) 4,000 (100) 100 (1,490) 1,490 (2,000) 2,000 (2,500) 2,500 (9,700) 9,700 (1,000) 1,000 (1,600) 1,600 (180) 180 $0 ($65,000) $65 000 0 (65,000) $0 ($65,000) O (20,151) O (1,137) O (6,000) O (6,000) O (1,070) O (2,400) 0 (1,550) 0 (428) 0 (3,694) 0 (4,000) 0 (100) 0 (1,490) 0 (2.300) (2,500) O (9,700) O (1,000) O (1,600) O (180) $0 ($65,000) 2,723 1,140 1,187 0 180 360 $30,000 1,898 1,161 200 300 30 336 $20000 Fund Dept ID Prog Prop Desc 1 11 Acct Fund AR Op Unit Account Desc FY 2019 FY 2020 FY 2021 Co. Exec Rec Revised Bud Rec Increase/ (Decrease) Co. Exec Rec Revised Bud Rec increase/ Decrease) Co Exec Rec Revised Bud Rec Increase/ (Decrease) 0 2,723 1,140 1,187 0 180 360 $30,000 Ml Health & Wellness 4x4 (#283201 GR0000000696 Bud Ref. 2019 Activity: GLB Analysis: OLD Revenue 28320 1060233 133390 General Health Promotion Total Revenues 28315 1060233 133490 28315 1060233 133490 28315 1060233 133490 28315 1060233 133490 28315 1060233 133490 28315 1060233 133490 28315 1060233 133490 Total Expenditures Expenditures 28320 1060233 138390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 28320 1060233 133390 Total Expenditures HENS - Tobacco HENS - Tobacco HENS-Tobacco HENS - Tobacco HENS - Tobacco HENS - Tobacco HENS - Tobacco General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion General Health Promotion Advertising Indirect Costs Personal Mileage Printing Training-Educational Supplies Insurance Fund Telephone Communications State Operating Grants Salaries Regular Fringe Benefits Advertising Contracted Services Education Programs Indirect Costs Interpreter Fees Personal Mileage Printing Training Travel and Conference Workshops and Meeting Incentives Material and Supplies Metered Postage Office Supplies Training-Educational Supplies Insurance Fund 422 0 (825) 2,723 21 1,140 (987) 1,187 300 (150) 180 (24) 360 ($10,000) $30 000 0 (65,000) 65,000 $0 ($65,000) $65,000 (20,151) 20,151 (1,137) 1,137 (6,000) 6,000 (6,000) 6,000 (1,070) 1,070 (2,400) 2,400 (1,550) 1,550 (428) 428 (3,694) 3,694 (4,000) 4,000 (100) 100 (1,490) 1,490 (2000), 2.000 (2,500) 2,500 0 (9,700) 9,700 (1,000) 1,000 (1.600) 1,600 (180) 150 $0 ($65,000) $65 000 65,000 20,151 1,137 6,000 6,000 1,070 2,400 1,550 428 3,694 4,000 100 1,490 2,000 2,500 9,700 1,000 1,600 180 $65 000 422 1,898 1,161 200 300 30 336 $20,000 Immunization Action Plan (#28550) GRO000000182 Bud Ref: 2019 Activity: OLD Analysis: OLD Revenue 28550 1060218 133910 Immunizations 28550 1060218 133910 Immunizations Total Revenues 610313 615463 Federal Operating Grants Grant Pees and Collections 503,403 22,031 $525,434 500,998 30,107 $531 105 (2,405) 8,076 $5 671 503,403 22,031 $525,434 500,998 30,107 $531,105 (2,405) 8,076 $5,671 503,403 22,031 $525,434 500,998 30,107 $531.t (2,405) 8,016 $5 671 Expenditures 70110 722 40 730646 730926 731346 731388 732018 750392 750399 750567 770631 774636 774137 774577 778675 Immunizations Immunizations Immunizations Immunizations Immunizations Immunizations Immunizations Immunizations Immunizations Immunizations Immunizations Immunizations Immunizations Immunizations Immunizations Salaries Regular Fringe Benefits Equipment Maintenance Indirect Costs Personal Mileage Printing Travel and Conference Metered Postage Office Supplies Training-Educational Supplies Bldg Space Cost Allocation Info Tech Operations Info Tech Managed Print Svcs Insurance Fund Telephone Communications 249,642 187,682 200 29,732 2,169 1,500 1,500 12,000 1,000 1,339 11,190 22,000 3,280 180 2,020 $525,434 257,022 195,769 200 32,873 2,210 1,000 1,500 9,000 522 1,000 11,442 11,832 3,280 744 2,711 $531 105 249,642 187,682 200 29,732 2,169 1,500 1,500 12,000 1,000 1,339 11,190 22,000 3,280 180 2,020 $525,434 257,022 195,769 200 32,873 2,210 1,000 1,500 9,000 522 1,000 11,442 11,832 3,280 744 2,711 $531,105 249,642 157,682 200 29,732 2,169 1,500 1,500 12,000 1,000 1,339 11,190 22,000 3,280 180 2020, $525,434 257,022 195,769 200 32,873 2,210 1,000 1,500 9,000 522 1,000 11,442 11,832 3,280 744 2,711 $531,105 28550 1060218 133910 28550 1060218 133910 28550 1060218 133910 28550 1060218 133910 28550 1060218 133910 28550 1060218 1339)0 28550 1060218 133910 28550 1060218 133910 28550 1060218 133910 28550 1060218 133910 28550 1060218 133910 25550 1060218 133910 28550 1060218 133910 28550 1060218 133910 28550 1060218 133910 Total Expenditures 7,380 8,087 0 3,141 41 (500) 0 (3,000) (478) (339) 252 110,168) 0 564 691 $5,671 7,380 8,087 0 3.141 41 (500) 0 (3,000) (478) (339) 252 (10,168) 0 564 691 $5 671 7,380 8,087 0 3,141 41 (500) 0 (3,000) (478) (339) 252 (10,168) 564 691 $5,671 Women Infant Children (228553) GR0000000205 Bud Ref: 2019 Activity: GLB Analysis: GLB Page 2 Salaries Regular Fringe Benefits Advertising Contracted Services Equipment Maintenance Freight and Express Indirect Costs Interpreter Fees Laundry and Cleaning Personal Mileage Printing Professional Services Rent Training Travel and Conference Computer Supplies Expendable Equipment Material and Supplies Medical Supplies Metered Postage Office Supplies Training-Educational Supplies Bldg Space Cost Allocation Info Tech Operations Into Tech Managed Print Svcs Insurance Fund Telephone Communications Salaries Regular Fringe Benefits Advertising Contracted Services Indirect Costs Interpreter Fees Personal Mileage Printing Training Travel and Conference Medical Supplies Metered Postage Office Supplies Insurance Fund Telephone Corn munications 702010 722740 730072 7303V3 7306t6 730772 730926 730982 731059 731346 731388 731468 731626 731941 732018 750049 750154 750294 750391 750392 750399 750567 770681 774686 774637 774677 778675 702010 722740 730072 730373 730926 730982 73136 3 731 8 731941 732018 75031 750392 750399 77467 77845 45,678 48,678 48,678 4$679 O 48,678 48,678 0 $48 678 848 678 $0 $48,678 $48,678 $0 $48,678 $48,678 $0 12,802 722 250 1,525 817 15,304 14,637 806 250 1,872 817 15,304 1,835 84 0 347 0 12,802 722 250 1,525 817 15,304 14,637 806 250 1,872 817 15,304 1,835 84 0 347 0 12,802 722 250 1,525 817 15,304 14,637 806 250 1,872 817 15,304 1,535 84 0 347 0 Salaries Regular Fringe Benefits Equipment Maintenance Indirect Costs Interpreter Fees Laboratory Fees 702010 72040 730646 730926 7309 2 7310)31 Fund Dept ID Ping Prog Desc Acpt Fund Aft Op Unit Account Desc FY 2019 FY 2020 FY 2021 Co. Exec Rec Revised Bud Rec Increase/ (Decrease) Co. Exec Rec Revised Bud Rec Increase/ (Decrease) Co Exec Rec Revised Bud Rec Increase/ (Decrease) Revenue 28553 1060284 133270 WIC 610313 Federal Operating Grants 2,435,330 2,326,580 (108,750) 2,435,330 2,326,580 (108,750) 2,435,330 2,325,580 (108,750) 28553 1060284 133271 Peer Counseling 510313 Federal Operating Grants 219,199 219,199 0 219 199 219,199 • 219,199 219,199 Total Revenues $2,654,529 $2,545,779 ($108,750) $2,654,529 $2,545,779 ($108,750) $2,654,529 $2,545,779 ($108,750) Expenditures 28553 1069284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 28563 1060284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 25553 1060284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 VVIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 28553 1060284 133270 WIC 25553 1060284 133270 WIC 25553 1060284 133270 VVIC 25553 1060284 133270 WIC 25663 1060254 133270 WIC 25553 1060284 133270 WIC 28553 1060284 133271 Peer Counseling 28553 1060284 133271 Peer Counseling 25553 1060284 133271 Peer Counseling 25553 1060284 133271 Peer Counseling 28553 1060284 133271 Peer Counseling 25553 1060284 133271 Peer Counseling 28553 1060284 133271 Peer Counseling 28553 1060284 133271 Peer Counseling 28553 1060284 133271 Peer Counseling 28553 1060284 133271 Peer Counseling 28553 1060284 133271 Peer Counseling 28553 1060284 133271 Peer Counseling 25553 1060284 133271 Peer Counseling 28553 1060284 133271 Peer Counseling 28553 1060284 133271 Peer Counseling Total Expenditures 975,732 955,243 (20,489) 975,732 955,243 620,037 605,513 (14,524) 620,037 505,513 18,000 18,000 o 18,000 18,000 430,560 414,000 (16,560) 430,560 414,000 1,750 750 (1,000) 1,750 750 100 100 0 100 100 116,210 122,176 5,966 116,210 122,178 500 200 (300) 500 200 1,000 1,000 0 1,000 1,000 3,611 3,270 (341) 3,611 3,270 8,000 3,750 (4,250) 8,000 3,750 500 0 (500) 500 0 14,172 11,999 (2,173) 14,172 11,999 1,500 1,750 250 1,500 1,750 2,218 500 (1,718) 2,218 500 100 0 (100) 100 0 600 500 o 500 500 1,525 553 (972) 1,525 553 15,000 8,159 (6,841) 15,000 8,159 2,000 500 (1,500) 2,000 500 8,000 7,000 (1,000) 8,000 7,000 7,000 3,000 (4,000) 7,090 3,000 87,149 83,354 (3,795) 87,149 83,354 95,616 67,408 (28,208) 95,616 67,408 10,170 4,400 (5,770) 10,170 4,400 180 3,456 3,275 180 3,455 14,200 10,000 (4,200) 14,200 10,000 77,456 79,097 1,551 77,456 79,007 42,273 33,194 (9,079) 42,273 33,194 224 5,000 5,776 224 6,000 75,897 73,397 (2,500) 75,897 73,397 9,225 13,105 880 9,225 10,105 O 1,000 1,000 0 1,000 1,200 1,222 22 1,200 1,222 1,000 3,000 2,000 1,000 3,000 2,331 2,331 0 2,331 2,331 1,000 1,000 o 1,000 1,000 3,597 3,625 28 3,597 3,625 O 1,000 1,000 o 1,000 1,000 2,000 1,000 1,000 2,000 150 325 145 180 325 3,816 1,993 (1,823) 3,816 1,993 $2,654,529 $2,545,779 ($108,750) $2.654,529 $2,545 779 (20,489) 976,732 955,243 (14,524) 620,037 605,513 0 18,000 18,000 (16,560) 430,560 414,000 (1,000) 1,750 750 O 100 100 5,966 116,210 122,176 (300) 500 200 O 1,090 1,000 (341) 3,611 3,270 (4,250) 8,000 3,750 (500) 500 0 (2,173) 14,172 11,999 250 1,500 1,750 (1,718) 2,218 500 (100) 100 0 O 500 500 (972) 1,525 553 (6,841) 15,000 8,159 (1,500) 2,000 500 (1,000) 8,000 7,000 (4,000) 7,000 3,300 (3,795) 87,149 83,354 (28,205) 95,616 67,408 (5,770) 10,170 4,400 3,275 180 3,455 (4,200) 14,200 10,000 1,551 77,456 79,007 (9,079) 42,273 33,194 5,776 224 6,000 (2,500) 75,897 73,397 880 9,225 10,105 1,000 0 1,000 22 1,200 1,222 2,000 1,000 3,000 O 2,331 2,331 0 1,000 1,000 28 3,597 3,625 1,000 o 1,000 1,000 1,000 2,000 145 180 325 (1,823) 3,816 1,993 ($108,750) $2,654,529 $2.545,779 (20,489) (14,524) (16,560) (1,000) 5,966 (300) 0 (341) (4,250) (500) (2,173) 250 (1,718) (100) (972) (6,841) (1,500) (1,000) (4,000) (3,795) (28,208) (5,770) 3,275 (4,200) 1,551 (9,079) 5,776 (2,500) 880 1,000 22 2,000 28 1,000 1,000 145 (1,823) ($108,750) TB Outreach (#28556) GR0000000192 Bud Ref: 2019 Activity: GLB Analysis: GLB Revenue 28556 1060235 133970 TB Total Revenues Expenditures 28556 1060235 133970 TB 28556 1060235 133970 TB 28556 1060235 133970 TB 28556 1060235 133970 TB 25556 1060235 133970 TB 25556 1060235 133970 TB 6103 3 Federal Operating Grants Page 3 Personal Mileage Transportation of Clients Travel and Conference Incentives Medical Supplies Office Supplies Postage-Standard Mailing Info Tech Managed Print Svcs Insurance Fund Telephone Communications Federal Operating Grants State Operating Grants 5,560 500 4,000 1,453 1,000 200 250 420 180 695 $48 678 8,720 500 2,377 1,453 1,000 200 250 420 72 0 $48 678 160 0 (1,623) 0 0 0 0 0 (108) (695) $0 5,560 500 4,000 1,453 1,000 200 250 420 180 695 $48,678 8,720 500 2,377 1,453 1,000 200 250 420 72 0 $48,678 160 8,660 0 500 (1,6231 4,000 0 1,453 0 1,000 0 200 0 250 0 420 (108) 180 (695) 695 $0 $48,678 8,720 500 2,377 1453 1,000 200 250 420 72 0 $48,678 160 0 (1,623) 0 0 0 0 0 (108) (695) $0 155,514 363.386 $518 900 130,234 320,091 $450,325 (25,280) (43,295) ($68,575) 155,514 363,386 5518900 130,234 320,091 $450 325 (25,280) 155,514 (43,295) 363,386 ($68575) $518000 130,234 320,091 $450 325 (25,280) (43,295) ($68 575) Salaries Regular 290,006 233,066 (56,940) 290.006 233,066 (56,940) 290,006 233,066 (56,940) Fringe Benefits 130,116 123,120 (6,996) 130.116 123,120 (5,996) 130,116 123,120 (6,996) Advertising 5,500 6,760 1,260 5,500 6,760 1,260 5,500 6,760 1,260 Indirect Costs 34,540 29,809 (4,731) 34,540 29,809 (4,731) 34,540 29,809 (4,731) Interpreter Fees 600 600 0 600 600 0 600 600 0 Laboratory Fees 1,500 0 (1,500) 1,500 0 (1,500) 1,500 0 (1,500) Personal Mileage 5,869 5,979 110 5,869 5,979 110 5,869 5,979 110 Printing 6,000 6,000 0 6,000 6,000 0 6,000 6,000 0 Transportation of Ctients 345 345 0 346 345 0 345 345 0 Travel and Conference 5,500 5,500 0 5,500 5,500 0 5,500 5,500 0 Laboratory Supplies 1,000 1,029 29 1,000 1,029 29 1,000 1,029 29 Medical Supplies 3,000 3,000 0 3,000 3,000 0 3,000 3,000 0 Metered Postage 1,000 1,000 0 1,000 1,000 0 1,000 1,000 0 Office Supplies 2,000 2,000 0 2,000 2,000 0 2,000 2,000 0 Training-Educational Supplies 5,790 5,970 180 5,790 6,970 180 5,790 5,970 180 Bldg Space Cost Allocation 7,754 7,942 188 7,754 7,942 188 7,754 7,942 188 Info Tech Operations 15,000 14,504 (496) 15,000 14,504 (496) 15,000 14,504 (496) Info Tech Managed Print Svcs 1,200 1,200 0 1,200 1,200 0 1,200 1,200 0 Insurance Fund 180 669 489 180 669 489 180 669 489 Telephone Communications 2,000 1,832 (168) 2,000 1,832 (168) 2,000 1,832 (1681 $518,900 $450,325 (868 575) $518900 $450 325 ($68.575) $518,900 $460,325 ($68,575) Federal Operating Grants Salaries Regular Fringe Benefits Indirect Costs Bldg Space Cost Allocation Telephone Communications State Operating Grants 6155/1 Page 4 105,231 (4,950) 110,181 105,231 (4,950) $105,231 ($4,950) $110,181 $105,231 ($4,950) (4,950) 110 181 ($4,950) $110,181 7.501 39,071 46,572 39,071 46,572 7,501 $7,501 7,501 $7 501 $39071 $46,572 (2,460) (142) (293) 9,285 1,111 $7,501 (2.460) (142) (293) 9,285 1 111 $7,501 2,460 142 293 27,404 8 772 $39,071 0 36,689 9,883 $46,572 $7,501 $39,071 $46 572 (2,460) (142) (293) 9,285 1,111 $7,501 2,460 142 293 27,404 8,772 $39,071 0 0 0 36,689 9,883 $48,572 39,071 46,572 $39.071 $46 572 2,460 142 293 27,404 8,772 $39,071 0 0 0 36,689 9883 $46572 110,181 105,231 $110,181 $105,231 731346 731997 732015 750245 750301 750399 750448 774637 7746t77 778&75 610313 615571 702Ctil 0 722740 730072 730926 730962 731081 731346 731388 731997 7320'18 7502 7503 1 7503 2 750399 750567 770631 77486 77461 7 774577 778615 6103 3 702010 722740 7309 6 770631 778675 Fund De.t ID Pro. Pro. Desc Acct Fund Aff Op Unit Account Desc FY 2019 FY 2020 FY 2021 Co. Exec Rec Revised Bud Rec Increase/ Decrease Co. Exec Rec Revised Bud Rec Increase/ Decrease) Co Exec Rec Revised Bud Rae Increase/ Decrease) Exnditures 28557 1060294 133940 28557 1060294 133940 28557 1060294 133940 28557 1060294 133940 25557 1060294 133940 28557 1050294 133940 28557 1080294 133940 28557 1060294 133940 28557 1060294 133940 28557 1060294 133940 28557 1060294 133940 28557 1060294 133940 28657 1060294 133940 28557 1060294 133940 28557 1060294 133940 28557 1060294 133940 28557 1060294 133940 28557 1060294 133940 28557 1060294 133940 28557 1060294 133940 28556 1060235 133970 TB 28556 1060235 133970 TB 28556 1060235 133970 TB 28556 1060235 133970 TB 28556 1060235 133970 TB 28556 1060235 133970 TB 28556 1060235 133970 TB 28556 1060235 133970 TB 28556 1060235 133970 TB 28556 1060235 133970 TB Total Expenditures AIDS Counseling Testing (#285571 GR0000000194 Bud Ref: 2019 Activity: GLB Analysis: GLB Revenue 28557 1060294 133940 HIV/AIDS 28557 1060294 133940 HIV/AIDS Total Revenues HIV/AIDS HIV/AIDS HIV/AIDS HIV/AIDS HIV/AIDS HIV/AIDS HIV/AIDS HIV/AIDS HIV/AIDS HIV/AIDS HIV/A1DS HIV/AIDS HIV/AIDS HIVIAIDS HIV/Al DS HI VIA DS H IV/AI DS HIV/AIDS HIV/AIDS HIV/AIDS Total Expenditures HIV Surveillance Support (#285581 GR0000000666 Bud Ref: 2019 Activity: GLB Analysis: GLB Revenue 28558 1060294 133940 HIV/AIDS Total Revenues Expenditures 28558 1060294 133940 HIV/AIDS 28558 1060294 133940 HIV/AIDS 28558 1060294 133940 HIV/AIDS 28558 1060294 133940 HIV/AIDS 28558 1060294 133940 HIV/AIDS Total Expenditures Health Vaccines for Children (#28560) GR0000000200 Bud Ref 2019 Activity: GLB Analysis: GLB Revenue 28560 1060234 133910 Immunizations Total Revenues Expenditures 89,875 3,509 84,413 257,597 47,790 2,617 49,563 119,854 5,625 10,704 454 10,054 30,680 2,500 992 3,478 203 487 4,314 3,000 1,000 272 1,000 300 3,375 3,000 500 0 500 2,000 0 2,306 2,950 25,241 5,520 5,600 38,330 2,500 180 0 180 1,301 1,050 21,535 4,042 146,523 271,424 13,093 2,650 88,989 119,988 3,375 2,754 517 18,740 34,715 2,046 1,005 3,543 207 3,082 4,752 1,714 1,000 245 3,000 300 3,375 3,000 1,030 200 2,000 2,000 2,377 3,556 1,888 25,241 2,936 3,024 41.280 2,500 477 33 423 1,135 566 89,875 3,809 84,413 257,597 47,790 2,617 49,563 119,854 5,625 10,704 454 10,054 30,680 2,500 992 3,478 203 487 4,314 3,000 1,000 272 1,000 300 3,375 3,000 500 0 500 2,000 0 2,306 2,950 25,241 5,520 5,600 38,330 2,500 180 0 180 1,301 1,050 21,535 4,042 146,523 271,424 13,093 2,650 88,989 119,988 3,375 2,754 517 18,740 34,715 2,046 1,005 3,543 207 3,082 4,752 1,714 1,000 245 3,000 300 3,375 3,000 1,030 200 2,000 2,000 2,377 3,556 1,888 25,241 2,936 3,024 41,280 2,500 477 33 423 1,135 566 Fund Dept ID Prog Frog Dose Aoct Fund A:if Op Unit Account Peso FY 2019 FY 2020 FY 2021 Co. Exec Rec Revised Bud Rec Increase/ (Decrease) Co. Exec Rec Revised Bud Rec Increase/ (Decrease) Co Exec Rec Revised Bud Rec Increase/ (Decrease) 702010 722740 730926 731346 731458 750294 774677 610313 615463 610313 61171 610 13 615 71 NIICH Block (#28563) GR0000000207 Bud Ref: 2019 Activity: GLB Analysis: GLB Revenue 28563 1060291 133190 Maternal Infant Support Sew 28563 1060291 134420 CSHCS Outreach and Advocacy 28563 1060291 134420 CSHCS Outreach and Advocacy 28563 1060291 134420 CSHCS Outreach and Advocacy 28563 1060291 133200 Infant Mortality Reduction 28563 1060291 133200 Infant Mortality Reduction Total Revenues 28560 1060234 133910 28560 1060234 133910 28560 1060234 133910 28560 1060234 133910 28560 1060234 133910 28560 1060234 133910 28560 1060214 133910 Total Expenditures Immunizations Immunizations Immunizations Immunizations Immunizations Immunizations Immunizations Salaries Regular Fringe Benefits Indirect Costs Personal Mileage Professional Services Material and Supplies Insurance Fund Federal Operating Grants Grant Fees and Collections Federal Operating Grants State Operating Grants Federal Operating Grants State Operating Grants 59,232 33,995 7,055 498 1,500 7,721 180 $110 181 321,457 202,537 142,500 142,500 22,500 $831,494 54,974 43,070 7,031 0 0 156 $105 231 321,457 227,483 142,500 142,500 2,250 20,250 $856 440 59,232 33,995 7,055 498 1,500 7,721 180 $110,181 321,457 202,537 142,500 142,500 0 22,500 $831,494 54,974 43,070 7,031 0 156 $105 231 321,457 227,483 142,500 142,500 2,250 20,250 $856,440 69,232 33,995 7,055 498 1,500 7,721 180 $110,181 321,457 202,537 142,500 142,500 0 22,500 $831494 54,974 43,070 7,031 0 0 0 156 $105 231 321,457 227,483 142,500 142,500 2,250 20,250 $855,44Q (4,258) 9,075 (24) (498) (1,500) (7,721) (24) ($4 950) 0 24,946 0 0 2,250 (2,250) $24 946 (4,258) 9,075 (24) (498) (1,500) (7,721) (24) ($4,950) 24,946 2,250 (2,250) $24,946 (4,258) 9,075 (24) (498) (1,500) (7,721) (24) ($4,950) 0 24,946 0 0 2,250 (2,250) $24,946 21,535 4,042 146,523 271,424 13,093 2,650 88,989 119,988 3,375 2,754 517 18,740 34,715 2,046 1,005 3,543 207 3,082 4,752 1,714 1,000 245 3,000 300 3,375 3,000 1,030 200 2,000 2,000 2,377 3,556 1,888 25,241 2,936 3,024 41,280 2,500 477 33 423 1,135 566 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 25563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 28563 Expenditures 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1050291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 1060291 702d10 702d10 702010 702010 722740 722740 722740 722740 730072 730026 730 26 73020 730926 730982 731::46 73146 731346 731388 731388 731388 731388 731997 732018 732018 750245 750392 750399 750399 750399 750399 750567 750567 750 770 774 774 774 774 774 774 774677 778675 778 75 67 31 36 36 36 37 77 77 89,875 3,809 84,413 257,597 47,790 2,617 49,563 119,854 5,625 10,704 454 10,064 30,680 2,500 992 3,478 203 487 4,314 3,000 1,000 272 1,000 300 3,375 3,000 500 0 500 2,000 2,306 2,950 25,241 5,520 5,600 38,330 2,500 180 180 1,301 1,050 0 (68,340) 233 62,110 13,827 (34,597) 33 39,426 134 (2,250) (7,950) 63 8,686 4,035 (454) 13 65 4 2,595 438 (1,286) 0 (27) 2,000 0 0 0 530 200 1,500 0 2,377 1,250 (1,062) 0 (2,584) (2,576) 2,950 0 297 33 243 (166) (484) 133190 Maternal Infant Support Sew 133200 Infant Mortality Reduction 133213 Women 134420 CSHCS Outreach and Advocacy 133190 Maternal Infant Support Serv 133200 Infant Mortality Reduction 133213 Women 134420 CSHCS Outreach and Advocacy 133200 Infant Mortality Reduction 133190 Maternal Infant Support Serv 133200 Infant Mortality Reduction 133213 Women 134420 CSHCS Outreach and Advocacy 133213 Women 133190 Maternal Infant Support Sew 133213 Women 134420 CSHCS Outreach and Advocacy 133190 Maternal Infant Support Sew 133200 Infant Mortality Reduction 133213 Women 134420 CSHCS Outreach and Advocacy 134420 CSHCS Outreach and Advocacy 133190 Maternal Infant Support Sew 134420 CSFICS Outreach and Advocacy 133200 Infant Mortality Reduction 134420 CSHCS Outreach and Advocacy 133190 Maternal Infant Support Sew 133200 Infant Mortality Reduction 133213 Women 134420 CSHCS Outreach and Advocacy 133190 Maternal Infant Support Sew 133200 Infant Mortality Reduction 133213 Women 134420 CSHCS Outreach and Advocacy 133190 Maternal Infant Support Sew 133213 Women 134420 CSHCS Outreach and Advocacy 134420 CSHCS Outreach and Advocacy 133190 Maternal Infant Support Sew 133200 Infant Mortality Reduction 134420 CSHCS Outreach and Advocacy 133190 Maternal Infant Support Sew 133213 Women Salaries Regular Salaries Regular Salaries Regular Salaries Regular Fringe Benefits Fringe Benefits Fringe Benefits Fringe Benefits Advertising Indirect Costs Indirect Costs Indirect Costs Indirect Costs Interpreter Fees Personal Mileage Personal Mileage Personal Mileage Printing Printing Printing Printing Transportation of Clients Travel and Conference Travel and Conference Incentives Metered Postage Office Supplies Office Supplies Office Supplies Office Supplies Training-Educational Supplies Training-Educational Supplies Training-Educational Supplies Bldg Space Cost Allocation Info Tech Operations Info Tech Operations Info Tech Operations Info Tech Managed Print Svcs Insurance Fund Insurance Fund Insurance Fund Telephone Communications Telephone Communications (68,340) 233 62,110 13,827 (34,697) 33 39,426 134 (2,250) (7,950) 63 8,686 4,035 (454) 13 55 4 2,595 438 (1,286) 0 (27) 2,000 0 0 0 530 200 1,500 0 2,377 1,250 (1,062) 0 (2,584) (2,576) 2,950 297 33 243 (166) (484) (68,340) 233 62,110 13,827 (34,697) 33 39,426 134 (2,250) (7,950) 63 8,686 4,035 (454) 13 65 4 2,595 438 (1,286) 0 (27) 2,000 0 530 200 1,500 0 2,377 1,250 (1,062) 0 (2,584) (2,576) 2,950 0 297 33 243 (166) (484) Page 5 Health PHEP (#28610) GR0000000796 Bud Ref: 2019 Activity: GLB Analysis: GLB Revenue 28610 1060290 115010 Bioterror Coordinator 28610 1060290 115035 Cities Readiness Total Revenues Expenditures 28610 1060290 115035 28610 1060290 115010 28610 1060290 115035 28610 1060290 115010 28610 1060290 115035 28610 1060290 115010 28610 1060290 115035 28610 1060290 115010 28610 1060290 115035 28610 1060290 115010 Cities Readiness Bioterror Coordinator Cities Readiness Bioterror Coordinator Cities Readiness Bioterror Coordinator Cities Readiness Bioterror Coordinator Cities Readiness Bioterror Coordinator 10,1 6,380 3,780 6,380 10,160 (2.500) 20,000 17,500 (2,500) 20 000 17,500 (2,500) 20,000 17,500 $20,000 $17,500 ($2,500) $20,000 $17,500 ($2,500) $20,000 $17,500 ($2,500) 16,871 952 2,009 168 $20,000 3,644 2,276 466 10,513 26 575 $17,500 (13,227) 1,324 (1,543) 10,513 (142) 575 ($2,500) 16,871 952 2,009 0 168 0 $20,000 3,644 2,276 466 10,513 26 575 $17,500 (13,227) 1,324 (1,543) 10,513 (142) 575 ($2,600) 16,871 952 2,009 168 $20,000 3,644 2,276 466 10,513 26 575 $17,500 (13,227) 1,324 (1,543) 10,513 (142) 575 ($2,500) $831,494 $856,440 $24,946 $831,494 $856,4-40 $24,946 $831494 $856,440 $24,946 31,052 589,988 $621,040 323,198 225,611 17,784 100 7,300 1,400 1,701 375 0 1,200 1,842 330 17,649 14,000 3,690 180 4,680 $621,040 372,624 248,416 $621 040 341,572 (341,572) $0 31,052 589,988 $621,040 372,624 248.416 $621,040 341,572 (341.572) $O 31,052 589,988 $621,040 372,624 248,416 $621,040 341,572 (341.572) $0 339,477 208,833 17,984 7,848 237 1,000 2,000 1,826 432 17,649 15,120 3,712 922 4,000 $621,040 16,279 323,198 (16,778) 225,611 200 17,784 (100) 100 548 7,300 (1,163) 1,400 (1,701) 1,701 (375) 375 1,000 800 1,200 (16) 1,842 102 330 17,649 1,120 14,000 22 3,590 742 180 (680) 4,580 $0 $621,040 339,477 208,833 17,984 0 7,848 237 0 1,000 2,000 1,826 432 17,649 15,120 3,712 922 4,000 $621,040 323,198 225,811 17,784 100 7,300 1,400 1,701 375 0 1,200 1,842 330 17,649 14,000 3,690 180 4,680 $621,040 339,477 208,833 17,984 7,848 237 1,000 2,000 1,826 432 17,649 15,120 3,712 922 4,000 $621,040 16,279 (16,778) 200 (100) 548 (1,163) (1,701) (375) 1,000 800 (16) 102 0 1,120 22 742 (680) $0 16,279 (16,778) 200 (100) 548 (1,163) (1,701) (375) 1,000 800 (16) 102 1,120 22 742 (680) $0 69,939 114,798 53,700 88,141 8,330 13,672 0 0 161 535 62,196 107,256 42,959 79,177 7,955 13,718 1,000 1,000 1,635 2,000 (7,743) (7,542) (10,741) (8,964) (375) 46 1,000 1,000 1,474 1,465 69,939 114,798 53,700 88,141 8,330 13,672 0 0 161 536 62,196 107,256 42,959 79,177 7,955 13,718 1,000 1,000 1,635 2,000 (7,743) (7,542) (10,741) (8,964) (375) 1,000 1,000 1,474 1,465 89,939 114,798 53,700 88,141 8,330 13,672 0 0 161 535 62,196 107,256 42,959 79,177 7.955 13,718 1,000 1,000 1,635 2,000 (7,743) (7,542) (10,741) (8,964) (375) 46 1,000 1,000 1,474 1,465 222,390 152.128 $374518 219,102 150,507 $369,709 222,390 152,128 8374,515 219,102 150,607 $369,709 (3,288) 222,390 219,102 (1,521) 152,128 150,607 ($4,809) $374,518 $369,709 (3,288) (1,521) ($4,809) (3,288) (1,521) ($4,809) 778675 510113 702d10 72140 730 26 750280 774d77 778675 610313 615571 70110 722 40 730373 730 82 73l46 731q88 731941 731997 732918 750245 750399 750448 770531 774r6 77437 774577 775675 610313 610313 Fund Dept ID Prog Prog Desc Acct Fund Aff Op Unit Account Deco FY 2019 FY 2020 FY 2021 Co. Exec Rec Revised Bud Rec Increase/ (Decrease) Co. Exec Rec Revised Bud Rec Increase/ (Decrease) Co Exec Rec Revised Bud Rec Increase/ (Decrease) Evenditures 28605 1060290 115140 28605 1060290 115140 28605 1060290 115140 28605 1060290 115140 28605 1060290 115140 28605 1060290 115140 Total Expenditures Expenditures 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 28607 1060230 133215 Total Expenditures Nurse Family Partnership (#286073 GR0000000279 Bud Ref. 2019 Activity: GLB Analysis: GLB Revenue 28607 1060230 133215 Nurse Family Partnership 28607 1060230 133215 Nurse Family Partnership Total Revenues 702010 702010 72M0 722/40 730 730 731 731 731446 731 6 Lab Enhancement Lab Enhancement Lab Enhancement Lab Enhancement Lab Enhancement Lab Enhancement Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Nurse Family Partnership Telephone Communications Federal Operating Grants Salaries Regular Fringe Benefits Indirect Costs Laboratory Supplies Insurance Fund Telephone Communications Federal Operating Grants Stale Operating Grants Salaries Regular Fringe Benefits Contracted Services Interpreter Fees Personal Mileage Printing Training Transportation of Clients Travel and Conference Incentives Office Supplies Postage-Standard Mailing Bldg Space Cost Allocation Info Tech Operations Info Tech Managed Print Svcs Insurance Fund Telephone Communications Federal Operating Grants Federal Operating Grants Salaries Regular Salaries Regular Fringe Benefits Fringe Benefits 26 Indirect Costs 26 Indirect Costs 88 Printing 88 Printing Personal Mileage Personal Mileage 28563 1060291 134420 CSI-ICS Outreach and Advocacy Total Expenditures Health Bioterrorism (#28605) GR0000000277 Bud Ref: 2019 Activity: GLB Analysis: GLB Revenue 28605 1060290 115140 Lab Enhancement Total Revenues Page 6 28610 1060290 116035 Cities Readiness 28610 1060290 115035 Cities Readiness 28610 1060290 115010 Bioterror Coordinator 28610 1060290 115035 Cities Readiness 28610 1060290 115035 Cities Readiness 28610 1060290 115010 Bioterror Coordinator 28610 1060290 115035 Cities Readiness 28610 1060290 115010 Bioterror Coordinator 28610 1060290 115035 Cities Readiness 28610 1060290 115035 Cities Readiness 28610 1060290 115035 Cities Readiness 28610 1060290 115010 Bioterror Coordinator 28610 1060290 115010 Bioterror Coordinator 28610 1060290 115035 Cities Readiness 28610 1060290 115010 Bioterror Coordinator 286/0 1060290 115035 Cities Readiness Total Expenditures Zika Mosquito Surveillance (#286181 GR0000000786 Bud Ref: 2019 Activity: GLB Analysis: GLB Revenue 28618 1060220 134865 ZIka Total Revenues Expenditures 28618 1060220 134865 Zfica 28618 1060220 134865 Ma 28618 1060220 134865 Zlica 28618 1060220 134865 Lica 28618 1060220 134865 Mica Total Expenditures Zika Community Support (#28618) GR0000000279 Bud Ref: 2019 Activity: GLB Analysis: GLB Revenue 28618 1060233 134865 Zika Total Revenues Expenditures 28618 1060233 134865 Zika 28618 1060233 134865 Zika 28618 1060233 134865 Zika 28618 1060233 134865 Zika Total Expenditures HIV Data to Care (#28619) GR0000009811 Bud Ref: 2019 Activity: GLB Analysis: GLB Revenue 28619 1060294 133250 Case Mgmt Total Revenues Expenditures 28619 1060294 133250 Case Mgmt 28619 1060294 133250 Case Mort 28619 1060294 133250 CaSe Mgmt 28619 1060294 133250 Case Mgmt 28619 1060294 133250 Case Mgmt 28619 1060294 133250 Case Mgmt 28619 1050294 133250 Case Mgmt 28619 1060294 133250 Case Mgmt 28619 1060294 133250 Case Mgmt 28619 1060294 133250 Case Montt Total Expenditures 7319,41 7320118 732018 732165 750077 750077 7503,99 750399 750448 77061 7746)36 774637 774677 774677 778675 778675 610313 702010 722740 730926 731346 750399 610313 730072 731388 750448 750567 615571 70110 722 40 73002 730926 731r) 73l58 750 45 774636 774677 778675 0 0 1,983 240 1,460 0 500 0 126 7,236 7,512 576 135 135 2,550 2 799 $374,518 3,000 11,555 4,950 3,000 2,000 5,131 1,681 1,500 270 2,530 9,146 1,400 270 180 2,700 1,400 $369 709 0 128,600 128,800 $0 $128,800 $128,800 70,979 0 39,400 1,273 0 9,078 500 0 2,000 2,019 3,024 0 191 0 336 $0 $128,800 70,979 39,400 1,273 9,078 500 2,000 2,019 3,024 191 336 $128,800 3,000 11,555 4,950 3,000 2,000 5,131 1,681 1,500 270 2,630 9,146 1,400 270 180 2,700 1.400 $369,709 3,000 11,555 2,967 2,760 550 5,131 1,181 1,500 144 (4,606) 1,634 824 135 45 150 (1,399) (54 809) 3,000 (3,000) 1,790 (1,700) 300 (300) 5 000 (5,000) $10,000 $0 ($10,000) 0 128,800 128,800 $0 $128,800 $128.800 70,979 39,400 1,273 9,078 500 2,000 2,019 3,024 191 336 $0 $128 800 70,979 39,400 1,273 9,078 500 2,090 2,019 3,024 191 336 $128,800 0 128.800 128800 $0 $128,890 $128,800 70,979 39,400 1,273 9,078 500 2,000 2,019 3,024 191 336 $128 800 70,979 39,400 1,273 9,078 500 2,000 2,019 3,024 191 336 $128,800 0 0 0 0 $0 Fund Dept ID Prog Prog Desc Act Fund Aff Op UM Account Desc FY 2019 FY 2020 FY 2021 Co. Exec Rec Revised Bud Rec Increase/ (Decrease) Co. Exec Rec Revised Bud Ret Increase/ (Decrease) Co Exec Rec Revised Bud Rec Increase/ (Decrease) • (10,000) 10,000 $0 ($10000) $10000 0 (3,959) 3,959 O (2,692) 2,692 O (472) 472 O (1,874) 1,874 0 (1,003) 1 003 $0 ($10,000) $10 000 • (10,000) 10,000 $0 ($10 000) $10,000 Training Travel and Conference Travel and Conference Workshops and Meeting Disaster Supplies Disaster Supplies Office Supplies Office Supplies Postage-Standard Mailing Bldg Space Cost Allocation Info Tech Operations Info Tech Managed Print Svcs Insurance Fund Insurance Fund Telephone Communications Telephone Communications Federal Operating Grants Salaries Regular Fringe Benefits Indirect Costs Personal Mileage Office Supplies Federal Operating Grants Advertising Printing Postage-Standard Mailing Training-Educational Supplies State Operating Grants Salaries Regular Fringe Benefits Advertising Indirect Costs Printing Professionai Services Incentives Info Tech Operations Insurance Fund Telephone Communications 0 1,983 240 1,450 0 500 0 126 7,236 7,512 576 135 135 2,550 2,799 $374,518 (10,000) 10,000 $0 ($10.000) $10000 (3,959) 3,959 (2,692) 2,692 0 (472) 472 0 (1,874) 1,674 (1,003) 1 003 $0 ($10,000) $10 000 0 (10.000) 10.000 $0 ($10 000) $10,009 10,000 $10,000 3,959 2,692 472 1,874 1,003 $10 000 10 000 $10 000 3,000 1,700 300 5,000 610,000 (3,000) (1,700) (300) (5,000) $0 ($10,000) 3,000 11,555 2,967 2,760 550 5,131 1,181 1,500 144 (4,606) 1,634 824 135 45 150 (1,399) (S4 809) 0 1,983 240 1,450 0 500 0 126 7,236 7,512 576 135 135 2,550 2.799 $374,518 3,000 1,700 300 5 000 $10 000 11,555 4,950 3,000 2,000 5,131 1,681 1,500 270 2,630 9,146 1,400 270 180 2,700 1,400 $369 709 11,555 2,967 2,760 550 5,131 1,181 1,500 144 (4,606) 1,634 824 135 45 150 (1,399) (S4 809) • (19,009) $0 ($10000) 0 (3,959) 0 (2,692) (472) (1,874) (1,003) $0 ($10,000) • (10,000) $0 ($10,000) (3,000) (1,700) (300) (5,000) $0 ($10,000) Page 7 Fund Dept ID Prog Frog Desc Acct Fund Aft Op Unit Account Desc FY 2019 FY 2020 FY 2021 Co. Exec Rec Revised Bud Rae Increase/ (Decrease) Co. Exec Rec Revised Bud Rec Increase/ (Decrease) Co Exec Roe Revised Bud Rec Increase/ (Decrease) 6155171 $5,000 Hen A Response 1#2862111 GR0000000614 Bud Ref: 2019 Activity: GLB Analysis: GLB Revenue 28620 1060290 133050 Outbreaks Total Revenues State Operating Grants 80 $5,000 $0 $5.000 $5,000 0 5 000 $0 $5,000 0 5,000 5,000 5,000 5,000 5,000 $5,000 7020t10 722740 7300}72 730928 730982 7313116 731388 7501 4 7502 4 750301 750329 760392 75039 750448 76010 774677 Expenditures Total Expenditures Outbreaks Outbreaks Outbreaks Outbreaks Outbreaks Outbreaks Outbreaks Outbreaks Outbreaks Outbreaks Outbreaks Outbreaks Outbreaks Outbreaks Outbreaks Outbreaks Salaries Regular Fringe Benefits Advertising Indirect Costs Interpreter Fees Personal Mileage Printing Expendable Equipment Material and Supplies Medical Supplies Medical Supplies-Injection Metered Postage Office Supplies Postage-Standard Mailing Equipment Insurance Fund 28620 1060290 133050 28620 1060290 133050 28620 1060290 133050 28620 1060290 133050 28620 1060290 133050 28620 1060290 133050 28620 1060290 133050 28620 1060290 133050 28620 1060290 133050 28620 1060290 133050 28620 1060290 133050 28620 1060290 133050 28620 1060290 133050 28620 1060290 133050 28620 1060290 133050 2E620 1060290 133050 0 0 4,993 0 0 0 0 0 7 $5,000 0 0 0 0 0 4,993 0 0 0 0 7 $5,000 a a $0 0 4,993 0 0 0 7 $5,000 4,993 0 7 $5,000 0 0 0 0 0 4,993 0 0 7 $5,000 0 0 0 0 4,993 0 7 $5,000 $0 West Nile Virus Surveillance (#28690) GR0000000722 Bud Ref: 2019 Activity: GLB Analysis: GLE3 Revenue 28690 1060220 134870 West Nile Total Revenues 610313 Federal Operating Grants 8,000 8,000 $8,000 $8,000 0 8,000 8,000 $0 $8,000 $8000 0 8,000 8.000 0 SO $8,000 $8,000 $0 Expenditures 28690 1060220 134870 28690 1060220 134870 28690 1060220 134870 28890 1060220 134870 28690 1060220 134870 28690 1080220 134870 28890 1060220 134870 Total Expenditures West Nile West Nile West Nile West Nile West Nile West Nile West Nile 702010 7227 0 73006 731346 732018 750399 774677 Salaries Regular Fringe Benefits Indirect Costs Personal Mileage Travel and Conference Office Supplies Insurance Fund 3,620 2,252 431 566 281 850 $8,000 3,693 2,184 472 577 281 781 12 $8,000 73 (68) 41 11 0 (69) 12 $0 3,620 2,252 431 566 281 850 0 $8,000 3,593 2,184 472 577 281 781 12 $8,000 73 (68) 41 11 (69) 12 $0 3,520 2,252 431 586 281 850 $8.000 3,693 2,184 472 577 281 781 12 $8,000 73 (68) 41 11 0 (59) 12 $0 Page 8 FISCAL NOTE (MISC. #18309) September 5, 2018 BY: Commissioner Thomas Middleton, Chairperson, Finance Committee IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION - 2018/2019 COMPREHENSIVE PLANNING, BUDGETING AND CONTRACTING (CPBC) AGREEMENT ACCEPTANCE To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: Pursuant to Rule XII-C of this Board, the Finance Committee has reviewed the above referenced resolution and finds: 1. Resolution authorizes acceptance of funding in the amount of $10,206,073 from the Michigan Department of Health and Human Services (MDHHS) through the Comprehensive Planning, Budgeting and Contracting Agreement (CPBC) for the period October 1, 2018 through September 30, 2019. 2. The initial FY 2019 agreement reflects a decrease in funding of $136,021 from the initial Fiscal Year 2017/2018 agreement amount of $10,342,094. 3. The FY 2019 agreement consists of $4,587,817 in General Fund Revenue, $5,618,256 in Grant Fund Revenue, and $257,590 for fees and collections for total program funding of $10,463,663. 4. Details of the total General Fund Revenue are as follows: Michigan Dept. of Health & Human Svcs. $2,251,290 Food Protection 859,213 MDEQ Private Drinking Water 514,301 MDEQ Private Sewage 372,426 Hearing 253,969 Vision 253,968 Sexually Transmitted Disease 82,650 Total General Fund $4,587,817 5. Details of the total Grant Fund Revenue are as follows: Adolescent Screening Immunization Action Plan Gonococcal Isolate WIC WIC Breastfeeding Peer Council TB Control Aids Prevention HIV Surveillance HIV Data to Care Hep A Response Vaccine Replacement/Handling Maternal Child Health Block CSHCS Outreach and Advocacy Infant Safe Sleep Public Health Emergency Preparedness BT Lab Program Cities Readiness Initiative Tobacco Reduction West Nile Virus Surveillance Nurse Family Partnership Total Grants Total Program $ 73,000 500,998 48,667 2,326.580 219,199 48,678 450,325 46,572 128,800 5,000 105,231 321,457 285,000 22,500 219,102 17,500 150,607 20,000 8,000 621,040 $5,618,256 $10,206,073 FINANCE COMMITTEE VOTE: Motion carried unanimously on a roll call vote with Crawford absent. 6. The General and Grant Fund Revenue Budgets are amended per the attached Schedule A to reflect the FY 2019 grant award of $10,206,073. 7. Schedule A also reflects revenue totaling $257,590 to recognize generated program fees and collections for CSHCS Outreach and Advocacy in the amount of $227,483 and Immunization Action Plan totaling $30,107. 8. The grant continues funding fifty-nine (69) Special Revenue (SR) positions as reflected on Schedule B. 9, Four (4) vacant Special Revenue (SR) positions as reflected on Schedule C to be deleted. Commissioner Thomas Middleton, District #4 Chairperson, Finance Committee Resolution #18309 September 5, 2018 Moved by Dwyer supported by Quarles the resolutions (with fiscal notes attached) on the Consent Agenda be adopted (with accompanying reports being accepted). AYES: Crawford, Dwyer, Gershenson, Gingell, Kochenderfer, Kowall, Long, McGillivray, Middleton, Spisz, Taub, Tietz, Weipert, Woodward, Zack, Berman, Bowman. (17) NAYS: None. (0) A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the Consent Agenda were adopted (with accompanying reports being accepted). (HR' APPROVE THIS RESOLUTION CHIEF DEPUTY COUNTY EXECUTIVE ACTING PURSUANT TO MCL 45.559A (7) STATE OF MICHIGAN) COUNTY OF OAKLAND) I, Lisa Brown, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and accurate copy of a resolution adopted by the Oakland County Board of Commissioners on September 5, 2018, 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 50 day of September, 2018. Lisa Brown, Oakland County 08/10/2018 Agreement #: Agreement Between Michigan Department of Health and Human Services hereinafter referred to as the "Department" and County of Oakland hereinafter referred to as the "Local Governing Entity" on Behalf of Health Department Oakland County Department of Health and Human Services/ Health Division 1200 N. Telegraph Rd. 34 East Pontiac MI 48341 0432 Federal I.D.#: 38-6004876, DUNS it: 136200362 hereinafter referred to as the "Grantee" for The Delivery of Public Health Services under the Local Health Department Agreement 1. Purpose This agreement is entered into for the purpose of setting forth a joint and cooperative Grantee/Department relationship and basis for facilitating the delivery of public health services to the citizens of Michigan under their jurisdiction, as described in the attached Annual Budget, established Minimum Program Requirements, and all other applicable Federal, State and Local laws and regulations pertaining to the Grantee and the Department. Public health services to be delivered under this agreement include Essential Local Public Health Services (ELPHS) and Categorical Programs as specified in the attachments to this agreement. 2. Period of Agreement: This agreement shall commence on the date of the Grantee's signature or October 1, 2018 whichever is later and continue through September 30, 2019. This agreement is in full force and effect for the period specified. The Department has the option to assume no responsibility for costs incurred by the Grantee prior to the signing of this agreement. 3. Program Budget and Agreement Amount A. Agreement Amount In accordance with Attachment IV - Funding/Reimbursement Matrix, the total State budget and amount committed for this period for the program elements covered by this agreement is $10,206,073.00. Local Health Department- 2019, Date: 08/10/2018 Page: 1 of 194 08/10/2018 B. Equipment Purchases and Title Any Grantee equipment purchases supported in whole or in part through this agreement must be specified in the Supporting Equipment Inventory Schedule as an attachment to the Final Financial Status Report. Equipment means tangible, non-expendable, personal property having useful life of more than one year and an acquisition cost of $5,000 or more per unit. Title to items having a unit acquisition cost of less than $5,000 shall vest with the Grantee upon acquisition. The Department reserves the right to retain or transfer the title to all items of equipment having a unit acquisition cost of $5,000 or more, - - e - - - • eee a". supports such retention or transfer of title. C. Budget Transfers and Adjustments 1. Transfers between categories within any program element budget supported in whole or in part by State/federal categorical sources of funding shall be limited to increases man expenditure budget category by $10,000 or 15% whichever is greater.. This transfer authority does not authorize purchase of additional equipment items or new subcontracts with state/federal categorical funds without prior written approval of the Department. 2. Any transfers or adjustments involving state/federal categorical funds, other than those covered by C.1, including any related adjustment to the total state amount of the budget, must be made in writing through a formal amendment executed by all parties to this agreement in accordance with Section IX. A. of Part II. 3. The C.1 and C.2 provisions authorizing transfers or changes in local funds apply also to the Family Planning program, provided statewide local maintenance of effort is not diminished in total. Any statewide diminishing of total local effort for family planning and/or any related funding penalty experienced by the Department shall be recovered proportionately from each local Grantee that, during the course of the agreement period, chose to reduce or transfer local funds from the Family Planning program. 4. Agreement Attachments A. The following documents are attachments to this Agreement Part I and Part II - General Provisions, which are part of this agreement through reference: 1. Attachment I - Annual Budget 2. Attachment III - Program Specific Assurances and Requirements 3. Attachment IV - Funding/Reimbursement Matrix 4. Attachment V - FY 2018 Agreement Addendum A B. The attachments are added into this Agreement as follows: 1. Original Agreement (Part I and Part II) - Attachment I, Ill, IV Local Health Department - 2019, Date: 08110/2018 Page 2 of 104 0811012018 Local Health Department - 2019, Date: 08/1012018 Page: 3 of 194 08/1012018 5. Statement of Work The Grantee agrees to undertake, perform and complete the service s d e s c r i b e d i n Attachment III - Program Specific Assurances and Requirements an d t h e o t h e r applicable attachments to this agreement which are part of this agre e m e n t t h r o u g h reference. 6. Method of Payments and Financial Reports The payment procedures shall be followed as described in Part ll and A t t a c h m e n t I - Annual Budget and Attachment IV - Funding/Reimbursement Matrix, whic h a r e p a r t o f this agreement through reference. 7. Performance/Progress Report Requirements The progress reporting methods, as applicable, shall be followed as desc r i b e d i n p a r t II and Attachment Ill, Program Specific Assurances and Requirements, w h i c h a r e p a r t of this agreement through reference. 8. General Provisions The Grantee agrees to comply with the General Provisions outlined in P a r t I I , w h i c h are part of this agreement through reference. 9. Administration of the Agreement The person acting for the Department in administering this agreem e n t ( h e r e i n a f t e r referred to as the Contract Consultant) is Name: Jeanette Hensler Title: Division Director Telephone 517-241-8764 E-Mail Address henslerjl@michigan.gov 10. Special Conditions A. This agreement is valid upon approval and execution by the Departm e n t w h i c h may be contingent upon State Administrative Board and Signature b y t h e Grantee. B. The Department and Grantee, under the terms of this agreement shall, s u b j e c t to availability of funding and other applicable conditions, provide r e s o u r c e s and continuous services throughout the period of this agreement as sho w n i n Attachment I - Annual Budget. C. The Department has the option to assume no responsibility or liability f o r c o s t s incurred by the Grantee prior to the signing of this agreement. D. The Grantee is required by PA 533 of 2004 to receive payments by e l e c t r o n i c funds transfer. Local Health Depariment - 2019, Date: 0811012018 Page: 4 of 104 08/10/2018 11. Special Certification The individual or officer signing this agreement certifies by his or h e r s i g n a t u r e t h a t h e or she is authorized to sign this agreement on behalf of the respo n s i b l e g o v e r n i n g board, official or Grantee. 12. Signature Section For Oakland County Department of Health and Human Se r v i c e s / H e a l t h D i v i s i o n Michael J Gingell Chairperson Name Title For the Michigan Department of Health and Human Services Christine H. Sanches 08/10/2018 Christine H. Sanches, Director Date Bureau of Grants and Purchasing Local Health Department - 2019, Date 0811012018 Page, 5 of 194 08/10/2018 Part II General Provisions Responsibilities - Grantee The Grantee in accordance with the general purposes and objectives of this agreement will: A. Publication Rights 1. Where the Grantee exclusively develops books, films, or other such copyrightable materials through activities supported by this agreement, the Grantee may copyright those materials. The materials that the rantee onvrrn CHIE personal identification data. Grantee grants the Department a royalty- free, non-exclusive and irrevocable license to reproduce, publish and use such materials copyrighted by the Grantee and authorizes others to reproduce and use such materials. 2. Any materials copyrighted:1)y the Grantee or modifications bearing acknowledgment of the Department's name must be approved by the Department before reproduction and use of such materials. The State of Michigan may modify the Material copyrighted by the Grantee and may combine it with otherbopyrightable intellectual property to form a derivative Work. The State of Michigan will own and hold all copyright and other intellectual property rights in any such derivative work, excluding. any rights or interest granted in this agreement to the Grantee. If the Grantee ceases to conduct business for any reason, or ceases to support the copyrightable materials developed under this agreement, the State of Michigan has the right to convert its licenses into transferable licenses to the extent consistent with any applicable obligations the Grantee has to the federal government. 3. The Grantee shall give recognition to the Department in any and all publications papers and presentations arising from the program and service contract herein; the Department will do likewise. 4. The Grantee must notify the Department's Bureau of Grants and Purchasing 30 days before applying to register a copyright with the U.S. Copyright Office. The Grantee must submit an annual report for all copyrighted materials developed by the Grantee through activities supported by this agreement and must submit a final invention statement and certification within 90 days of the end of the agreement period. 5. Not make any media releases related to this agreement, without prior written authorization from the Department's Communication office. Fees 1. Guarantee that any claims made to the Department under this Local Health Department - 2019, Date: 0811012018 Page: 6 of 194 08110/2018 Agreement shall not be financed by any sources other than t h e Department under the terms of this Agreement. If funding is re c e i v e d through any other source, the Grantee agrees to budget the addit i o n a l source of funds and reflect the source of funding on the Financ i a l S t a t u s Report. 2. Make reasonable efforts to collect 1st and 3rd party fees, wh e r e applicable, and report those collections on the Financial Status R e p o r t . Any unclerrecoveries of otherwise available fees resulting from failur e t o bill for eligible services will be excluded from reimbursable expend i t u r e s . C. Grant Program Operation Provide the necessary administrative, professional, and tec h n i c a l s t a f f f o r operation of the grant program. Obtain and maintain all necess a r y l i c e n s e s , permits or other authorizations necessary for the perfor m a n c e o f t h i s Agreement. D. Reporting Utilize all report forms and reporting formats required by the Departm e n t a t t h e effective date of this agreement, and provide the Departmen t w i t h t i m e l y review and commentary on any new report forms and rep o r t i n g f o r m a t s proposed for issuance thereafter. - E. Record MaintenakeiRetention Maintain adequate program and fiscal records and files, inc l u d i n g s o u r c e documentation, to support program activities and all expenditures m a d e u n d e r the terms of this agreement, as required. Assure that all t e r m s o f t h e agreement will be appropriately adhered to and that records an d d e t a i l e d documentation for the grant project or grant program id e n t i f i e d i n t h i s agreement Will be maintained for a period of not less than three yea r s f r o m t h e date of termination, the date of submission of the final expend i t u r e r e p o r t o r until litigation and audit findings have been resolved. This Sectio n a p p l i e s t o Grantee, any parent, affiliate, or subsidiary organization of Gran t e e , a n d a n y subcontractor that performs Agreement Activities in connectio n w i t h t h i s Agreement. F. Authorized Access 1. Permit within 10 calendar days of providing notification and a t reasonable times, access by authorized representatives o f t h e Department, Federal Grantor Agency, Inspector Generals, Comptr o l l e r General of the United States and State Auditor General, or any o f t h e i r duly authorized representatives, to records, papers, files, document a t i o n and personnel related to this agreement, to the extent authoriz e d b y applicable state or federal law, rule or regulation. 2. The rights of access is this section are not limited to the r e q u i r e d retention period but last as long as the records are retained, Local Health Department - 2019, Date: 08/1012018 Page: 7 of 194 08/10/2018 3. Grantee must cooperate and provide reasonable assistance to authorized representatives of the Department and others when those individuals have access to Grantee's grant records. G. Audits 1. Single Audit Grantee must submit to the Department a Single Audit consistent with the regulations set forth in Title 2 Code of Federal Regulations (CFR) Part 200, Subpart F. The Single Audit reporting package must include all components described in Title 2 Code of Federal Regulations, Section 200.512 (c) including a Corrective Action Plat', cold management letter (if one is issued) with a response to the Department. The Grantee must assure that the Schedule of Expenditures of Federal Awards includes expenditures for all federally-funded grants. 2. Other Audits The Department or federal agencies, may also conduct or arrange for "agreed upon procedures" or additional audits to meet their needs. 3. Due Date and Where to Send The Single Audit reporting package, management letter (if one is issued) with a response and Corrective Action Plan shall be submitted to the Department within nine months after the end of the Grantee's fiscal year by 6-mail at,MDHHS-AuditReports@michigan.gov . The required submission must be assembled as one document in a PDF file and compatible with Adobe Acrobat (read only). The subject line must state the agency name and fiscal year end. The Department reserves the right to request a hard copy of the audit materials if for any reason the electronic submission process is not successful. 4. Penalty a. Delinquent Single Audit or Financial Related Audit If the Grantee does not submit the required Single Audit reporting package, management letter (if one is issued) with a response, and Corrective Action Plan within nine months after the end of the Grantee's fiscal year and an extension has not been approved by the cognizant or oversight agency for audit, the Department may withhold from the current funding an amount equal to five percent of the audit year's grant funding (not to exceed $200,000) until the required filing is received by the Department. The Department may retain the amount withheld if the Grantee is more than 120 days delinquent in meeting the filing requirements and an extension has not been approved by the cognizant or oversight agency for audit. The Department may terminate the current grant if the Grantee is Locai Fleaith Department - 2019, Date: 08/1012018 Page, 8 of 194 08/10/2018 more than 180 days delinquent in meeting the filing requirements and an extension has not been approved by t h e cognizant or oversight agency for audit. b. Delinquent Audit Exemption Notice Failure to submit the Audit Exemption Notice, when requir e d , may result in withholding payment from Department to Grantee an amount equal to one percent of the audit year's gra n t funding until the Audit Exemption Notice is received. LirecipkntIContractor Monitoring When passing federal funds through to a subrecipient (if the a g r e e m e n t d o e s not prohibit the passing of federal funds through to a s u b r e c i p i e n t ) , t h e Grantee must: 1. Ensure that every subaward is clearly identified to the subrecipien t a s a subaward and includes the information required by 2 CFR 200.3 3 1 ( a ) . 2. Evaluate each subrecipient'S risk for noncompliance as required b y 2 CFR 200.331(b). 3. Monitor the activities of the subrecipient as necessary to ensure t h a t t h e subaward is used for authorized purposes, in compliance wit h f e d e r a l statutes, regulations, and the terms and conditions of the suba w a r d s ; that subaward performance goals are achieved; and that all m o n i t o r i n g requirements of 2 .CFR 200.331(d) are met including reviewing f i n a n c i a l and programmatic reports, following up on corrective actions, and issuing Management decisions for audit findings. 4. Verify that every subrecipient is audited as required by Subpart F o f 2 CFR 200. The Grantee must develop a subrecipient monitoring plan that a d d r e s s e s t h e above requirements and provides reasonable assurance tha t t h e s u b r e c i p i e n t administers federal awards in compliance with laws, regulati o n s , a n d t h e provisions of contracts, and that performance goals are a c h i e v e d . T h e subrecipient monitoring plan should include a risk-based a s s e s s m e n t t o determine the level of oversight, and monitoring activities, s u c h a s r e v i e w i n g financial and performance reports, performing site visits, an d m a i n t a i n i n g regular contact with subrecipients. The Grantee must establish requirements to ensure complianc e f o r f o r — p r o f i t subrecipients as required by Title 2 (CFR), Section 200.501(h), a s a p p l i c a b l e . The Grantee must ensure that transactions with contractors co m p l y w i t h l a w s , regulations, and provisions of contracts or grant agreements in c o m p l i a n c e with Title 2 CFR, Section 200.501(h), as applicable. 1. Notification of Modifications Provide timely notification to the Department, in writing, of any a c t i o n b y t h e Grantee, its governing board or any other funding source whi c h w o u l d r e q u i r e Lacal Health Department- 2010, Date: 0811012018 Page: 9 of 194 08/10/2018 or result in significant modification in the provision of services, funding or compliance with operational procedures. Local Health Department - 2019, Date: 0811012018 Page 10 of 194 08/10/2018 J. Software Compliance Ensure software compliance and compatibility with the Department's data systems for services provided under this agreement including, but not limited to: stored data, databases, and interfaces for the production of work products and reports. All required data under this agreement shall be provided in an accurate and timely manner without interruption, failure or errors due to the inaccuracy of the Grantee's business operations for processing date/time data. All information systems, electronic or hard copy that contain state or federal data must be protected from unauthorized access. K. Human Subjects Comply with Protection of Human Subjects Act, 45 CFR, Part 46. The Grantee agrees that prior to the initiation of the research, the Grantee will submit Institutional Review Board (IRB). application material for all research involving human subjects, which is conducted in programs sponsored by the Department or in programs which receive funding from or through the state of Michigan, to the Department's IRB for review and approval, or the IRB application and approval materials for acceptance of the review of another IRB. All such research mist be approved by a federally assured IRB, but the Department's 1RB can only accept the review and approval of another institution's IRB under a formally-approved IRB Authorization Agreement. The manner of the review will be agreed upon between the Department's Signatory Official and thaGrantee's1RB chairperson or executive officer(s). L. Mandatory Disclosures 1. Disclose to the Department in writing within 14 days of receiving notice of any litigation, investigation, arbitration, or other proceeding (collectively, "Proceeding") involving Grantee, a subcontractor, or an officer or director of Grantee or subcontract, or that arises during the term of this Agreement including: a. All violations of federal and state criminal law involving fraud, bribery, or gratuity violations potentially affecting the agreement. b. A criminal Proceeding; c. A parole or probation Proceeding; d. A Proceeding under the Sarbanes-Oxley Act; e. A civil Proceeding involving: 1. A claim that might reasonably be expected to adversely affect Grantee's viability or financial stability; or 2. A governmental or public entity's claim or written allegation of fraud; or f. A Proceeding involving any license that Grantee is required to possess in order to perform under this Agreement. Local Health Deparlment - 2019, Date: 08/1012018 Page: 11 of 194 08/10/2018 2. Notify the Department, at least 90 calendar days before the effective date, of a change in Grantee's ownership and/or executive management. M. Minimum Program Requirements Comply with Minimum Program Requirements established in accordance with Section 2472.3 of 1978 PA 368 as amended, MCL 333.2472,3, MSA 14.15 (2472.3), for each applicable program element funded under this agreement. N. Annual Budget and Plan Submission To submit an Annual Budget and Plan request to the Department, in merit, to serve-as-the accorsancewi ns ruc ions es a• - • • - - basis for completion of specific details for Attachments I, Ill, and IV of this agreement via Grantee/Department negotiated amendment(s). Failure to submit a complete Annual Budget and Plan by the due date through MI E- Grants will result in the deferral of Department payments until these documents are submitted. 0. Maintenance of Effort Comply with maintenance of effort requirements for Essential Local Public Health Services (ELPHS), as defined in the current Department appropriation act, and Family Planning in accordance with federal requirements, except as noted in Section 3C.3 of Part I. P. Accreditation I. Comply with the local public health accreditation standards and follow the accreditation process and schedule established by the Department to achievefull accreditation status. a, Grantees that fail to meet all accreditation requirements and/or implement corrective plans of action within the prescribed time period will receive the status of "Not Accredited." Grantees designated as "Not Accredited" may have their Department allocations reduced for costs incurred in the assurance of service delivery. b. Grantees that disagree with on-site review findings or their accreditation status may request an inquiry through written request to the Department. The request must identify the disagreement and resolution sought. The inquiry participants will be comprised of Grantee staff, Department staff, the Accreditation Commission Chair, and the Accreditation Coordinator as needed. Participants will clarify facts, verify information and seek resolution. 2. Consent Agreements/Administrative Compliance Orders/Administrative Hearings for "Not Accredited" Grantees: a, Grantees designated as "Not Accredited", will receive a Local Health Department - 2019, Date 0W10/2018 Page: 12 of 194 08/10/2018 Consent Agreement Package from the Department. Grantees and their local governing entities shall be given 75 days t o review the package, meet with the Department, and sign/return the Consent Agreement. b. Fulfillment of the terms and conditions of the Consent Agreement will not affect accreditation status, but impacts the Grantees' ability to fulfill its contractual obligations under the Comprehensive Planning, Budgeting and Contracting Agreement. Grantees designated as "Not Accredited", wil l retain this designation until the subsequen c. Grantee failure to fulfill the terms and conditions of the Consent Agreement within the prescribed time period will result in the issuance of an Administrative Compliance Order by the Department. d. Within 60 working days after receipt of an Administrative Compliance Order and proposed compliance period, a local governing entity may petition the Department for an administrative hearing. If the local governing entity does no t petition the Department for a hearing within 60 days after receipt of an Administrative Compliance Order, the order and proposed compliance date shall be final. After a hearing, the ' DepartMent may reaffirm, modify, or revoke the order or modify •the time permitted for compliance. If the local governing entity fails to correct a deficiency for which a final order has been issued within the period permitted for compliance, the Department may petition the appropriate circu i t court for a writ of mandamus to compel correction. Q. Medicaid Outreach Activities Reimbursement The Grantee agrees to report allowable costs and request reimb u r s e m e n t f o r the Medicaid Outreach activities it provides in accordance w i t h 2 C F R , P a r t 200 and the requirements in Medicaid Bulletin number: MSA 05- 2 9 . The Grantee agrees to submit a Cost Allocation Plan Certifica t i o n t o t h e Department to bill for the Medicaid Outreach Activities. The C o s t A l l o c a t i o n Plan Certification is valid until a change is made to the cost alloca t i o n p l a n o r the Department determines it is invalid. The Grantee will submit quarterly FSRs for the Medicaid Outrea c h a c t i v i t i e s and an annual FSR for the Children with Special Health C a r e S e r v i c e s Medicaid Outreach activities in accordance with the instructions c o n t a i n e d i n Attachment I. In accordance with the Medicaid Bulletin, MSA 05-29, the Gran t e e a g r e e s t o target their Medicaid outreach effort toward Department estab l i s h e d p r i o r i t i e s . Local Health Department - 2019, Date: 08/10/2018 Page: 13 of 194 08/10/2018 For fiscal year 2018, the Department priorities are: lead testing, outreach and enrollment for the Family Planning waiver, and outreach for pregnant women, mothers and infants for the Maternal and Infant Health Program. The Grantee will submit a report using the MDHHS Local Health Department Medicaid Outreach form describing their outreach activities targeting the priorities 30 days after the end of a fiscal year quarter and at the same time as the final COMPREHENSIVE FSR is due into the Department. The Local Health Department Medicaid Outreach report are to be sent through MI E-Grants as an attachment report to the Financial Status Report. R. Conflict ofinterestatui_Cade_ol_Conduct Standards 1. The Grantee is subject to the provisions of 1968 PA 317, as amended, 1973 PA 196, as amended, and Title 2 Code of Federal Regulations, Section 200.318 (c) (1) and (2). 2. The Grantee will uphold high ethical standards and is prohibited from: a. Holding or acquiring an interest that would conflict with this Agreement; b. Doing anything that creates an appearance of impropriety with respect to the award or performance of this Agreement; c. Attempting toinfluence or appearing to influence any State employee by the direct or indirect offer of anything of value; or d. Paying or agreeing to pay any person, other than employees and consultants working for Grantee, any consideration contingent upon the award of this Agreement. 3. Immediately notify the Department of any violation or potential violation of these standards. This Section applies to Grantee, any parent, affiliate, or subsidiary organization of Grantee, and any subcontractor that performs Agreement activities in connection with this agreement. S. Travel Costs 1. Be reimbursed for travel cost (including mileage, meals, and lodging) budgeted and incurred related to services provided under this agreement. 2. If the Grantee has a documented policy related to travel reimbursement for employees and if the Grantee follows that documented policy, the Department will reimburse the Grantee for travel costs at the Grantee's documented reimbursement rate for employees. Otherwise, the State of Michigan travel reimbursement rate applies. 3. State of Michigan travel rates may be found at the following website: http://www.michigan.govidtmb/0.5552.7-150-9141_13132-.00.html. T. Insurance Requirements 1. Maintain a minimum of the insurances or governmental self-insurances Local Health Department - 2019, Date: 08/10/201B Page: 14 of 194 08110/2018 listed below and is responsible for all ded u c t i b l e s . A l l r e q u i r e d insurance or self-insurance must: a. Protect the State of Michigan from claims that m a y a r i s e o u t o f , are alleged to arise out of, or result from Gr a n t e e ' s o r a subcontractor's performance; b. Be primary and non-contributing to any comp a r a b l e l i a b i l i t y insurance (including self-insurance) carried b y t h e S t a t e ; a n d C. Be provided by a company with an A.M. Bes t r a t i n g o f " A " o r ._____b_etter and a financial size of VII or better. 2. Insurance Types a. Commercial General Liability Insurance or Gov e r n m e n t a l S e l f - Insurance: Except for Governmental Self—Insura n c e , p o l i c i e s must be endorsed to add "the State of Mic h i g a n , i t s departments, divisions, agencies, offices, co m m i s s i o n s , officers, employees, and agents" as additional i n s u r e d s u s i n g endorsement CG 2010 07 04 and CG 2037 07 04. If the Grantee will deal with children, schools, or t h e c o g n i t i v e l y impaired, coverage must not have exclusio n s o r l i m i t a t i o n s related to sexual abuse and molestation liabil i t y . b. :Workers' Compensation Insurance or Go v e r n m e n t a l S e l f - Insurance: Coverage according to applicable l a w s g o v e r n i n g work activities Waiver of subrogation, except whe r e w a i v e r i s prohibited by law. c, Employers Liability Insurance or Governmental Se l f - I n s u r a n c e 3. Grantees must require that subcontractors m a i n t a i n t h e r e q u i r e d insurances contained in this Section. 4. This Section is not intended to and is not to be con s t r u e d i n a n y m a n n e r as waiving, restricting or limiting the liability o f t h e G r a n t e e f r o m a n y obligations under this agreement. 5. Each Party must promptly notify the other Part y o f a n y k n o w l e d g e regarding an occurrence which the notifying Pa r t y r e a s o n a b l y b e l i e v e s may result in a claim against either Party. The Par t i e s m u s t c o o p e r a t e with each other regarding such claim. U. Terms The Grantee must abide by the terms of th i s a g r e e m e n t i n c l u d i n g a l l attachments. II. Responsibilities - Department The Department in accordance with the gener a l p u r p o s e s a n d o b j e c t i v e s o f t h i s agreement wilt: A. Payment Local Health Department- 2019, Date 0811012018 Page. 15 of 194 08/10/2018 Provide payment in accordance with th e t e r m s a n d c o n d i t i o n s o f t h i s agreement based upon appropriate reports , r e c o r d s , a n d d o c u m e n t a t i o n maintained by the Grantee. B. Report Forms Provide any report forms and reporting forma t s r e q u i r e d b y t h e D e p a r t m e n t a t the effective date of this agreement, and p r o v i d e t o t h e G r a n t e e a n y n e w report forms and reporting formats proposed f o r i s s u a n c e t h e r e a f t e r a t l e a s t 9 0 days prior to their required usage in order to a f f o r d t h e G r a n t e e a n o p p o r t u n i t y ------to-review-and-offer_comment. C. Notification of Modifications To notify the Grantee in writing of modifica t i o n s t o f e d e r a l o r s t a t e l a w s , r u l e s and regulations affecting this agreement. D. Identification of Laws To identify for the Grantee relevant la w s , r u l e s , r e g u l a t i o n s , p o l i c i e s , procedures, guidelines and state and fed e r a l m a n u a l s , a n d p r o v i d e t h e Grantee with copies of these documents t o t h e e x t e n t t h e y a r e n o t o t h e r w i s e available to the Grantee. E. Modification of Funding . To notify the Grantee in writing within 30 ca l e n d a r d a y s o f b e c o m i n g a w a r e o f the need for any Modifications in agree m e n t f u n d i n g c o m m i t m e n t s m a d e necessary by action of the federal governm e n t , t h e g o v e r n o r , t h e l e g i s l a t u r e o r the Department of Technology Manag e m e n t a n d B u d g e t o n b e h a l f o f t h e governor or the legislature. Implement a t i o n o f t h e m o d i f i c a t i o n s w i l l b e determined jointly by the Grantee and the D e p a r t m e n t . F. Monitor Compliance To monitor dornpliance with all applicable p r o v i s i o n s c o n t a i n e d i n f e d e r a l g r a n t awards and their attendant rules, regulat i o n s a n d r e q u i r e m e n t s p e r t a i n i n g t o program elements covered by this agreem e n t . G. Reimbursement To reimburse local agencies for cost s b a s e d u p o n t i m e l y , a c c u r a t e l y completed Financial Status Reports in a c c o r d a n c e w i t h S e c t i o n I V , H. Technical Assistance To make technical assistance available to t h e G r a n t e e f o r t h e i m p l e m e n t a t i o n of this agreement. I. Health Insurance Portability and Accou n t a b i l i t y The Department assures that it will be in co m p l i a n c e w i t h t h e H e a l t h I n s u r a n c e Portability and Accountability Act. J. Accreditation The Department agrees to adhere to the a c c r e d i t a t i o n r e q u i r e m e n t s i n c l u d i n g the process for "Not Accredited" Grante e s . T h e p r o c e s s i n c l u d e s d e v e l o p i n g Local Heaith Depallment - 2019, Dale: 08/10/2018 Page: 16 of 194 08/10/2018 and monitoring consent agreements, issuing and monitoring administrative compliance orders, participating in administrative hearings and petitioning appropriate circuit courts. Local Health Department - 2019, Date: 08110/2018 Page: 17 of 194 013/10/2018 K. Medicaid Outreach Activities Reimbursement The Department agrees to reimburse the Grantee for all allowable Medicaid Outreach activities that meet the standards of the Medicaid Bulletin: MSA 05- 29 including the cost allocation plan certification and that are billed in accordance with the requirements in Attachment 1. In accordance with the Medicaid Bulletin, MSA 05-29, the Department will identify each fiscal year the Medicaid Outreach priorities and establish a reporting requirement for the Grantee. 111—Aszurances The following assurances are hereby given to the Department: A. Compliance with Applicable Laws The Grantee will comply with applicable federal and state laws, guidelines, rules and regulations in carrying out the terms of this agreement. The Grantee will also comply with all applicable general administrative requirements, such as Title 2 Code of Federal Regulations (CFR) covering cost principles, grant/agreement principles, and audits, in carrying out the terms of this agreement. The Grantee will comply with all applicable requirements in the original grant awarded to the Department if the Grantee is a subgrantee. The Department may determine that the Grantee has not complied with applicable federal or state .laws, guidelines, rules, and regulations in carrying out the terms of this agreement and May then terminate this agreement under Part II Section V. B. Anti-Lobbying Act The Grantee will comply with the Anti-Lobbying Act, 31 USC 1352 as revised by the Lobbying Disclosure Act of 1995, 2 USC 1601 et seq, and Section 503 of the DepartMents of Labor, Health and Human Services, and Education, and Related Agencies section of the FY 1997 Omnibus Consolidated Appropriations Act (Public Law 104-208). Further, the Grantee shall require that the language of this assurance be included in the award documents of all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. C. Non-Discrimination 1. In the performance of any contract or purchase order resulting herefrom, the Grantee agrees not to discriminate against any employee or applicant for employment or service delivery and access, with respect to their hire, tenure, terms, conditions or privileges of employment, programs and services provided or any matter directly or indirectly related to employment, because of race, color, religion, national origin, ancestry, age, sex, height, weight, marital status, physical or mental disability unrelated to the individual's ability to perform the duties of the Local Health Department 2019, Date: 08/1012018 Page: 18 of 194 08110/2018 particular job or position or to receive s e r v i c e s . T h e G r a n t e e f u r t h e r agrees that every subcontract entered in t o f o r t h e p e r f o r m a n c e o f a n y contract or purchase order resulting h e r e f r o m w i l l c o n t a i n a p r o v i s i o n requiring non-discrimination in emplo y m e n t , s e r v i c e d e l i v e r y a n d access, as herein specified binding upo n e a c h s u b c o n t r a c t o r . T h i s covenant is required pursuant to the Ellio t - L a r s e n C i v i l R i g h t s A c t , 1 9 7 6 PA 453, as amended, MCL 37.2101 et s e q . , a n d t h e P e r s o n s w i t h Disabilities Civil Rights Act, 1976 PA 22 0 , a s a m e n d e d , M C L 3 7 . 1 1 0 1 e t seq., and any breach thereof may be r e g a r d e d a s a m a t e r i a l b r e a c h o f the contract or purchai-d-d --- 2. The Grantee will comply with all federal st a t u t e s r e l a t i n g t o nondiscrimination. These include but a r e n o t l i m i t e d t o : a. Title VI of the Civil Rights .Act of 1964 (P.L. 88-352) which prohibits discrimination On the basis of r a c e , c o l o r o r n a t i o n a l origin; b. Title IX of the Education Amendmentsof 1 9 7 2 , a s a m e n d e d ( 2 0 U.S.C. §§1681-1683,i:::and 1685-1686), w h i c h p r o h i b i t s discrimination on the basis of sex; c. Section 504 of the Rehabilitation Act of 1 9 7 3 , a s a m e n d e d ( 2 9 §794),. Which prohibits discrimination on th e b a s i s o f disabilities d. the Age Discrimination Act of 1975, as a m e n d e d ( 4 2 U . S . C . 06101-6107), which prohibits discriminat i o n o n t h e b a s i s o f age; this Drug Abuse Office and Treatment A c t o f 1 9 7 2 ( P . L . 9 2 - 255), as amended, relating to nondiscrimin a t i o n o n t h e b a s i s o f drug abuse; f. the Comprehensive Alcohol Abuse and A l c o h o l i s m P r e v e n t i o n , Treatment and Rehabilitation Act of 197 0 ( P . L . 9 1 - 6 1 6 ) a s amended, relating to nondiscrimination on t h e b a s i s o f a l c o h o l abuse or alcoholism; g. §§523 and 527 of the Public Health Serv i c e A c t o f 1 9 1 2 ( 4 2 U.S.C. §§290 dd-3 and 290 ee 3), as ame n d e d , r e l a t i n g t o confidentiality of alcohol and drug abuse p a t i e n t r e c o r d s h. any other nondiscrimination provisions in t h e s p e c i f i c s t a t u t e ( s ) under which application for federal assi s t a n c e i s b e i n g m a d e ; and, i. the requirements of any other nondiscr i m i n a t i o n s t a t u t e ( s ) which may apply to the application. 3. Additionally, assurance is given to the De p a r t m e n t t h a t p r o a c t i v e e f f o r t s will be made to identify and encourag e t h e p a r t i c i p a t i o n o f m i n o r i t y Local Health Department - 2019, Date: 08/10 / 2 0 1 8 Page; 19 of 194 08/10/2018 owned and women owned businesses, and businesses owned by persons with disabilities in contract solicitations. The Grantee shall incorporate language in all contracts awarded: (1) prohibiting discrimination against minority owned and women owned businesses and businesses owned by persons with disabilities in subcontracting; and (2) making discrimination a material breach of contract. D. Debarment and Suspension The Grantee will comply with Federal Regulation, 2 CFR 180 and certifies to the best of it knowledge and belief that the Grantee's local health department em ees-,- official-of-the-Grantee,s-lecal-health-department-and-the-Grantee!s subcontractors: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or Grantee: 2. Have not within a three-year period preceding this agreement been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract Under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property, 3. Are not presently indicted or otherwise criminally or civilly charged by a -government entity (federal, state or local) with commission of any of the offenses enumerated in section 2, and; 4. Have not within a three-year period preceding this agreement had one or more public transactions (federal, state or local) terminated for cause or default. E. Federal Requirement: Pro-Children Act 1. The Grantee will comply with Public Law 103-227, also known as the Pro-Children Act of 1994, 20 USC 6081 et seq, which requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted by and used routinely or regularly for the provision of health, day care, early childhood development services, education or library services to children under the age of 18, if the services are funded by federal programs either directly or through state or local governments, by federal grant, contract, loan or loan guarantee. The law also applies to children's services that are provided in indoor facilities that are constructed, operated, or maintained with such federal funds. The law does not apply to children's services provided in private residences; portions of facilities used for inpatient drug or alcohol treatment; service providers whose sole source of applicable federal Local Health Department - 2019, Date: 08/10/2018 Page: 20 of 194 08/10/2018 funds is Medicare or Medicaid; or facilities where Women, Infants, and Children (WIC) coupons are redeemed. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity. The Grantee also assures that this language will be included in any subawards which contain provisions for children's services. 2. The Grantee also assures, in addition to compliance with Public Law 103-227, any service or activity funded in whole or in part through this agreement will be delivered in a smoke-free facility or environment. Smoking-shati-not be permitted—anywhere in-the-facifitvor-thuse-p-arts-of the facility under the control of the Grantee. If activities or services are delivered in facilities or areas that are not under the control of the Grantee (e.g., a mall, restaurant or private work site), the activities or services shall be smoke-free. F. Hatch Political Activity Act and Intergovernmental Personnel Act The Grantee will comply with the Hatch Political Activity Act, 5 USC 1501-1509 and 7324-7328, and the Intergovernmental Personnel Act of 1970, as amended by Title VI of the Civil Service Reform Act, Public Law 95-454, 42 USC 4728 - 4763, Federal funds cannot be used for partisan political purposes of any kind by any person or organization involved in the administration, of federally-assisted programs. G. National Defense Authoriation Act Employee Whistleblower Protections The Grantee will comply with the National Defense Authorization Act "Pilot Program for Enhancement of Grantee Employee Whistleblower Protections". 1. This agreement and employees working on this agreement will be subject to the whistleblower rights and remedies in the pilot program on Grantee employee whistleblower protections established at 41 U.S.C. 4712 by section 828 of the National Defense Authorization Act for Fiscal Year 2012 and FAR 3.908. 2. The Grantee shall inform its employees in writing, in the predominant language of the workforce, of employee whistleblower rights and protections under 41 U.S.C. 4712, as described in section 3.908 of the Federal Acquisition Regulation. 3. The Grantee shall insert the substance of this clause, including this paragraph (3), in all subcontracts over the simplified acquisition threshold. H. Clean Air Act and Federal Water Pollution Control Act The Grantee will comply with the Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), as amended. This agreement and anyone working on this agreement will be subject to the Local Health Department - 2019, Date: 08110/2018 Page: 21 of 194 0811012018 Clean Air Act and Federal Water Pollution Co n t r o l A c t a n d m u s t c o m p l y w i t h all applicable standards, orders or regulations i s s u e p u r s u a n t t o t h e s e A c t s . Violations must be reported to the Department, Local Health Department - 2C119, Date: 013/10/2018 Page. 22 of 194 08/1012018 Subcontracts For any subcontracted service, activity or product, the Grantee will ensure: 1. That a written subcontract is executed by all affected parties prior to the initiation of any new subcontract activity. Exceptions to this policy may be granted by the Department upon written request. 2. That any executed subcontract shall require the subcontractor to comply with all applicable terms and conditions of this agreement. In the event of a conflict between this agreement and the provisions of the subcontract, the provisions of this agreement shall prevail. A conflict between this agreement and a subcontract, however, shall not be deemed to exist where the subcontract: a. Contains additional non-conflicting provisions not set forth in this agreement; or b. Restates provisions of this agreement to afford the Grantee the same or substantially the same rights and privileges as the Department; or • c. Requires the subcontractor to perform duties and/or services in less time than that afforded the Grantee in this agreement. 3. That the subcontract does not affect the Grantee's accountability to the Department for the subcontracted activity. 4. That any billing orrequest for reimbursement for subcontract costs is supported by a valid subcontract and adequate source documentation on costs and services. 5. That the Grantee will submit a copy of the executed subcontract if requested by the Department. 6. That subcontracts in support of programs or elements utilizing funds provided by the Department, the State of Michigan or the federal government in excess of $10,000 shall contain provisions or conditions that will: a. Allow the Grantee or Department to seek administrative, contractual or legal remedies in instances in which the Contractor violates or breaches contract terms, and provide for such remedial action as may be appropriate. b. Provide for termination by the Grantee, including the manner by which termination will be effected and the basis for settlement. 7. That all subcontracts in support of programs or elements utilizing funds provided by the Department, the State of Michigan or the federal government of amounts in excess of $100,000 shall contain a provision that requires compliance with all applicable standards, orders or regulations issued pursuant to the Clean Air Act of 1970 (42 USC 1857(h)), Section 508 of the Clean Water Act (33 USC 1368), Executive Local Health Department - 2019, Date: 08/1012018 Page: 23 of 194 08/10/2018 Order 11738 and Environmental Protection Agency regulations (40 CFR Part 15). 8. That all subcontracts and subgrants in support of programs or elements utilizing funds provided by the Department, the State of Michigan or the federal government in excess of $2,000 for construction or repair, awarded by the Grantee shall include a provision: a. For compliance with the Copeland "Anti-Kickback" Act (18 USC 874) as supplemented in Department of Labor regulations (29 CFR, Part 3). b. For compliance with the Davis-Bacon Act (40 USC 276a to a-7) and as supplemented by Department of Labor regulations (29 CFR, Part 5) (if required by Federal Program Legislation). c. For compliance with Section 103 and 107 of the Contract Work Hours and Safety Standards Act (40 USC 327-330) as supplemented by Department of Labor regulations (29 CFR, Part 5). This provision also applies to all other contracts in excess of $2,500 that involve the employment of mechanics or laborers. J. Procurement Grantee will ensure that all purchase transactions, whether negotiated or advertised, shall be conducted openly and competitively in accordance with the principles and requirements of Title 2 Code of Federal Regulations, Part 200. Funding from this agreement shall not be used for the purchase of foreign goods or services or both. Records shall be sufficient to document the significant history of all purchases are maintained for a minimum of three years after the end of the agreement period. K. Health Insurance Portability and Accountability Act To the extent that this act is pertinent to the services that the Grantee provides to the Department under this agreement, the Grantee assures that it is in compliance with the Health Insurance Portability and Accountability Act (HIPAA) requirements including the following: 1. The Grantee must not share any protected health data and information provided by the Department that falls within HIPAA requirements except as permitted or required by applicable law; or to a subcontractor as appropriate under this agreement. 2. The Grantee will ensure that any subcontractor will have the same obligations as the Grantee not to share any protected health data and information from the Department that falls under HIPAA requirements in the terms and conditions of the subcontract. 3. The Grantee must only use the protected health data and information for the purposes of this agreement. Local Health Department - 2019, Date: OB/1012018 Page; 24 of 194 08/10/2018 4. The Grantee must have written policies and proce d u r e s a d d r e s s i n g t h e use of protected health data and information th a t f a l l s u n d e r t h e H I P A A requirements. The policies and procedures mu s t m e e t a l l a p p l i c a b l e federal and state requirements including the H 1 P A A r e g u l a t i o n s . T h e s e policies and procedures must include restricting a c c e s s t o t h e p r o t e c t e d health data and information by the Grantee's e m p l o y e e s , 5. The Grantee must have a policy and procedure t o i m m e d i a t e l y r e p o r t t o the Department any suspected or confirm e d u n a u t h o r i z e d u s e o r disclosure of protected health data and inform a t i o n t h a t f a l l s u n d e r t h e HIPAA require—mlifi-of-Whi-ctr-th-e --Grantee-becomes aware, The Grantee will work with the Department to mitig a t e t h e b r e a c h , a n d w i l l provide assurances to the Department of correc t i v e a c t i o n s t o p r e v e n t further unauthorized uses or disclosures. 6. Failure to comply with any of these contrac t u a l r e q u i r e m e n t s m a y result in the termination of this agreement in ac c o r d a n c e w i t h P a r t Section V. Agreement Termination. 7. In accordance with HIPAA requirements, the G r a n t e e i s l i a b l e f o r a n y claim, loss or damage relating to unauthorized u s e o r d i s c l o s u r e o f protected health data and information by the G r a n t e e r e c e i v e d f r o m t h e Department or any other source. 8, The Grantee will enter into a business associa t e a g r e e m e n t s h o u l d t h e Department determine such an agreement is requ i r e d u n d e r H 1 P A A . L. Home Health Services If the Grantee provides Home Health Services (a s d e f i n e d i n M e d i c a r e P a r t B ) , the following requirements apply: 1, The Grantee shall not use State ELPHS or ca t e g o r i c a l g r a n t f u n d s provided under this agreement to unfairly com p e t e f o r h o m e h e a l t h services available from private providers of th e s a m e t y p e o f s e r v i c e s i n the Grantee's service area. 2. For purposes of this agreement, the term "unfair c o m p e t i t i o n " s h a l l b e defined as offering of home health services a t f e e s s u b s t a n t i a l l y l e s s than those generally charged by private provide r s o f t h e s a m e t y p e o f services in the Grantee's area, except as a l l o w e d u n d e r M e d i c a r e customary charge regulations involving sliding f e e s c a l e d i s c o u n t s f o r low-income clients based upon their ability to p a y , 3. If the Department finds that the Grantee is no t i n c o m p l i a n c e w i t h i t s assurance not to use state ELPHS and ca t e g o r i c a l g r a n t f u n d s t o unfairly compete, the Department shall follow the p r o c e d u r e r e q u i r e d f o r failure by local health departments to ade q u a t e l y p r o v i d e r e q u i r e d services set forth in Sections 2497 and 24 9 8 o f 1 9 7 8 P A 3 6 8 a s amended (Public Health Code), MCL 333.24 9 7 a n d 2 4 9 8 , M S A 1 4 . 1 5 Local Health Department- 2019, Date: 08/10/2018 Page: 25 of 194 08/10/2018 (2497) and (2498), Local Health Department - 2019, Date: 08/1012018 Page: 26 of 194 08110/2018 M. Website Incorporation The Department is not bound by an y c o n t e n t o n G r a n t e e ' s w e b s i t e u n l e s s expressly incorporated directly into th i s A g r e e m e n t . N. Survival The provisions of this Agreement t h a t i m p o s e c o n t i n u i n g o b l i g a t i o n s w i l l survive the expiration or terminat i o n o f t h i s A g r e e m e n t . 0. Non-Disclosure of Confidential Inform a t i o n 1. The Grantee agrees that it will use Con f i d e n t i a l I n f o r m a t i o n s o l e l y f o r tlie-piirp-ose—of—this—ag-reenie Grantee agrees to hold all Confidential information in strict confide n c e a n d n o t t o c o p y , r e f S i t i d r i e w , - ---- --- sell, transfer or otherwise dispose of, g i v e o r d i s c l o s e s u c h C o n f i d e n t i a l Information to third parties other t h a n e m p l o y e e s , a g e n t s , o r subcontracts of a party who have a ne e d t o k n o w i n c o n n e c t i o n w i t h t h i s Agreement or to use such Confidentia l I n f o r m a t i o n f o r a n y p u r p o s e whatsoever other than the performan c e o f t h i s A g r e e m e n t . T h e G r a n t e e must take all reasonable precautions t o s a f e g u a r d t h e C o n f i d e n t i a l Information. These pretautions m u s t b e a t l e a s t a s g r e a t a s t h e precautions the Grantee takes to p r o t e c t i t s o w n c o n f i d e n t i a l o r proprietary informOtion. 2. Meaning of Confidential Information For the purpose of this Agreement the t e r m " C o n f i d e n t i a l I n f o r m a t i o n " means all information and documentati o n o f a p a r t t h a t Has been marked "confidential" or w i t h w o r d s o r s i m i l a r Meaning, at the time of disclosure b y s u c h p a r t ; Ildisclosed orally or not marked "co n f i d e n t i a l " o r w i t h w o r d s o f similar meaning, was subsequently s u m m a r i z e d i n w r i t i n g b y the disclosing party and marked "confi d e n t i a l " o r w i t h w o r d s o f similar meaning; c. Should reasonably be recognized as c o n f i d e n t i a l i n f o r m a t i o n o f the disclosing party; d. Is unpublished or not available to the g e n e r a l p u b l i c ; o r e. Is designated by law as confidential. 3. The term "Confidential Information" do e s n o t i n c l u d e a n y i n f o r m a t i o n o r documentation that was: a. Subject to disclosure under the M i c h i g a n F r e e d o m o f Information Act (FOIA); b. Already in the possession of the re c e i v i n g p a r t y w i t h o u t a n obligation of confidentiality; c. Developed independently by the r e c e i v i n g p a r t y , a s demonstrated by the receiving party , w i t h o u t v i o l a t i n g t h e Local Health Department - 2019, Dale: 08/1 0 1 2 0 1 8 Page: 27 of 194 08/10/2018 disclosing party's proprietary rights; d. Obtained from a source other than the disclosing party without an obligation of confidentiality; or e. Publicly available when received or thereafter became publicly available (other than through an unauthorized disclosure by, through or on behalf of, the receiving part). 4. The Grantee must notify the Department within one business day after discovering any unauthorized use or disclosure of Confidential Information. The Grantee will cooperate with the Department in every way possible to-aWattlwGra-nte-e-regairrpossesson of the C-onfidentiat Information and prevent further unauthorized use or disclosure. IV. Payment and Reporting Procedures A. Operating Advance Under the pre-payment reimbursement method, no additional operating advances will be issued. B. Comprehensive Prepayments The Department will make monthly prepayments equal to 1/12th of the agreement amount for each non-fee-for-service program contained in Attachment IV of this agreement. One single payment covering all non-fee- for-service programs will be made within the first week of each month. The Grantee can view their monthly prepayment within the MI E-Grants system. Prepayments for the months of October thru January will be based upon the initial agreement amounts in Attachment IV. Subsequent monthly prepayments may be adjusted based upon agreement amendments and/or Grantee adjustment requests per Department approval. C. Prepayment Adjustments If the sum of the prepayments does not equal at least 90% of the Grantee's expenditures for a quarter of the contract period, the Grantee may submit documentation for an adjustment to the monthly prepayment amount via the following process: 1. Submit a written request for the adjustment to the Department's Accounting Division, Expenditure Operations Section. 2. The adjustment request must be itemized by program and must list the amount received from the Department, the expenditure amount reported per the quarterly Financial Status Report (FSR), and the difference. The amount received from the Department and the expenditures must be for the same reporting quarterly FSR period. 3. The Department will review the requests and if an adjustment is approved, it will be included in the next scheduled monthly prepayment. 4. Adjustment requests will not be accepted prior to submission of the FSR Local Health Department - 2019, Date: 08/10/2018 Page: 28 of 194 08/10/2018 for the quarter ending December 31. No adjustments will be m a d e prior to the February monthly prepayment. 5. The ability of the Department to approve adjustments may be limited b y the quarterly allotments of spending authority in the Departm e n t ' s appropriation account mandated by the Office of the State Budge t Director. The quarterly allotment limits the amount of each acc o u n t (program) that the Department may expend during each fiscal quarte r . D. Financial Status Report Submission A-Eivnancial__Status Report (FSR) must be submitted for all progra m s l i s t e d o n Attachment IV and fee for services project budgeted. AftFS R U t b e - prepared in accordance with the Department's FSR instructions and s u b m i t t e d electronically not later than 30 days after the close of the fiscal q u a r t e r s through MI E-Grants. Reports are due January 30, April 30, a n d J u l y 3 1 . FSR's must report total actual program expenditures regardless of th e s o u r c e of funds. The Department will reimburse the Grantee for exp e n d i t u r e s i n accordance with the terms and conditions of this agreement. Failure t o c o m p l y with the reporting due dates will result in the deferral of the Grant e e ' s m o n t h l y prepayment. E. Reimbursement Method The Grantee will be reimbursed in accordance with the reim b u r s e m e n t methods for applicable program elements described as follows : 1. Performance Reimbursement - A reimbursement method by whic h Grantees are reimbursed based upon the understanding that a ce r t a i n level of performance (measured by outputs) must be met in order t o receive full reimbursement of costs (net of program income and o t h e r earmarked sources) up to the contracted amount of state funds. A n y local funds used to support program elements operated under s u c h provisions of this agreement may be transferred by the Grantee withi n , among, to or from the affected elements without Department app r o v a l , subject to applicable provisions of Sections 3.B. and 3.C.3 of Part I a n d Section XIV of Part II. If Grantee's performance falls short of t h e expectation by a factor greater than the allowed minimum performance percentage, the state maximum allocation will be reduced equival e n t t o actual performance in relation to the minimum performance. 2. Staffing Grant Reimbursement - A reimbursement method by wh i c h Grantees are reimbursed based upon the understanding that s t a t e dollars will be paid up to total costs in relation to the state's share o f the total costs and up to the total state allocation as agreed to i n t h e approved budget. This reimbursement approach is not direc t l y dependent upon whether a specified level of performance is met b y t h e local health department. Department funding under th i s Local Health Department- 2019, Date: 48/10/2058 Page: 29 of 194 08/10/2018 reimbursement method is allocable as a source before any local funding requirement unless a specific local match condition exists. 3. Fixed Unit Rate Reimbursement - A reimbursement method by which Grantee are reimbursed a specific amount for each output actually delivered and reported. 4. Essential Local Public Health Services (ELPHS) - A reimbursement method by which Grantees are reimbursed a share of reasonable and allowable costs incurred for required services, as noted in the current Appropriations Act. F. Reimbursement Mechanism All Grantees must sign up through the on-line vendor registration process to receive all State of Michigan payments as Electronic Funds Transfers (EFT)/Direct Deposits. Vendor registration information is available through the Department of Technology, Management and Budget's web site: http://wvvw.cpexpress.state.mi. us/ G. Unobligated Funds Any unobligated balance of funds held by the Grantee at the end of the agreement period will be returned to the Department or treated in accordance with instructions provided by the Department. H. Fiscal Year-End Reporting An Obligation Report is based on annual guidelines and due date using the format provided by the Department through MI E-Grants. The Grantee must provide, by program, an estimate of total expenditures for the entire agreement period (October 1 through September 30). This report must represent the Grantee's best estimate of total program expenditures for the agreement period. The information on the report will be used to record the Department's year-end accounts payables and receivables by program for this Agreement. The report assists the Department in reserving sufficient funding to reimburse the final expenditures that will be reported on the Final FSR without materially overstating or understating the year-end obligations for this agreement. The Department compares the total estimated expenditures from this report to the total amount reimbursed to the Grantee in the monthly prepayments and quarterly fee-for-service payments to establish accounts payable and accounts receivable entries at fiscal year-end. The Department recognizes that based upon payment adjustments and timing of agreement amendments, the Grantee may owe the Department funding for overpayment of a program and may be due funds from the Department for underpayment of a program at fiscal year-end. Within 75 days after the agreement fiscal year-end, the Grantee must liquidate any unpaid year-end commitments and obligations. Any obligation remaining Local Health Department - 2019, Date: 013/10/2019 Page: 30 of 194 08/10/2018 unliquidated after 75 days from the end of the agreement period shall revert to the Department for disposition in accordance with applicable state and/or federal requirements, except as specifically authorized in writing by the Department. Final Total Grantee FSR Project Final FSR Due Date Public Health Emergency Preparedness 11/15/2018 WIC 11/30/2018 All Remaining Projects 12/15/2018 The final total Grantee FSR is dile -December 15, afterthe agreement period end date. WIC financial data reporting and final FSR must be received by November 30. Upon receipt of the final FSR electronically through MI E- Grants, the Department will determine by program, if funds are owed to the Grantee or if the Grantee owes funds to the Department. If funds are owed to the Grantee, payment will be processed:. However, if the Grantee underestimated their year-end obligations in the Obligation Report as compared to the final FSR and the total reimbursement requested does not exceed the agreement amount that is due to the Grantee, the Department will make every effort to process full reimbursement to the Grantee per the final FSR. Final payment may be delayed pending final disposition of the Department's year-end obligations. If funds are owed to the Department, it will generally not be necessary for Grantee to send in a payment. Instead the Department will make the necessary entries to offset other payments and as a result the Grantee will receive a . net Monthly prepayment. When this does occur, clarifying documentation will be provided to the Grantee by the Department's Accounting Division. Penalties for Reporting Noncompliance For failure to submit the final total Grantee FSR report by December 15, through MI E-Grants after the agreement period end date, the Grantee may be penalized with a one-time reduction in their current ELPHS allocation for noncompliance with the fiscal year-end reporting deadlines. Any penalty funds will be reallocated to other Comprehensive Grantees (local health departments). Reductions will be one-time only and will not carryforvvard to the next fiscal year as an ongoing reduction to a Grantee's ELPHS allocation. Penalties will be assessed based upon the submitted date in MI E-Grants: ELPHS Penalties for Noncompliance with Reporting Requirements: 1. 1% - 1 day to 30 days late; 2. 2% - 31 days to 60 days late; 3. 3% - over 60 days late with a maximum of 3% reduction in the Grantee's ELPHS allocation. LocaI Heath Department -2019, Date: 08/10/2018 Page: 31 of 194 08/10/2018 K. Indirect Costs and Cost Allocations/Distribution Plans The Grantee is allowed to use approved federal indirect rate, 10% d e m i n i m i s indirect rate and/or cost allocation/distribution plans in t h e i r b u d g e t calculations. 1. Costs must be consistently charged as indirect, direct or cost allocated, but may not be double charged or inconsistently charged. 2. If the Grantee does not have an existing approved federal indirect r a t e , they may use a 10% de minimis rate in accordance with Title 2 C o d e o f Federal Regulations (CFR) Part 200 to recover their indirect costs. _ 3. Grantees using the cost allocation/distribution method must -develop-- certified plan in accordance with the requirements described in T i t l e 2 CFR, Part 200 which includes detailed budget narratives and is retaine d by the Grantee and subject to Department review. 4. There must be a documented; Well-defined rationale and audit trail f o r any cost distribution or allocation bated upon Title 2 CFR, Pa r t 2 0 0 Cost Principles and subject to Department review. V. Agreement Termination The Department may cancel this agreement without further liabil i t y o r p e n a l t y t o t h e Department for any of the following reasons: A. This agreement may be terminated by either party by giving 3 0 d a y s w r i t t e n notice to the Other party::stating the reasons for termination and the effective date. B. This agreemetiti:mayiAlso be terminated on 30 days prior written n o t i c e u p o n the failure of either party to carry out the terms and conditions of this agreement, the alleged defaulting party is given notice of the alleged breach and fails to cure the default within the 30 day period. C. This agreement may be terminated immediately if the Grantee's l o c a l h e a l t h department, or an official of the Grantee's local health department, is c o n v i c t e d of any activity referenced in Part II, Section HID, of this agreeme n t d u r i n g t h e term of this agreement or any extension thereof. D. This agreement may be terminated or modified immediately upon a fin d i n g b y the Department in accordance with MCL 333.2235 that the Gr a n t e e l o c a l health department for the delivery of public health services und e r t h i s agreement is unable or unwilling to provide any or all of the s e r v i c e s a s provided in this agreement, and the Department may redirect f u n d s a s necessary to ensure that the public health services are provided w i t h i n t h e Grantee's jurisdiction. VI. Stop Work Order The Department may suspend any or all activities under this Agree m e n t a t a n y t i m e . The Department will provide the Grantee with a written stop o r d e r d e t a i l i n g t h e suspension. Grantee must comply with the stop work order u p o n r e c e i p t . T h e Local Health Department- 2019, Date: 08/10/2018 Page: 32 of 194 08/10/2018 Department will not pay for Activities, Grantee's lost profits, or any additional compensation during a stop work period. Local Health Department - 2019, Dale: 08/1012018 Page: 33 of 194 08/10/2018 VII. Final Reporting upon Termination Should this agreement be terminated by either party, within 30 days after the termination, the Grantee shall provide the Department with all financial, performance and other reports required as a condition of this agreement. The Department will make payments to the Grantee for allowable reimbursable costs not covered by previous payments or other state or federal programs. The Grantee shall immediately refund to the Department any funds not authorized for use and any payments or funds advanced to the Grantee in excess of allowable reimbursable expenditures. Any dispute arising as a result of this agreement shall be resolved in the State of Michigan. VIII. Severability _ If any provision of this agreement or any provision of any document attached to or incorporated by reference is waived or held to be invalid, such waiver or invalidity shall not affect other provisions of this agreement. IX. Amendments Except as otherwise provided, any changes to this agreement will be valid only if made in writing and accepted by all parties to this agreement. A. This agreement, including attachments, may be amended by mutual written consent of the Grantee and the Department. When submitting a proposed agreement/budget amendment, the Grantee must submit copies of the revised sheets and a summary description of the changes. B. In the event that circumstances occur that are not reasonably foreseeable, or are beyond the Grantee's or Department's control, which reduce or otherwise interfere with the Grantee's or Department's ability to provide or maintain specified services or 'operational procedures, immediate written notification must be Provided to the other party and an amendment to this agreement negotiated. C. Except as otherwise provided, amendments to this agreement shall be made as follows: 1. Any change proposed by the Grantee which would affect the state funding of any element funded in whole or in part by funds provided by the Department, subject to Part I, Section 3.C, of the agreement, must be submitted in writing to the Department immediately upon determining the need for such change. The proposed change may be implemented upon receipt of written notification from the Department. Within thirty (30) days after receipt of the proposed change, the Department shall advise the Grantee in writing of its determination. Subsequently the Department will initiate any necessary formal amendment to the agreement for execution by all parties to the agreement. Local Health Department 2019, Date: 08/10/2018 Page: 34 of 194 08/10/2018 Any changes proposed by the Department must be agreed to in writing by the Grantee and upon such written agreement, the Department shall initiate any necessary formal amendment as above. 2. Other amendments of a routine nature including applicable changes in budget categories, modified indirect rates, and similar conditions which do not modify the agreement scope, amount of funding to be provided by the Department or, the total amount of the budget may be submitted by the Grantee at any time prior to June 2, The Department will provide a written response within 30 calendar days. All-amendments must be submitted to - the Department by June 15 through MI E-Grants to assure the amendment can be executed prior to the end of the agreement period. X. Liability A. All liability to third parties, loss, or damage as a result of claims, demands, costs, or judgments arising out of activities, such as direct service delivery, to be carried out by the Grantee in The performance of this agreement shall be the responsibility of the Grantee, and not the responsibility of the Department, if the liability, loss, or damage is 'caused by, or arises out of, the actions or failure to act on the part of the Grantee, any subcontractor, anyone directly or indirectly employed by the Grantee, provided that nothing herein shall be construed as a waiver of any governmental immunity that has been provided to the Grantee or its employees by statute or court decisions. B. All liability to third parties, loss, or damage as a result of claims, demands, costs, or judgments arising out of activities, such as the provision of policy and procedural direction, to be carried out by the Department in the performance of this agreement shall be the responsibility of the Department, and not the responsibility of the Grantee, if the liability, loss, or damage is caused by, or arises out of, the action or failure to act on the part of any Department employee or agent, provided that nothing herein shall be construed as a waiver of any governmental immunity by the state, its agencies (the Department) or employees as provided by statute or court decisions. C. In the event that liability to third parties, loss, or damage arises as a result of activities conducted jointly by the Grantee and the Department in fulfillment of their responsibilities under this agreement, such liability, loss, or damage shall be borne by the Grantee and the Department in relation to each party's responsibilities under these joint activities, provided that nothing herein shall be construed as a waiver of any governmental immunity by the Grantee, the state, its agencies (the Department) or their employees, respectively, as provided by statute or court decisions. Local Health Department 2019, Date: 08/10/2018 Page: 35 of 194 08/10/2018 XI. Waiver Failure to enforce any provision of this Agreement will not constitute a waiver. Any clause or condition of this agreement found to be an impediment to the intended and effective operation of this agreement may be waived in writing by the Department or the Grantee, upon presentation of written justification by the requesting party. Such waiver may be temporary or for the life of the agreement and may affect any or all program elements covered by this agreement. XII. State of Michigan Agreement This is a State of Michigan Agreement and must be exclusively governed by the laws and construed-by the laws of-Michigan,- excluding Michigan's choice ,of,law principle. All claims related to or arising out of this agreement, or its breach, whether sounding in contract, tort, or otherwise, must likewise be governed exclusively by the laws of Michigan, excluding Michigan's choice-of-law principles. Any dispute as a result of this agreement shall be resolved in the State of Michigan. XIII. Funding A. State funding for this agreement shah be provided from the applicable and available Department appropriations for the current fiscal year. The Department provided funds shall be as stated in the approved Annual Budget - Attachment I Instructions for the Annual Budget, Attachment Ill , Program Specific Assurances and Requirements, and as outlined in Attachment IV, Funding/Reimbursement Matrix. . - B. The funding provided through the Department for this agreement shall not exceed the amount shown for each federal and state categorical program element except as adjusted by amendment. The Grantee must advise the Department in writing by May 1, if the amount of Department funding may not be used in its entirety or appears to be insufficient for any program element. ELPHS transfer requests between MDHHS, MDARD and MDEQ must also be requested in writing by May 1. All ELPHS required services must be maintained throughout the entire period of the agreement. C. The Department may periodically redistribute funds between agencies during the agreement period in order to ensure that funds are expended to meet the varying needs for services. Local Health Department - 2019, Date: 013/10/2018 Page: 36 of 194 08/10/2018 AA Attachments Al Attachment I - Instructions for the A n n u a l B u d g e t Attachment I - Instructions for the Annu a l B u d g e t A2 Attachment III - Program Specific A s s u r a n c e s a n d R e q u i r e m e n t s Attachment III - Program Specific Ass u r a n c e s a n d R e q u i r e m e n t s A3 Attachment V- Agreement A d d e n d u m A Oakland County FY Agreement Adden d u m A Local Health Department - 2019, Date: 0 1 3 / 1 0 1 2 0 4 8 Page: 37 of 184 Contract # Date: 08/1012018 MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTACHMENT IV - Local Health Department - 2019 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source (a) MDHHS Source Fed/St Funding Amount Reimbursement Method (b) Performance Target Output Measurement Total (c) Perform Expect State (d) Funded Target Perform State Funded Minimum Performance Percent Number (e) Contractor! Subrecepient (r) Adolescent STD Screening Reg. Alloc. F 73,000 Staffing (6) N/A N/A WA N/A N/A Subrecepient Body Art Fixed Fee Calc. Amt. 250.00/Numb ers Fixed Unit Rate (2) NTA N/A WA • N/A N/A Recepient Children's Special Hlth Care Services (CSHCS) Care Calc. Amt. 150.00Nario us Fixed Unit Rate (1), • (7) N/A • N/A WA N/A N/A Su brecepient Coordination Children's Special Hlth Care Reg. Alloc. F 142,500 Staffing (6) N/A • N/A N/A N/A N/A Subrecepient Services (CSHCS) Outreach & Advocacy Reg. Alloc. S 142,500 CSI-ICS Medicaid Elevated Blood Lead Case Mgmt Calc. Amt. 201.58/Vario us Fixed .Un it Rate(2) . - ' N/A N/A N/A N/A N/A Subrecepient Enabling Services Women - MCH Local MCH S 269,033 Local MCH (3), (6) N/A N/A N/A ! N/A N/A Subrecepient Fetal Infant Mortality Review (FIMR) Case Abstraction Calc. Amt. 270.00/Vario iis Fixed Unit Rate (2) • N/A N/A N/A ! N/A N/A Subrecepient FIMR Interviews Calc. Amt. 85.00/Numbe rs Fixed Unit Rate (2), (11) N/A N/A N/A 1 N/A N/A Su brecepient Food ELPHS ELPHS Food S 859,213 ELPHS (3), (4) N/A N/A N/A , N/A N/A Recepient General Communicable Disease ELPHS S 463,192 ELPHS (3), (6) N/A N/A N/A N/A N/A Recepient ELPHS MDHHS Other . Gonococcal Isolate Surveillance Reg. Alloc. F 12,167 Staffing (6) N/A N/A NIA N/A N/A Su brecepient Project Reg. Mac. S 36,500 Hearing ELPHS ELPHS s 253,969 ELPHS (3), (6) N/A N/A N/A N/A N/A Recepient Hearing Hepatitis A Response Reg. Alloo. S 5,000 Staffing WA N/A N/A NIA N/A Recepient HIV Data to Care Reg. Alloc. P 128,800 Staffing (6) N/A N/A WA N/A N/A N/A HIV ELPHS ELPHS S 311,659 ELPHS (3), (4) N/A N/A N/A N/A N/A Recepient MDHHS Other HIV Prevention Reg. Alloc. F 130,234 Staffing (6) N/A N/A N/A ; N/A N/A Subrecepient Local Health Department - 2019, Date. 08/1012018 Page: 38 of 194 MD1-11-IS Source Fed/St Funding Amount Reimbursement Method (b) Performance Target Output Measurement Total (c) Perform Expect Reg. Alloc. Reg. Alice. Reg. Alloc. ELPHS MDHHS Other Calc. Amt. Reg. Alloc. S Reg. Alloc, F Reg. Alloc. S Reg. Allot. F Reg. Alloc, S ELPHS On- site VVastew 320,091 46,572 500,998 879,147 300.00/Numb era 105,231 2,250 20,250 17,500 20.000 372,426 Staffing (6) Staffing (6) ELPHS (3), (6) Staffing (6) Staffing (6) ELPHS (3), (6) N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Fixed Unit Rate (2), N/A (7) Staffing (6) Staffing (6) N/A N/A State (d)i Fundedi Target Perform State Funded Minimum Performance Percent Number (e) Contractor / Subrecepient (f) Subrecepient Subrecepient Recepient Subrecepient Recepient Subrecepient Subrecepient Recepient Recepient Recepient Subrecepient Subrecepient Subrecepient Subrecepient N/A Subrecepient N/A N/A N/A N/A N/A N/A N/A N/A N/4 N/A N/A N/A N/A NIA WAI N/A N/A N/A N/A N/A N/A N/A 14k N/A N/A N/A N/A IstlA N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A NIA Contract # Date: 08/1 0/2018 MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTACHMENT IV - Local Health Department - 2019 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source (a) HIV Surveillance Support Immunization Action Plan (IAP) Immunization ELPHS Immunization Fixed Fees Immunization Vaccine Quality Assurance Infant Safe Sleep ELPHS S 514.301 ELPHS (3), (6) N/A Private and Ty Reg. Alloc. F 372,624 Staffing (6) N/A Reg. Alloc. S 248,416 Public Health Emergency Reg. Alloc. F 219,102 Staffing (6), (14), N/A Preparedness (PHEP) 10/1/18- (18) 6/30/19 Public Health Emergency Reg. Alloc. F 150,607 Staffing (6), (14), N/A Preparedness (PHEP) CRI 1(18) 10/1/18 -6/30/19 Public Hlth Functions & Infratruct - Local MCH I S 52,4241Staffing (6) N/A MCH Sexually Transmitted Disease Reg. Alloc. F 40,1351Staffing (6) N/A (STD) Control Laboratory Services Bo Local Tobacco Reduction MDEQ On-site Wastewater Treatment MDEQ Private and Type III Water Supply Nurse Family Partnership Services N/A N/A N/A N/A N/A N/A Local Health Department- 201'D, Date: 06110/2018 Page: 30 of 194 Contract It Date 08110/2018 MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTACHMENT IV - Local Health Department - 2019 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Divisio Program Element/Funding Source (a) MDFIFIS Source Fed/St Funding Amount Reimbursement Method (b) Performance Target Output Measurement Total (c) Perform Expect State (d) Funded Target Perform State Funded Minimum Performance Percent Number (e) Contractor / Subrecepient (0 Reg. Alb°. S 42,515 Sexually Transmitted Disease ELPHS s 597,292 ELPHS(3), (6) N/A N/A N/A N/A N/A Recepient (STD-ELPHS) MDHHS Other Tuberculosis (TS) Control Reg. Alloc. F 48,678 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Vision ELPHS ELPHS s 253,968 ELPHS (3), (6) N/A N/A N/A N/A N/A Recepient Vision West Nile Virus Community Reg. Alloc. F 8.000 Staffing • N/A N/A N/A N/A N/A Subrecepient Surveillance WIC Breastfeeding Reg. Moo. F 219,199 Staffing (6) N/A N/A N/A N/A N/A Subrecepient WIC Resident Services Reg. Alloc. F 2,326,580 Performance (8) # Average N/A N/A 97 0 Subrecepient Monthly Participation TOTAL MDHHS FUNDING 10,206,073 *SPECIFIC OUTPUT PERFORMANCE MEASURES WILL BE INCORPORATED VIA AMENDMENT Attachment IV Notes Attachment IV Notes Local Health Department - 2019, Date: 08/1012018 Page: 40 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / Administration DATE PREPARED 8110/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2016 To : 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT F; Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 5,531,835.00 5,531,835.00 2 Fringe Benefits 3,510,265.00 3,510,265.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 148,455.00 148,455.00 5 Supplies and Materials 368,860.00 368,860,00 6 Travel 53,520.00 53,520.00 7 Communication 80,002.00 80,002.00 8 County-City Central Services 0.00 0.00 9 Space Costs 642,159.00 642,159.00 10 All Others (ADP, Con: Misc.) 1,338,294.00 1,338,294.00 Total Program Expenses 11,673,390.00 11,673,390.00 TOTAL DIRECT EXPENSES 11,673,390.00 11,673,390.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 707,522.00 707,522.00 2 Cost Allocation Plan / Other -9,430,205.00 -9,430,205.00 Total Indirect Costs -8,722,683.00 -8,722,683.00 TOTAL INDIRECT EXPENSES -8,722,683.00 -8,722,683.00 TOTAL EXPENDITURES 2,950,707.00 2,950,707.00 Local Health Department - 2019, Date: 08110/2018 Page: 41 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash] Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 685,600.00 0.00 685,600.00 Fees and Collections - 3rd Party 0.00 117,003.00 0.00 117,003.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost BasedRelmbursement -0.00 0_00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 _ Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0,00 ... 0.00 0.00 0.00 MDHHSComprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0,00 0.00 000 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHI-IS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private /Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0,00 Local Funds - Other 0.00 2,148,104.00 0.00 2,148,104.00 . Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate 0.00 0.00 0.00 0.00 Total Source of Funds 0.00 2,950,707.00 0.00 2,950,707.00 Totals 0.00 2,950,707.00 0.00 2,950,707.00 Local Health Department - 2019, Date' 0811012018 Page: 42 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail [Line item Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 5,531,835.00 2 Fringe Benefits _. 3,510,265.00 3 Cap. Exp. for Equip & Fac. . 4. .Contractual _ 148,455.00 5 Supplies and Materials -368,860,00 6 Travel 53,520.00 7 Communication 80,002.00 County-City Central Services 0.00 9 Space Costs 642,159.00 10 All Others (ADP, Con. Employees, Misc . ) 1,338,294,00 Total Program Expenses 11,673,390.00 TOTAL DIRECT EXPENSES 11,673,390.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 1 707,522.00 2 Cost Allocation Plan I Other Other Cost Distributions-Other Inf Disease/CD -1,595,551.00, Other Cost Distributions-Misc Distribution -1,710,199.00 Other Cost DistributionS-SIDS fee -2,000.00 Health Mm Distribution -6,551,817.00 Other Cost Distributions-Education 429,362.00 Total for Cost Allocation Plan I Other -9,430,205.00 Total Indirect Costs -8,722,683.00 TOTAL INDIRECT EXPENSES -8,722,683.00 TOTAL EXPENDITURES 2,950,707.00 Local Health Department - 2019, Date: 08/1012 0 1 8 Page. 43 of 194 Contract # Date: 0811012018 1 Program Budget Summary PROGRAM/PROJECT Local Health Department - 2019/ Administration - Environmental DATE PREPARED 81101201B CONTRACTOR NAME Oakland County Department of Health and Human S e r v i c e s / Health Division BUDGET PERIOD From : 10/1/2018 To : 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd, 34 East BUDGET AGREEMENT pi Original 17 Amendment AMENDMENT # 0 CITY Pagt[ac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 , Category --Amount - Total DIRECT EXPENSES Program Expenses _ 1 Salary & Wages 5,014,620.00 5,014,620.00 2 Fringe Benefits .3,080,355.00 3,080,355.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 58,285.00 58,285.00 6 Travel 261,090.00 261,090.00 7 Communication 80,408.00 80,408.00 8 County City Central Services 0.00 0.00 9 Space Costs 142,909.00 142,909.00 10 All Others (ADP, Con. Employees, Miser) 578,539.00 578,539.00 Total Program Expenses 9,216,206.00 9,216,206.00 TOTAL DIRECT EXPENSES 9,216,206.00 9,216,206.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 641,370.00 641,370.00 2 _ Cost Allocation Plan / Other -2,579,537.00 -2,579,537.00 Total Indirect Costs -1,938,167.00 -1,938,167,00 TOTAL INDIRECT EXPENSES -1,938,167.00 -1,938,167.00 TOTAL EXPENDITURES 7,278,039.00 7,278,039.00 Local Health Department - 2019, Date: 08/10/2018 Page: 44 of 194 Contract # Date: 08/1012018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 781,794.00 0.00 781,794,00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 2,027,438.00 0.00 2,027,438.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0,00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 -I Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHSHearing 0,00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 i 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0,00 0.00 0.00 0 00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0,00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 4,468,807.00 0.00 4,468,807.00 lnkind Match 0.00 0.00 0,00 0.00 MDHHS Fixed Unit Rate 0.00 0.00 0.00 0.00 Total Source of Funds 0.00 7,278,039.00 0.00 7,278,039.00 Totals 0.00, 7,278,039.00 0.00 7,278,039.00 Local Health Department - 2019 Date: 08110/2018 Page: 45 of 194 Contract # Date 08/10/2018 3 Program Budget - Cost Detail Line Item Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 5,014,620.00 2 Fringe Benefits 3,080,355.00 3 Cap. Exp. for Equip & Fac. 0.00 4 Contractual 0.00 5 Supplies and Materials 58,285.00 6 Travel 261,090.00 7 Communication 80,408 00 8 County-City Central Services 0.00 9 Space Costs 142.909.00 10 All Others (ADP, Con. Employees, Misc.) 578,539.00 Total Program Expenses 9,216,206.00 TOTAL DIRECT EXPENSES 9,216.206,00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 641,370.00 2 Cost Allocation Plan / Other EH Adm Distribtions -5,217,081.00 Other Cost Distributions-Body Art Fees -45,000,00 Health Adm Distribution 2,615,423.00 Other Cost Distributions-Use 67,121.00 Total for Cost Allocation Plan / Other -2,579,537.00 Total Indirect Costs -1,938,167.00 TOTAL INDIRECT EXPENSES -1,938.167.00 TOTAL EXPENDITURES 7,278,039.00 Local Health Department 2019, Date: 08/10/2018 Page: 46 of 194 Contract # Date: 08/1012018 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / Adolesce n t S T D S c r e e n i n g DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and H u m a n S e r v i c e s / Health Division BUDGET PERIOD From : 10/1/2018 To : 9/30/2019 MAILING ADDRESS (Number and Stree t ) 1200 N. Ea Telegraph Rd. 34 st BUDGET AGREEMENT p Original 17 Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 , reitirgbly I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 42,732.00 42.732.00 2 Fringe Benefits 15,635.00 15,635.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0 00 5 Supplies and Materials 5,355,00 5,355.00 6 Travel 681.00 681.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 000 9 Space Costs 0.00 0.00 10 All Others (ADP, Con, Employees, Misc.) 3,132.00 3,132.00 Total Program Expenses 67,535.00 67,535,00 TOTAL DIRECT EXPENSES , 67,535.00 67,535.00 INDIRECT EXPENSES _ Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 13,863.00 13.863.00 Total Indirect Costs 13,863.00 13,863,00 TOTAL INDIRECT EXPENSES 13,863.00 13,863.00 TOTAL EXPENDITURES 81,398.00 81,398.00 Local Heath Department - 2019, Date: 08/10/ 2 0 1 8 Page 47 of 194 Contract # Date: 08110/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount I Cash] Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0,00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 73,000.00 0.00 0.00 73,000.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 4.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 8,398.00 0.00 8,398.00 inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 73,000.00 8,398.00 0.00 81,398.00 Local Health Department - 2019, Date. 08/10/2018 Page: 48 of 194 Contract # Date: 08110/2018 3 Program Budget - Cost Detail , Line Item Qty Rate , Units[UOM Total DIRECT EXPENSES Program Expenses "I Salary & Wages Public Health Nurse Notes : GFGP position - overtime only 0.0962 106145.000 0.000 FTE 10,211.00 Public Health Nurse Notes : GFGP Position-overtime only 0.0962 101225.000 0.000 FTE 9,738.00 Technician 0.1236 55385,000 0,000 FTE 6,846.00 Public Health Nurse Notes : CV, PT non-eligible 0.0721 59750.000 0.000 FTE 4,308.00 Assistant 0.2769 41996 000 0.000 FTE 11,629.00 Total for Salary & Wages 42,732.00 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 36,589 42732.000 15,635,00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0,0000 0.000 0.000 392.00 Medical Supplies 0.0000 0.000 0.000 1,099.00 Printing 0.0000 0,000 0.000 300.00 Educational Supplies 0,0000 0.000 0.000 _ 3,564.00 Total for Supplies and Materials 5,355.00 6 Travel Mileage Notes :1250 miles @ .545 0.0000 0.000 0.000 r 681.00 7 Communication Local Health Department - 2019, Date: 08110/2018 Page: 49 of 94 Contract # Date. 0811012018 Line Item Qty • Rate UnitslUOM Total 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 , 0.000 108.00 Information Technology 0.0000 0.000 0.000 3,024.00 Total for All Others (ADP, Con, Employees, Misc. ) 3,132.00 Total Program Expenses 67,535.00 TOTAL DlRECT EXPENSES 67,535.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 2 Cost Allocation Plan I Other Cost Allocation Plan Notes : 12.79% 0.0000 0.000 0.000 5,465 00 Health Adm Distribution 0.0000 0.000 0.000 6,074.00 Nursing Adm Distribution 0.0000 0.000 0.000 2,324.00 Total for Cost Allocation Plan / Other 13,863.00 Total Indirect Costs 13,863.00 TOTAL INDIRECT EXPENSES 13,863.00 TOTAL EXPENDITURES 81,398.00 Local Health Department - 2019, Date: 08/10/2018 Page- 50 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019/ Public Health Emergency Preparedness (PHEP) 10/1/17 - 6/30/18 DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To :6/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 east BUDGET AGREEMENT F Original rm Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 112,908.00 112,908,00 2 Fringe Benefits 83,349.00 83,349.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 7,631.00 7,631.00 6 Travel 6,950.00 6,950.00 7 Communication 2,700.00 2,700.00 8 County-City Central Services 0.00 0.00 9 Space Costs 7,994.00 7.994.00 10 All Others (ADP, Employees, Misc.) .Con. 5,762.00 5,762.00 Total Program Expenses 227,294.00 227,294.00 TOTAL DIRECT EXPENSES 227,294.00 227,294.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 33,771.00 33,771.00 Total Indirect Costs 33771.00 , 33,771 .00 TOTAL INDIRECT EXPENSES 33.771.00 33,771.00 TOTAL EXPENDITURES 261,065.00 261,065.00 ;_ocal Health Department - 2019, Date: 08/10/2010 Page: 51 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0,00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 21,910.00 0.00 21,910.00 Local Non-ELPHS 0.00 0.00 0.00 0,00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0,00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 219,102.00 0.00 0.00 219,102.00 , ELPHS - MDHHS Hearing ' 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision . 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0,00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 20,053.00 0.00 20.053.00 lnkind Match 0.00 0.00 0.00 0,00 MDHHS Fixed Unit Rate Totals 219,102.0D 41,963,00 0,00 261,065.00 Local Health Department - 2019, Date: 08/10/2018 Page: 52 of 194 Contract # Date: 0811012018 3 Program Budget - Cost Detail rune Item I Qty Rate UnitslUOM I Total DIRECT EXPENSES Program Expenses Salary & Wages Coordinator Notes : EP Coordinator 0.7500 71164.000 0.000 FTE 53,373.00 Specialist Notes : EP Specialist 0.3750 55408.000 0.000 FTE 20,778.00 Assistant Notes : Technical Assistant 0.3750 , 44064.000 0.000 16,524.00 FTE Outreach Worker Notes : Auxiliary Health Worker 0.3750 44217.000 0.000 FTE 16,581.00 Administrator Notes : MATCH 0.0601 94050.000 0.000 FTE 5,652.00 Total for Salary & Wages 112,908.00 2 Fringe Benefits All Composite Rate Notes : MATCH $4172 FICA Unemp Ins Retirement Hospital Ins Life Ins Vision Ins Short/Long Term Disability Dental Ins Work Comp 0.0000 73,820 112908.000 83,349.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 1,500.00 Printing 0.0000 0.000 0.000 1,000.00 Disaster Supplies _ 0.0000 0.000 0.000 5,131.00 Total for Supplies and Materials 7,631.00 6 Travel Mileage Notes : 3670 miles @ .545 0.0000 0.000 0.000 2,000.00 Conferences 0.0000 0.000 0.000 7 4,950.00 Total for Travel 6,950.00 Local Health Department - 2019, Date: 08/10/2018 Page: 53 of 194 Contract # Date 08/1012918 Line Item I Qty I Rate I Units I UOM Total 7 Communication Telephone Communications 0.0000 0.000 0.000 2,700.00 8 County-City Central Services 9 Space Costs Building Space Rental Notes : MATCH 0.0000 0.000 0.000 7,994.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 270.00 Copier 0.0000 0.000 0.000 1,400.00 IT Operations Notes : MATCH 0.0000 0.000 0.000 4,092.00 Total for All Others (ADP, Con. Employees, Misc.) 5,762.00 Total Program Expenses 227,294.00 TOTAL DIRECT EXPENSES 227,294.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Cost Allocation Plan Notes : 12.79% 0.000 0.000 0.000 13,718.00 Health Adm Distribution 0.0000 0.000 0,000 20,053.00 Total for Cost Allocation Plan I Other 33,771.00 Total Indirect Costs 33,771.00 TOTAL INDIRECT EXPENSES 33,771.00 TOTAL EXPENDITURES 261,065.00 Local Health Department 2019, Date; 0811012018 Page: 54 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2019 / Body Art Fixed Fee DATE PREPARED 811012018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/112018 To : 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Fir Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category i , Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 000 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) _ 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 45,000.00 45,000.00 Indirect Costs _Total 45,000.00 45,000.00 TOTAL INDIRECT EXPENSES 45,000.00 45,000.00 TOTAL EXPENDITURES 45,000.00 45,000.00 Local Health Department - 2019, Date: 08/10/2018 Page: 55 of 194 Contract # Date 0811012018 2 Program Budget - Source of Funds SOURCE OF FUNDS _ Category Amount Cash lnkind Total , 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0,00 0,00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0 00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0,00 0.00 MD1-11-IS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0,00 0.00 ELPHS - MDHHS Vision . 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Private / Type III VVater Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0,00 0.00 0.00 0.00 lnkind Match 0.00 0.00 0.00 0,00 MDHHS Fixed Unit Rate Body Art Fee 45,000.00 0.00 0 00 45,000.00 Totals 45,000.00 0.00_ 0.00 45.000,00 Local Health Department- 2019, Date: 08110/2018 Page: 66 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail 'Line Item I Qty_l Rate' UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 6 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs Indirect Costs 2 Cost Allocation Plan / Other Cost Distributions for Fees-from Environmental Administration 0.0000 0.000 0.000 45,000.00 Total ndirect Costs 45,000.00 TOTAL INDIRECT EXPENSES 45,000.00 TOTAL EXPENDITURES 45,000.00 Local Health Department - 2019, Date: 08/10/2018 Page: 57 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 20191Children's Special Hith Care Services (CSHCS) Care Coordination DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2018 To : 9130/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT f7, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0,00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0,00 0,00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0,00 0.00 2 Cost Allocation Plan / Other 227,483.00 227,483.00 Total Indirect Costs 227,483.00 227,483.00 TOTAL INDIRECT EXPENSES 227,483.00 227,483.00 TOTAL EXPENDITURES 227,483.00 227,483.00 Local Health Department - 2019, Date: 08/10/2018 Page: 58 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash_ Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Fkeimbursement - 0.00 0.00 0.00 _ 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0•0(lL Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 000 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0,00 0,00 ELPHS - MDHHS Vision 0.00 0,00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 inkind Match 0.00 0.00 0,00 0.00 MDHHS Fixed Unit Rate CSHCS Care Coordination 227,483.00 0.00 0.00 227,483.00 Totals 227,483.00 0.00 0.00 227,483.00 Local Health Department- 2019, Date: 0811012018 Page: 59 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail DIRECT 'Line Item Qty I Rate' Units IUOM Total EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fee, 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Cost Distributions for Fees-from CSHCS Outreach & Advoc 0.0000 0 000 0,000 227,483.00 Total Indirect Costs 227,483.00 TOTAL INDIRECT EXPENSES 227,483.00 TOTAL EXPENDITURES 227,483.00 Local Health Department - 2019, Date: 08110/2018 Page: 60 of 194 Contract # Date: 08/1012018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2019 / GSHCS M e d i c a i d Outreach DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and H u m a n S e r v i c e s / Health Division BUDGET PERIOD From : 10/1/2018 To: 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p-, Original r. Amendment AMENDMENT # 0 CITY Pontiac STATE MI , ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 , Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0,00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 332,530.00 332,530.00 Total Indirect Costs 332.530.00 332,530.00 TOTAL INDIRECT EXPENSES 332,530.00 332,530.00 TOTAL EXPENDITURES 332,530.00 332,530.00 Local Health Department- 2019, Date, 08/10120 1 5 Page 61 of 194 Contract # Date: MP 0/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 - Federal Cost Based Reimbursement _ 0_00 0.00 _ 0.00 _ 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 108,072.00 0.00 0.00 108,072.00 Required Match - Local 0.00 108,072.00 0.00 108,072.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS _ 0.00 0.00 0.00 0.00 -1 MDHHS Non Comprehensive 0,00 0.00 0.00 0.00 MDHHS Comprehensive '0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds-Other 0.00 116,386.00 0.00 116,386.00 lnkind Match 0.00 0.00 0.00 0.00 MDFINS Fixed Unit Rate Totals 108,072.00 224,458.00 I 0.00 332,530.00 Local Health Department - 2019, Date: 08110/2018 Page: 62 of 194 Contract # Date: 0811012018 3 Program Budget - Cost Detail , !Line Item Qty_ Rate' UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other _. Distributions for Medicaid 0.0000 0.000 0.000 332,530.00 Total Indirect Costs 332,530.00 TOTAL INDIRECT EXPENSES 332,530 00 TOTAL EXPENDITURES 332,530.00 Local Health Department- 2019, Date: 08110/201 8 Page: 63 of 194 Contract # Date: 08110/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2019 / CSHCS Medicaid Elevated Blood Lead Case Mgmt DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To• 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT RI Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses .-- 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0 00 10 All Others (ADP, Con. Employees, Misc.) — 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 25,000.00 25,000.00 Total Indirect Costs 25,000.00 25,000.00 TOTAL INDIRECT EXPENSES 25,000.00 25,000.00 TOTAL EXPENDITURES 25,000.00 25,000.00 Local Health Department - 2019, Date: 08/10/2018 Page 64 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash I Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 ,Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 -I 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0,00 0.00 0.00 7 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing -, 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate CSHCS Medicaid Elevated Blood Lead Case 25,000.00 0.00 0.00 25,000.00 Totals 25,000.00 0.00 0.00 25,000.00 Local Health Department - 2019, Date: 08/10/2018 Page: 65 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail Line Item Qty Rate UnitslUOM I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Travel 7 Communication B County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan (Other Cost Distributions for Fees-Fees for Lead Case Mgt 0.0000 0.0001 0.000 25,000.00 Total Indirect Costs 25,000.00 TOTAL INDIRECT EXPENSES _ 25,000 00 TOTAL EXPENDITURES 26,000.00 Local Health Department - 2019, Date: 08/10/2018 Page: 66 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2019 / Public Health Emergency Preparedness (PHEP) CRI 10/1117 - 6/30/18 DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From . 10/1/2018 To . 6/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT w Original n Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category -I _ Amount] Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 66,719.00 66,719.00 2 Fringe Benefits 46,083.00 46,083.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 Contractual 0.00 0.00 5 Supplies and Materials 4,951.00 4,951.00 6 Travel 13,190.00 13,190.00 7 Communication i 1,400.00 1,400.00 8 County-City Central Services 0.00 0.00 9 Space Costs 10,044.00 10,044.00 10 All Others (ADP, Con. Employees, Misc,) 15,326.00 15,326.00 Total Program Expenses 157,713.00 157,713.00 TOTAL DIRECT EXPENSES 157,713.00 157,713.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 21,739.00 21,739.00 Total Indirect Costs 21,739.00 21,739.00 TOTAL INDIRECT EXPENSES 21,739.00 21,739.00 TOTAL EXPENDITURES 179,452.00 179,452.00 Local Health Department - 2019, Dale: 0811012018 Page 67 of 194 Contract # Date: 08/1012018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 15,061.00 0.00 15,061.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 000 0.00 0.00 0.00 MDHHS Comprehensive 150,607.00 0.00 0.00 150,607.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site VVastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds-Other 0.00 13,784.00 0.00 13,784.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 150,607.00 28,845.00 I 0.00 179,452.00 Local Health Department - 2019, Date: 08/1012018 Page: 68 of 194 Contract # Date: 08/1012018 3 Program Budget - Cost Detail ILine Item I Qty I- Rate' Units UOM i Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Specialist Notes : PH Emer Prep Specialist 0.3750 55408.000 0.000 FTE 20,778.00 Assistant Notes : Tech Assistant 0.3750 44064.000 0.000 FTE 16,524.00 Outreach Worker Notes : Office Leader 0.3750 44217.000 0.000 FTE 16,581.00 Health Educator 0.1930 43075.000 0.000 FTE 8,313.00 Chief-Admin Services Notes : MATCH 0.0481 94039.000 0.000 FTE 4,523.00 Total for Salary & Wages 66,719.00 2 Fringe Benefits All Composite Rate Notes : MATCH $3,124 FICA Unemp Ins Retirement Hospital Insurance Life Insurance Vision Ins. Short/Long Term Disability Dental Insurance Work Comp 0.0000 69.070 66719.000 46,083.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Disaster Supplies 0.0000 0.000 0.000 2,000.00 Postage 0.0000 0.000 0.000 270.00 Office Supplies 0.0000 0.000 0.000 1,681.00 Printing _ 0.0000 0.000 0.000 1,000.00 Total for Supplies and Materials 4,951.00 6 Travel Mileage Notes : 3000 miles @ .545 0.0000 0.000 0.000 1,635.00 Conferences 0.0000 0.000 0.000 11,555.00 Total for Travel 13,190.00 Local Health Department- 2019, Date: 08/10/2018 Page: 69 of 194 Contract # Date: 08110/2018 Line Item Qty Rate' Units I UOM Total 7 Communication Telephone 0.0000 0.000 0.000 1,400.00 8 County-City Central Services 9 Space Costs Space/Rental Costs Notes : MATCH $7414 0.0000 0.000 0.000 10,044.00 10 All Others (ADP, Con, Employees, Misc.) Insurance 0.0000 0.000 0.000 180.00 IT Operations 0.0000 0.000 0.000 9,146.00 Workshops & Meetings 0.0000 0.000 0.000 3,000.00 Staff Training 0.0000 0.000 0.000 _3,000.00 Total for All Others (ADP, Con. Employees, Misc.) 15,326.00 Total Program Expenses 157,713.00 TOTAL DIRECT EXPENSES 157,713,00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Cost Allocation Plan Notes : 12.79% 0.0000 0 000 0.000 7,955.00 Health Adm Distribution 0.0000 0.000 0.000 13,784.00 Total for Cost Allocation Plan ! Other 21,739.00 Total Indirect Costs 21,739.00 TOTAL INDIRECT EXPENSES 21,739.00 TOTAL EXPENDITURES 179,452.00 Local Health Department -2019, Date: 08/10/2018 Page: 70 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2019 / Children's Special Hlth Care Services (CSHCS) Outreach & Advocacy DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To: 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Fo,. Original r• Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE ,48341-0432 FEDERAL ID NUMBER 38-6004876 _ Category I Amount 1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 271,424.00 271,424.00 2 Fringe Benefits 119,988.00 119,988.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 6,000.00 6,000.00 6 Travel 752.00 752.00 7 Communication 10.160.00 10,160.00 8 County-City Central Services 0.00 0.00 9 Space Costs 25,241.00 25,241.00 10 All Others (ADP, Con. Employees, Misc.) 44,203.00 44,203.00 Total Program Expenses 477,768.00 477,768.00 TOTAL DIRECT EXPENSES 477,768.00 477,768.00 INDIRECT EXPENSES Indirect Costs 1 indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other -192,768.00 -192,768.00 Total Indirect Costs -192,768.00 -192,768.00 TOTAL INDIRECT EXPENSES -192,768.00 L -192,768.00 TOTAL EXPENDITURES 285,090.00 285,000.00 Local Health Department - 2019, Date: 08/10f2018 Page: 71 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category . Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0,00 Federal Cost Based Reimbursement 0.00 0.00 0,00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0,00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0,00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 285,000.00 0.00 0.00 285,000.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHI-IS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0,00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 285,000.00 0.00 0.00 285,000.00 Local Health Department - 2019, Date: 0811012018 Page 72 of 194 Contract* Date 08/10/2018 3 Program Budget - Cost Detail Line Item Qty Rate] UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Supervisor 1.0000 89128.000 0.000 FTE 89,128.00 Public Health Nurse 0.4808 59742.000 0.000 FTE 28,724 00 Public Health Nurse 0.4808 56512.000 0.000 FTE 27.171.00 Outreach Worker 0.3846 44217.000 0.000 FTE 17,006.00 Assistant 1.0000 36002.000 0.000 FTE 36,002.00 Assistant 1.0000 41992.000 0.000 FTE 41,992.00 Assistant Notes : in MCH 0.9615 32658.000 0.000 FTE 31,401.00 Total for Salary & Wages 271,424.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 44.207 271424.000 119.988.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies '- 0.0000 0.000 0.000 2,000.00 Postage 0.0000 0.000 0.000 3,000.00 Printing 0.0000 0.000 0.000, 1,000.00 Total for Supplies and Materials 6,000.00 6 Travel Mileage Notes : 380 miles @.545 0.0000 0.000 0.000 207.00 Conferences 0.0000 0.000 0.000 300.00 client transportation 0,0000 0.000 0.000 245.00 Local Health Department - 2019, Date: 08P1012018 Page 73 of 194 Contract # Date: 08/10/2018 Line Item ! Qty i Rate! UnitslUOM Total Total for Travel 752.00 7 Communication Telephone 0.0000 _ 0.000 0.000 10,160.00 8 County-City Central Services 9 Space Costs Building Space Rental 0.0000 _ 0.000 0.000 25,241.00 10 All Others (ADP, Con. Employees, Misc.) Convenience Copier 0.0000 - - - - 0.000 0.000 2,500,00 Insurance 0.0000 0.000 0,000 423.00 IT Operations 0.0000 0.000 0.000 41,280.00 Total for All Others (ADP, Con. Employees, Misc.) 44,203.00 Total Program Expenses 477,768.00 TOTAL DIRECT EXPENSES 477,768.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan I Other Other Cost Distributions-CSHCS Care Coor Fees 0.0000 0.000 0.000 -227,483.00 Health Adm Distribution 0.0000 0.000 0.000 40,600.00 Other Cost Distributions-Nursing Staff 0.0000 0.000 0.000 277.396.00 Nursing Adm Distribution 0.0000 0.000 0.000 14,534.00 Other Cost Distributions-CSHCS - Medicaid Outreach 0.0000 0.000 0.000 -332,530.00 Cost Allocation Plan Notes : 12.79% 0.0000 0.000 0.000 34,715.00 Total for Cost Allocation Plan / Other -192,768.00 Total Indirect Costs -192,768.00 TOTAL INDIRECT EXPENSES -192,768.00 TOTAL EXPENDITURES 285,000.00 Local Heath Department- 2019, Date: 08/10/2018 Page: 74 of 104 Contract # Date. 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / Enabling Services Women - MCH DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/112018 To : 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT P. Original n Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount i Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 146,523.00 146,523.00 2 Fringe Benefits 88,989.00 88,989.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 5,602.00 5,602.00 6 Travel 3,543.00 3,543.00 7 Communication 566.00 566.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 5,070.00 5,070.00 Total Program Expenses 250293.00 , 250,293.00 TOTAL DIRECT EXPENSES 250,293.00 250,293.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 49,688,00 49,688.00 Total Indirect Costs 49,688.00 49,688.00 TOTAL INDIRECT EXPENSES 49,688.00 49,688.00 TOTAL EXPENDITURES 299,981.00 299,981.00 Local Health Department - 2019, Date: 08110/2018 Page: 75 of 194 Contract # Date: 08110/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0,00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0,00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 259,033.00 0.00 0.00 269,033.00 Local Funds - Other 0.00 30,948.00 0.00 30,948.00 lnkind Match 0.00 0.00 0.00 0.00 MDHNS Fixed Unit Rate Totals 269,033.00 30,948.00 0.00 299,981.00 Local Health Department - 2019, Date: 08/10/2018 Page: 76 of 194 Contract # Date 08/10/2018 3 Program Budget - Cost Detail !Line Item I Qty Rate Units! UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Nutritionist/Dietician 0.4808 57844.000 0,000 FTE 27,811.00 Nutritionist/Dietician 1.0000 61870.000 0.000 FTE 61.870.00 Public Health Nurse 0.7500 68981.000 0.000 FTE 51,736.00 OVERTIME 0.0481 106160.000 0.000 FTE 5,106.00 Total for Salary & Wages 146,523.00 2 Fringe Benefits Composite Rate Notes : FICA, UNEMPLY INS, RETIREMENT, HOSPITAL INS, LIFE INS, VISION. DENTAL, WORK COMP, SHORT/LONG- TERM DISABILITY 0.0000 60.734 146523.000 88,989 00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Printing 0.0000 0.000 0.000 1,714,00 Educational Supplies , 0.0000 0.000 0.000 1,888.00 Office Supplies 0.0000 0.000 0.000 2,000.00 Total for Supplies and Materials 5,602.00 6 Travel Mileage Notes : 6500 miles @ .545 0.0000 0.000 0.000 3,543.00 7 Communication Telephone I 0.0000 0.000 0.000 566,00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) IT operations 0.0000 0.000 0.000 3,024,00 Interpretation 0.0000 0.000 0.000 2,046.00 Total for All Others (ADP, Con. Employees, Misc.) 5.070.00 Total Program Expenses 250,293 00 TOTAL DIRECT EXPENSES 250,293.00 INDIRECT EXPENSES Local Health Department - 201 9, Date: 08/10/2018 Page: 77 of 194 Contract # Date: 08/10/2018 'Line Item I Qty I Rate' UnitslUOM I Total Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 22,384.00 Nursing Adm Distribution 0.0000 0.000 0.000 8,564.00 Cost Allocation Plan Notes : 12.79% 0.0000 0.000 0.000 18,740.00 Total for Cost Allocation Plan I Other 49,688.00 Total Indirect Costs 49,688.00 TOTAL INDIRECT EXPENSES 49,688.00 TOTAL EXPENDITURES 299,981.00 Local Health Department- 2019, Date: 08/10/2018 Page: 78 of 194 Contract Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -20191 Fetal Infant Mortality Review (FIMR) Case Abstraction DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Servic e s / Health Division BUDGET PERIOD From : 10/1/2018 To : 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT P`. Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 [Category , I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0,00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 6,480.00 6,480.00 Total Indirect Costs 6,480.00 6,480.00 TOTAL INDIRECT EXPENSES 6,480.00 6,480.00 TOTAL EXPENDITURES 6,480.00 6,480.00 Local Health Department - 2019, Date' 08110/2018 Page 79 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount _ Cash inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement - - 0.00 - 0.00 - 0.00 0.00 Federally Provided Vaccines 0.00 0,00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 . Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0,00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0,00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0,00 0.00 0.00 0.00 Local Funds - Other 0,00 0.00 0.00 0.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Fetal Infant Mortality Review 6,480.00 0.00 0.00 6,480.00 Totals 6,480.00 0.00 0.00 6,480.00 Local Health Department - 2019, Date: 08110/20113 Page: 80 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail !Line Item Qty Rate! Units UOM 1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 indirect Costs 2 Cost Allocation Plan / Other Cost Distributions for Fees-F1MR Cases Notes : Cost Distribution for FIMR fees from Community Nursing 0.0000 0,000 0.000 6.480.00 Total Indirect Costs 6,480.00 TOTAL INDIRECT EXPENSES 6,480.00 TOTAL EXPENDITURES 6,480.00 Local Health Department - 2019, Date: 08/10120 1 8 Page: 81 of 194 Contract # Date: 0811012018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / Food ELPHS DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To: 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT go7 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category 1 Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0,00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0,00 7 Communication 0.00 0.00 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan/Other 4,917,803.00 4,917,803.00 Total Indirect Costs 4,917,803.00 4,917,803.00 TOTAL INDIRECT EXPENSES 4,917,803.00 4,917,803.00 TOTAL EXPENDITURES 4,917,803.00 4,917,803.00 Local Health Department -2019, Date, 08/10/2018 Page: 82 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash _ lnkind Total 1 Source of Funds Fees and Collections - let and 2nd Party 0.00 1,245,000.00 0.00 1,245,000.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 -0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 859,213.00 0.00 0.00 859,213.00 ELPHS - Private / Type ill Water Supply 0.00 0,00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0,00 2,813,590.00 0.00 2,813,590.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 859,213.00 4,058,590.00 0.00 4,917,803.00 Loca Heaith Department - 2019, Date: 08/10/2018 Page: 83 of 194 Contract # Date. 08/10/2018 3 Program Budget - Cost Dete 1Line Item Qty Ratel UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Envfronmental Hlth Adm Distribution 0.0000 0.000 0.000 3,503,405.00 Health Adm Distribution 0.0000 0.000_ 0.000 1,414,398.00 Total for Cost Allocation Plan / Other 4,917,803.00 Total indirect Costs 4,917,803.00 TOTAL INDIRECT EXPENSES 4,917,803.00 TOTAL EXPENDITURES 4,917,803.00 Local Health Department - 2019, Date: 0811012018 Page: 84 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM /PROJECT Local Health Department -2019 / General Communicable Disease ELPHS DATE D 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2018 To: 9130/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT ri, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan I Other 1,852,869.00 1,852,869.00 Total Indirect Costs 1,852,869.00 1,852,869.00 TOTAL INDIRECT EXPENSES 1,852,869.00 1,852,869.00 TOTAL EXPENDITURES 1,852,869.00 1,852,869.00 Local Health Department - 2018, Date 0811012018 Page. 85 of 194 Contract # Date: 08110/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash inkind Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0,00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDFIHS Other 463,192.00 0.00 0.00 463,192.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 1,389,677.00 0.00 1,389,677.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 463,192.00 0.00 1,852,869.00 Local Health Department - 2019, Date' 08/10/2018 Page: 86 of 194 Contract # Date 08/10/20 1 8 3 Program Budget - Cost Detail 'Line Item 1 Qty Rate' Units , UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan! Other Other Cost Distributions-CD Unit Staff Notes : 50% of FTE Medical Director's salary and fringes 100% of CD Staff Unit time includes,Epidemiologists, PHN's, PHN Supervisor, Office Assistants 0.0000 0.000 0.000 1,595,551.00 Other Cost Distributions-Misc Cost distibution Notes : 1% of total Health Division Clinic Expenses (based on a workload management program that tracks Clinic Nursing time) 0.0000 0.000 0.000 73,735.00 Health Adm Distribution Notes : 1.14% of Central Support Unit Staff expenses 0.18% of Lab Support staff expenses Adm O'head distribution 0.0000 0.000 0.000 132,791.00 Nursing Adm Distribution 0.0000 _ 0.000 0.000 50,792.00 Total for Cost Allocation Plan / Other 1,852,869.00 Total Indirect Costs 1,852,869.00 Local Health Department - 2019, Date: 08/10/2018 Page: 87 of 194 Contract # Date: 0811012018 fLine Item [ Qtyr Rate! UnitslUOM Total TOTAL INDIRECT EXPENSES 1,852,869.00 TOTAL EXPENDITURES 1,852,869.00 Local Health Department- 2019, Date: 0811012018 Page: 88 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / Gonococcal Isola t e Surveillance Project DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Huma n S e r v i c e s / Health Division BUDGET PERIOD From' 10/1/2018 To : 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT P:: Original IT Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 , Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 48,595.00 48,595.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 L Space Costs 0,00 0.00 10 All Others (ADP, Con. Employees, Misc.) 72.00 72.00 Total Program Expenses 48,667.00 48,667.00 TOTAL DIRECT EXPENSES 48,667.00 48,667.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0 00 2 Cost Allocation Plan / Other 5,598.00 5,598.00 Total Indirect Costs 5,598.00 5,598.00 TOTAL INDIRECT EXPENSES 5,598.00 5,598.00 TOTAL EXPENDITURES 54,265.00 54,265.00 Local Health Department - 2019, Date 0811012018 Page: 89 of 194 Contract # Date: 0811012018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections -1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0,00 0.00 0.00 0,00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 --I 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0.00 0.00 0.00 , Local Non-ELPHS 0.00. 0.00 0.00 0,00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDFINS Non Comprehensive 0.00 0.00 0,00 0.00 MDHHS Comprehensive 48,667.00 0.00 0.00 48,667.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0,00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water Supply - 0.00 0.00 0.00 0.00 ELPHS - On-Site VVastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 5,598.00 0.00 5,598.00 lnkind Match 0.00 0.00 0.00 0.00 MDFIHS Fixed Unit Rate Totals 48,667.00 5,598.00 -, ___ 0.00 Local Health Department - 2019, Date: 08/10/2018 Page' 90 of 194 Contract # Date 08/10/2018 3 Program Budget - Cost Detail Line Item I Qty Rate UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials ._ Laboratory Supplies 0.0000 0.000 0,000 48,595.00 6 Travel Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) 1 Insurance 0.0000 0.000 0.0001 72.00 Total Program Expenses 48,667.00 TOTAL DIRECT EXPENSES 48,667.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0,000 0.000 4,049.00 Nursing Adm Distribution 0.0000 0.000 0.000 1,549.00 Total for Cost Allocation Plan / Other 5.598.00 Total Indirect Costs 5,598.00 TOTAL INDIRECT EXPENSES 5,598.00 TOTAL EXPENDITURES 54,265.00 Local Health Department - 2019, Date: 08/10/2018 Page: 91 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2019 / Hepatitis A Response DATE PREPARED 811012018 CONTRACTOR NAME Oakland County Health Division Department of Health and Human Services/ BUDGET PERIOD From :10/1/2018 To: 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT .17 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & VVages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. • 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 4,993.00 4,993.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees,,Misc.) 7.00 7.00 Total Program Expenses 5,000.00 5,000.00 TOTAL DIRECT EXPENSES 5,000.00 5,000.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 575.00 575.00 Total Indirect Costs 575.00 575.00 TOTAL INDIRECT EXPENSES 575.00 575.00 TOTAL EXPENDITURES 5,675.00 5,575.00 Local Health Department - 2019, Date: 0811012018 Page: 92 of 194 Contract # Date 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category 1 Amount Cash _ Inkind Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 000 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00. 0.00 0.00 0.00 MDHHS Comprehensive 5,000.00 0.00 0.00 5,000.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 000 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private I Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 575.00 0.00 575.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 5,000.00 575.00 0.00 5,575.00 Local Health Department - 2019, Date: 08/10/2018 Page: 93o1 194 Contract # Date 08110/2018 3 Program Budget - Cost Detail DIRECT ILine Item I Qtyl Rate] UnitslUOM Total EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Medical Supplies 0.0000 0.004 0.000 4,993.00 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000_ 7.00 Total Program Expenses 5,000.00 TOTAL DIRECT EXPENSES 5.00000 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 416.00 Nursing Adm Distribution 0.0000 0.000 0.000 159.00 Total for Cost Allocation Plan / Other 575.00 Total Indirect Costs 575.00 TOTAL INDIRECT EXPENSES 575.00 TOTAL EXPENDITURES 5,575.00 Local Health Department - 2019, Date: 08/1W2018 Page: 94 of 194 Contract # Date: D8/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / Hearing ELPHS DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To '9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 17 Original IT Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 281,591.00 281,591 00 2 Fringe Benefits 74,797.00 74,797.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 3,555.00 3,555.00 6 Travel 4,725.00 4,725.00 7 Communication 1,080.00 1,080.00 8 County-City Central Services • 0.00 0.00 9 Space Costs 11,590.00 11,590.00 10 All Others (ADP, Con, Employees, Misc.) 6,159.00 6.159.00 Total Program Expenses 383,497.00 383,497.00 TOTAL DIRECT EXPENSES 383,497.00 383,497.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 86,663.00 86.663.00 Total Indirect Costs 86,663.00 86,663.00 TOTAL INDIRECT EXPENSES 86,663.00 86,663.00 TOTAL EXPENDITURES 470,160.00 470,160.00 Local Health Department - 2019, Date: 08/10/2018 Page 95 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS -, Category Amount _ Cash , Unkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 • 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0,00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00, Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local _..1 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0,00 0.00 0.00 Local Non-ELPHS 0.00 . 0.00 0.00 0.00 Other Non-ELPHS . 0.00 0.00 0,00 0.00 J rV1DHHS Non Comprehensive 0.00 0.00 0.00 0.00 (VIDFiHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 253,969.00 0.00 0.00 253,969.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0,00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0,00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0,00 clod 0,00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 216,191.00 0.00 216,191.00 Inkind Match 0.00 _ 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 253,969,00 216,191.00 0.00 470,160.00 Local Health Department - 2019, Date: 08/1012018 Page 96 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail Line Item Qty Rate Units UOM Total DIRECT EXPENSES Program Expenses I Salary & Wages Supervisor 1.0000 51181.000 0.000 FTE 51,181.00 Technician 0.4808 33951.000 0.000 FTE 16,323.00 Technician 0.4808 33951.000 0.000 FTE 16,323.00 Technician 0,4808 44217.000 0.000 FTE 21,260.00 Technician 0.4808 38057.000 0.000 FTE 18,298.00 Technician 0.4808 38057.000 0.000 FTE 18,298.00 Technician 0.4808 33951.000 0.000 FTE 16,324.00 Technician 0.4808 33951.000 0.000 FTE 16,324.00 Technician 0.4808 . 40109.000 0.000 FTE 19,284.00 Technician 0.4808 33951.000 0.000 FTE 16,324.00 Technician 0.4808 33951.000 0.000 FTE 16,324.00 Coordinator 0.5000 74654.000 0.000 FTE 37,327.00 Auxiliary Health Worker 0.5000 36002.000 0.000 FTE 18,001.00 Total for Salary & Wages 281,591.00 2 Fringe Benefits All Composite Rate Notes : FICA UNEMPLOYMENT INS RETIREMENT HOSPITAL INS LIFE INS VISION INS HEARING INS DENTAL INS WORK COMP SHORT/LONG TERM DISABILITY 0.0000 26.562 281591.000 74,797.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Medical Supplies 0.0000 0,000 0.000 765.00 Office Supplies 0.0000 0.000 0.000 900.00 Printing 0.0000 0.000 0.000 1,890.00 Total for Supplies and Materials 3,555.00 6 'Travel Local Health Department - 2019, Date: 08/10/2018 Page: 97 of 194 Contract # Date 08/10/2018 Line Item Qty Rate Units UOM Total Personal Mileage Notes : 8,669.72 miles @ .545 0.0000 0.000 0.000 4,725.00 Communication LTelephone 0.0000 0.000 0.000 _ 1,080.00 8 County-City Central Services 9 Space Costs Space/Rental Costs 0.0000 0.000 0.000 11,590.00 10 All Others (ADP,-Cent Employees, Misc.) Copier 0.0000 0.000 0.000 242.00 Insurance 0.0000 0.000 0.000 1.417.00 Equipment Repair 0.0000 0.000 0.000 2,025.00 Staff Training 0,0000 0.000 0.000 , 2,475.00 Total for All Others (ADP, Con. Employees, Misc.) 6,159.00 Total Program Expenses 383,497.00 TOTAL DIRECT EXPENSES 1 383,497.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan I Other Other Cost Distributions-Misc. 0.0000 0.000 0.000 15,744 00 Health Adm Distribution 0.0000 0.000 0.000 34,904.00 Cost Allocation Plan Notes : 12.79% 0.0000 0.000 0.000 36,015.00 Total for Cost Allocation Plan / Other 86,663.00 Total Indirect Costs 86,663.00 TOTAL INDIRECT EXPENSES 86,663.00 TOTAL EXPENDITURES 470,160.00 Local Health Department - 2019, Date: 08/10/2018 Page: 98 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / HIV ELPHS DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 101112018 To : 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT FF Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER _38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. EmplOyees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan/Other 665,319.00 665,319.00 Total Indirect Costs 665,319.00 665,319.00 TOTAL INDIRECT EXPENSES 665,319.00 665,319.00 TOTAL EXPENDITURES 665,319.00 665,319.00 Local Health Department - 2019, Date: 0811012018 Page: 99 of 194 Contract # Date: 0811012018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement - - 0.-00 0.00 - - 0.00 0.00 Federally Provided Vaccines 0.00 0,00 0.00 0.00 : Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 000 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 acia 0.00 0.00 _. MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 311,659.00 0.00 0.00 311,659.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 353,660.00 0.00 353,660 00 lnkind Match 0.00 0.00 0.00 0,00 MDHHS Fixed Unit Rate Totals 311,659.00 353,660.00 0.00 665,319.00 Local Health Department - 2019, Date: 08110/2018 Page' 100 of 194 Contract # Date: 08/1012018 3 Program Budget - Cost Detaii Line Item , Qty Rate, , Units UOM , Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractua 5 Supplies and Materials 6 Travel 7 Communication County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employe e s , M i s c . ) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other , Nursing Adm Distribution 0,0000 0.000 0.000 14,524.00 Other Cost Distributions-Misc 0.0000 0.000 0.000 650,795.00 Total for Cost Allocation Plan I O t h e r 665,319.00 Total Indirect Costs 665,319.00 TOTAL INDIRECT EXPENSES 665,319 00 TOTAL EXPENDITURES 665,319.00 Local Health Department - 2019, Date : 0 8 / 1 0 / 2 0 1 5 Page 101 of 194 Contract # Date: 0811012018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / HIV Data to Care DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p Original 17 Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 1 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 70,979.00 70,979.00 Fringe Benefits 39,400.00 39,400.00 3 Cap. Exp. for Equip & Fac. 0.00 0,00 Contractual 0.00 0.00 5 Supplies and Materials 2,519.00 2,519.00 6 Travel 0.00 0.00 7 Communication 336.00 336.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0,00 10 All Others (ADP, Con. Employees,.Misc.) 6,488.00 6,488.00 Total Program Expenses 119,722.00 119,722,00 TOTAL DIRECT EXPENSES 119,722.00 119,722.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0,00 2 Cost Allocation Plan / Other 23,894.00 23,894.00 Total Indirect Costs 23,894.00 23,894.00 TOTAL INDIRECT EXPENSES 23,894.00 23.894 00 TOTAL EXPENDITURES 143,616.00 143,616.00 Local Health Department- 2019, Date 08/10120113 Page: 102 of 194 Contract # Date: 08/1012018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 - - 0.00 - _ 0,00 _0.00 _0.00 -Federal Cost Based Reimbursement - Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 , 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0,00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 128,800.00 0.00 0.00 128,800.00 ELPHS - MDHHS Hearing ' 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water , Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 14,816.00 0.00 14,816.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 128,800.00 14,816.00 0.00 143,616.00 Local Health Department - 2019, Date: 08/1012018 Page 103 of 194 Contract # Date 08110/20 1 8 3 Program Budget - Cost Detail Line Item i Qty 1 Ratel Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Epidemiologist 1.0000 64802.000 0.000 FTE 64,802.00 Public Health Nurse 0.0962 64215.000_ 0.000_ FTE 6,177.00 Total for Salary & Wages 70,979.00 2 Fringe Benefits AU Composite Rate Notes 1 FICA, UNEMP INS, RETIREMENT, HOSPITAL INS. LIFE INS, VISION INS, HEARING INS, DENTAL, WORK COMP, SHORT/LONG TERM DISABILITY 0.0000 55.509 _ 70979.000 39,400.00 - 3 Cap. Exp. for Equip & Fac. Contractual 5 Supplies and Materials - Printing 0,0000 0.000 0.000 500.00 Incentives 0.0000_ 0.000 0.000 2,019.00 Total for Supplies and Materials 2,51900 6 Travel 7 Communication Telephone _ 0.0000 0.000 0,000 r 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Professional Svcs-TOL Database 0.0000 0.000 0.000 2,000.00 Info Tech Operations 0.0000 0.000 0,000 3,024.00 Advertising 0.0000 0.000 0.000 1,273.00 Insurance 0.0000 0.000 0.000 191.00 Total for All Others (ADP, Con. Employees, Mis c . ) 6,488.00 Total Program Expenses 119,722.00 TOTAL DIRECT EXPENSES 119,722.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Local Health Department - 2019, Date: 08/10/2018 Page 104 of 194 Contract # Date: 08110/2018 Line Item I Oty I Rate! UnitslUOM Total 2 Cost Allocation Plan / Other Cost Allocation Plan Notes : 12.79% of salaries 0.0000 0.000 0.000 9,078.00 Health Mm Distribution 0.0000 0.000 0.000 10,716.00 Nursing Adm Distribution 0.0000 0.000 0.000 4,100.00 Total for Cost Allocation Plan / Other 23,894.00 Total Indirect Costs 23,894.00 TOTAL INDIRECT EXPENSES 23,894.00 TOTAL EXPENDITURES 143,616.00 Local Health Department - 2019, Date: 08/10/2018 Page: 105 of 194 Contract # Data 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2019 / HIV Prevention DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To: 9/3012019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT P", Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category 1 Amount I Iota! DIRECT EXPENSES Program Expenses 1 Salary & Wages 233,066.00 233,066.00 2 Fringe Benefits 123,120.00 123,120.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 18,999.00 18,999.00 6 Travel 11,824.00 11,824.00 7 Communication 1,832.00 1,832.00 8 County-City Central Services 0,00 0.00 9 Space Costs 7,942.00 7,942.00 10 All Others (ADP, Con. Employees, Misc.) 23,733.00 23,733.00 Total Program Expenses 420,516.00 420,516.00 TOTAL DIRECT EXPENSES 420,516.00 420,516.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 72,956,00 72,956.00 Total Indirect Costs 72,956.00 72,956.00 TOTAL INDIRECT EXPENSES 72,956.00 72,956.00 TOTAL EXPENDITURES 493,472.00 493,472.00 Local Health Department - 2018, Date: 08/10/2018 Page: 106 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category , Amount Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd _Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal_or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 -----m- -0.00_ 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0,00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.,00 0.00 0.00 0.00 MDHHS Comprehensive 450,325.00 0.00 0.00 450,325.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 --1 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0,00 Local Funds - Other 0.00 43,147.00 0.00 43,147.00 lnkind Match 0.00 0.00 0.00 0.00 IVIDHHS Fixed Unit Rate Totals _ 450,325.00 43,147.00 0.00 493,472.00 Local Health Department - 2019, Date: 09)10/2018 Page: 107 of 194 Contract # Date 08/10/2018 3 Program Budget - Cost Detail Line Item Qty Ratel Units 1 UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Public Health Nurse 0.1923 70797.000 0.000 FTE 13,615.00 Coordinator 1.0000 74654,000 0.000 FTE 74,654.00 Assistant 0.7404 41994.000 0.000 PIE 31,092.00 Public Health Nurse 0.4808 56508.000 0.000 FTE 27,169.00 Public Health Nurse 0.2014 64255.000 0.000 FTE 12,941.00 Public Health Nurse 1.0000 70797.000 0.000 FTE 70,797.00 Technician 0.0500 55962.000 0.000 FTE 2,798.00 Total for Salary & Wages 233,066.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0,0000 52.826 233066.000 123,120.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0,000 0.000 2,000.00 Medical Supplies 0.0000 0.000 0.000 3,000.00 Postage 0,0000 0,000 0.000 1,000.00 Lab Supplies 0.0000 0.000 0.000 1,029.00 Printing 0.0000 0.000 0.000 6,000.00 Educational Supplies 0.0000 0.000 0.000 5,970.00 Total for Supplies and Materials 18,999.00 6 Travel Mileage Notes : 10,970 miles @ .545 0.0000 0.000 0.000 , 5,979.00 Client Transportation _ 0.0000 0.0001 0.000 345.00 Local Health Department- 2019, Date: 08/10/2018 Page. 108 of 194 Contract # Date: 08110/2018 Line Item Qty Rate Units UONI Total Conferences 0.0000 0.000 0.000 5,500.00 Total for Travel 11,824.00 7 , Communication Telephone 0.0000 0.000 0.000 1,832.00 8 County-City Central Services Space Costs _Space/Rental Costs i 0.0000 0.000 0.000 7,942.00 10 All Others (ADP, Con. Employees, Misc.) IT Operations 0.0000 0,000 0.000 14.504.00 Convenience Copier 0.0000 0.000 0.000 1,200.00 Interpretation 0.0000 0.000 0.000 600.00 Insurance 0.0000 0.000 0.000 669.00 Advertising 0.0000 0.000 0.000 6,760.00 Total for All Others (ADP, Con. Employees, Misc.) 23,733.00 Total Program Expenses 420,516.00 TOTAL DIRECT EXPENSES 420,516.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 43,147.00 Cost Allocation Plan Notes . 12.79% 0.0000 L 0.000 0.000 29,809.00 Total for Cost Allocation Plan / Other 72,956.00 Total indirect Costs 72,956.00 TOTAL INDIRECT EXPENSES 72,956.00 TOTAL EXPENDITURES 493,472.00 Local Health Department -2019, Date: 08/10/2018 Page 109 of 194 Contract # Date: 08110/2018 1 Program Budget Summary PROGRAM) PROJECT Local Health Department -2019 / HIV Surveillance Support DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To : 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 17 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 9,883.00 9,883.00 8 County-City Central Services 0.00 0.00 9 Space Costs 36,689.00 36,689.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 Total Program Expenses - . 46,572.00 46,572.00 TOTAL DIRECT EXPENSES 46,572.00 46,572.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 5,358.00 5,358.00 Total Indirect Costs 5,358.00 5,358.00 TOTAL INDIRECT EXPENSES 5,358.00 5,358.00 TOTAL EXPENDITURES 51,930.00 51,930.00 Local Health Department - 2019, Date, 013110/2018 Page: 110 of 194 Contract # Date. 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Federa4-ar-State (Non IVIDI-IHS) Federal Cost Based Reimbursemen t 0.00 0.00 0.00 0:00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0,00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 000 0.00 Local Non-ELPHS 0.00 0.00 0.00 0 00 Local Non-ELPHS 0.00 0.00, 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0,00 0.00 MDHHS Non Comprehensive 0.00 0.00 0 00 0.00 MDHHS Comprehensive 46,672.00 0.00 0.00 46,572.00 ELPHS - MDHHS Hearing 0.00 0,00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 5,358.00 0.00 5,358.00 lnkind Match 0.00 _ 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 46,572.00 5,358.00 0.00 51.930.00 Local Health Department - 2019, Cate: 0 8 / 1 0 / 2 0 1 8 Page: 111 of 194 Contract # Date: 08/1012018 3 Program Budget - Cost Detail 'Line Item Qty Rate Units UOM I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual _ 5 Supplies and Materials 6 Travel 7 Communication Telephone Communications I 0.0000 0.000 0.000 9,883.00 8 County-City Central Services 9 Space Costs Space/Rental Costs 0.0000 0.000 0.000 36,689.00 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses 46,572.00 TOTAL DIRECT EXPENSES 46,572.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan [Other Health Adm Distribution 0.0000 0.000 0.000 3,875.00 Nursing Adm Distribution 0.0000 0.000_ 0.000 1,483.00 Total for Cost Allocation Plan / Other 5,358.00 Total Indirect Costs 5,358.00 TOTAL INDIRECT EXPENSES 5,358.00 TOTAL EXPENDITURES 51,930.00 Local Health Department - 2019, Date: 08/10/2018 Page 112 of 194 Contract # Date: 0811012018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2019 / Imm u n i z a t i o n A c t i o n P l a n (lAP) DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Hea l t h a n d H u m a n S e r v i c e s / Health Division BUDGET PERIOD From : 10/1/2018 To: 9/30/2019 MAILING ADDRESS (Number an d S t r e e t ) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT F;o7 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 257,022.00 257.022.00 2 Fringe Benefits 195,769.00 195,769.00 ,. 3 Cap, Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 11,522.00 11,522.00 6 Travel 3,710.00 3,710.00 7 Communication 2,711.00 2,711.00 8 County-City Central Services 0.00 0.00 9 Space Costs 11,442.00 11,442.00 10 All Others (ADP, Con. Employees, Misc . ) 16,056.00 16,056.00 Total Program Expenses 498,232.00 498,232.00 TOTAL DIRECT EXPENSES 498,232.00 498,232.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 63,861.00 63,861.00 Total Indirect Costs 63,861.0D 63,861.00 TOTAL INDIRECT EXPENSES 63,861.00 63,861.00 TOTAL EXPENDITURES 562,093.00 562,093.00 Local Health Department - 2019, Date: 0 8 / 1 0 1 2 0 1 8 Page: 113 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0,00 0.00 Fees and Collections - 3rd Party 0.00 0,00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 -0-.-00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0.00 0.00 0,00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0,00 0.00 MDHHS Comprehensive 500998.00 0.00 0.00 500,998.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0,00 ELPHS - MDHHS Vision . 0.00 0.00 ... 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type 111 Water Supply 0,00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 61,095,00 0.00 61,095.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals _ 500,998.00 61,095.00 0.00 562,093.00 Local Health Department- 2019, Dat e : 0 5 / 1 0 / 2 0 1 8 Page: 114 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail !Line Item I Qty I Ratel UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Coordinator 1.0000 74654.000 0.000 FTE 74,654.00 Vaccine Supply Clerk Notes : Shared Vaccine Quality 0.7702 46438.000 0.000 FTE 35,766.00 Public Health Nurse 1.0000 57688.000 0.000 FTE 57,688,00 Office Leader 1.0000 46573.000 0.000 FTE 46,573.00 Assistant 1.0000 41994.000 0.000 FTE 41,994.00 Overtime 0.0048 72260.000 0.000 FTE 347.00 Total for Salary & Wages 257,022.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 76.168 257022.000 195,769.00 3 Cap. Exp. for Equip & Fac, 4 Contractual 5 Supplies and Materials _ Office Supplies 0.0000 0.000 0.000 522 00 Postage 0.0000 0.000 0.000 9,000.00 Printing 0.0000 0.000 0.000 1,000.00 Educational Supplies 0.0000 0.000 0.000 1,000.00 Total for Supplies and Materials 11,522.00 6 Travel Mileage Notes : 4055 miles @ .545 0.0000 0.000 0.000 2,210.00 Conferences 0.0000 0.000 0.000 1,500.00 Total for Travel 3,710.00 7 Communication Telephone 0.0000 0.000 0.000 2,711.00 Local Health Department. 2019, Date: 0811012018 Page: 115 of 194 Contract # Date: 08/10/2018 Line Item I Qtyl Ratel UnitslUOM Total 8 County-City Central Services Space Costs Building Space Rental 0.0000 0.000 11,442.00 10 All Others (ADP, Con. Employees, Misc.) - Equipment Repair 0.0000 0.000 0.000 200.00 Convenience Copier 0.0000 0.000 0.000 3,280.00 IT Operation 0.0000 0.000 0.000 11,832.00 — 0;0004 0.000. _0.000 744.00 Insurance Total for All Others (ADP, Con. Employees, Misc.) 16,056.00 Total Program Expenses 498,232.00 TOTAL DIRECT EXPENSES 498,232.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Other Cost Distributions-Nurse TrainNFC/AFIX 0.0000 0.000 0.000 -30,107.00 Health Adm Distribution 0.0000 0.000 0.000 44,189.00 Nursing Adm Distribution 0.0000 0.000 0.000 16,906.00 Cost Allocation Plan Notes : 12.79 % 0.0000 0.000 0.000 32,873.00 Total for Cost Allocation Plan / Other 63,861.00 Total Indirect Costs 63,861.00 TOTAL INDIRECT EXPENSES 63,861.00 TOTAL EXPENDITURES 562,093.00 Local Health Department - 2019, Date: 08110/2018 Page: 116 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / Immunization ELPHS DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Sentices/ Health Division BUDGET PERIOD From :10/1/2018 To: 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT R Original r--,- Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category I Amount! Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan/Other 3,822,215.00 3,822,215.00 Total Indirect Costs 3822,215.00 3,822,215.00 TOTAL INDIRECT EXPENSES 3,822,215.00 3,822,215.00 TOTAL EXPENDITURES 3,822,215.00 3,822,215.00 Local Health Department - 2019, Date; 08/10/2018 Page 117 of 194 Contract l/ Date 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2n d Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 FeWraror State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursemen t 0.00 0.00 0.00 -0;00- Federally Provided Vaccines 0.00 1,346,899.00 0.00 1,346,899.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 . 0.00 0.00 0.00 ' Local Non-ELPHS 0,00. apo law (No Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0,00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 879,147.00 0,00 0.00 879,147.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0,00 1,596,169.00 0.00 1,596,169.00 Inkind Match _ 0.00 0.00 0.00 0.00 MDFIHS Fixed Unit Rate Totals 879,147.00 _ 2,943,068.00 0.00 3,822,215.00 Local Health Deparlment - 2019, Date : 0 8 / 1 0 / 2 9 1 8 Page: 118 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail 1Line Item Qtyl Ratel Units , UOIVI Total DIRECT EXPENSES 1 Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Other Cost Distributions-Clinic . 0.0000 0.000 0.000 2.453,230.00 Federally Provided Vaccines Notes : Used 2017-18 budgetary figure/current not available yet. 0.0000 0.000 0.000 1,346,899.00 Health Adm Distribution 0.0000 0.000 0.000 21,455.00 Nursing Adm Distribution _ 0.0000 0.000 0,000 631.00 Total for Cost Allocation Plan / Other 3,822,215.00 Total Indirect Costs 3,822,215.00 TOTAL INDIRECT EXPENSES 3.822,215,00 TOTAL EXPENDITURES 3,822,215.00 Local Health Department - 2019, Date: 0811012018 Page: 119 of 194 Contract # Date: 08/1012018 1 Program Budget Summary PROGRAM 1 PROJECT Local Health Department - 2019 / infant Safe Sleep DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human S e r v i c e s / Health Division BUDGET PERIOD From : 10/1/2018 To: 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT r,-,:. Original n Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount 1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 4,042.40 4,042.00 2 Fringe Benefits 2,650.00 2,650.00 3 Cap. Exp. for Equip & Fac. 0,00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 9,633.00 9,633.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.40 0,00 10 All Others (ADP, Con. Employees. Misc.) 5,658,00 5,658.00 Total Program Expenses 21,983.00 21,983.00 TOTAL DIRECT EXPENSES 21,983.00 21,983.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 3,105.00 3,105.00 Total Indirect Costs 3,105.00 3,105.00 TOTAL INDIRECT EXPENSES 3,105.00 3,105.00 TOTAL EXPENDITURES 25,088.00 25,088.00 Local Health Department - 2019, Date 08/10/201B Page: 120 of 194 Contract # Date: 0811012018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash Inkind_ Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0,00 0.00 Federal or State (Non MDHHS) 0.00 0,00 0.00 0.00 0.15-0 -4.00- Federal Cost Based Reimbursement 0:0D- 0700-- Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0,00 Local Non-ELPHS 0.00 0 00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 iV1DHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 22,500.00 0.00 0.00 22,500,00 ELPHS - MIDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision . 0.00 0.00 0,00 0,00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 2,588.00 0.00 2,588.00 lnkind Match 0.00 0.00 0.00 0.00 IVIDHHS Fixed Unit Rate Totals 22,500.00 2,588,00 0.00 25,088,00 Local Heaith Department - 2019, Date 08/10/2018 Page 121 of 194 Contract # Date 08/10/2018 3 Program Budget - Cost Detail Line Item Qty Rate Units UOIVI Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Health Educator Notes : Step 4 GFGP 0.0601 48450.000 0.000 FTE 2,912.00 Chief Community Health Nursing Notes : Step 5 GFGP 0.0120 94150.000 0.000 FTE 1,130.00 Total for Salary & Wages 4,042.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Ins Retirement Ins Hospital Ins Life Ins Vision Ins Dental Ins Workers Comp Short/Long Terms Disability Ins 0.0000 65.562 4042.000 2 650 00 3 Cap. Exp. for Equip & Fac. 4 Contractual Supplies and Materials ' Printing Notes : We print a significant quantity of locally developed client education materials and distribute them to 15.000+ WIC clients annually, as well as our other community outreach." 0.000 0.000 3,952.00 0.0000 Educational Supplies 0.0000 0.000 0.000 2,306.00 Client Support Materials 0.0000 0.000 0.000 3,375.00 Total for Supplies and Materials 9,633.00 6 Travel 7 Communication County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Advertising 0.0000 0.000 0.000 5,625.00 Insurance 0.0000 0.000 0.000 33.00 Local Health Devartment - 2019, Date 08/1012018 Page: 122 of 194 Contract # Date: 08/10/2018 :Line Item : Qty Rate Units!UOM Total Total for All Others (ADP, Con. E m p l o y e e s , M i s c . ) 5,658.00 Total Program Expenses 21,983.00 TOTAL DIRECT EXPENSES 21.983.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2—CUM-Allocation Plan / Other Health Adm Distribution 0.0000 1,872.00 0.000 0,000 Nursing Adm Distribution 0.0000 0.000 0.000 716.00 Cost Allocation Plan Notes : 12.79% 0.0000 0.000 0.000 517.00 Total for Cost Allocation Plan / O t h e r 3,105.00 Total Indirect Costs 3,105.00 TOTAL INDIRECT EXPENSES 3,105.00 TOTAL EXPENDITURES 25,088.130 Local Health Department -2019, Date: 08/10/2018 Page: 123 of 194 Contract # Date 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / Laboratory Services B i o DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Se r v i c e s / Health Division BUDGET PERIOD From : 10/1/2018 To 9130/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT pi,. Original I'D Amendment AMENDMENT # 0 CITY Pontiac i STATE IMP CODE MI 148341-0432 FEDERAL ID NUMBER 38-6004876 1 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 3,644.00 3,644.00 2 Fringe Benefits 2,276.00 2,276.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 10,513.00 10,513.00 6 Travel 0.00 0.00 7 Communication 575.00 r 575,00 County-City Central Services . • 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 26.00 26.00 Total Program Expenses 17,034.00 17,034.00 TOTAL DIRECT EXPENSES - 17,034.00 17,034.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 1,922.00 1,922.00 Total Indirect Costs 1,922.00 1,922.00 TOTAL INDIRECT EXPENSES 1,922.00 1,922.00 TOTAL EXPENDITURES 18,956.00 18,956.00 Local Health Department - 2019, Date: 08/10/2018 Page: 124 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash lnkind Total i Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 _ 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 17,500.00 0.00 0.00 17,500.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private I Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 1,456.00 0.00 1,456,00 Inkind Match 0.00 _ 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 17,500.00 _ 1,456.00 0.00 18,956.00 Local Health Department - 2019, Date; 01311012018 Page: 125 of 194 Contract # Date: 08/1012018 3 Program Budget - Cost Detail Line Item Qtyl Rate, Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Supervisor Notes : 0 0481 75786.000 0.000 FTE 3,644.00 2- Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 3644.000 2,276.00 0.0000 62 459 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Lab supplies 0.0000 0.000 0.000 10,513.00 6 Travel 7 Communication Telephone 0.0000 0.000 0.000 575.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employe e s , M i s c . ) Insurance , 0.0000 0.000 0.000 26.00 Total Program Expenses 17,034.00 TOTAL DIRECT EXPENSES 17,034.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 1,456.00 Cost Allocation Plan Notes : 11.91% 0.0000 0.000 0.000 466.00 Local Health Department - 2019, Date: 09 / 1 0 1 2 0 1 8 Page. 126 of 194 Contract # Date: 08/10/2018 Line Item L Qty Rate UnitsiUOM -, Total Total for Cost Allocation Plan / Other 1,922.00 Total Indirect Costs 1,922.00 TOTAL INDIRECT EXPENSES 1922.00 TOTAL EXPENDITURES 18,956.00 Local Health Department -2019, Date: 08/10/2018 Page: 127 of 194 Contract # Date: 08/1012018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2019 / Nurse Family Partnership - MCH DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To: 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East — BUDGET AGREEMENT lv: Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 , Category- 1 Amount I_ Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 _ Cost Allocation Plan / Other 0.00 0.00 Total Indirect Costs 0.00 0,00 TOTAL INDIRECT EXPENSES 0.00 0.00 TOTAL EXPENDITURES 0.00 0.00 Local Health Department - 2019, Date: 08/10/2018 Page: 128 of 194 Contract # Date. 0811012018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0,00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0,00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.60 Federal Medicaid Outreach 0.00 , 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0,00 0.00 , Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0,00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0,00 ELPHS - MDHHS Vision 0.00 0,00 0.00 0.00 L ELPHS - MDHHS Oth-er' 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private! Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0,00 Local Funds - Other 0.00 0.00 0.00 0.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 0.00 0.00 0.00 0.00 Local Health Department -2019, Date: 08/10/2018 Page: 129 of 194 Contract # Date: 08/1012018 3 Program Budget - Cost Detail 'Line Item __ Qty! Rate Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs Indirect Costs 2 Cost Allocation Plan / Other Total Indirect Costs 0.00 TOTAL INDIRECT EXPENSES 0.00 TOTAL EXPENDITURES 0.00 Local Health Department - 2019. Date: 08/10/201B Page 130 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019/ Nurse Fami l y P a r t n e r s h i p Services DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Hum a n S e r v i c e s / Health Division BUDGET PERIOD From : 10/1/2018 To 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT fc/.• Original n Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Kinounti - Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 339,477.00 339,477.00 2 Fringe Benefits 208,833.00 .. 208,833.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 17,784.00 17,784.00 5 Supplies and Materials 4,695.00 4,695.00 6 Travel 8,848.00 8,848.00 7 Communication 4,000.00 4,000.00 8 County-City Central Services 0.00 0,00 9 Space Costs 17,649.00 17,649.00 10 All Others (ADP, Con. Employees, Misc..) 19,754.00 19,754.00 Total Program Expenses 621,040.00 621040.00 , TOTAL DIRECT EXPENSES 621,040.00 621.040.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 71,440.00 71,440.00 Total Indirect Costs _ 71,440.00 71,440.00 TOTAL INDIRECT EXPENSES 71,440.00 71,440 00 TOTAL EXPENDITURES 692,480.00 692,480.00 Local Health Department - 2019, Date: 05110(20 1 8 Page: 131 of 194 Contract # Date: 08110/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind 1 Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 0.00 0.00 ' 0.-00 Federal Cost Based Reimbursement Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0,00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00. 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 621,040.00 0.00 0.00 621,040.00 ELPHS - MDHHS Hearing 0.00 0.00 0,00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0,00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0,00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 71,440.00 0,00 71,440.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 621,040.00 71,440.00 0.00 692,480.00 Local Health Department - 2019, Date: 08/10/2018 Page 132 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail Line Item I Qty Ratel UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages - Public Health Nurse 0.2500 70797.000 0.000 FTE 17,699.00 Public Health Nurse 1.0000 70797.000 0.000 FTE 70,797.00 Public Health Nurse 1.0000 67519.000 0.000 FIE 67,519.00 Public-Health Nurse- - -1-.0000- --58570000- - - 0.000 FIE 58T570.00 Public Health Nurse 1.0000 70797.000 0.000 FTE 70,797.00 OVERTIME Notes : Overtime (PHNs) 0.0096 101700.000 0.000 FTE 976.00 Coordinator 0.7115 74658.000 0.000 FTE 53,119.00 Total for Salary & Wages 339,477.00 Fringe Benefits Composite Rate Notes : Fica Unemp Ins Retirement Hosp Ins Life Ins Vision Ins Dental Ins Work Comp Short/Long Term Disability 0.0000 61.516 339477.000 208,833.00 3 Cap. Exp. for Equip & Fac, 4 Contractual NFP National Office Program Support 0.0000 0.000 0.000 8,088.00 NFP Consultation 0.0000 0.000 0.000 9,696.00 Total for Contractual 17,784.00 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 1,826.00 Postage 0.0000 0.000 0.000 432.00 Printing 0.0000 0.000 0.000 237.00 Client Support Materials 0.0000 0.000 0.000 2,000.00 Educational Supplies 0.0000 0.000 0.000 200.00 Total for Supplies and Materials 4,695.00 6 Travel Mileage 0.0000 0.000 0.000 7,848.00 Local Health Department - 2019, Date: 08/10/2018 Page 133 of 194 Contract # Date: 08/10/2018 Line Item Qty Rate Units UOM Total Notes : 14,400 miles @ .545 Conferences 0.0000 _ 0.000 0.000 1,000.00 Total for Travel 8,848.00 7 Communication Telephone Communications , 0.0000 0.000 0.000 8 County-City Central Services ----9- Space Costs - Building Space Rental 0.0000 17,649.00 0.000 0.000 10 All Others (ADP, Con. Employees , M i s c . ) Insurance 0.0000 0.000 0,000 922.00 Copier 0.0000 0.000 0.000 3,712.00 I T Operations 0,0000 0.000 0.000 15,120.00 Total for All Others (ADP, Con. Em p l o y e e s , M i s c . ) 19,754.00 Total Program Expenses 621,040,00 TOTAL DIRECT EXPENSES 621,040.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan 1 Other Health Adm Distribution 0:0000 0.000 0,000 51,671.00 Nursing Adm Distribution. 0.0000 0.000 0.000 19,769.00 Total for Cost Allocation Plan 1 Other 71,440.00 Total Indirect Costs 71,440.00 TOTAL INDIRECT EXPENSES 71,440.00 TOTAL EXPENDITURES 692,480.00 Local Health Department - 2019. Date: 08/1 0 / 2 0 1 8 Page: 134 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary 7 PROGRAM / PROJECT Local Health Department - 2019/ Medicaid Outreach DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To : 9/30/2019 , MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East F BUDGET AGREEMENT AMENDMENT # p. Original r Amendment a CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category 1- Amount 1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 342,015.00 342,015.00 Fringe Benefits 200,246.00 200,246.00 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0,00 8 County-City Central Services 0,00 0.00 9 Space Costs 6.234.00 6,234.00 10 All Others {ADP, Con. Employees, Misc.) 0.00 0.00 Total Program Expenses 548,495.00 548,495.00 TOTAL DIRECT EXPENSES 548,495.00 548,495.00 INDIRECT EXPENSES Indirect Costs 1 , Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 93,019.00 93,019.00 Total Indirect Costs r 93,019.00 93,019.00 TOTAL INDIRECT EXPENSES 93,019.00 93,019.00 TOTAL EXPENDITURES 641,514.00 641,514.00 Local Health Department - 2019, Date: 0811012018 Page 135 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind I Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 ederator State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimburseme n t 0.00 0.00 0.00 --OM- Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 296,120.00 0.00 0.00 296,120.00 Required Match - Local 0.00 296,119,00 0.00 296,119.00 Local Non-ELPHS 0.00 . 0.00 0.00 0 00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0,00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0 00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private I Type 10 Water. Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0,00 0.00 0.00 Local Funds - Other 0.00 49,275.00 0.00 49,275.00 lnkind Match 0.00 0.00 0.00 0.00 MIDHHS Fixed Unit Rate _Totals 296,120.00 345,394.00 0.00 641,514.00 Local Health Department- 2019, Date : 0 8 / 1 0 ( 2 0 1 8 Page: 136 of 194 Contract # Date 08/10/2018 3 Program Budget - Cost Detail !Line Item Qty Rate Units UOM , Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Multiple positons Notes : Amount determined based on time studies 1.0000 342015.000 0.000 FTE 342,015.00 2 Fringe BenefitS - All Composite Rate Notes : FICA UNEMPLOY RETIREMENT HOSPITAL LIFE INSURANCE VISION DENTAL WORKERS COMP SHORT/LONG TERM DISABILITY 0.0000 58.549 342015.000 200,246.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication • 7 8 County-City Central Services 9 Space Costs Office Space Rental 0.0000 .__ 0.000 0.000 6,234.00 10 All Others (ADP, Con. Employees, Misc. ) Total Program Expenses 548,495.00 TOTAL DIRECT EXPENSES 548,495.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 49,275.00 Cost Allocation Plan Notes : 12.79% 0.0000 0,000 0.000 43,744.00 Total for Cost Allocation Plan / Othe r 93.019.00 Total Indirect Costs 93,019.00 Local Health Department - 2019, Date: 08/10 / 2 0 1 8 Page. 137 of 194 Contract # Date: 08110/2018 !Line Item I Qty Rate! UnitslUOM Total TOTAL INDIRECT EXPENSES 93,019.00 TOTAL EXPENDITURES 1 641,514.00 Local Health Department - 2019, Date: 08/10/2018 Page: 138 of 194 Contract # Date. 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019/ Public Hlth Functions & Infratruct - MCH DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To 9/3012019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 21,535.00 21,535.00 Fringe Benefits 13,093.00 13,093.00 3 Cap, Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 6,489.00 6,489.00 6 Travel 4,005.00 4,005.00 7 Communication 1,135.00 1,135.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 3,413.00 3,413.00 Total Program Expenses 49.670.00 49.670.00 TOTAL DIRECT EXPENSES 49,670.00 49,670.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 2,015,655.00 2,015,655.00 Total Indirect Costs 2,015,655.00 2,015,655,00 TOTAL INDIRECT EXPENSES 2,015,655.00 2,015,655.00 TOTAL EXPENDITURES 2,065,325.00 2,065,325.00 Local Health Department - 2019, Date: 0811012018 Page 139 of 194 Contract At Date. 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 j Federal Cost Based Reimbursement -0-.-00--r---- 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 1 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0,00 0.00 0.00 Local Non-ELPHS 0.00 . 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 1 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision . 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0,00 0.00 0.00 ELPHS - On-Site VVastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 52,424.00 0.00 0.00 52,424.00 Local Funds - Other 0.00 2,012,901.00 0.00 2,012,901.00 inkind Match 0.00 0.00 0.00 0.00 MOI-IFIS Fixed Unit Rate Totals 52,424.00 2,012,901.00 0.00 2,065,325.00 Local Health Department- 2019, Date. 08h0/2018 Page: 140 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail !Line Item Qty Rate[ Units l_t_JOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Coordinator 0.2885 74645.000 0.000 FTE 21,535.00 2 Fringe Benefits -AILComposite Rate 0.0000 60.799 21535.000 13,093.00 Notes : FICA, LIFE INS, DENTAL, UNEMPLOYMENT, VISION, WORK COMP, RETIREMENT, HOSPITALIZATION, SHORT/LONG TERM DISABILITY 3 Cap. Exp. for Equip & Fac. 4 _1 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 1,030.00 Printing 0.0000 0.000 0.000 3,082.00 Educational Supplies 0.0000 0.000 0.000 2,377.00 Total for Supplies and Materials 6,489.00 6 Travel Mileage Notes : 1844 miles @ .546 0.0000 0 000 0,000 1,005.00 Conferences 0•0000, 0.000 0.000 3,000.00 Total for Travel 4,005.00 7 Communication Telephone 0.0000 0,000, 0.000 1,135.00 8 County-City Central Services 9 Space Costs s 10 All Others (ADP, Con. Employees, Misc.) Info Tech Operations 0.0000 0.000 0.000 2.936.00 Insurance 0.0000 0.000 0.000 477.00 Total for All Others (ADP, Con. Employees, M i s c . ) 3,413.00 Total Program Expenses 49,670.00 TOTAL DIRECT EXPENSES 49,670.00 INDIRECT EXPENSES Indirect Costs Local Health Department - 2019, Date. 0811012018 Page 141 of 194 Contract # Date 08/1012018 Line Item Qty I Ratel Units UOM Total 1 Indirect Costs 2 Cost Allocation Plan /Other Health Adm Distribution 0.0000 0.000 0.000 5,269.00 Other Cost Distributions-Nursing Notes : This distribution takes total costs of Field Nursing and allocates them back to various cost centers by a time study. The % back to MCH is 71.42%. 0.0000 0.000 0.000 1,978,548.00 Nursing Adm Distribution 0.0000 0.000 0.000 1,695.00 Other Cost Distributions- Education Notes : This distribution takes total costs of Education and allocates them back to various cost centers by a time study. The % back to MCH for Education is .47%. 0.0000 0.000 0.000 27,389.00 Cost Allocation Plan Notes :12,79% 0.0000. 0.000 0.000 2,754.00 Total for Cost Allocation Plan / Other 2,015,655.00 Total Indirect Costs 2,015,655.00 TOTAL INDIRECT EXPENSES 2,015,655.00 TOTAL EXPENDITURES 2,065,325.00 Local Health Department - 2019, Date: 08/10/2018 Page. 142 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2019 / MDEQ On-site Wastewater Treatment DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To : 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT WI Original r Amendment AMENDMENT # 0 CITY Pontiac STATE 'ZIP CODE MI ,48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount, Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 1,006,805.00 1,006,805.00 Total Indirect Costs 1,006,805.00 1,006,805.00 TOTAL INDIRECT EXPENSES 1,006,805.00 1,006,805.00 TOTAL EXPENDITURES 1,006,805.00 1,006,805.00 Local Health Department - 2019, Date: 08/10/2018 Page: 143 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0,00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 - Federally Provided Vaccines 0.00 0,00 0.00 0.00 Federal Medicaid Outreach 0.00 . 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 r 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0,00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - IV1DHHS Vision 0.00 0,00 0.00 0.00 _.J ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 372,426.00 0.00 0.00 372,426.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 634,379.00 0.00 634,379,00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 372,426.00 634,379.00 0.00 1,006,805.00 Local Health Department- 2010 Date: 08/1012018 Page: 144 of 194 Contract # Date: 0811012018 3 Program Budget - Cost Detail Line Item I Qtyl Ratel UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Environmental Hlth Adm Distribution 0,0000 0.000 0.000 717,245.00 Health Adm Distribution 0.0000 0.000 0.000 289,560.00 Total for Cost Allocation Plan / Other 1,006,805.00 Total Indirect Costs 1,006,805.00 TOTAL INDIRECT EXPENSES 1,006,805.00 TOTAL EXPENDITURES 1,006,805.00 Local Health Department - 2019, Date: 08/10/2018 Page 145 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019/ FIMR Interviews DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Fif Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services _ 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs E 0.00 0.00 2 Cost Allocation Plan / Other 2,000.00 2,000.00 Total Indirect Costs 2,000.00 2,000.00 TOTAL INDIRECT EXPENSES 2,000.00 2,000.00 TOTAL EXPENDITURES 2,000.00 2,000.00 Local Health Department - 2019, Date: 08/10/2018 Page: 146 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category , Amount Cash_ lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0,00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 4- Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement -ifl.C10 0.00 _am_ 0.00 Federally Provided Vaccines ..1 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00. 0,00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0,00 ELPHS - MDHHS Vision 0,00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0,00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water., Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0,00 0.00 0.00 0.00 Local Funds - Other 0.00 0,00 0.00 0.00 Inkind Match _ 0.00 0.00 0.00 0.00 r MDFIHS Fixed Unit Rate Sudden Infant Death Syndrome Fees 2,000.00 0.00 0.00 2,000.00 Totals 2,000.00 0.00 0.00 2,000.00 Local Health Department - 2019, Date. 08/104 2 0 1 8 Page: 147 or194 Contract # Date: 08/1012018 3 Program Budget - Cost Detail ;Line Item Qty Rate' Units UOM , Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. —C-eiritit-ctUal — 4 5 Supplies and Materials Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Mi s c . ) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution Notes : Cost Distributions for FIMR Interviews (SIDS) Fees from Health Adminstration 0.0000 0.000 0.000 2,000.00 Total Indirect Costs 2000.00 TOTAL INDIRECT EXPENSES 2,000.00 TOTAL EXPENDITURES 2,000.00 Local 1-lea!th Department - 2019, Date 08110/2018 Page 148 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / Sexually Transmitted Disease (STD) Control DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To: 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT go; Original n Amendment AMENDMENT It 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 49,083.00 49,083.00 2 Fringe Benefits 33,567.00 33,567.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0,00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 Total Program Expenses 82,650.00 82,650.00 TOTAL DIRECT EXPENSES 82,650.00 82,650.00 INDIRECT EXPENSES Indirect Costs 1 indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 13,463.00 13,463.00 Total Indirect Costs 13,463.00 13,463.00 TOTAL INDIRECT EXPENSES 13,463.00 13,463.00 TOTAL EXPENDITURES 96,113.00 96,113.00 Local Health Department - 2019, Date: 0811012018 Page: 149 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 federal Cost -Based-Reimbursement- 0.00- - -0.00 n na 000 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 82,650.00 0.00 0.00 82,650.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 000 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 13,463,00 0.00 13,463.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 82,650.00 13,463.00 0.00 96,113.00 Local Health Department- 2019, Date: 08/1012018 Page: 150 of 194 Contract # Date 0811012018 3 Program Budget - Cost Detail Line Item 1 Qty Rate Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Medical Technologist 0.7216 68019.000 0.000 FTE 49,083.00 2 Fringe Benefits AU t;omposite Rate Notes : RCA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 68,388 49083.000 33,567.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, M i s c . ) Total Program Expenses 82,650.00 TOTAL DIRECT EXPENSES 82,650.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution J 0.0034 0.0001 0.000 13,463.00 Total Indirect Costs 13.463.00 TOTAL INDIRECT EXPENSES 13,463.00 TOTAL EXPENDITURES 96,113.00 Loca! Healtn Department - 2019, Date 08( 1 0 / 2 0 1 8 Page: 151 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM/PROJECT Local Health Department - 2019 / Sexually Transmitted Disease (STD-ELPHS) DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To: 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT g Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Mt ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 --I Category I Amount_ I _ Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0,00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 1,372,517.00 1,372,517.00 Total Indirect Costs 1,372,517,00 1,372,517.00 TOTAL INDIRECT EXPENSES 1,372,517.00 1,372,517.00 TOTAL EXPENDITURES 1,372,517.00 1,372,517.00 Local Health Department -2010, Date: 08/10/2018 Page: 152 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0,00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 - ----r Federal or State (Non MDHHS) - -- 0.00 0.00 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 Federally Provided Vaccines 0,00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0,00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 .--I MDHHS Non Comprehensive 0,00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing . 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision. 0,00 0.00 0.00 0.00 ELPHS - MDHHS Other 597,292.00 0.00 0.00 597,292.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type lli Water Supply 0,00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 .., 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 775,225.00 0.00 775.225 00 Inkind Match 0.00 _ 0.00 0.00 0,00 MDHI-IS Fixed Unit Rate Totals 597,292.00 _ 775,225.00 i 0.00 1,372,517,00 Local Health Department - 2019, Date: 0811012018 Page: 153 of 194 Contract # Date. 0811012018 3 Program Budget - Cost Detail Line Item Qty Rate] Units I , UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan !Other Nursing Adm Distribution 0:0000 0.000 0.000 20,417.00 Other Cost Distributions-Clinic & Lab distributions 0.0000 0.000 0.000 1,352,100.00 Total for Cost Allocation Plan / Other 1,372,517,00 Total Indirect Costs 1,372,517.00 TOTAL INDIRECT EXPENSES 1,372,517.00 TOTAL EXPENDITURES 1,372,517.00 I ocal Health Department - 2019, Date: 08;1012018 Page 154 of 194 Contract # Date: 08/1C/2018 1 Program Budget Summary PROGRAM 1 PROJECT Local Health Department - 2019 / Tuberculosis (TB) Control DATE PREPARED 8/1012018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To : 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT rs7, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 14,637.00 14,637.00 Fringe Benefits 806.00 806.00 1 Cap. Exp. for Equip & Fac. 0.00 0.00 , 4 Contractual 0.00 0.00 Supplies and Materials 52,903.00 52,903.00 Travel 11,597.00 11,597.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 39,773.00 39,773.00 Total Program Expenses 119,716.00 119,716.00 TOTAL DIRECT EXPENSES 119,716.00 119,716.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 892,381.00 892,381.00 Total Indirect Costs 892,381.00 892,381.00 TOTAL INDIRECT EXPENSES 892,381.00 892,381.00 TOTAL EXPENDITURES 1,012,097.00 1,012,097.00 Local Health Department- 2019, Date: 08,10/2018 Page: 155 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount _ Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 000 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0,00 0.00 Federal Cost Based Reimbursement 0-.00- -- -o..00 _ a.00 To Federally Provided Vaccines 0.00 0.00 --, 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 • 0.00. 0.00 0.00 Local Non-ELPHS 0.00 0,00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0,00 0.00 MDHHS Comprehensive 48,678.00 0.00 0.00 48,678.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0,00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Private / Type Ill Water Supply 0,00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 963,419.00 0.00 963,419.00 lnkind Match 0.00 0.00 0.00 0.00 IVIDHHS Fixed Unit Rate Totals 48,678.00 963,419.00 0.00 1,012,097.00 Local Health Department - 2019, Date: 08110/2018 Page: 156 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail 'Line Item I Qty Rate UnitslUOM , Total DIRECT EXPENSES Program Expenses I Salary & Wages Outreach Worker Notes : GRANT POSITION 0.3846 38057.000 0.000 FTE 14,637.00 2 Fringe Benefits 5.51-0- —0.-0000 _14631000 806.00 All Composite-Rate Notes : Social Security Unemployment Ins Retirement Hospital Ins Life Ins Vision Ins Dental Ins Work Comp GRANT FRINGES 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Medical Supplies Notes : TB grant 0.0000 0.000 0.000 1,000,00 Office Supplies Notes : TB GRANT 0.0000 0.000 0.000 200.00 Client Support Materials Notes : TB GRANT 0.0000 0.000 0.000 1,453.00 Postage Notes : TB GRANT 0.0000 0.000 0.000 250.00 Drugs/Pharm - COUNTY BUDGET 0.0000 0.000 0.000 50,000.00 Total for Supplies and Materials 52,903.00 6 Travel Mileage Notes :16,000 miles @ .545 TB GRANT 0.0000 0.000 0.000 8,720,00 Conferences Notes : TB GRANT 0.0000 0.000 0.000 2,377.00 Client Transporation Notes : TB GRANT 0.0000 0.000 0.000 500.00 Total for Travel 11,597.00 Local Health Department - 2019, Date: 08/1012018 Page; 157 of 194 Contract # Date 08110/2018 Line Item Qty[ Rate Units UOM Total 7 Communication County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance Notes : TB GRANT 0.0000 0.000 0.000 72.00 Lab Fees Notes : TB GRANT $15,304.00 0.0000 0.000 0.000 15,304.00 Translation/Interpretation Notes : TB GRANT 0.0000 0.000 0.000 817.00 Copier Notes : TB GRANT $420.00 0.0000 0.000 0.000 420.00 Equipment Repair Notes : TB GRANT 0.0000 0.000 0.000 250.00 Lab Fees, Membership-COUNTY BUDGET 0.0000 0.000 0.000 1,500.00 Prof Svcs, Copier-COUNTY BUDGET 0.0000 0.000 0.000 10,110.00 TB Cases/Outside-COUNTY BUDGET 0.0000 0.000 0.000 10,000.00 Memberships & Dues-COUNTY BUDGET 0.0000 0.000 0.000 1,300.00 Total for All Others (ADP, Con. Employees, Misc.) 39,773.00 Total Program Expenses 119.716,00 TOTAL DIRECT EXPENSES 119,716.00, INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan /Other Health Adm Distribution 0.0000 0,000 0.000 15,677.00 Nursing Adm Distribution 0.0000 0.000 0,000 10,735.00 Other Cost Distributions-Misc 0.0000 0.000 0.000 864,097.00 Cost Allocation Plan Notes : 12.79% TB GRANT BUDGET 0.0000 0.000 0.000 1,872.00 Total for Cost Allocation Plan / Other 892,381.00 Total Indirect Costs 892,381.00 Local Health Department - 2019, Date: 08/10/2018 Page 58 of 194 Contract # Date: 0811012018 'Line Item I Qty Rate' Units UOM Total TOTAL INDIRECT EXPENSES 892,381.00 TOTAL EXPENDITURES 1,012,097.00 l_ocal Health Department - 2019, Date: 08/10/2018 Page: 159 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department -2019 / Local Tobacco Reduction DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To : 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT F., Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 -Category I Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 14,836.00 14,836.00 2 Fringe Benefits 817.00 817.00 3 Cap. Exp. for Equip & Fac. 0.00 0,00 4 Contractual 0.00 0.00 5 Supplies and Materials 500.00 500.00 6 Travel 1,161.00 1,161.00 7 Communication 336.00 336.00 8 County-City Central Services . 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, IVIlsc.) 452.00 452.00 Total Program Expenses 18,102.00 18,102.00 TOTAL DIRECT EXPENSES - 18,102,00 18,102,00 INDIRECT EXPENSES Indirect Costs Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 3,562.00 3,562.00 Total Indirect Costs 3,562.00 3,562.00 TOTAL INDIRECT EXPENSES 3,562.00 3,562.00 TOTAL EXPENDITURES 21,664.00 21,664.00 Local Health Department - 2019, Date: 08/101201B Page: 160 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 0:00 0.00 (LOU 0.00 Federal Cost Based Reimbursemeni Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0,00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0,00 0.00 0.00 0.00 MDHHS Comprehensive 20,000.00 0.00 0.00 20,000.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0,00 0,00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 1,664.00 0.00 1,664.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 20,000.00 1,654.00 0.00 21,664.00 Local Health Department- 2019, Date: 08110/2018 Page: 161 of 194 Contract # Date: 08110/2018 3 Program Budget - Cost Detail 'Line Item Qty Rate] UnitslUOM I Total DIRECT EXPENSES Program Expenses L 1 Salary & Wages Health Educator 0.2404 61712.000 0.000 FTE 14,836.00 2 Fringe Benefits All Composite Rate 0.0000 5.507 14836.000 817.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Printing 0,0000 0.000 0.000 200.00 Educational Supplies 0.0000 0.000 0.000 300.00 Total for Supplies and Materials 500.00 6 Travel Mileage Notes : 2130 @ .545 0.0000 0.000 0.000 1,161.00 Communication Telephone Communications 0,0000 0,000 0.000 336,00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) - Insurance 0.0000 0.000 0.000 30.00 Advertising 0.0000 0.000 0.000 422.00 Total for All Others (ADP, Con. Employees, Misc.) 452.00 Total Program Expenses 18,102.00 TOTAL DIRECT EXPENSES 18,102.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution .- 0.0000 0,000 0.000 1,664.00 Cost Allocation Plan Notes : 12.79% 0.0000 0.000 0.000 1,898.00 Total for Cost Allocation Plan / Other 3,562.00 Total Indirect Costs 3,562.00 TOTAL INDIRECT EXPENSES 3,562.00 Local Health Department - 2019, Date: 08/10/2018 Page: 162 of 194 Contract # Date: 08/10/2018 I Line Item I QtY I Rate' Units [UOM Total TOTAL EXPENDITURES 21,664.00 Local Health Department - 2019, Date: 0911012018 Page: 163 of 194 Contract # Date: 08/1012018 Program Budget Summary PROGRAM I PROJECT Local Health Department - 2019 / Immunization Fixed Fees DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 1011/2018 To: 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Pi Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0,00 0.00 _ 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan /Other 30,107.00 30,107.00 Total Indirect Costs 30,107.00 30,107.00 TOTAL INDIRECT EXPENSES 30,107 00 30,107.00 TOTAL EXPENDITURES 30,107.00 30,107.00 Local Health Department- 2019, Date: 08/1012018 Page: 164 of 194 Contract # Date 08/1012018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 -0;0 0,00_ Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0,00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0,00 0.00 0,00 MDHHS Non Comprehensive 0.00. 0.00 0.00 0.00 MDHHS Comprehensive , 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 i ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 1 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 -1 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 lnkind Match , 0.00 0.00 0.00 0.00 MDFIHS Fixed Unit Rate IMM: VFC - AFIX Visits 30.107.00 0.00 0.00 30.107.00 Totals 30,107.00 0.00 0.00 30,107.00 Local Health Department - 2019, Date: 00/10/2018 Page: 165 of 194 Contract # Date 08/10/2018 3 Program Budget - Cost Detail Line Item Qtyl Rate Units UOM Total DIRECT EXPENSES Program Expenses -1 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Cost Distributions for Fees-from IAP 0,0000 0.000 0.000 30,107.00 Total Indirect Costs 30,107.00 TOTAL INDIRECT EXPENSES 30,107 00 TOTAL EXPENDITURES 30,107.00 Local Health Department - 2019, Date: 08110/2018 Page: 166 of 194 Contract # Date: 08110/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / Vision ELPHS DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2019 To: 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Pi Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 , Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 346,198.00 346,198.00 2 Fringe Benefits 88,648.00 88,648,00 3 Cap. Exp. for Equip & Fac, 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 4,345.00 4,345,00 6 Travel 5,775.00 5,775.00 7 Communication 1,319.00 1,319.00 8 County-City Central Services 0.00 0,00 9 Space Costs 14,165.00 14,166.00 10 All Others (ADP, Con, Employees, Misc,) 7,527.00 7,527.00 Total Program Expenses 467,977.00 467,977,00 TOTAL DIRECT EXPENSES 467,977.00 467,977.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0,00 2 Cost Allocation Plan / Other 102,643.00 102,643.00 Total Indirect Costs 102,643.00 102,643.00 TOTAL INDIRECT EXPENSES 102,643.00 102,643.00 TOTAL EXPENDITURES 570,620.00 570,620.00 Local Health Department -2019, Date: 0811012018 Page: 167 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.90 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0,00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 253,968.00 0.00 0.00 253,968.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 316,652.00 0.00 316,652.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 253,968.00 316,652.00 I 0.00 570,620.00 Local Health Department- 2019, Date: 08/10/2018 Page: 168 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail !Line Item Qtyl Rate Units UOM Total DIRECT EXPENSES Program Expenses .1 Salary & Wages Supervisor 1.0000 39300.000 0.000 FTE 39,300.00 Technician 0.4808 33951.000 0,000 FTE 16,324.00 Technician 0.4808 33951.000 0.000 FTE 16,324.00 Technician FTE 26,530.00 0.6000 4421-67000 0.000 Technician 0 4808 44217.000 0.000 FTE 21,260.00 Technician 0.4808 33951.000 0.000 FTE 16,324.00 Technician 0.4808 33951.000 0.000 FTE 16.324.00 Technician 0.4808 38057.000 0.000 FTE 18,298.00 Technician 0.4808 36002.000 0.000 FTE 17,310,00 Technician 0.4808 38057.000 0.000 FTE 18,298.00 Technician 0.4808 33961.000 0.000 FTE 16,324.00 Technician 0.4808 36002.000 0.000 FTE 17,310.00 Technician 0.4808 36002.000 0.000 FTE 17,310.00 Technician 0.4808 33951.000 0.000 FTE 16,324.00 Technician 0.4808 36002.000 0.000 FTE 17,310.00 Coordinator 0.5000 74654.000 0.000 FTE 37,327.00 Auxiliary Health Worker 0.5000_ 36002.000 0.000 FTE 18,001.00 Total for Salary & Wages 346,198.00 2 Fringe Benefits All Composite Rate Notes : FICA UNEMPLOYMENT INS RETIREMENT HOSPITAL INS LIFE INS VISION INS HEARING INS DENTAL INS WORK COMP SHORT/LONG TERM DISABILITY 0.0000 25,606 346198.000 88,648.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.0001 0.000 _ 1,100.00 Local Health Department- 2019, Date: 08110/2018 Page: 169 of 194 Contract # Date: 08/10/2018 Line Item Qty Rate Units UOM Total Medical Supplies 0.0000 0.000 0.000 935.00 Printing 0.0000 0,000 0,000 2,310.00 Total for Supplies and Materials 4,345.00 6 Travel Personal Mileage Notes : 10,596.33 miles @ ,545 0,0000 0.000 0.000 5,775.00 7 Communication 0.0000 0.000 1319.00 Telephone 0.000- 8 County-City Central Services 9 Space Costs Space/Rental Costs 0.0000 0.000 0.000 14,165.00 10 All Others (ADP, Con. Employees, Misc.) Staff Training 0.0000 0.000 0.000 3,025.00 Equipment Repair 0.0000 , 0.000 0.000 2,475.00 Copier 0.0000 0.000 0.000 295.00 Insurance 0.0000 0.000 0.000 1,732.00 Total for All Others (ADP, Con. Employees, Misc.) 7,527.00 Total Program Expenses 467,977.00 TOTAL DIRECT EXPENSES 467,977.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Other Cost Distributions-Misc Distribution 0.0000 0.000 0.000 15,744.00 Health Acim Distribution 0.0000 0.000 0.000 42,620.00 Cost Allocation Plan Notes :12.79% 0.0000 0.000 0.000 ., 44,279.00 Total for Cost Allocation Plan / Other 102,643.00 Total Indirect Costs 102,643.00 TOTAL INDIRECT EXPENSES 102,643.00 TOTAL EXPENDITURES 570,620.00 Local Health Department - 2019, Date: 08/10/2019 Page: 170 of 194 Contract # Date: 08/1012018 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / Immunization Vaccine Quality Assurance DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2018 To: 9130/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p: . Original 17. Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount- Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2,097,782.00 2,097,782.00 Fringe Benefits 1,265,119.00 1,265,119.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 1,275,610.00 1,275,610.00 6 Travel 6,182.00 6,182.00 7 Communication 27,636.00 27,636.00 8 County-City Central Services 0.00 0.00 9 Space Costs 188,451.00 188,451.00 10 All Others (ADP, Con. Employees, Misc.) 239,076.00 239,076.00 Total Program Expenses 5,099,856.00 5,099,856.00 TOTAL DIRECT EXPENSES 5,099,856.00 5,099,856.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other -3,613,614.00 -3,613,614.00 Total Indirect Costs -3,613,614.00 -3,613,614.00 TOTAL INDIRECT EXPENSES -3,613,614.00 -3,613,614.00 TOTAL EXPENDITURES 1,486,242.00 1,486,242.00 Local Health Department - 2019, Date: 08/10/2018 Page 171 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind I Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 1,109,011.00 0.00 1,109,011.00 Fees and Collections - 3rd Party 0.00 272,000.00 0.00 272,000.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 FederaLC_ost.13.aae.d _Fte_intursement p.po am .. ................ 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 ..0.00 0.00 0.00 Local Non-ELPHS 0.00:: 0:00,, 0.00 0.00 Local Non-ELPHS 0:00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0:.00,:. 0.00 0.00 0.00 MDHHS Comprehensive 106,231.00 0.00 0.00 105,231.00 ELPHS - MDHHS Hearing sf0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision . 0.00 0.00 0.00 0.00 ELPHS - MDHHS 0010' 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water , Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 105,231.00 1,381,011.00 0.00 1,486,242.00 Local Health Department - 2019, Date: 08/10/2018 Page: 172 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail 'Line Item Oty Rate Units UOM Total DIRECT EXPENSES Program Expenses I Salary & Wages Coordinator Notes : VQA GRANT 1.0000 44064.000 0.000 FTE 44,064.00 Coordinator Notes : Shared IAP 0.2298 47475.000 0.000 FTE 10,910.00 2,0427W:1.0U PH Clinic Nurses-COUNTY BUDGET 1.0000 2042808.000 0.000 FTE Total for Salary & Wages 2,097782.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance VQA GRANT 0.0000 78,346 54974.000 43,070.00 Composite Rate - COUNTY BUDGET Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 100.000 1222049.00 0 1,222,049.00 Total for Fringe Benefits 1,265,119.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials DrugsNaccines-COUNTY 0.0000 0.000 0.000 1,187,285.00 _ocal Health Departme-rt -2019, Date 08[1012019 Page: 173 of 194 Contract # Date: 08/10/2018 Line Item Qty Rate Units UOM Total BUDGET Medical Supply-COUNTY BUDGET 0.0000 0.000 0.000 77,675.00 Office Supply-COUNTY BUDGET 0.0000 0,000 0.000 7,200.00 Postage-COUNTY BUDGET 0.0000 0.000 0.000 200.00 Printing-COUNTY BUDGET 0.0000 0.000 0.000 3,250.00 Total for Supplies and Materials 1,275,610.00 6 Travel Mileage Notes : COUNTY BUDGET 0.0000 0.000 0.000 5,700.00 Conferences Notes : COUNTY BUDGET 0,0000 0.000 0.000 482.00 Total for Travel 6,182.00 Communication Telephone-COUNTY BUDGET 0.0000 0.000 0,000 27,636.00 8 County-City Central Services 9 Space Costs Space/Rental Costs Notes : COUNTY BUDGET 0.0000 0.000 0,000 188,451.00 10 All Others (ADP, Con. Employees, Misc.) Insurance Notes : VOA budget 0.0000 0.000 0.000 156.00 Insurance Notes : COUNTY BUDGET 0.0000 0.000 0.000 6,939.00 Professional Services-COUNTY BUDGET 0.0000 0.000 0.000 26,000.00 IT Oper-COUNTY BUDGET 0.0000 0.000 0.000 187,205.00 Copier $1336, Equip Rental $840-COUNTY 0.0000 0.000 0.000 2,176,00 Staff Training Notes : COUNTY BUDGET 0.0000 0.000 0.000 200.00 Laundry-COUNTY BUDGET 0.0000 0.000 0.000 2,900,00 Softward Support Maint- COUNTY BUDGET 0.0000 0.000 0.000 13,500.00 Total for All Others (ADP, Con. Employees, Misc.) 239,076.00 Total Program Expenses 5,099,856.00 TOTAL DIRECT EXPENSES 5,099,856.00 INDIRECT EXPENSES Local Health Department - 2019, Date: 08(10/2018 Page: 174 of 194 Contract # Date: 08110/2018 !Line Item I Qty I Rate' UnitslUOM Total Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 446,638.00 Nursing Adm Distribution 0.0000 0.000 0.000 170,883.00 Other Cost Distributions-misc 0.0000 0,000 0.000 -4,499,441.00 Cost Allocation Plan Notes : 12.79% VQA BUDGET 0.0000 0.000 0.000 7,031,00 07000-0000- ---26t275.00 CbsrAllocaticiffPtan Notes : 12.79 % COUNTY BUDGET G:0000 Total for Cost Allocation Plan / Other -3,613,614.00 Total Indirect Costs -3,613,614.00 TOTAL INDIRECT EXPENSES -3,613,614.00 TOTAL EXPENDITURES 1,486,242.00 Local Health Department - 2019, Date: 08/10/2018 Page 175 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / WC Breastfeeding DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To: 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT F7. Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 79,007.00 79,007.00 2 Fringe Benefits 33,194.00 33,194.00 3 Cap, Exp. for Equip & Fac. 0.00 0.00 4 Contractual 73,397.00 73,397.00 5 Supplies and Materials 9,625.00 9,625.00 6 Travel 2,222.00 2,222.00 7 Communication 1,993.00 1,993.00 8 County City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees. Misc.) 9,656.00 9,656.00 Total Program Expenses 209,094.00 209,094.00 TOTAL DIRECT EXPENSES 209,094.00 209,094.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 28,343.00 28,343,00 Total Indirect Costs 28,343.00 28,343.00 TOTAL INDIRECT EXPENSES 28,343,00 28,343.00 TOTAL EXPENDITURES 237,437.00 237,437.00 Local Health Department - 2019, Date: 013/1012018 Page: 176 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category [ Amount Cash inkind 1 Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDFIHS) 0.00 0.00 0.00 0,00 Federal Cost Based Reimbursement 0.00 " " -------- 0.00- 0.00-- ------ ------ ------aca_ Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 i 0.00 0.00 0.00 Required Match - Local 0.00 0,00 0.00 0,00 Local Non-ELPHS 0.00 - 0.00 0.00 0.00 Local Non-ELPHS 0.00 000. 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0,00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 000 , 0.00 0.00 0.00 MDHHS Comprehensive 219,199.00 0.00 0,00 219,199.00 ELPHS - MDHFIS Hearing 0,00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0,00 ELPHS - Private / Type III Water Supply -i 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment - 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 18,238.00 0.00 18,238.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 219,199.00 1 18,238.00 0.00 237,437.00 Local Health Department- 2019, Date; 08/10/2018 Page: 177 of 194 Contract # Date. 08110/2018 3 Program Budget - Cost Detail I Line Item , Qty[ Rate Units UOM _ • Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Lactation Specialist 1.0000 29845.000 0.000 FTE 29,845,00 Lactation Specialist 0.4808 29845.000 0.000 FTE 14,349.00 Lactation Specialist 0.4808 29845.000 0.000 FTE 14,349.00 Lactation Specialist 0.000 0.4808 29845.000 FTE 14,3.9.00 -1 Nutritionist/Dietician 0.0899 68017.000 0.000 FTE 6,115.00 Total for Salary & Wages 79,007.00 2 Fringe Benefits All Composite Rate Notes : FICA UNEMP INS RETIREMENT HOSPITAL INS LIFE INS VISION INS DENTAL INS WORK COMP SHORT/LONG TERM DISABILITY 0.0000 . 42.014 , 79007.000 33,194.00 3 Cap. Exp. for Equip & Fac. 4 Contractual Subcontracting Agency-OLSHA 0.0000 0.000, 0.000 73,397.00 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 2,000.00 Printing 0.0000 0.000 0,000 3,000.00 Medical Supplies 0.0000 0.000 0.000 3,625.00 Postage 0.0000 0,000 0.000 1,000.00 Total for Supplies and Materials 9,625.00 Travel Mileage Notes : 2243 miles @ .545 0.0000 0.000 0.000 1,222.00 Conferences 0.0000 0.000 0.000 1,000.00 Total for Travel 2,222.00 7 Communication Telephone Communications 0.00001 0.000 0.000 1.993.00 8 County-City Central Services Lccal Health Department - 2019, Date: 08/10/2018 Page: 178 of 194 Contract # Date 08/1012018 Line Item 1.. Qty Rate' Units ,UOM Total 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 325.00 Advertising 0.0000 0.000 0.000 6,000.00 Staff Training 0.0000 0.000 0.000 2,331.00 Interpretation 0.0000 0.000 0.000 1,000.00 Total for All Others (ADP, Con. Employees, Misc.) 9,656.00 Total Program Expenses 209,094.00 TOTAL DIRECT EXPENSES 209,094.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 18,238.00 Cost Allocation Plan Notes : 12.79% 0.0000 0.000 0.000 10,105,00 Total for Cost Allocation Plan / Other 28,343.00 Total Indirect Costs • 28,343.00 TOTAL INDIRECT EXPENSES 28,343.00 TOTAL EXPENDITURES 237,437.00 Lace/ Health Department - 2019, Date: 08/10/2018 Page: 179 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM / PROJECT Local Health Department - 2019 / WIC Resident Services DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2018 To : 9130/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT T7 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount 1 Total DIRECT-EXPE-N-SES Program Expenses 1 Salary & Wages 955,243.00 955,243.00 2 Fringe Benefits 605,513.00 605,513.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 414,000.00 414,000.00 5 Supplies and Materials 23,562.00 23,562.00 6 Travel 3,770.00 3,770.00 7 Communication 10,000.00 10,000.00 8 County-City Central Services 0.00 0.00 9 Space Costs 95,353.00 95,353.00 10 All Others (ADP, Con. Employees, Misc.) 96,963.00 96,963.00 Total Program Expenses 2,204,404.00 2,204,404.00 TOTAL DIRECT EXPENSES 2,204,404,00 2,204,404.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 385,620.00 385,620.00 Total Indirect Costs 385,620.00 385,620,00 TOTAL INDIRECT EXPENSES 385,620.00 385,620.00 TOTAL EXPENDITURES 2,590,024.00 2,590,024.00 Local Health Department- 2019, Date: 08/1012018 Page: 180 of 194 Contract # Date; 08/1012018 2 Program Budget - Source of Funds SOURCE OF FUNDS , Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement cod --' ---'D.Gir -0.00 _ -0:00- Federally Provided Vaccines 0,00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 '0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0,00 MDHHS Non Comprehensive (Loa - 0.00 am 0.00 MDHHS Comprehensive 2,326,580.00 0.00 0.00 2,326,580.00 ELPHS - MOHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other' 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 263,444.00 0.00 263,444.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 2,326,580.00 263,444.00 0.00 2,590,024.00 Local Health Department- 2019, Date: 08/10120113 Page: 181 of 194 Contract # Date: 08/10/2018 3 Program Budget - Cost Detail _ Line Item t Qty 1 Rate[ Units ItiOM Total DIRECT EXPENSES Program Expenses Salary & Wages Supervisor 1.0000 80011.000 0.000 FTE 80,011,00 Supervisor 1.0000 51190.000 0.000 FTE 51,190.00 Supervisor 1.0000 61870.000 0.090 FTE 61,870.00 Outreach Worker 1.0000 44217.006 0.006FTE --------------- -- - 44,247,00- Outreach Worker 1.0000 44217.000 0.000 FTE 44,217.00 Outreach Worker 0,4808 33950.000 0.000 FTE 16,323.00 putreach Worker 0.4808 44213.000 0.000 FTE 21,258.00 Outreach Worker 1.0000 33285.000 0.000 FTE 33,285.00 Outreach Worker 1.0000 40109,000 0.000 FTE 40,109.00 Outreach Worker 1.0000 38057.000 0.000 FTE 38,057.00 Technician 1.0000 46573.000 0.000 FTE 46,573,00 Technician 1.0000 37926.000 0.000 FTE 37,926.00 Technician 140000 40089.000 0.000 FTE 40,089.00 Technician 1.0000 46573.000 0.000 FTE 46,573.00 Technician 1.0000 37926.000 0.000 FTE 37,926.00 r Technician 1.0000 46573.000 0.000 FTE 46,573.00 Nutritionist/Dietician 0.9101 68017.000 0.000 FTE 61,902.09 Nutritionist/Dietician 1.0000 61870.000 0.000 FTE 61,870.00 Nutritionist/Dietician 1,0000 61870.000 0.000 FTE 61,870.00 OVERTIME 0.2404 69556.000 0.000 FTE 16,721.00 Nutritionist/Dietician 1.0000 _ 66683.000 0.000 FTE 66,683.00 Total for Salary & Wages 955,243.00 2 _ Fringe Benefits All Composite Rate Notes : FICA Unemployment Ins. Retirement Hospital Ins. Life Ins. Vision Ins. Hearing Ins. Dental Ins. Work Comp Short/Long Term Disability 0.0000 63.388 955243.000 605,510.00 Local Health Department - 2019, Date: 0W1012018 Page: 182 of 194 Contract # Date: 0811012018 Line Item Qty Rate Units UOM Total % on composite rate won't calculate $3 0,0000 100.000 3.000 3.00 Total for Fringe Benefits 605,513.00 Cap. Exp. for Equip & Fac, 4 Contractual Subcontracting Agency-OLSHA- WIC svcs in Oakland Co. 0.0000 0.000 0.000 414,000.00 5 Supplies and Materials . ... Office Supplies 0.0000 0.000 0.000 .... 7,000.00 Medical Supplies 0.0000 0.000 0.000 8,159.00 Educational Supplies 0.0000 0.000 0.000 3,000.00 Postage 0.0000 0.000 0.000 600.00 Printing 0.0000 0.000 0.000 3,750.00 Materials & Supplies 0.0000 0.000 0.000 553.00 Expendable Equip Expense 0.0000 0.000 0.000 500.00 Total for Supplies and Materials 23,562.00 6 Travel Mileage Notes : 6,000 miles @ .545 0.0000 0.000 0.000 3,270.00 Conferences 0.0000 0.000 0.000 500.00 Total for Travel 3,770.00 7 Communication Telephone 0.0000 0.000, 0.000 1 10,000.00 8 County-City Central Services 9 Space Costs Space/Rental Costs 0,0000 0.000 0.0001 95,353.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0,000 0.000 3,455.00 Equipment Repair 0.0000 0.000 0.000 750.00 Convenience Copier 0.0000 0.000 0.000 4,400.00 IT Operatons 0.0000 0.000 0.000 67,408.00 Advertising 0.0000 0.000 0.000 18,000.00 Staff Training 0.0000 0.000 0.000 1,750.00 interpretation & Laundry/Cleaning 0.0000 0.000 0.000 1,200.00 Total for All Others (ADP, Con. Employees, Misc.) _ 96,963.00 Total Program Expenses 2,204,404,00 Local Health Department - 2019, Date: 0811012018 Page. 183 of 194 Contract # Date: 08/10/2018 I Line Item 1 Qty I Rate' Units I UOIVI Total TOTAL DIRECT EXPENSES 2,204,404.00 INDIRECT EXPENSES Indirect Costs I Indirect Costs 2 Cost Allocation Plan / Other Health Adm Distribution 0.0000 0.000 0.000 193,575.00 Other Cost Distributions-Health Education 0.0000 0.000 0.000 69,869.00 Cost Allocation Plan Notes : 12.79% 0.0000 0.000 0.000 122,176.00 Total for Cost Allocation Plan / Other 385,620.00 Total Indirect Costs 385,620.00 TOTAL INDIRECT EXPENSES 385,620.00 TOTAL EXPENDITURES 2,590,024.00 Local Health Department - 2019, Date: 08/1012018 Page: 184 of 194 Contract # Date: 08/10/2018 1 Program Budget Summary PROGRAM I PROJECT Local Health Department - 2019 / West Nile Virus Community Surveillance DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Ser v i c e s / Health Division BUDGET PERIOD From : 10/1/2018 To : 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT g . Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 ._.._ Category --- --------- Amount 1 _ -------- ........ Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 3,693.00 3,693,00 Fringe Benefits 2,184.00 2,184.00 -, Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 Supplies and Materials 781.00 781.00 6 Travel 858.00 858.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP. Con. Employees, Misc.) 12.00 12.00 Total Program Expenses 7,528.00 7,528.00 TOTAL DIRECT EXPENSES J_ 7,528,00 7,528.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0,00 0.00 2 Cost Allocation Plan/Other 1,138.00 1,138.00 Total Indirect Costs 1,138.00 1,138.00 TOTAL INDIRECT EXPENSES 1,138,00 1,138,00 TOTAL EXPENDITURES 8,666.00 8,666.00 Local Health Department - 2019, Date: 0B/101201B Page: 185 of 194 Contract # Date: 08/10/2018 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections - let and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0,00 0.00 __._........ ____ Federal Cost Based Reimbursement-- -- - -0:00 - ---- - apo ----------- ----- --tloo-- - - Federally Provided Vaccines 0.00 0.00 0.00 0.00 , Federal Medicaid Outreach 0.00 . 0.00 0,00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Non-ELPHS _Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0,00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0,00 . 0.00 0.00 0.00 MDHHS Comprehensive 8000.00 0.00 0,00 8,000,00 ELPHS - MDHHS Hearing : 0,00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MD1-IHS Other 0.00 0.00 0,00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0,00 Local Funds-Other 0.00 666.00 0.00 666.00 lnkind Match 0.00 _ 0.00 0.00 0.00 IVIDHI-IS Fixed Unit Rate Totals 8,000.00 666.00 0.00 8,666.00 Local Health Department 2019, Date: 08/1012018 Page: 186 of 194 Contract # Date: 08110/2018 3 Program Budget - Cost Detail iLine Item I Qty Rate! UnitslUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages -0 Sanitarian 0.0462 79925.000 0.000 FTE 3,693.00 2 Fringe Benefits All Composite Rate Notes : FICA, UNEMP INS, RETIREMENT, HOSP INS, LIFE INS, VISION INS, HEARING INS, DENTAL INS, WORK COMP, SHORT/LONG TERM DISABILITY 0,0000 59.139 3693,000 2,184.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 0.0001 781.00 Travel Mileage Notes : 1058 miles x .545 0.0000 0.000 0.000 577.00 Conferences 0.0000 0.000 0.000 281.00 Total for Travel 858.00 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 12.00 Total Program Expenses 7,528.00 TOTAL DIRECT EXPENSES 7,528.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan 1 Other Health Adm Distribution 0.0000 0.000 0.000 666.00 Cost Allocation Plan Notes : 12.79% 0.0000 0.000 0.000 472.00 - Total for Cost Allocation Plant Other 1,138.00 Total Indirect Costs 1,138.00 Local Health Department.- 2019, Date: 08/10/2018 Page: 187 of 194 Contract # Date: 0811012018 'Line Item Qty I Rate' UnitalUOM Total TOTAL INDIRECT EXPENSES 1,138.00 TOTAL EXPENDITURES 8,666.00 Local Health Department - 2019, Date: 01311012018 Page: 188 of 194 Contract # Data 08110/2018 1 Program Budget Summary PROGRAM I PROJECT Local Health Department - 2019 / MDEQ Private arid Type ill Water Supply DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/112018 To :9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT W Original r Amendment AMENDMENT # 13 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category —Amount- Total_ DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.60 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 0.00 0.00 2 Cost Allocation Plan / Other 1,308,086.00 1,308,086.00 Total Indirect Costs 1,308,086.00 1,308,086.00 TOTAL INDIRECT EXPENSES 1,308,086.00 1,308,086.00 TOTAL EXPENDITURES 1,308,086.00 1,308,086.00 Local Health Department- 2019, Dote: 08/10/2018 Page: 189 of 194 Contract # Date: 08/10/2019 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash inkind Total "I Source of Funds Fees and Collections - let and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 ,.... . _____ ----- .. ........ ._.......... Federal Cost Based Reimbursement ........._.... .__. . 0.00 -0-.00- ------ - ------ --- ----0.00 ------- - ------- -0;00- Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 , 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 - Other Non-ELPHS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0,00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Private / Type Ill Water . Supply 514,301.00 0.00 0.00 514,301.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 793,785.00 0.00 793,785.00 lnkind Match 0.00 0.00 0.00 0.00 MD1-11-1S Fixed Unit Rate , Totals 514,301.00 793,785.00 0.00 1,308,086.00 Local Health Department- 2019, Date: 08110/2018 Page: 190 of 194 Contract # Date. 08/10/2018 3 Program Budget - Cost Detail 'Line Item I Qty Ratel Units I UONI Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services Space Costs 10 All Others (ADP, Con, Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Cost Allocation Plan / Other Environmental Hlth Adm Distribution 0,0000 0.000 0.000 827,315.00 Other Cost Distributions--Misc. Distribution 0.0000 0.000 0.000 146,763.00 Health Adm Distribution 0.0000 0.000 _. 0.000 334,008.00 Total for Cost Allocation Plan / Other 1,308,086.00 Total Indirect Costs 1,308,086.00 TOTAL INDIRECT EXPENSES 1,308,086.00 TOTAL EXPENDITURES 1,308,086.00 Local Health Department - 2019, Date: 08/10/2018 Page: 191 of 194 Contract # Date: 08110/2018 Summary of Budget PROGRAM / PROJECT Local Health Department - 2019 / Local Health Department - 2019 DATE PREPARED 8/10/2018 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From ; 10/1/2018 To' 9/30/2019 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34_East BUDGET AGREEMENT P, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341- 0432 FEDERAL ID NUMBER 38-6004876 I Category Amount! Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 16,300,611.00 16,300,611.00 2 Fringe Benefits 9,834,696.00 9,834,696.00 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 653,636.00 653,636.00 5 Supplies and Materials 1,945,523.00 1,945,523.00 6 Travel 404,403.00 404,403.00 7 Communication 238,072.00 238,072.00 8 County-City Central Services 0.00 0.00 9 Space Costs 1,217,862.00 1,217,862.00 10 All Others (ADP, Con. Employees, Misc.) 2,465,151.00 2,465,151.00 Total Program Expenses 33,059,954.00 33,059,954.00 TOTAL DIRECT EXPENSES 33,059,954.00 33,059,954.00 INDIRECT EXPENSES Indirect Costs 1 indirect Costs 1,348,892.00 1,348,892.00 2 Cost Allocation Plan / Other 3,788,347.00 3,788,347.00 Total Indirect Costs 5,137,239.00 5,137,239.00 TOTAL INDIRECT EXPENSES 5,137,239.00 5,137,239.00 TOTAL EXPENDITURES 38,197,193.00 38,197,193.00 Local Health Department - 2019, Date: 08/1012018 Page: 192 of 194 Contract # Date: 08/10/2018 SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Fees and Collections - 1st and 2nd Party 0.00 3,821,405.00 0.00 3,821,405.00 2 Fees and Collections - 3rd Party 0.00 389,003.00 0.00 389,003.00 3 Federal or State (Non MDHHS) 0.00 0.00 0.00 0.00 4 Federal or State (Non MDHHS) 0.00 2,027,438.00 G.00 2,027,438.00 5 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 6 Federally Provided Vaccines 0.00 1346,89900 0.00 1,346,899.00 Federal Medicaid Outreach 404,192.00 0.00 0.00 404,192.00 8 Required Match - Local 0.00 441,162.00 0.00 441,162.00 9 Local Non-ELPHS 0.00 0.00 0.00 0.00 10 Local Non-ELPHS 0.00 0.00 0.00 0.00 11 Local Non-ELPHS 0.00 0.00 0.00 0.00 12 Other Non-ELPHS 0.00 0.00 0.00 0.00 13 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 14 MDHHS Comprehensive 5,379,449,0 0 0.00 0.00 5,379,449.00 15 ELPHS - MDHHS Hearing 253,969.00 0.00 0.00 253,969.00 16 ELPHS - MDHHS Vision 253,968.00 0.00 0.00 253,968.00 17 ELPHS - MDHHS Other 2,251,290.0 0 0.00 0.00 2,251,290.00 18 ELPHS - Food 859,213.00 0.00 0.00 859,213.00 19 ELPHS - Private / Type III Water Supply 514,301.00 0.00 0.00 514,301.00 20 ELPHS - On-Site Wastewater Treatment 372,426.00 0.00 0.00 372,426.00 21 MCH Funding 321,457.00 0.00 0.00 321,457.00 22 Local Funds-Other 0.00 19,224,951.0 0 0.00 19,224,951.0 0 Local Health Department- 2019, Date: 08/10/2018 Page 193 of 194 Contract # Date. 08/10/2018 23 Inkind Match 0.00 0.00 0.00 0.00 24 MDHHS Fixed Unit Rate 336,070.00 0.00 0.00 336,070.00 TOTAL 10,946,335. 00 27,250,858.0 0 0.00 38,197,193.0 0 Local Health Department - 2019, Date: 09/10/2018 Page: 194 of 194 Version: Comprehensive MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES FY 18119 AGREEMENT ADDENDUM A 1 This addendum adds the following section to Part I and Renumbers existing 11 Special Certification to 12 and existing 12 Signature Section to 13: Part I 11. Agreement Exceptions and Limitations Notwithstanding any other term or condition in this Agreement including, but not limited to, any provisions related to any services as described in the Annual Action Plan, any Contractor (Oakland County) services provided pursuant to this Agreement, or any limitations upon any Department funding obligations herein, the Parties specifically intend and agree that the Contractor may discontinue, without any penalty or liability whatsoever, any Contractor services or performance obligations under this Agreement when and if it becomes apparent that State or Department funds for any such services will be no longer available. Notwithstanding any other term or condition in this Agreement, the Parties specifically understand and agree that no provision in this Agreement shall operate as a waiver, bar or limitation of any kind, on any legal claim or right the Contractor may have at any time under any Michigan constitutional provision or other legal basis (e.g., any Headlee Amendment limitations) to challenge any State or Department program funding obligations; and, the parties further agree that no term or condition in this Agreement is intended and no such provision shall be argued to state or imply that the Contractor voluntarily assumed or undertook to provide any services as described in the Annual Action Plan, and thereby, waived any rights the Contractor may have had under any legal theory, in law or equity, without regard to whether or not the Contractor continued to perform any services herein after any State or Department funding ends. 2. This addendum modifies the following sections of Part 11, General Provisions: Part II I. Responsibilities-Contractor J. Software Compliance. This section will be deleted in its entirety and replaced with the following language: Version: Comprehensive The Michigan Department of Health and Human Services and the County of Oakland will work together to identify and overcome potential data incompatibility problems. Ill. Assurances A. Compliance with Applicable Laws. This first sentence of this paragraph will be stricken in its entirety and replace with the following language: - - - ------ The Contractor will comply with applicable Federal and State laws, and lawfully enacted administrative rules or regulations, in carrying out the terms of this agreement. I. Health Insurance Portability and Accountability Act. The provisions in this section shall be deleted in their entirety and replaced with the following language: Contractor agrees that it will comply with the Health Insurance Portability and Accountability Act of 1996, and the lawfully enacted and applicable Regulations promulgated there under. IX. Liability. Paragraph A. will be deleted in its entirety and replaced with the following language. A. Except as otherwise provided by law neither Party shall be obligated to the other, or indemnify the other for any third party claims, demands, costs, or judgments arising out of activities to be carried out pursuant to the obligations of either party under this Contract, nothing herein shall be construed as a waiver of any governmental immunity for either party or its agencies, or officers and employees as provided by statute or modified by court decisions. 2 ATTACHMENT I MICHIGAN DEPARTMENT OF HEALTH & H U M A N S E R V I C E S Local Health Department Agreement October 1, 2018- September 30, 2019 Fiscal Year 2019 INSTRUCTIONS FOR THE ANNUAL BUDGET INSTRUCTIONS FOR THE ANNUAL BUDGET FOR LOCAL HEALTH DEPARTMENT SERVICES TABLE OF CONTENTS Page I. INTRODUCTION 3 II. MINIMUM BUDGETING REQUIREMENTS 3 III. REIMBURSEMENT CHART 4 IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION PROCEDURES 5 V. FORM PREPARATION - GENERAL 5 VI. FORM PREPARATION - EXPENDITURE CATEGORIES 5 VII. FORM PREPARATION - SOURCE OF FUNDS 8 VIII. SPECIAL BUDGET INSTRUCTIONS A. Public Health Emergency Preparedness (PHEP) 10 B. WIC 11 C. Family Planning 12 D. Breast and Cervical Cancer 13 E. CSHCS Outreach and Advocacy 14 F. Program Budget Detail- Cost Detail Schedule Preparation 15 Annual Budget Forms 15 G. Medicaid Outreach Activities Reimbursement Procedures 20 Example 1-Medicaid Outreach Activities Cost Allocation Plan Certification 25 Example 2 -Medicaid Outreach Cost Allocation Methodology Certification 26 Example 3-Medicaid Outreach Activities Cost Allocation Plan Sample 27 H. Michigan Colorectal Cancer-Screening Program 30 I. Immunization 317 and VFC Allowable Expenditures 31 INSTRUCTIONS FOR THE ANNUAL BUDGET FOR LOCAL HEALTH SERVICES I. INTRODUCTION The Annual Budget for Local Health Services is completed on a state fiscal year basis and is used to establish budgets for many Department programs. In the Annual Budget, the Department consolidates many of its categorical _ programs' funding and Essential Local Public Health Services (ELPHS) (formerly known as the local public health operation's furiding -)-into--a-singte,-Comprehensive-Agreement-for-local---____ health departments. The Department's Plan and Budget Framework serves as a principal reference point for budget development. The Annual Budget for Local Health Services must be completed in accordance with and adhere to the established requirements as specified in these instructions and submitted to the Department as required by the agreement. II. MINIMUM BUDGETING REQUIREMENTS A. Cost Principles - Types or items of cost which will be considered for reimbursement are generally consistent with definitions contained in Title 2 Code of Federal Regulations CFR, Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. B. Federal Block Grant Funds - Maternal & Child Health and Preventive Health Block Grant funds may not be used to: provide inpatient services; make cash payments to intended recipients of health services; purchase or improve land; purchase, contract or permanently improve (other than minor remodeling defined as work required to change the interior arrangements or other physical characteristics of any existing facility or installed equipment when the cost of the remodeling incident does not exceed $2,000) any building or other facility; or purchase major medical equipment (any item of medical equipment having a unit cost of over $10,000 and used in the diagnosis or treatment of patients, excluding equipment typically used in a laboratory); satisfy any requirement for the expenditure of non-federal funds as a condition for the receipt of Federal funds; or provide financial assistance to any entity other than a public or nonprofit private entity. C. Expenditure and Funding Source Breakdown - For purposes of development, analysis and negotiation activities must be budgeted at the individual expenditure and funding source category level on the Annual Budget for Local Health Services. D. Special Budget Requirements for Certain Categorical Program Elements - The Annual Budget for Local Health Services is completed in the MI E-Grants System through the application budget to include details for all program elements (excluding Administration and Grantee Support). E. Local MCH - Local MCH funds can be used for general Maternal Child Health (MCH) activity. These funds are to be budgeted as a funding source under any of the appropriate program element(s) listed or a locally defined program which is defined in the LMCH Plan. The Local MCH projects need to be budgeted separately: 1 Public Health Functions & Infrastructure-MCH 2. Direct Services Children-MCH 3. Direct Services Women- MCH 4:Enab1ing-Services Children -MCH - - 5, Enabling Services Women -MCH These funding sources cannot be used under the WIC element except in extreme circumstances where a waiver is requested in advance of expenditures, and evidence is provided that the expenditures satisfy all funding requirements. The MCH activities and strategies should address one or more of the Title V Maternal Child Health Block Grant national/state performance measures and/or a local MCH priority need identified in the community. III. REIMBURSEMENT CHART A. Program Element/Funding Source The Program Element/Funding Source column has been moved to Attachment III and provides the listing of all currently funded MDHHS programs that are included in the Comprehensive Local Health Department Agreement. B. Type of Project The type of project designation is indicated by footnote and is used if the project meets the Research and Development Project criteria. Research and Development Projects are defined by Title 2 CFR, Section 200.87, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. Research and development (R&D) means all research activities, both basic and applied, and all development activities that are performed by non-Federal entities. Research is defined as a systematic study directed toward fuller scientific knowledge or understanding of the subject studied. The term research also includes activities involving the training of individuals in research techniques where such activities utilize the same facilities as other research and development activities and where such activities are not included in the instruction function. Development is the systematic use of knowledge and understanding gained from research directed toward the production of useful materials, devices, systems, or methods, including design and development of prototypes and processes. C. Reimbursement Chart The Reimbursement Chart notes elements/funding sources, applicable payment methods, target levels, output measures for each program/element having a performance reimbursement option. In addition, the chart also provides the subrecipient, contractor, or recipient designations, as in prior years: IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION PROCEDURES As in past years, no additional accounting system detail is being required beyond local uniform accounting procedures prescribed by the Michigan Department of Treasury, Local Financial Management System requirements, documentation requirements of categorical program funding sources and any local requirements. Some agencies may already have separate cost centers in their accounting system to directly identify costs and related funding of required services, but such breakdowns are not essential to being able to meet minimum reporting requirements if proper allocation procedures are used and adequate documentation is maintained. All allocations must have clearly measurable bases that directly apply to the amounts being allocated, must be documented with work papers that will provide an adequate audit trail and must result in a representative reporting of costs and funding for affected programs. More specific - guidance -can-be-found•-in-Title-2-•CERT Part 200 -Appendix V State/Local Government-and-Indian -Tribe- Wide Central Service Cost Allocation Plans and the brochure published by the Department of Health and Human Services entitled "A Guide for State, Local and Indian Tribal Governments: Cost Principles and Procedures for Developing Cost Allocation Plans and Indirect Cost Rates for Agreements with the Federal Government. V. FORM PREPARATION - GENERAL The MI E-Grants System on-line application, including the budget entry forms, are utilized to develop a budget summary for each program element administered by the local Grantee. The system is designed to accommodate any number of local program elements including those unique to a particular local Grantee. Applications, including budget forms, are completed for all program elements, regardless of the reimbursement mechanism, including Agency administration(s) fee for service program elements, categorical program elements, performance-based program elements and Medicaid Outreach associated program elements. Budget entry is required for each major expenditure and source of fund categories for which costs/funds are identified. VI. FORM PREPARATION - EXPENDITURE CATEGORIES Budgeted expenditures are to be entered for each program element, project or group of services by applicable major category. A. Salaries and Wages- This category includes the compensation budgeted for all permanent and part- time employees on the payroll of the Grantee and assigned directly to the program. This does not include contractual services, professional fees or personnel hired on a private contract basis. Consulting services, vendor services, professional fees or personnel hired on a private contracting basis should be included in "Other Expenses." Contracts with secondary recipient organizations such as cooperating service delivery institutions or delegate agencies should be included in Contractual (Sub-contract) Expenses. B. Fringe Benefits - This category is to include, for at least the specified elements, all Grantee costs for social security, retirement, insurance and other similar benefits for all permanent and part-time employees assigned to the specified elements. C. Cap Exp for Equip & Fac - This category includes expenditures for budgeted stationary and movable equipment used in carrying out the objectives of each program element, project or service group. The cost of a single unit or piece of equipment includes necessary accessories, installation costs, freight and other applicable expenses associated with the purchase of the equipment. Only budgeted equipment items costing $5,000 or more may be reported under this category. Small equipment items costing less than $5,000 are properly classified as Supplies and Materials or Other Expenses. This category also includes capital outlay for purchase or renovation of facilities. D. Contractual (Subcontracts/Subrecipient) - Use for expenditures applicable to written contracts or agreements with secondary recipient organizations such as cooperating service delivery institutions or delegate agencies. Payments to individuals for consulting or contractual services, or for vendor services are to be included under Other Expenses. Specify subcontractor(s) address, amount by subcontractor and total of all subcontractors. E. Supplies and Materials - Use for all consumable items and materials including equipment-type items costing less than $5,000 each. This includes office, printing, janitorial, postage and educational supplies; medical supplies; contraceptives and vaccines; tape and gauze; prescriptions and other appropriate drugs and chemicals. Federal Provided Vaccine Value should be reported and identified on in Other Cost Distributions category, Do not combine with supplies. F. T-ravel---T-raveloosts of-permanent and_part=time_employees_assigneclia_ea.ch program element. This includes costs of mileage, per diem, lodging, meals, registration fees and other approved travel costs incurred by the employee. Travel of private, non-employee consultants should be reported under Other Expenses. G. Communication Costs -These are costs for telephone, Internet, telegraph, data lines, websites, fax, email, etc., when related directly to the operation of the program element. H. County/City Central Services - These are costs associated with central support activities of the local governing unit allocated to the local health department in accordance with Title 2 CFR, part 200. I. Space Costs - These are costs of building space necessary for the operation of the program. J. All Others (Line 11) - These are costs for all other items purchased exclusively for the operation of the program element and not appropriately included in any of the other categories including items such as repairs, janitorial services, consultant services, vendor services, equipment rental, insurance, Automated Data Processing (ADP) systems, etc. K. Total Direct Expenditures — The MI E-Grants System sums the direct expenditures budgeted for each program element, project or service grouping and records in the Total Direct Expenditure line of the Budget Summary. L. Indirect Cost These cost categories are used to distribute costs of general administrative operations that have not been directly charged to individual subrecipient programs. The Indirect Cost expenditures distribute administrative overhead costs to each program element, project or service grouping. Two separate local rates may apply to the agreement period (i.e., one for each local fiscal year). Use Calendar Rate 1 to reflect the rate applicable to the first part of the agreement period and Calendar Rate 2 for the rate applicable to the latter part. Indirect costs are not allowed on programs elements designated as vendor relationship An indirect rate proposal and related supporting documentation must be retained for audit in accordance with records retention requirements. In addition, these documents are reviewed as part of the Single Audit, subrecipient monitoring visit, or other State of Michigan reviews. Following is further clarification regarding indirect rate and/or cost allocation approval requirements to distribute administrative overhead costs, in accordance with Title 2 CFR Part 200 (formerly Circular A- 87 2 CFR Part 225, Appendix E), for Local Health Departments budgeting indirect costs: 1. Local Health Departments receiving more than $35 million in direct Federal awards are required to have an approved indirect cost rate from a Federal Cognizant Agency. If your Local Health Department has received an approved indirect rate from a Federal Cognizant agency, attach the Federal approval letter to your MI E-Grants Grantee Profile. 2. Local Health Departments receiving $35 million or less in direct Federal awards are required to prepare indirect cost rate proposals in accordance with Title 2 CFR and maintain the documentation on file subject to review. 3. Local Health Departments that received approved indirect cost rates from another State of Michigan Department should attach their State approval letter to their MI E-Grants G r a n t e e P r o f i l e . 4. Local Health Departments with cost allocation plans should reflect these alloca t i o n s i n t h e O t h e r Cost Distributions budget category. See Section M. Other Cost Distrib u t i o n f o r b u d g e t i n g guidance. 5. As a Subrecipient of federal funds from MDHHS, a Local Health Departm e n t t h a t h a s n e v e r received a negotiated indirect cost rate, your Local Health Department may e l e c t t o c h a r g e a d e minimis rate of 10% of modified total direct costs (MTDC) based on Ti t l e 2 C F R p a r t 2 0 0 requirements. MTDC includes all direct salaries and wages, fringe benefits, supplies and mat e r i a l s , t r a v e l , ---servicesand_c_o_ntractual expenses up to the first $25,000 of each contract. MT D C e x c l u d e s a l l equipment, capital expenditures, charges for 0-tient care, rentat-costs-;-tuition--remission, ---------- scholarships and fellowships, participant support costs, and portions subcontr a c t u a l / s u b a w a r d expenses in excess of $25,000 per contract. Attach a current copy of the letter stating the applicable indirect costs r a t e o r c a l c u l a t i o n information justifying the de minimis rate calculation to you MI E-Grants Grantee p r o f i l e . Detail on how the indirect costs was calculated must be shown on the Budget D e t a i l S c h e d u l e . The amount of Indirect Cost should be allocated to all appropriate program eleme n t s w i t h t h e t o t a l equivalent amount reflected as a credit or minus in the Administration projects. M. Other Cost Distributions - Use to distribute various contributing activity costs to appropriate program areas based upon activity counts, time study supporting data or other reasona b l e a n d e q u i t a b l e m e a n s . An example of Other Cost Distributions is nursing supervision. The distribution proc e s s p e r m i t s c o s t s reflected in a single program element to be subsequently distributed, perhaps on l y i n p a r t , t o o t h e r programs or projects as appropriate. If an allocation is made, the charges must b e r e f l e c t e d i n t h e appropriate program element and the offsetting credit reflected in the progra m e l e m e n t b e i n g distributed. There must be a documented, well-defined rationale and audit tra i l f o r a n y c o s t distribution or allocation based upon Title 2 CFR, Part 200 C o s t P r i n c i p l e s Local Health Departments using the cost distribution or cost allocation must develop the plan i n a c c o r d a n c e w i t h t h e requirements described in Title 2 CFR, Part 200. Local Health Departments should m a i n t a i n s u p p o r t i n g documentation for audit in accordance with record retention requirements. The pl a n s h o u l d i n c l u d e a Certification of Cost Allocation plan in accordance with Title 2 CFR, Part 200 Ap p e n d i x V . T h e c o s t allocation plan documentation is not required to be submitted unless specifica l l y r e q u e s t e d . Cost associated with the Essential Local Public Health Services (ELPHS), Mat e r n a l a n d C h i l d H e a l t h (MCH) Block Grant and Fixed Fee may be budgeted in the associated program e l e m e n t a n d d i s t r i b u t e d to the associated projects. Federal Provided Vaccine Value should be reported on a separate line and c l e a r l y i d e n t i f i e d . N. Total Direct & Admin. Expenditures - The MI E-Grants System sums the indirect expenditures program element and records in the Total Indirect Expenditure line of the Bud g e t S u m m a r y . 0. Total Expenditures - The MI E-Grants System sums the direct and indirect expenditures and records in the Total Expenditure line of the Budget Summary. VII. FORM PREPARATION - SOURCE OF FUNDS Source of Funds are to be entered for each program element, project or group of services by applicable major category as follows: A. Fees & Collections - Fees 1st & 2nd Party- i. 1st party funds projected to be received from private payers, including patients, source users and any member of the general population receiving services. ii. 2nd party funds received from organizations, private or public, who might reimburse services for a group or under a special plan. iii. Any Other Collections B. Fees & Collections - 3' Party — 3rd Party Fees - Funds projected to be received from private insurance, Medicaid, Medicare or other applicable titles of the Social Security Act directly related to the cost of providing patient care or other services (e.g., includes Early Periodic Screening, Detection and Treatment [EPSDT] Screening, Family Planning.) C. Federal/State Funding (Non-MDHHS) - Funds received directly from the federal government and from any state Contractor other than MDHHS, such as the Department of Natural Resources and Environment (MDNRE). This line should also be used to exclude state aid funds such as those provided through the Michigan Department of Treasury under P.A. 264 of 1987 (cigarette tax). D. Federal Cost Based Reimbursement — Funds received for Federal Cost Based Reimbursement which should be budgeted in the program in which they were earned. E. Federally Provided Vaccines — The projected value of federally provided vaccine. F. Federal Medicaid Outreach — (Please note: to be used only for Medicaid Outreach, CSHCS Medicaid Outreach or Nurse Family Partnership Medicaid Outreach program elements.) Funds projected to be received from the federal government for allowable Medicaid Outreach activities. This amount represents the anticipated 50% federal administrative match of local contributions. G. Required Match - Local — Funds projected to be local contribution for programs that have a match contribution requirement (Please note: for Medicaid Outreach, CSHCS Medicaid Outreach, or Nurse Family Partnership Medicaid Outreach, this amount represents the 50% matching local contribution for allocable Medicaid Outreach Activities. Federal Medicaid Outreach and Required Local match amounts should equal each other.) H. Local Non-ELPHS - Local funds budgeted for the following expenditures: 1. Expenditures for services not designated as required and allowable for ELPHS funding (e.g., medical examiner and inpatient maternity services); expenditures determined not to be reasonable; and, expenditures in excess of the maximum state share of funds available. 2. Any losses arising from uncollectible accounts and other related claims. Under-recovery of reimbursable expenditures from, or failure to bill, available funding sources that would otherwise result in exclusions from ELPHS funding, if recovered. However, no exclusion is required where the local jurisdiction has made and documented a decision to have local funds underwrite; a. The cost of uncollectible accounts or bad debts incurred in support of providing required or allowable health services. An example of this condition would be for services provided to indigents who are billed as a matter of procedure with little chance for receipt of payment. b. Potential recoveries or under-recoveries from other sources for the principal purpose of providing required and allowable health services at free or reduced cost to the public served by the Grantee. An example would be keeping fees for services at a reduced level for the benefit of the people served by the Grantee while recognizing that to do so limits recovery from third parties for the same types of services. 3. Contributions to a contingency reserve or any similar provisions for unforeseen events. 4. Charitable contributions and donations. 5. Salaries and other incidental expenditures of the chief executive of a political subdivision (i.e., county executive and mayor). 6. Legislative expenditures; such as, salaries and other incidental expenditures of local governing bodies (i.e., county commissioners and city councils). Do not enter board of health expenses. 7. Expenditures for amusements, social activities and other incidental expenditures related thereto; such as, meals, beverages, lodging, rentals, transportation and gratuities. 8. Fines, penalties and interest on borrowings. 9. Capital Expenditures - Local capital outlay for purchase of facilities and equipment (assets) are excluded from ELPHS funding. I. Other Non- ELPHS - Funds budgeted from sources other than state, federal and local appropriations to the extent that they are not eligible for ELPHS (e.g., funding from local substance abuse coordinating grantee, local area on aging grantees). J. MDHHS NON-COMPREHENSIVE - Funds budgeted for services provided under separate MDHHS agreements. Examples include: funding provided directly by the Community Services for Substance Abuse for community grants, etc. K. MDHHS - COMPREHENSIVE - This section includes all funding projected to be due under the Comprehensive Agreement from categorical programs and needs to equal the allocation. L. ELPHS MDHHS Hearing — This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS MDHHS Hearing program and has to equal the MDHHS ELPHS Hearing allocation. Additional ELPHS to be budgeted for the Hearing Program must be entered into ELPHS — MDHHS Other. Hearing allocations may only be spent on the Hearing Program. M. ELPHS MDHHS Vision — This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS MDHHS Vision program and has to equal the ELPHS MDHHS Vision allocation. Additional ELPHS to be budgeted for the Vision Program must be entered into ELPHS MDHHS Other. Vision allocations may only be spent on the Vision Program. N. ELPHS MDHHS Other — This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS MDHHS Other program for eligible program elements. Please note: The MI E-Grants System validates the ELPHS MDHHS Other budgeted funds across the applicable program elements to assure the agreement does exceed the ELPHS MDHHS Other allocation. 0. ELPHS — Food - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS Food program and has to equal the ELPHS Food allocation. P. ELPHS — Drinking Water - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS Drinking Water program and has to equal the ELPHS Drinking Water allocation. Q. ELPHS — On-site Sewage - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS On-site Sewage program and has to equal the ELPHS On-site Sewage allocation. R. MCH Funding - This section includes all funding projected to be due under Comprehensive Agreement specific to the MCH eligible program elements. Please note: The MI E-Grants System validates the MCH budgeted funds across applicable program elements to assure the agreement does exceed the MCH allocation. S. Local Funds - Other - Enter all local support in the appropriate element, project or service group column. This may include local property tax, and other local revenues (does not include fees). T. In kind Match — Enter Local Support from donated time or services. U. MDHHS Fixed Unit Rate — Select the type of fee-for-services from the lookup to correspond with the program element. VIII. SPECIAL BUDGET INSTRUCTIONS Certain elements are supported by federal or other categorical program funds for which special budgeting requirements are placed_upon _grantees and subgrantees. These include: Element Federal or Other Funding Contractor Public Health Emergency Preparedness U.S. Department of Health & Human Services, Centers for Disease Control WIC U.S. Department of Agriculture, Food & Nutrition Service Family Planning U.S. Department of Health & Human Services, Public Health Service Breast and Cervical Cancer U.S. Department of Health & Human Services, Centers for Disease Control CSHCS Outreach & Advocacy Michigan Department of Health & Human Services Medicaid Outreach Activities Centers for Medicare and Medicaid Services In general, subgrantee budgets must provide sufficient budget detail to support grantee budget requests and be in a format consistent with grantor Contractor requirements. Certain types of costs must receive approval of the federal grantor Contractor and/or the grantee prior to being incurred. A. Public Health Emergency Preparedness (PHEP) Special Budget Requirements Local Health Departments will receive the initial FY 18/19 allocation of the CDC Public Health Emergency Preparedness (PHEP) funds in nine equal prepayments for the period October 1, 2018 through June 30, 2019. LH Ds must submit a nine-month budget and a quarterly Financial Status Report (FSR) for each of the following COMPREHENSIVE Local Health Department program elements: 1. Public Health Emergency Preparedness (PHEP) (October 1, 2018— June 30, 2019) 2. Public Health Emergency Preparedness (PHEP)— Cities of Readiness (October 1, 2018—June 30, 2019) 3. Laboratory Services - Bioterrorism (October 1,2018 — September 30, 2019) B. WIC Special Budget Requirements I. Cost/Funding Categories - The following local budget breakdowns are required to fulfill WIC grant application budget requirements each fiscal year: Salaries & Fringe Benefits Automated Management Systems Space Utilization Costs Equipment Supplies Communications & Travel All Other Direct Costs Indirect Gosts All Funding Sources by Type The WIC cost/funding categories and supporting budget detail requirements are satisfied by completion of an application budget form in the M1E-Grants System. General instructions for these forms are contained at the end of this section. Agencies receiving WIC-USDA Infrastructure grants must budget these funds as a separate element. Agencies must track and report expenditures separately on the FSR. Agencies receiving WIC-USDA Breastfeeding Peer Counselor funds must budget these funds as a separate element. Agencies must track and report expenditures separately on the FSR. And comply with special reporting requirements. 2. Costs Allowable Only With Prior Approval - The following costs are allowable only with prior review/approval of the Michigan Department of Health & Human Services as specified by the U.S. Department of Agriculture, Food and Nutrition Service (Ref.: 7 CFR Part 246, and USDA- WIC Administrative Cost Handbook 3/86). Prior approval is accomplished by providing appropriate detail in the budget request approved by MDHHS or subsequently in a written request approved in writing by MDHHS. A. Automated Information Systems - which are required by a local Grantees except for those used in general management and payroll, including acquisition of automated data processing hardware or software whether by outright purchase or rental-purchase agreement or other method of acquisition. B. Capital Expenditures of $2,500 or More - such as the cost of facilities, equipment, including medical equipment, other capital assets and any repairs that materially increase the value or useful life of capital assets. C. Management Studies - performed by agencies or departments other than the local Grantee or those performed by outside consultants under contract with the local Grantee. D. Accounting and Auditing Services - performed by private sector firms under professional service contracts for purposes of preparation or audit of program and financial records/reports. E. Other Professional Services - rendered by individuals or organizations, not a part of the local Grantee, such as: 1. Contractual private physician providing certification data. 2. Contractual organization providing laboratory data. 3. Contractual translators and interpreters at the local Grantee level. F. Training and Education - provided for employee development, which directly or indirectly benefits the grant program, to the extent that such training is contracted for or involves out-of-service training over extended periods of time. G. Building Space and Related Facilities - the cost to buy, lease or rent space in privately or publicly owned buildings for the benefit of the program. H. Non-Fringe Insurance and Indemnification Costs All charges to WIC must be necessary, reasonable, allowable and allocable for the proper and efficient administration of the program. Further information and cost standards are provided in federal instructions including Title 2 CFR, Part 200 and 7 CFR Part 3015. C. Family Planning Special Budget Requirements 1. -Cost/Funding Categofies - The following local budget brealvd-owns are required to fulfill Family Planning grant application budget requirements each fiscal year: Salaries & Wages Fringe Benefits Travel Equipment Supplies Contractual Construction All Other Direct Costs Indirect Costs All Funding Sources by Type The Family Planning cost/funding categories and supporting budget detail requirements are satisfied by completion of an application budget in the MI E-Grants System. General instructions for these forms are contained at the end of this section. 2. Costs Allowable Only With Prior Approval - The following costs are allowable only with prior review/approval of MDHHS. Prior approval is accomplished by providing appropriate detail in the budget request approved by MDHHS or subsequently in a written request approved in writing by MDHHS. A. Alterations and Renovations - to change the interior arrangements or other physical characteristics of existing facilities or installed equipment, to the extent that such changes cost more than $1,000 each. B. Audiovisual Materials and Activities - acquired, produced, presented, or disseminated to the general public. C. Consultant Contracts for General Support Services - including equipment and supplies, that will cost in excess of $25,000 or 10% of the total direct cost budget (whichever is greater). D. Equipment - including general purpose and special equipment (e.g., air conditioning) costing $5,000 or more per unit. E. Insurance - contributions to a reserve for a self-insurance program. F. Public Information Service Costs for the cost of providing public information services. G. Publication and Printing Costs - for the cost of publications. H. Capital Expenditures - for land or buildings. I. Indemnification Against Third Parties Costs - insurance against potential liabilities. J. Mass Severance Pay - involving grant-supported personnel. K. Organization/Reorganization Costs - allocable to the program. L. Overtime Premium - involving grant-supported personnel. M. Patient Care Costs - rebudgeting out of or reduction in patient care costs (considered a change in scope). N. Professional Services - in connection with Patent/Copyright Infringement Litigation. 0. Trailers or Modular Units — for costs of trailers and modular units. P. Transfers Between Construction and Nonconstruction - for approved construction funds. Q. Transfers Between Indirect and Direct Costs - for amounts awardedforindirect_costs.to absorb -increases T direct costs. R. Transfers for Substantive Programmatic Work - to a third party, by contracting, or any other means used for the actual performance of substantive programmatic work. All charges to Family Planning must be necessary, reasonable, allowable, and allocable, for the proper and efficient administration of the program. Further information and cost standards are provided in federal instructions including 2 CFR, Part 225 (OMB CircularA-87), A-102 Common Rule and 2 CFR, Part 215 (OMB Circular A-110) D. Breast and Cervical Cancer Control Coordination Program Special Budget Requirements 1. The Breast and Cervical Cancer Control Navigation Program (BCCCNP) budget is to be developed in the following way: BCCCNP Coordination should be used to budget costs associated with coordination of the program in assuring implementation of all minimum program requirements and policies and procedures. . Only coordination expenses will be reimbursed through the Comprehensive Agreement. All Direct Service claims, including MTA Navigation Services and Navigation- Only Services, must be billed to the MDHHS Cancer Prevention and Control Section for claim processing. The Local Coordinating Agency (LCA) and/or direct service providers with contracts or letters of agreement with the LCA will be responsible for billing Direct Service claims to the MDHHS Cancer Prevention and Control Section. No Direct Services or MTA Navigation or Navigation-Only Service expenses will be reimbursed through the Comprehensive Agreement. The Coordination amount $200 per woman based on a target caseload established by MDHHS. There is no longer a match requirement. Match is recorded by the program and reported to MDHHS. For specific billing requirements refer to the most recent BCCCNP Billing Manual. For specific program requirements, including current fiscal year Direct Service Reimbursement Rates and documentation related to the match requirement, refer to the current fiscal year Special Budgeting and Other Program Instructions for the BCCCNP issued in August of each fiscal year. The above referenced documents are available at www.michigancancer.org/BCCCNP. 2. The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) budget is to be developed in the following way: W1SEWOMAN Coordination and Screening should be used to budget costs associated with coordination of the program and delivery of the initial screening and risk reduction counseling to WISEWOMAN participants. This includes administration and interpretation of health risk instrument, WISEWOMAN screening services (height, weight, body mass index, 2 blood pressure readings, total cholesterol, HDL cholesterol, and glucose orAl C), and delivery of risk reduction counseling. All Direct Service claims must be billed to the MDH HS Cancer Prevention and Control Section for claim processing. The Local Coordinating Agency (LCA) and/or direct service providers with contracts or letters of agreements with the LCA will be responsible for billing Direct Service claims to the MDH HS Cancer Prevention and Control Section. This includes follow-up fasting lipid panel, fastio_g_glucose,.Alc,and_one_diagnostic_examAo-Dired-Services-expenses -will ---- be reimbursed through the Comprehensive Agreement. The Coordination and Screening amount is $200 per woman based on a target caseload established by MDHHS. Performance reimbursement will be based upon the understanding that a certain level of performance (measured by outputs) must be met. There is a 95% caseload performance requirement for this project. For specific billing requirements refer to the most recent Billing Manual. For specific program requirements, including current fiscal year Direct Service Reimbursement rates and documentation related to the match requirement, refer to the current fiscal year Special Budgeting and other Program instructions for the WISEWOMAN Program issued in August of each fiscal year. The above referenced documents are available at www.michigan.govicancer. E. Children's Special Health Care Services (CSHCS) Outreach and Advocacy - The program element, titled CSHCS Outreach and Advocacy should be used to budget costs associated with this program. I. Program Budget - Online Detail Budget Application Entry Complete the appropriate budget forms contained within the MI E-Grants System for each program element. An example of this form is attached (see Attachment 1 for reference). 1. Salary and Wages - a. Position Description - Select from the expenditure row look-up all position titles or job descriptions required to staff the program. If the position is missing from the list, please use Other and type in the position in the drop-down field provided. b. Positions Required - Enter the number of positions required for the program corresponding to the specific position title or description. This entry may be expressed as a decimal (e.g., Full-Time Equivalent — FTE) when necessary. If other than a full-time position is budgeted, it is necessary to have a basis in terms of time reports to support time charged to the program. c. Amount — The MI E-Grants System calculates the salary for the position required and records it on the Budget Detail. Enter this amount in the Amount column. d. Total Salary —The MI E-Grants System totals the amount of all positions required and records it on the Budget Summary. e. Notes - Enter any explanatory information that is necessary for the position description. Include an explanation of the computation of Total Salary in those instances when the computation is not straightforward (i.e., if the employee is limited term and/or does not receive fringe benefits). 2. Fringe Benefits — Select from the expenditure row look-up applicable fringe benefits for staff working in this program. Enter the percentage for each. The Ml E-Grants system updates the _total amount forsalary and wages in the unit field and calculates the fringe benefit amount. If the "Composite Rate" fringe benefit item is selected from the expenditure row look up, record the applicable fringe benefit items (i.e. FICA, Life insurance, etc.) in the "Notes" tab. 3. Equipment - Enter a description of the equipment being purchased (including number of units and the unit value), the total by type of equipment and total of all equipment purchases. 4. Contractual - Specify subcontractor(s)/subrecipient(s) working on this program, including the subcontractor's/subrecipient's address, amount by subcontractor/subrecipient and total of all subcontractor(s)/subrecipient(s). Multiple small subcontracts can be grouped (e.g., various worksite subcontracts). 5. Supplies and Materials - Enter amount by category. A description is required if the budget category exceeds 10% of total expenditures. 6. Travel - Enter amount by category. A description is required if the budget category exceeds 10% of total expenditures. 7. Communication - Enter amount by category. A description is required if the budget category exceeds 10% of total expenditures. 8. County-City Central Services - Enter amount by category and total for all categories. 9. Space Costs - Enter amount by category and total for all categories. 10. Other Expenses - Enter amount by category and total for all categories. A description is required if the budget category exceeds 10% of total expenditures. 11. Indirect Cost Calculation - Enter the base(s), rate(s) and amount(s). 12. Other Cost Distributions - Enter a description of the cost, percent distributed to this program and the amount distributed. 13. Total Exp. - MI E-grants totals the amount of all positions required and records it on the Budget Summary. Aec HealINDenartment, eepacalo.p: Eamny Planning Seeks-9 EA9111.. -:Pregrp .poiemehemeNn Agreement - 4),0t: Show Documents Fecosheet nenuncauWW nenuni 1..aileCeniesose j ypli.gatp j j 11,E)E 52NY: Trooi i@ (E.). michitten.gou -4012, The Wistet al 4 Micthaze wet•Nte pit.eflcolt Applitakten g 20: wine ic EGrAMS App avis:00,1 34,202.001 1n.4-19:001 3.040 0a' 7,2.02:66i 000003l lh,k366! 165,523.00! 0, , 7_ :(10011 0.001; F. Program Budget-Cost Detail Schedule Preparation B1 Attachment B1-Program Budget Summary Budget Summary DIRECT EXPENSES Program Expenses - Salary & Wa9se Ning9-5n1°I8 Cap. Exp. far-Euslp kFa0. dontractual Supnliee arx1 fyinteriate Travel Ccrinnunidelion County-Cily"Cerithal ij Space Conte All 'Mere (ADP. Con: Eniployeen, Ken; Total Prognun Expenses TOTAL DIRECT EXPENSES INDIftECT ExPfrisEs. Incfirect Costs Indirect Costs Other Costs Oletnhutions Tolet limited Costs TOTAL INEHRECT EXPEN SES TOTAL,. EXPPIDTEURES Li1I óiI 1)011 1,5.85:0-0 1.645,6011 31D90.00I1 0109000 31 090 . 31.090.001 I..... ...10,51.591*0.111.,100 slO.00 30 J :I 33 00 0 00 0 .33 O.60,1 o 0.001 I 0 P3 06813-.00 . f 0 30 0.33 0.00': ,"):3 , 0.00: 1. 000 1-2 IF1 Source of Funds taiebigettlou SP, 114: `-ble EGrAMS App ' cation dout ego,v AI:kWh:attest 0 to IttnovILY of Agency Appllcahlon Al3C..1:10011 Depvtrard rainlly Planning 'Seri,Ices ampLE- -Program .Comprettensive Aweenient-FY 20)C4 • Shaw Pocumente Faocsheet ceOlcolkine Iloolv-t '641ecelteneotke' [111 LIII $.o&LLI. I V VaiidOpj I 03 ii.n•n (, LETE •S;aurwolFidtdb. I 11 Shaw-2.216j 0 ,E-.) 1g6.6.13,00L, , Source of Funds Fees and colacknnE 1nyod2nct00rty Fees and dollections - 3n:S .Party F000ra or Federal Cosi Based i4olm6urterneril • . Fatlerally.Protricleel vacci003 Foneral medicaid OAF:la-eh. ..RenaheiiMaLth thcot I Local NonTSPHS 0.00 o 00 001 00.3 00)0 .003 55 333 00 33.3 ' S,0"30 OC 30 0.00 .303. 0.00 0.00 0.00 0.00 0.30 0.30 - 0.30 UL,CJL 03 3.00 19.3001j10 0.00 0 013 0.013 , Local Nen•ELPFIS plhv:Nprl-E:L.PHs. MOON Non COlnphengnslve MbCH Com.priskenain. .ELPHS - MDCKHeanng ELPHS MdCHNWan ELPHS -MDCM Qthier WEIS Food. ELPHS -Drinking. Water ELPHS--Orx-Slte gewage trICH Funding LocaJ f kinds °low inkInd Match 4112r-ti Hod 1 II s are,' I Save b nig validate j Sub-T)pe : Budget Detail Calegery: ClasstRatiort Seq.: Program Expanses -.Watt& Wages :Select She position tiesbridiail Shindy Ste weeny ea Mee denlity the Tele is even:ipotesi per FTE. Instructors tr, copy ] nudge! Detail 'Category - 'Classilication Set IPTod Sri) e Ps Pp; RP, ler:Ep utp E Fat misprolosiiiimimammigo a00 000RFJ xtpub0oieatibm4.0 -1111 044 3493243n-4TE Ii 18.Q69•601— 16.069.06i " 0:00f 4;04). t Z( cintrdinaiar , ..13.111L 5.1036.0014FTE JiJ 2092.$.(l20,54.?5.15.5.:._ _U00 ti —1.10-35.-00r 20135.00 500; 0.06i description D'Pe Et:W911 Sit TYP itXTSCI NEttUbve Lt.4 kShow Tree SaVal I ei Sova*i pi Validates ) f=1 MIMIC 2. II ME= L I-11 Save 4.1 Ei Validate I 9. Fr rrirb FIEZI cuald rh Show Tr ea Burtigitietin Category I. Prolramppeoss - suppuds and Meter' s DO: ;Ernnencnture Classification Seu ,1... Level : °line Item 0 CalegorF t.larrative El [ Inatnicnona terns that end 6st shop Oeixt. J3F 411 Validale ei (STITIDFI i?tritp 05ddetneta,_ _ Catenert 63st-15-cation get', ;Program apnoea -Travel Una !tern OCIs c,ry Instiudorin _ x *age -Ej 0 74 IConrerenres E=111.11MBI =TM En -3,0D0.001 3,00n. Lo.ou .6:66 40.00[ -340.0,41.,. 000 1 0,00 11311= B2 Attachment B2-Program Budget Cost Detail flitch igamou 7.- The (nEdd Reis hurlikret. Wellsee ate; kisr -25- 13 EGrAMS Application Budget category Application Tirrebut :AC nuns Altennr AEC Health Depertillent Fttliiihn!= .tarnittefifulnlve Awe emertlifV 20)0( Application t Panty Planning Seerlats SAMPLE replevin I cbrvication* f Buritatt lollueflaneotts dek [ h;;tirriettitiViiined as !based et 11 singlell'eonveleed et Staid or Side erte .eritit usettii If rat re Pleiteire year: Coatis spout it:ewe Ole gem Pad any ,itokapie eipeeseti3upe OXIndefisEno cosiSsibeiblenenre far.cliz li4Pi**41knelltee.tll'yi.100eftelifii-Seinferest into the Stipples mut lieferisis Etb. Show Ducuments ..... ...... ............... rite 15 Shiver Troo I 0 0 . .. NerfAINCI OIN=111101111111701MMIMIOMM o El Vaildeted iT -E-D,„, entittet Detail ... Catenary:. Program &mimes Contractual Classification anq . Sub Type Expenditure Instructient "Contractual refers to.seentAtini reettiert organtrebbiet 'only: Please enter tee contact itiorntithin Gonauttants end supporting serves eirbeortesets.shouiri be budgetee under the ether expense the. 11011 10 Ei X iFeribod 1Pusisgs 000 o6:1_ o.oa O.00: ID *iiiiittf 70Fai1r 0.00 o ont • lii E;hig sr' Treei 0 Too : Expenditure Sub TypeCirerd Narrative • Satre • Ser. 4, tur Vaiidati OMEN F PDF VIE= M11182111:: O . _1E31: • 7 Eli 1 ill Save I LILSILI lLgyaliLLej •Ki LELIJILI &au j Budget Detail CalegoN Diasslitealon End. 0 line dam OCatogory ,pe. Expenditure SUb TYPO; " 10vel Inetructione : MISIN111111.111111111111111.1111 111111111311111=111111011 02100 6,573.001 5.00 2,§013,041 2,prin,dolt ; [12, ,„jn111121 j IETHJ Le_LCORLI &KW iletal • 11 0.1!t • !ORI_!.r 00 Show Tree - Communfdalen . _ TYPe :Eiponduti I Classiecadon Seq, : I Level: ()Line Item 0 CategoN Sub Type: !Direct . Narrative 105111-15t515. ' 111111==.111 ;2:NAIL i,26t061;_: irrogram.Expensue-.Coenty-Cityeentai Services TOR lit—e-d4tere Budget Petal avot" 1,1P liBM CLICSOSION - Classification-See 1-instr0cons autilype !!Direei erativEl 1.21 k Show Tree 0-0 DEM MEMO IMU=1 REIM UM DEMI ' Budget Detail ,.... _.. .. .... .. __ . __ ,. .., . _._ : 1 Calpgdfy : !Indirect Costa . Indirect-Cue-kr , 1. Classification Seo : Inetrurnans : ! 25.0001170214 29,45.091 29.405 3 is]ay 1.11ITIOTer41 Budget Num Category: :Program Expenses -A5 Calm OOP, Con. Employees Mad Type : Expenditure L Clataillcatiori! I Instructiond.; II k!10 [ 0-4.@[ am.* progscrv.,. 1, r. 1LaiTeas idarratpitY -OA; lg.:1r Alit) (du ono orr, VeF IExpendittite 81.101055! .15-515.0t1 slu,v, Tree NarMli90 I. }r !Placa' Year Rale ..... 1 ET 11--I li-Show Tree' 0 C.) Lie10,12 j I 5 Save 1.1 55 Validate 111=1 le1124.i LaNcaPY Budikell Detedi [category l'indirecCoe3e,; Oth5lCOols 61555055s Claseincation Seq. :. Type : Expenditure Sok Twe ' :Indirect Narrative 'Instructions Ma=0 riM1 1,000:061 0.00 000 MN = O 14 Naming ;Wm DItidridon G. Medicaid Outreach Activities Reimbursement Procedures Medicaid Outreach Activities that are funded by local dollars and meet federal requirements are eligible for reimbursement at a 50% federal administrative match rate. Local Health Departments must maintain proper documentation of the activities performed and those activities must conform with the activities outlined in MSA Bulletin 05-29. Medicaid Outreach Activities funding is a subrecipient relationship. I. Budget Preparation A. Medicaid Outreach Activities Complete the MI E-Grants application and budget forms for the application Medicaid Outreach Activities that occur during the fiscal year: 10/1/18-09/30/19. Reimbursable activities included in the budget must conform to the requirements as specified in the MSA Bulletin 05-29, Complete the MI E-Grants application and budget forms for this program. 1. Expenditure Category Tab Enter the expenditures budgeted for the fiscal year: 10/01/18-09/30/19. Expenses budgeted for each of the listed expenditure categories are allowable and must be specific to the Medicaid program as described in MSA Bulletin 05-29. Outreach activities must not be part of direct service. Expenditures must be reflected in the cost allocation plan, 2. Source of Funds Tab Budget the amount expected from the federal government for allowable Medicaid Outreach Activities. Federal Medicaid Outreach represents the anticipated 50% federal administrative match of local contributions. Budget the local contribution. Required Match- Local represents the 50% matching local contribution for Medicaid Outreach activities. These two amounts must match. 3. Sources of Local Funds Types Local Health Departments may utilize their county appropriation, any earned income, funds received from local or private foundations, local contributors or donators, and from other non-state/non-federal grant agreements that are specific to Medicaid outreach or are to be used at the discretion of the Health Department as a source for matching funds. Other state and/or federal grant awards for Medicaid Outreach must be recorded on the appropriate line as indicated in the Comprehensive Budget Instructions - Attachment I. B. Nurse-Family Partnership Outreach (applicable only for Berrien, Calhoun, Ingham, Kalamazoo, Kent, Oakland, and Saginaw) Complete the MI E-Grants application and budget forms for the application titled Nurse-Family Partnership Medicaid Outreach for the timeframe: 10/01/18-09/30/19. Complete the MI E-Grants application and budget forms for this program. Expenditures related to Nurse-Family Partnership Medicaid Outreach should be reflected under one program element and adhere to Section VIII, Special Budget Instructions section found in the Comprehensive Budget Instructions - Attachment I. The budget should reflect the entire fiscal year period: 10/1/18-09/30/19. 1 Federal Medicaid Outreach Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the LHD Nurse-Family Partnership program has been applied. The formula for calculating the federal funding is as follows: Federal funding = (Local funds x % of Medicaid Participation Rate) x 50% Federal Administrative Match rate) 2. Required Match - Local Represents the 50% match of local contributions. Budget the local match contribution in Required Match — Local. Federal Medicaid Outreach and Required Match — Local must equal each other. Additional local contribution related to service provision for non-Medicaid eligible participants which are not eligible for the 50% federal match should be reported in Local Funds Other. 3. Sources of Local Fund Types Local Health Departments may utilize their county appropriation, funds received from local or private foundations, local contributors or donators, and from other non-state/non-federal grant agreements that are specific to Medicaid Outreach or are to be used at the discretion of the Health Department as a source for matching funds. C. CSHCS Medicaid Outreach Complete the MI E-Grants application and budget forms for the application titled CSHCS Medicaid Outreach for the timeframe: 10/01/18-09/30/19. Expenditures related to CSHCS Medicaid Outreach should be reflected under one program element and adhere to Section IV, Special Instruction Section found in the Comprehensive Budget Instructions - Attachment I. The budget should reflect the entire fiscal year period: 10/1/18-09/30/19. 1, Federal Medicaid Outreach Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the LHD CSHCS program has been applied. A table containing each health jurisdiction Medicaid Participation Rate is located in the MI E-Grants site. The formula for calculating the federal funding is as follows: Federal funding = (Local funds x % of Medicaid Participation Rate) x 50% Federal Administrative Match rate) 2. Required Match - Local Represents the 50% match of local contributions. Budget the local match contribution. Federal Medicaid Outreach and Required Match — Local must equal each other. Additional local contribution that is not eligible for the 50% federal match should be reported on the Local Funds — Other line. 3. Sources of Local Fund Types Local Health Departments may utilize their county appropriation, funds received from local or private foundations, local contributors or donators, and from other non-state/non-federal grant agreements that are specific to Medicaid Outreach or are to be used at the discretion of the health department as a source for matching funds to be used at the discretion of the health department as a source for matching funds. 4. Comprehetisive-CSHCS-Outreach-and-Advocacy-and Case-Management/Care Coordination Funds Should be reported in a separate program element. D. Indirect Costs There are three (3) options for indirect costs. They are: 1. an approved federal or state indirect rate; 2. a 10% de minimis rate; or 3. a cost allocation/distribution plan For further detail, go to VI. Form Preparation, L. Indirect Cost, on page 5 of this document. E. Cost Allocation Certification The Cost Allocation Certification remains on file with the Department until there is a change in the Cost Allocation Plan. When the cost allocation plan on file with the program (MDHHS-Medicaid- Outreach), the local health department must: 1) submit a copy of the revised cost allocation plan with the budget request; and 2) complete a revised cost allocation methodology certification. Both documents are to be attached to a Detailed Budget line in EGrAMS. 11. Financial Status Report (FSR) LHDs seeking 50% federal administrative match must request reimbursement by submitting their actual expenses for allowable Medicaid Outreach activities on their quarterly FSRs through MI E-Grants. A. Quarterly and Final FSR LHDs must reflect the actual Medicaid Outreach expenses incurred on the quarterly and final FSR. Actual expenses incurred must be specific to Medicaid Outreach as defined by the MSA Bulletin 05-29 and not part of a direct service. All expenses should be supported by an approved methodology and appropriate support documentation. 1. Federal Medicaid Outreach Should be used to request the 50% federal administrative match for Medicaid Outreach. 2. Required Match - Local Should be used to report the local match for Medicaid Outreach, both the federal and local amounts must match. 3. Source of Funds Category Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDHHS grants, etc.) should be reported on the appropriate line has indicated in the Comprehensive Budget Instructions - Attachment I (e.g., Local non-ELPHS or Local Funds — Other). Total Source of Funds must equal Total Expenditures. B. Nurse-Family Partnership Medicaid Outreach — Quarterly and Final FSRs For Quarters 1-3, LHDs must reflect the actual Medicaid Outreach expenses incurred in a separate program element titled Medicaid Outreach. Actual expenses incurred for each of the listed expenditure categories are allowable, but must be specific to Medicaid Outreach as defined by MSA Bulletin 05-29 and not part of a direct service. Expenses should be supported by a time study or other federally approved methodology. 1. Federal Medicaid Outreach Should be used to request the 50% federal administrative match. Match is determined by multiplying local contribution for the program by the percentage of Medicaid enrollees. This product is then multiplied by 50% in order to determine the eligible federal administrative match. 2. Required Match - Local Should be used to report the remaining portion of the local contribution for the Medicaid Outreach Match. Both lines should equal. Additional local contribution related to service provision for non-Medicaid eligible participants which are not eligible for the 50% federal match should be reported in Local Funds - Other. 3. Source of Funds Category Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDHHS grants, etc.) should be reported on the appropriate line has indicated in the Comprehensive Budget Instructions - Attachment I (e.g., Local non- ELPHS or Local Funds — Other). C. CSHCS Medicaid Outreach — Final FSR CSHCS Medicaid Outreach billing should occur on the final FSR through the MI E-Grants system after Comprehensive Agreement CSHCS Outreach and Advocacy funds have been expended. Local contributions eligible for the Medicaid Outreach match should be cost distributed to the CSHCS Medicaid Outreach program element from the CSHCS Outreach and Advocacy program element and reported as indicated below. 1 Federal Medicaid Outreach Should be used to request the 50% federal administrative match. Match is determined by multiplying local contribution for the program by the percentage of Medicaid enrollees. This product is then multiplied by 50% in order to determine the eligible federal administrative match. 2. Required Match - Local Should be used to report the remaining portion of the local contribution for the Medicaid Outreach Match. Additional local contribution that is not eligible for the 50% federal match should be reported in Local Funds - Other. 3. Source of Funds Category Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDHHS grants, etc.) should be reported on the appropriate line has indicated in the Comprehensive Budget Instructions - Attachment I. 4. Comprehensive CSHCS Outreach and Advocacy and Care Coordination Should be billed as separate program element, Ill. Comprehensive Local Health Department Agreement Obligation Report — filed in September 20xx. The Obligation report is used to estimate the payable amount due to Local Health Departments from MD1-11-IS for each program element. A. In the Estimate Column, enter the maximum projected federal administrative match earnings for allowable Medicaid Outreach Activities to be earned from Medicaid Outreach on the Federal Medicaid Outreach row. B. In the Estimate Column, enter the maximum projected federal administrative match earnings for allowable Medicaid Outreach activities to be earned from CSHSC — Medicaid Outreach. This should reflect the local contribution multiplied by the Medicaid enrollment participation rate x 50% federal match rate. C. In the Estimate Column, enter the maximum projected federal administrative match earnings for allowable Medicaid Outreach activities to be earned from Nurse Family Partnership Outreach. This should reflect the local contribution multiplied by the Medicaid enrollment participation rate x 50% federal match rate. Note: CSHCS Outreach and Advocacy and CSHCS Care Coordination activities funded through the Comprehensive Agreement are recorded as separate program element. Example 1 Medicaid Outreach Cost Allocation Plan Orange County Health Department Cost Allocation Methodology For Medicaid Outreach Activities , Orange County Health Department allocated costs for Med ipAI'd Outieach as follows: Salaries & Fringes: Distributed based on the actual amount of'1.1m6'eacemployee spends in each program for which they work. Vacation/sick/holiday pay is..allatell in thelamei rmaniler. Supplies and Materials: Directly expensed to the,rspe6ifit pr'b9ram(S),Identified by the employee as needed. Costs that benefit all programs will be(allotai0 bed r RercerttagV,fr in each program. Travel: All travel costs are charged dir,..tiOolh'e.program foik.which the travel was incurred. \ -s Cornmunications: Distrilicrted\based oiT,ttibcp r el-Atele\bf time staff worked in each program. Space Costs: Distributd bsid,pn\thOokhre tr? tage used by the FTE and the percentage of time they worked in ea0 prpprarri. Cbmmbn ar qualelootage is allocated based on percentage staff in each ,.., program. All Others: (TranslatIo—s'ervi'aeiz, Miscellaneous services, insurances, dues, etc...) Costs are charged directly - to the program for wlhthe eMce occurred. Indirect costs: distributed across all programs based on the salaries and fringes of staff in each program. Example 2 Orange County Health Department Medicaid Outreach Cost Allocation Methodology Certification This is to certify that I have reviewed the cost allocation plan and to the best of my knowledge and belief that: 1. All costs contained in this proposal to establish cost allocations or billings for Medicaid Outreach Activities are allowable in accordance with the requirements of Title 2 CFR Part 200, "Uniform Administrative Requirements, Cost PrineiPies and Audit Requirements for , Federal Awards," and the federal and state awards ía whiCh they apply. Unallowable costs have been adjusted for in allocating costs .s,indicai0 wthe east allocation plan. , , 2. All costs included in this proposar,are p,rope V-allricableto\t,he'MedOid Outreach Activities Administration award on a b'esiS4-aterefical scautrelatlanShip between the expenses \ ) incurred and the Mecileaid\OL6a6h Administration awAfd to which they are allocated in \ \ accordance wjttfapplic\atAre-'04,man,iii. Firther, the same costs that have been treated \— as indirect costs have,not beb.A dal ed'as\duect costs. Similar types of costs have been accounted Tqr consisle\ntly„ \\ , \ 3. This,„bertificatiati„ will be‘tesubmitted if a significant change occurs that impacts the , Medicaid pli1Teath potiVities or upon a Department review that results in a finding of non-\ compliancef\--„it,:neither of these conditions exists, the certification remains valid in subsequent fiscal years. I declare that the foregoing is true and correct: Health Department: Signature: Name of Official: Title: Date: An authorized official of the organization must certify that the plan has been prepared in accordance with authorizing legislation and regulations, and state or other applicable requirements. Every cost allocation plan must include a certification. Example 3 SAMPLE 3 ORANGE COUNTY HEALTH DEPARTMENT Budgeted Costs for Medicaid Outreach Activities 1 Program BudgerSurnmary PROGRAM i-PROJECr Comprehensive Agreement -2016 / Mer4 d lltreach -DATE PREPARED 0ergr2015 CONTRACTOR NAME Orange County Health Department BUDGET PERIOD From :101112015 To .:9I3C2C1e 1.1 ENT 4 10 MAILING ADDRESS (Number and Street) 123 Acme Rd., BUDGET AGREEMENT -1AMEN0 orgriai Amendment CITY 'STATE Orangegrove Ml ZIP CODE 49555 FEDERAL ID NUMBER 38-5555555 Categ ry Amount 1 . ...JCas" naind Total DIRECT EXPENSES Program Expenses 1 Salary 8, Wages 153.556.00 0.00 - 0.00 153,556.00 2 Fringe Benefits TI201_00 0.00 0_00 71,204.00 3 Cap. Exp. for Equip & Fac. ,, CIN .....„—T..—....,—,—,—,—. 0.00 0,00 0.00 4 Contractual k - - „ o..06 —.,-„--- 0.00 0.00 0.00 5 Supplies and Materials 2,50000 0.00 0.00 2.500.00 6 Travel , 50040 0110 0.00 500.00 7 Communica ,....-- 5,000110 0.00 0.00 5.,000..00 8 County City Central Serviced 0.00 0.00 000 9 Space Costs 8,7000.00 0.00 0.00 800000 10 All Others (ADP Con EmplOyees, Misc.) 4,500;00 0.00 0.(10 4_500,00 Total Program Expenses 245,260.00 0.00 0MG 245,260.0E) TOTAL DIRECT EXPENSES 245,26400 000 0_00 245,260.00 INDIRECT EXPENSES Indirect Costs 1 indiectCsth 37.220.00 0.00 0.00 27,610 00 2 Other Costs Djstithutlons 35,000.00 000 000 35,000.00 Total Indirect Costs 72,220.00 0.00 400 72,220.00 TOTAL INDIRECT EXPENSES g220.00 0.00 0.00 72 220 - TOTAL EXPENDITURES 31 7,480.00 11.00 0.00 317,46E000 2 Program Midget- SOurve of Funds Source of Funds Category Amount Cash In Ind Total Fees and CollectiOns - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 000 Federal or State (Non MOCH) 0.00 0.00 , 0.00 0.00 FecteratCost BasectReimbursement -000 -0 Federally Provided Vaccines 0_00 000 ,.. 0.00 0_00 Federal Medicaid OtreAth 158,740.00 0.00 '. 0.00 156,740.00 Required Match - Local , ODD 1t:S.740.0a -,1-1.- .„----,- 0.00 158,740.00 Local Non-ELPHS ' 0 00 ' t) 00 , , i,r--- 0.00 13 nb 0.00 Local Non-ELPHS 0.00 0.00 Local Non-ELPHS , . '0.00 000 ' -.----1, 0.00 100 Other Non-ELPHS 0,00 0.00 0.00 0.00 DCH Non Corapmtiensiv . 0.00 ' , 0.00 - ----..-, 0,00 0.00 MDCH Comprehensive 6,00 ' 0.00 000 0.00 ELPHS - MDCH hearing 0.00 000 0,00 0.00 ELPHS -- MDCH Vision 0.00 000 0.00 0.00 ELPHS - fulDCH Other 000 0.00 0.00 0.00 ELPHS - Food 0.00 0,00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0_00 000 ELPHS - On-Site Sewage 0.00 0.00 0,00 0,00 MCH Funding 0.00 0:00 0OQ 0_00 Local Funds - Other 0.00 000 0_00 0.00 Inkind Match 0_00 0.00 0.00 0.00 OCH Fixed Unit Rate Totals 158j40.00 158,74000 0.00 317,480.00 .4 .Pr0Wm 13.udget - tsist:Deait !Line te Q RateI 110 I Amount J h .. I kind Total I3IRECT EXPENSES PratatfatU ExpenseS i S Miry & •Wageis Pubdc HealttittUrse 1 0370 54;54500- Il 68,,56 •.17 0 MD 0 DO 56 56 Social Vitro-her 0 2500 51„;p76 ..013 14 525 -,,E, ' 0,60, 0 PP 14..525 Technician 0 5550 40,6543-00 FTE 23,700:20 „ . 6: 0:01:1 2a 780 ealtii Educator 0 5550 50,055.00 FTE 20,20.03 0.0•0 01/r/ ,. 28 250 Cloncal 0 4 50 -34.071-00 FTE 662444 ''', ',P2 0..0.0 18,524 Supervisor 02200 i5.3;1 00 FTE 13,852,34 0 00 0.00 13,882 Tol for Salary gee , ..., , 15;3 55.00 000 0.100 153.658 Fringe Be e All CornOeSite Rate Ncites z:FIA, r OTA; LiFE,,--„ HEALTH, -= DENTALIViSION, ' PENSPON, UNEMPLOYMENT, WORKMANSECQMP: 0.0600 :45:.310 ' \ 7203 llc;.73 0,00 0.00 74204 It Exp, for Equip gi. Fac. 4 o]fl( 5. Supptie arid itatertais prthljn 750.00 0.00 000 750.00 Office Supplies 1,250.00 :0:00 0.00 1,250_00 Postage. 500.60 0.00 0.00 0_00 Travel Mileage 5001, 0-1 0.0 0.00 :13 Comas co ion Tadophone, Cell sc00008I 0.001 0_001 5 00.00 COuntsr-City Centro/ Servio.es Space Costs SpaCe 'Costa 8 000:aoI so4 0_001 8,0100.00 0 All Otti re (ACV, con.:emOloyees,.Misc; TrarialaSoo Seto es 4,000.00 0,00 5.00 4. 0 NilacellarxecUs 500 00 0.00 000 5000* Total Pronram Expenses 24250.00 0..a•0 0.00 245260.0& TOTAL DIRECT EXPENSES •245260. DLO o.00 245,26000 INDIRECT EXPENSES Indirect Costs I cdirect Costs Fiscal year Rate 10.0009 16.560 I --1.... 37,2;70.1 0.01i 0.00 37,220 Other Costs oistributionS casing Adrian Distribution , _ j........ Di.0 ..,01... . I ' ' 35,000.0 0_ 0 0.00 as 000 Total Indirect Costs , , 72220.15 0.00 0 00 72,220 TOTAL INDIRECT EXPENSES 72,220,15 0. 0 0 OD 72 220 TOTAL EXPENDITURES 317400. 0,00 9.00 S317,480 H. Michigan Colorectal Cancer Screening Program — The Michigan Colorectal Cancer Early Detection program (MCRCEDP) budget is to be developed in the following ways. 1. This budget is intended to cover all staffing and coordination for the program. All allowable expenses will be reimbursed through the Comprehensive Agreement. 2. All direct service claims must be billed through the MDHHS Cancer Prevention and Control Section. The LHD and/or direct service providers with contracts or letters of agreement with the LHD will be responsible for billing. 3. The staffing, coordination and direct service total amount is $255 per woman or man based on a target caseload established by MDHHS. Performance reimbursement will be based upon the understanding that a certain level of performance n('Ieasured by outputs) must be met. There is a 90% performance requirement for this program. The performance target output measure is the number of women and men that complete a screening test for colorectal cancer. 4. For specific program requirements, including current direct service reimbursement rates and other documentation refer to the most current MCRCEDP manual. Allowable with 317 operations fonds Allowable with lire " with V.FC operation ordering s finds•ttS, MO* *ft Pan -- NrFCIAFIX. fufld MOWS Allmitabk with I Allowable VFC Distribution with PPHF:. ilvads funds auic Tim/04 I Sa1arVtWages Comptagatinifringt bentra Trave &attolocalltegional conference trrwel smepses Local- rneetingsiconierenu.s (Ad hot) (excluding meals) In-state travel costs ..ItAng,Progratu ManagersiPHA Meeting, ACIP meethigs, AFLX and VFC trainings, Program I Managers Orientation, and other CDC-I sponsored itinnunization progport meetin r t *Beast, refer to Operatiou Funcliv Categolia, pgs., 29– far additional_ fafornafion. 9/1612.016 Seetinn I—The Basics IPOM 2011 1-.40.447: (1;Ft-g-niate4i Allowable ti es of 3 7 and VFC FA (Verations funds P011 dtvtlopW the following-table to assist awardees in preparing budgets that are in compliame with-federal grantspiicies_ and CDC ward requirements. The table was developed using combination of OMB Circular A47, PHS (rroets, Policy Statement 9505, and POB-identified program priorities. wattle th 317 operations funds Innen Fax .hitieS fiat vaedite or Voce storage equipment for VFC Walt Ve Croy tgoirb otifficlip4 1111121111111111111111111111111111111111111 *Equipment; mamide of tamihte roneweridable persowl proorty haying .1001 of more thinTorie year ta tan acqUisition cost of $5,600 ar mire perung If east is below•thiv threshold "mount item inct_); he Oefeed Allowable 1 wilt PRITP funds I Allowable witti VFC operation funds Allowable Allowable Allnble Allowable With 'with lift with with Pan VFC Distribution ordering ITFC/FIX nu funds fonds fonds putts ifivitete appli.:ctoie) ANC-only it visits AIII(kmly site visits Combined (ARK & VFC site visits1 .Pcrinatal howitareoord reviews 31J1i05 i Vaccine adminiStati011Supplios 1 (including, but not limited to, nasal •Pharrn PA swabs sYringes ibr • I elt elle ) r VAccination clinics) Office stpplies-compul, m., gooral oft (pens, papa, paper clips, etc..), ink carrid . calculators Pers.°, corn /Lo/TbIe Pink Books, Red Books, lielbw Bookl ILnriiitLrr.... 911612W6 WI p Section (—The Basics p.22 WOW/ 2017 Object Class Categoiyil Allowable with Allowable VFC Weitributioe• with P111-1F funds , funds 4rPacab A11ow2bk Allowable Allowable With VFC with with Pza ordering N-FfClunAEdsIX Yin fund 5 Allowable _Allowable with MI with NTC operations operation funds s funds Laboratory supplies (influenza cuirures and PeRs, ektitur6s. and molecular. 10 media serntypink Diitsildell logger With valid uertificam of callbrationlvalidationitesting report Vaccine shipping supplies (storage containers ice ileks bubble mai, ete3 I. Coniractuai •Statelocal conferences expenses • (conference site-, materials printing, hotel acapitmodations expanses, speaker fees) Food cost is not ailowabk, (F4 ordy) egionallocal medin General. contractual service$ (e.g.. lAls‘ local health departments, contractual gaff, advisory committez media, rovider traini GSA CoriLnetuill services (CDC I. •managed) ter uSeontracti gal agreements (support, enliancement, upgrades) 7C-relzti (FA on11.4 Financial AssistaiilelyAl_ I Not-CIX Contract vaccines ; 117 vat-tine futtl inuA-be requested in funding pplicatiori (aCrATIS) under 317 FA =tines 9/1612016 Seefien I---The Basics p.23 1130M 2017 AIIOWabk Ailawable -7-1Allowahle with Pan WC13bitrihation with PPI1F Flu funds fuuds funds t IfwitagiVPPeabk) Indirect indireat costs: Accountitig services _Advertising (restricted to reornitment staff or trainees, procurement of „goo& and sevim., disposal of scrap or surplus materials) it Fee BUSS Survey Committee meetings (-room r equipment mite, ete.) Communication (electonieicompurer transmittal, =ranger, postage, local and• long &tante telephone) ver V Consumer information activities Comma f providet board participado (trawl reimbumment) Local service delivery nberhipfsuhscñprions NIS Nersampling Paeersicell phones ri tin of vaccine woo= forms 70. W16/2016 Section 1--The Basics 014 IPM1 2017 class-VategoryfEtpens bffhI !;;:',-;441*Vft: ALHorittible with 317 Operations Allosvable with yFolva Object Class Categoryffl.xpenscs knowable with 317 operations hinds 11( -41 'tam diaributiv. faegior) Vt if• Allowable Allowable with VFC with VFC operation I ordering s funds funds Allowable Allowable r, . able with ; Allowatrle..1 with with Pan `. VFCDistribution with VPC/AF1X Flu funds filuds funds funds ; ()vitae aPPqcabie) Professional service costs directly related to immunization activities (limited tetiai staff), Attorney General Office services Public relatiOnS PUbliatiCOlprtillg cOAS (all other immunization related publication and . . printing expenses) Rent (requires explanation of why these costs are not included in the indirect (-;ost rats agreement or cost allocation plan) Shipping for materials (other than vaccine L.2_21i plak_liaccirie __ Software limn/Renewals (ORACLE, etc.) Stipend Reimbursements Toll-free phone !hits for Aractin ordoeing Training costs – Statewide, stall, viders Translations Iransiatin materials) ' Vehicle lease (restricted to awardees with policies that prohibit Inca' travel reimborsemer VFC enrolbrent materials VFC provider feedback survey VIScamera-ready copies (FA 640 9/16a010 Section I—The Basics p:25 1POM 2017 Non-Allowable Expenses with Federal immunization Funds :Expense , . _. .. . • . ' • • - NOT allowable with federal 'Minimization funds Honoraria 1 Advertising costs (e,g„ canvergiont Aspfays, axhibits„ Nowlingi% , ftienturcrVia Altb,Aglivvritt___ A ir9brottiireVelapl filiiidifit Urchases, construction 'fiaiTil im rovernents Land F orheses . , ' 1 ve lobbvin tiv ties -- Pionlliag_ ,../ Mpreciation on tise charges Researett Fundraising V Interest on loans for the acquisition andlor Me dernizatiort of 1 Cljnical Gam (narr-intaminizatton xervioo "Entertainment 1.," -Pa monfol bia 'dtbt — leanin , Vehicle P rehas Promot omit andfor In c Ivlaterlals fe.,g., proniacT, 4,q`elhing and tortart$OPnarative ken a rmtaft aspens. Integ*tvg„fardarkitylios, ict000rds, eolith-Tow* bow) N, Purchase of 1.60c1 fimiessparx ofrwprieerl imrpill pwr diem cants) Other restrictions which most be taken into account while writing the budget: • Funds. ffirty be spent only for activities vind personnel. costs that FliV directly related to the Iminuni2ation and Vamirics for Children Cooperative Agreement, .Fu.nding requests not directly related to hrumunization activities.are outside the scope of this cooperative agreement program and will not be fu.nded. Pre-award costs will not be reimbursed. 9/1612016 Section 1—The Basics p,26 IPOM 2,017 ATTACHMENT III MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES LOCAL HEALTH DEPARTMENT AGREEMENT October 1, 2018 — September 30, 2019 Fiscal Year 2019 PROGRAM SPECIFIC ASSURANCES AND REQUIREMENTS Local health service program elements funded under this agreement will be administered by the Grantee and the Department in accordance with the Public Health Code (P.A. 368 of 1978, as amended), rules pro mulgated-u-ndar-the-Code , minimum-program-requirements and all_other applicable_F_ederal,_State_and Local laws, rules and regulations. These requirements are fulfilled through the following approach: A. Development and issuance of minimum program requirements, further describing the objective criteria for meeting requirements of law, rule, regulation, or professionally accepted methods or practices for the purpose of ensuring the quality, availability and effectiveness of services and activities. B. Utilization of a Minimum Reporting Requirements Notebook listing specific reporting formats, source documentation, timeframes and utilization needs for required local data compilation and transmission on program elements funded under this agreement. C. Utilization of annual program and budget instructions describing special program performance and funding policies and requirements unique to each State fiscal year. D. Execution of an agreement setting forth the basic terms and conditions for administration and local service delivery of the program elements. E. Emphasis and reliance upon service definitions, minimum program requirements, local budgets and projected output measures reports, State/local agreements, and periodic department on-site program management evaluation and audits, while minimizing local program plan detail beyond that needed for input on the State budget process. Many program specific assurances and other requirements are defined within the referenced documents including Minimum Program Requirements established for the following program elements as of October 1, 2006: A. B. C. D. E. F. G. H. Breast and Cervical Cancer Control Clinical Laboratory Family Planning Food Service Sanitation General Communicable Disease Control Healthy Homes and Lead Poisoning Hearing HIV/STD Prevention & Treatment I. Immunization (Essential Local Public Health Services & Categorical) J. LHD/CSHCS K. Michigan Care Improvement Registry L. On-Site Wastewater Treatment Management M. Private and Type III Water Supply N. Vision 0. WIC For Fiscal Year 2019, special requirements are applicable for the remaining program elements listed in the attached pages. EGrAMS Code Program Element Title ADOLSTD Adolescent Sexually Transmitted Disease (STD) Screening BODY-FIX Body Art Facility Licensing BCCCP Breast and Cervical Cancer Control Navigation Program CLPEO Childhood Lead Poisoning Education & Outreach CLPP Childhood Lead Poisoning Prevention CC-FIX Children's Special Health Care Services (CSHCS) Care Coordination CSHCS Children's Special Health Care Services (CSHCS) Outreach & Advocacy CHA Climate Health Adaptation CUSP Communities Uniting for Suicide Prevention CCCIP Comprehensive Cancer Control Community Implementation Project CCFIX-EB CSHCS Medicaid Elevated Blood Lead Case Mgmt CC-MED CSHCS Medicaid Outreach EATFISH Eat Safe Fish FP Family Planning Services-Pregnancy Prevention FASD Fetal Alcohol Spectrum Disorder F1MR Fetal Infant Mortality Review (F1MR) Case Abstractions GWR Grayling Water Response GTHMP Getting to the Heart of the Matter — Project Management GISP Gonococcal Isolate Surveillance Project (GISP) HAR Hepatitis A Response HEC Health Education Communication HIVDC HIV Data to Care HIVSTD HIV/STD Partner Services HIVPD HIV PrEP Data Collection HIVPREV HIV Prevention Services HIV-FIX HIV Prevention Non-Categorical HIVMHI HIV Ryan White Part B HIVRWM HIV Ryan White Part B MAI HIVSURV HIV Surveillance Support HALCP HIV/AIDS Linkage to Care HOPWA Housing Opportunities for Persons Living with HIV/AIDS IAP Immunization Action Plan IMMFSR Immunization - Field Service Representatives VFCA-FIX Immunization Fixed Fees 1) Immunization Assessment Feedback Incentive Exchange (AFIX) Follow- up Site Visit 2) Immunization - Nurse Education Reimbursement 3) Immunization - VFC/AFIX Site Visit MCIR Immunizations Michigan Care Improvement Registry (MCIR) Regional Michigan Care Improvement Registry VQA Immunization - Vaccine Quality Assurance Program ISS Infant Safe Sleep INCON-FIX Informed Consent LABBIO Laboratory Services LACT Lactation Consultant LHDS Local Health Department (LHD) Sharing Support Local Maternal and Child Health (MCH) OTHER-MCH Direct Services Children — MCH OTHERMCHW Direct Services Women — MCH ESCMCH Enabling Services Children — MCH ESWMCH Enabling Services Women - MCH OTHERMCHV Public Hlth Functions & lnfratruct - MCH TOBACCO Local Tobacco Reduction MIECHVLLG Maternal Infant Early Childhood Home Visiting Initiative (MIECHV) Local Home Visiting Leadership Group MHVRLH Maternal Infant Early Childhood Home Visiting Initiative (M1ECHV) Rural Local-Home Visiting-Leadership Group MHVRLH3 Maternal Infant Erly Chd Home Visiting Initiative Rural Local Home Visiting Grp3 BMHFAE Maternal Infant Childhood Home Visiting Program (MIECHVP) Healthy Families America Expansion MHVIRE MI Home Visiting Initiative Rural Expansion Grant MHVIRE3 MI Home Visiting Initiative Rural Expansion Grant Region 3 OR-MED Medicaid Outreach MIAPPP Michigan Adolescent Pregnancy & Parenting Program MCRCSP Michigan Colorectal Cancer Early Detection Program NFP-MED Nurse Family Partnership Medicaid Outreach NFP-SEV Nurse Family Partnership (NFP) Services Public Health Emergency Preparedness (PHEP) BIONINE Public Health Emergency Preparedness (PHEP) 10/1/16 - 6/30/17 CRININE Public Health Emergency Preparedness (PHEP) 10/1/16 - 6/30/17 RPCS Regional Perinatal Care System SEAL SEAL! Michigan Dental Sealant SOPP Safer Opioid Prescribing Practices And Data Collection: Health Departments STD Sexually Transmitted Disease (STD) Control STDGC STD Neisseria Gonorrhoeae Enhanced Surveillance Project RAPEPRE Sexual Violence Prevention (Rape Prey Ed) SIDS-FIX Fetal Infant Mortality Review Interviews TPIP Taking Pride in Prevention TCDC Tobacco Cessation — Dental Clinic TDT Tobacco Dependence Treatment TOBHIV Tobacco Reduction in People with HIV/AIDS TB Tuberculosis (TB) Control 340B Tuberculosis (TB) Control and Elimination V1R Vapor Intrusion Relocation WR Water Recovery WSVCS West Nile Virus Community Surveillance WIC Women and Infant Children TWIC) WICBRST WIC Breastfeeding Peer Counseling W1CMIG WIC Migrant W1CRES WIC Resident Services W1SEC Wise Choices WI SEW Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) WNR Wurtsmith Water Recovery Essential Local Public Health Services (ELPHS) ADM-ELPHS Administration - ELPHS FOOD-ELPHS Food ELPHS GCD-ELPHS General Communicable Disease ELPHS HEAR-ELPHS Hearing ELPHS HIV-ELPHS HIV ELPHS DHIV-ELPHS HIV & STD Testing and Prevention IMM-ELPHS Immunization ELPHS SEW-ELPHS MDEQ On-site Wastewater Treatment -WTR=ELPHS— iVIDEQ-Private and-Type-Ill Water Supply VIS-ELPHS Vision ELPHS FORMAT (PROGRAM/ELEMENT1 SPECIAL REQUIREMENTS Reimbursement Chart — a Program Element: The Program Element indicates currently funded Department programs that are included in the Comprehensive Local Health Department Agreement. b. Reimbursement Methods: The Reimbursement Methods specifies the type of method used for each of the program element/funding sources. Funding under the Comprehensive Local Health Department Agreement can generally be grouped under four (4) different methods of reimbursement. These methods are defined as follows: 1. Performance Reimbursement - A reimbursement method by which local agencies are reimbursed based upon the understanding that a certain level of performance (measured by outputs) must be met in order to receive full reimbursement of costs (net of program income and other earmarked sources) up to the contracted amount of state funds prior to any utilization of local funds. Performance targets are negotiated starting from the last year's negotiated target and the most recent year's actual numbers except for programs in which caseload targets are directly tied to funding formulas/annual allocations. Other considerations in setting performance targets include changes in state allocations from past years, local fiscal and programmatic factors requiring adjustment of caseloads, etc. Once total performance targets are negotiated, a minimum state funded performance target percentage is applied (typically 90% unless otherwise specified). If local Grantee actual performance falls short of the expectation by a factor greater than the allowed minimum performance percentage, the state maximum allocation for cost reimbursement will be reduced equivalent to actual performance in relation to the minimum performance. 2. Fixed Unit Rate Reimbursement - A reimbursement method by which local health departments are reimbursed a specific amount for each output actually delivered and reported. 3. ELPHS - A reimbursement method by which local health departments are reimbursed a share of reasonable and allowable costs incurred for required Essential Local Public Health Services (ELPHS), as noted in the current Appropriations Act. 4. Staffing Grant Reimbursement - A reimbursement method by which local health departments are reimbursed based upon the understanding that State dollars will be paid up to total costs in relation to the State's share of the total costs and up to the total state allocation as agreed to in the approved budget. This reimbursement approach is not directly dependent upon whether a specified level of performance is met by the local health department. Department funding under this reimbursement method is allocable and a source before any local funding requirements unless a special local match condition exists. Performance Level If Applicable The Performance Level column specifies the minimum state funded performance target percentage for all program elements/funding sources utilizing the performance reimbursement method (see above). If the program elements/funding source utilizes a reimbursement method other than performance or if a target is not specified, N/A (not-available) appears in the space provided. D. Performance Target Output Measures Performance Target Output Measure column specifies the output indicator that is applicable for the program elements/ funding source utilizing the performance reimbursement method. Output measures are based upon counts of services delivered. E. Relationship Designation The Subrecipient, Contractor, or Recipient Designation column identifies the type of relationship that exists between the Department and grantee on_a program-by-programbasis_ Federal awards expended as a subrecipient are subject to audit or other requirements of Title 2 Code of Federal Regulations (CFR). Payments made to or received as a Contractor are not considered Federal awards and are, therefore, not subject to such requirements. 1. Subrecipient A subrecipient is a non-Federal entity that expends Federal awards received from a pass-through entity to carry out a Federal program, but does not include an individual that is a beneficiary of such a program; or is a recipient of other Federal awards directly from a Federal Awarding agency. Therefore, a pass-through entity must make case-by-case determinations whether each agreement it makes for the disbursement of Federal program funds casts the party receiving the funds in the role of a subrecipient or a contractor. Subrecipient characteristics include: a. Determines who is eligible to receive what Federal assistance; b. Has its performance measured in relation to whether the objectives of a Federal program were met; c. Has responsibility for programmatic decision making; d. Is responsibility for adherence to applicable Federal program requirements specified in the Federal award; and e. In accordance with its agreements uses the Federal funds to carry out a program for a public purpose specified in authorizing status as opposed to providing goods or services for the benefit of the pass-through entity. 2. Contractor A Contractor is for the purpose of obtaining goods and services for the non-Federal entity's own user and creates a procurement relationship with the Grantee. Contractor characteristics include: a. Provides the goods and services within normal business operations; b. Provides similar goods or services to many different purchasers; Normally operates in a competitive environment; d. Provides goods or services that are ancillary to the operation of the Federal program; and e. Is not subject to compliance requirements of the Federal program as a result of the agreement, though similar requirements may apply for other reasons. In determining whether an agreement between a pass-through entity and another non- Federal entity casts the latter as a subrecipient or a contractor, the substance of the relationship is more important than the form of the agreement. All of the characteristics listed above may not be present in all cases, and the pass-through entity must use judgment in classifying each agreement as a subaward or a procurement contract. 3. Recipient A Recipient is for grant agreement with no federal funding. II. Budget and Agreement Requirements - Lists those special funding and agreement requirements applicable to the program/element as a whole. II. Grantee Requirements - Lists those special requirements applicable to all agencies administering the program element. III. Department Requirements - Lists those special requirements applicable to the Department. IV. Grantee Specific Requirements- Lists those unique requirements applicable only to the single Grantee covered by this agreement. Reimbursement Method Footnotes key: (1) Program element or funding source as applicable. (2) Refer to the master Local Health Department agreement and the program and budget instructions package for further explanation of applicability of these reimbursement methods. Allocation to be reflected in individual programs during budgeting process. Funding Source (not a single element). Hearing and Vision are single elements. Subject to statewide maintenance of effort requirement for Title X. State funding is first source (after fees and other earmarked sources). Fixed unit rate subject to actual costs. The performance reimbursement target will be the base target caseload established by the Department. Subject to a match requirement (hard or in-kind) of $1 for each $3 of the Department agreement funding for coordination. (10) Fixed rate _limited to_ contractamount (11) Up to 6 visits per family. (12) Non-categorically funded Health Departments will be reimbursed at $11.00 per HIV test conducted up to a maximum of $2,000 annually. (13) Each delegate agency must serve a minimum percentage of Title X users to access their total allocated funds. Semi-annual FPAR data will be used to determine total Title X users served. (14) Public Health Emergency Preparedness funding BPI must be expended by June 30, and is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHDs must submit a nine-month budget and a quarterly Financial Status Report (FSR) column for this program element. (15) Public Health Emergency Preparedness funding for October 1-June 30, and July 1-September 30, is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHD's must submit a three-month budget and a quarterly Financial Status Report (FSR) column for this program element. (16) Project meets the Research and Development Criteria as defined by Title 2 CFR Section 200.87. (17) Not Applicable. (18) Subject to match requirement as specified in Attachment III — Program Assurances and Specific Requirements. Grant Start Date Grant Contract Administrator 517-241-5861 linzmeier@michigan.gov • Subreciplent„. 1 .'Contractor, or Reelpient.(non. federal) Designatidn . rormance Target Output MeasUre Contact Info (phone & email) Reimbursement Method Subrecipient ADOLESCENT SEXUALLY TRANSMITTED DISEASE (STD) SCREENING Special Requirements 10/1/2018 I Grant End Date 9/30/2019 Jennifer Linzmeier BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS Project Summary: Individuals 15-24 years of age will be screened for chlamydia and gonorrhea at the following Oakland County sites: 1. Oakland County Main Jail 2. Oakland County Work Release 3. Oakland County Community Sites where Priority Population Gathers Utilizing the identified project sites: 1. Test at least 100 adolescents and young adults per month, using NAAT tests for gonorrhea and chlamydia. 2. Collect race, gender, age, test result, and treatment date for all tests. 3. Refer clients for further health evaluation if indicated. 4. Provide client centered risk reduction plan, promoting abstinence. 5. Treat all positives on site if possible. 6. Contact positive clients that are released prior to treatment with treatment options in community. 7. Promote self-notification of partners. 8. Analyze and forward screening and treatment data to the Department quarterly: April 15, July 15, October 15, and January 15. 9. Develop one annual slide set highlighting year end data by demographic variable including trend data. 10. Continue to promote awareness of prevalence of STDs within adolescent and young adult populations. 11. Participate in quarterly Michigan Infertility Prevention Project meetings; providing quarterly screening project data. REPORTING REQUIREMENTS N/A Contact- Info email) 517-284-4915: coylej@rnichigan.gov N/A 'Performance Level Applicable). Grant Start Da 10/1/2018 G rant End • Date :.• 9/30/2019 • ....Grao. Contract 'Administrator:. Joseph Coyle Fixed Unit Rate (2) Subrecipient, Contractor, or Recipient (n on-federal) Designation Recipient ReimbUrsement Method Performance Target Output Measure N/A II BODY ART FACILITY LICENSING Special Requirements BUDGET AND AGREEMENT REQUIREMENTS This agreement is intended to establish a payment schedule to the Grantee, following notification of a completed inspection and recommendation for issuance of license. The intent is to help offset costs related to the licensing of a body art facility, when fees are collected from the respective Grantee's jurisdiction in accordance with Section 13101-13111 of the Public Health Code, Public Act 149 of 2007, which was updated on December 22, 2010 and is now Public Act 375. The Department will reimburse the Grantee on a quarterly basis according to the following criteria: $264.07 $132.04 $117.53 $261.20 $396.11 $26,40 Initial annual license for a Body Art Facility prior to July 1 50% of state fee Initial annual license for a Body Art Facility on or after July 1 50% of state fee Issue a temporary license for a Body Art Facility °A of state fee License renewal prior to December 1 52.32% of state fee License renewal after December 1 50% of state fee + 50% of penalty Duplicate License Payment will be made for those body art facilities that have applied and paid in full to the Department, following notification of a completed inspection and recommendation for issuance of license. GRANTEE REQUIREMENTS The Grantee is authorized to enforce PA 375 and conduct an inspection of all body art facilities under its jurisdiction, investigate complaints, and enforce licensing regulations and requirements. The Grantee must complete a Body Art Facility Inspection Report IDCH-1468 (07-09)1, as provided by the Department, or other report form approved by the Department that meets, at minimum, all standards of the state inspection report. Only body art facilities that have applied for licensure should be inspected. All body art facilities must be inspected annually. Licenses will only be released from the Department following notification of a completed inspection and upon recommendation by the Grantee. Completed inspection reports should be signed by the facility owner and recommendation for licensure should be forwarded to the Department within two to four weeks following the inspection. Reports should be entered via the online interface or can be sent to: HIV/STD and Body Art Section Division of Communicable Diseases 333 S. Grand Ave, 3rd Floor Lansing, Michigan 48933 DEPARTMENT REQUIREMENTS The Department will notify the Grantee by email when an applicant has paid for licensure or renewal. This will —s-e-rve-as tire-request-to-the-Grantee to perform-an-tnspectio-The Department wtrissue a lien se-to an applicant upon the recommendation of the Grantee performing the inspection. The Department will reimburse the Grantee according to this payment schedule to help offset the costs related to the licensing of the body art facility. Payments will be released quarterly based on the FSR submitted. The Department will provide a reporting template to be attached to the FSR. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A 9/30/2019 Grant S art Date -Grant nd Date Grant Contrac Administrator. • 10/1/2018 E.J. Siegl 517-335-8814; siegle@michigan.gov —Staffing-(6) Contact Info Apnone & email Reimbursement Method 4-..-Suhrecipieritr Contracter,,H_Subrecipient or Recipient (non-federal).- • Designation • Performance Target ()LAW Measure N/A Performance Level (if Applicable) N/A BREAST AND CERVICAL CANCER CONTROL NAVIGATION PROGRAM (BCCCNP) Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS The BCCCNP (Breast and Cervical Cancer Control Navigation Program) provides individualized assistance to low-income women, <250% FPL, in overcoming barriers that may impede their access to receiving breast and cervical cancer services. Program services are targeted to women in hard to reach populations, such as minorities, particularly African American, Hispanic, and Native American women, and women aged 50-64, as well as women who have insurance but do not know how to access the healthcare system to receive breast or cervical cancer services. The BCCCNP provides specific services to uninsured, underinsured, and insured women both within and outside the program. Breast and/or cervical screening and diagnostic services are reimbursed for uninsured and underinsured low-income women enrolled through the program that meet the following criteria: • Age 21-39; referred from either a BCCCNP or non-BCCCNP provider with an abnormal Pap test result or an abnormal clinical breast exam requiring diagnostic follow-up to rule out or confirm a cancer diagnosis. • Age 40-64; self-referred, referred from a BCCCNP provider or a non-BCCCNP provider and requires breast/cervical cancer screening and/or diagnostic services for an identified abnormality. The BCCCNP provides navigation services to low-income insured women, not enrolled in the program, to assist them in accessing the healthcare system so they can receive breast and/or cervical cancer screening, diagnostic, and/or treatment services through their insurance provider. For specific BCCCNP requirements, refer to the most current BCCCNP Policies and Procedures Manual (http://www.michioancancer.oro/bcccp/). DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A Grant Start Date Grant Contract Performance Level N/A (if Applicable) Reimbursement Method Staffing (6) H CHILDHOOD LEAD POISONING EDUCATION & OUTREACH Special Requirements Administrator Contact Info Aphone-& emajl 10/1/2018 Martha Stanbury 1 ..0rant End Date 517-284-4820; stanburym@michigan.gov 9/30/2019 Subrecipient, Contractor, Subrecipient or Recipient (non-federal) . Designation .Perfonnence-Targe QutpigiMeasure. BUDGET AND AGREEMENT REQUIREMENTS The purpose of the project is to provide outreach and education to professionals interacting with families of children at risk of lead exposure to ensure that children are tested, elevated test results from capillary blood are confirmed with venous tests, and families and health care providers are knowledgeable about the prevention of lead exposure and elevated blood lead levels. GRANTEE REQUIREMENTS 1. Provide services described below in the Michigan "prosperity region" for which the grantee is designated. 2. Provide education, outreach, and training about blood lead testing and exposure prevention to Local Health Departments in their prosperity region and professionals that serve families of children at risk of exposure to lead, especially those living in geographical areas with a higher risk of lead exposure. Strategies, activities, and materials must address: a. Ensuring that providers include blood lead testing, as appropriate and as mandated by Medicaid policy, in patient visits; b. Ensuring that unconfirmed elevated blood lead capillary test results are followed up with confirmatory venous tests. c. Engaging parents/caregivers of children at risk for lead exposure and elevated blood lead in testing and lead exposure prevention activities. 3. Professionals, and organizations to which they belong, to target for outreach and training should include, but not be limited to: a. Agencies/organizations providing services to children, including • Great Start Collaborative partners • Great Start Parent Coalition participants • Child care providers b. Agencies, organizations and professionals providing/overseeing clinical care and/or blood lead testing, including • Primary care providers • Medicaid Health Plans • WIC clinics Local Health Department clinics 4. Distribute, through trainings and other means, educational materials that provide families and caregivers with information about lead poisoning prevention, 5. Participate in quarterly conference calls scheduled by the Department's Childhood Lead Poisoning Prevention Program. Prohibited expenditures a. These funds may not be used to provide direct health care services such as lead testing, care coordination, case management, or to provide services such as environmental investigations or remediation/repair of a dwelling. b. These funds may not be used to fund other local public health operations. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS Submit a work plan that identifies activities that will accomplish objectives of this project. Quarterly reports must include a description of accomplishments and challenges associated with each item in the work plan. REPORTING REQUIREMENTS Required Reporting due 30 days after the end of each quarter and a final annual report due 90 days after the close of the fiscal year. Reporting Time Period pue Date October 1 — December 31 January 30 January 1 — March 31 April 30 April 1 June 30 July 30 July 1 — Sept 30 October 30 Grant Start Date I 10/1/2017 Martha Stanbury 517-284-4820; stanburym@michigan.gov Contact Info (phone ,& email) Staffing (6) PerfOrrOnde.::40*el N/A (if Applicable) Subrecipient, Contractor, or Recipient (non-federal) Designation Performance Target : .:Otitpi*MeatUte:r::: N/A CHILDHOOD LEAD POISONING PREVENTION (CLPP) Special Requirements BUDGET AND AGREEMENT REQUIREMENTS purpose: The purpose of this project is to provide lead poisoning prevention services to high risk communities as designated by MDHHS CLPPP. GRANTEE REQUIREMENTS 1. Provide lead poisoning prevention intervention services for the target population of children under the age of 6, and pregnant women living in homes built before 1978. For children with elevated blood lead levels, these services could be done in coordination with the nurse case manager. Services may include but are not limited to: a. Providing information on lead safe cleaning methods b. Providing lead safe cleaning supplies/equipment C. Providing direct training and coaching on lead safe cleaning methods d. Conducting lead safe cleaning in the home e. Lending HEPA vacuums f. Creating temporary barriers to possible lead hazards (e.g. window sills, areas of deteriorating paint) g. Providing funds for technical cleaning by trained crew h. Covering bare soil Providing help with application to the Lead Safe Home Program 2. Provide case management services to children with elevated blood lead levels of >=5mcg/dI that are not eligible for services provided under the "CSHCS-Medicaid Elevated Blood Lead Nursing Case Management Program" (i.e. — children without Medicaid) or where case management services are being provided by another agency. 3. Participate in conference calls and training scheduled by MDHHS CLPPP. Conference calls will take place at a minimum on a quarterly basis. Note: Grantees are encouraged to involve community partners e.g. churches, community health workers, colleges, service organizations, or other community base agencies to expand the scope and reach of these activities. DEPARTMENT REQUIREMENTS Prohibited expenditures: 1. Screening or Testing for Blood Lead. 2. Services for children that are reimbursable under the "CSHCS- Medicaid Elevated Blood Lead Nursing —Case-Management-program% 3. Case management services in a jurisdiction where another agency has been contracted by the Department to provide those services. 4. Childhood Lead Poisoning Prevention funds may not be used to fund other local public health operations. Funding requirements: Funds may be used to provide prevention services in the following locations: 1. Adrian (Lenawee Co. Health Dept.) 2. Dearborn, Hamtramck and Highland Park (Wayne Co. Health Dept.) 3. Detroit (Detroit Health Dept.) 4. Flint (Genesee Co. Health Dept.) 5. Grand Rapids, Kentwood and Wyoming (Kent Co. Health Dept.) 6. Jackson and Leoni Township (Jackson Co. Health Dept.) 7. Lansing (Ingham Co. Health Dept.) 8. Muskegon and Muskegon Heights (Muskegon Co. Health Dept.) 9. Kalamazoo (Kalamazoo Co. Health Depart.) GRANTEE SPECIFIC REQUIREMENTS 1. Grantees shall submit a work plan that identifies activities to accomplish project objectives. 2. Reports are due 30 days after the end of each quarter, January 30, April 30, July 30, and October 30. 3. Quarterly activity reports must include a description of accomplishments and challenges associated with each item in the work plan. 4. All nursing case management services provided to EBL children must be documented in the MDHHS HHLPSS database. 10/1/2018 Subrecipient, -Contractor, or Recipient (non-federal) -Designation .. . Performance Target Output Measure CHILDREN'S SPECIAL HEALTH CARE SERVICES (CSHCS) OUTREACH AND ADVOCACY Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Relationship between Grantees and Medicaid Health Plans: The Grantee must establish and maintain care coordination agreements with all Medicaid Health Plans for CSHCS enrollees in the Grantees service area. Grantees and the Medicaid Health Plans may share enrollee information to facilitate coordination of care without specific, signed authorization from the enrollee. The enrollee has given consent to share information for purposes of payment, treatment and operations as part of the Medicaid Beneficiary Application. The agreement must address all of the following topics: a. Data sharing b. Communication on development of Care Coordination Plan C. Reporting requirements d. Quality assurance coordination e. Grievance and appeal resolution f. Dispute resolution g. Transition planning for youth Care coordination agreements between Grantees and the Medicaid Health Plans will be available for review upon request from the Department. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Program Management: Reporting Requirements The Grantee shall submit: 1 Annual Narrative Progress Report A brief annual narrative report is due by November 15 following the end of the fiscal year. The reporting period is October 1 — September 30. The annual report will be submitted to the Department-and-shall include: a. Summary of successes and challenges b. Technical assistance needs the Grantee is requesting the Department to address c. Brief description of how any local MCH funds allocated to CSHCS were used (e.g. CSHCS salaries, outreach materials, mailing costs, etc.), if applicable d. The duplicated number of clients referred for diagnostic evaluations e. The unduplicated number of CSHCS eligible clients assisted with CSHCS enrollment f. The unduplicated number of CSHCS clients in the CSHCS renewal process. Duplicated Number of Clients Referred for Diagnostic Evaluation is defined as: Number of individuals the Grantee referred for and/or assisted in obtaining a diagnostic evaluations during the fiscal year. Those eligible for this service must have symptoms and medical history indicating the information. Individuals currently enrolled in a commercial Health Maintenance Organization (HMO), Medicaid Health Plan (MHP) or with other commercial insurance coverage must seek an evaluation by an appropriate physician sub-specialist through their respective health insurer. A diagnostic may be issued for insured persons to cover the cost of the evaluation that is by policy not covered by the health insurance (e.g. co-pay, deductible). Unduplicated Number of CSHCS Eligible Clients Assisted with CSHCS Enrollment is defined as: Number of CSHCS eligible clients the Grantee assisted in the CSHCS enrollment process during the fiscal year. This assistance includes but is not limited to helping the family obtain necessary medical reports to determine clinical eligibility, completing the CSHCS Application for Services, completing the CSHCS financial assessment forms, etc. "Assisted" refers to help provided either over the telephone or in person with the client. Unduplicated Number of CSHCS Clients Assisted in the CSHCS Renewal Process is defined as: Number of CSHCS enrollees the Grantee assisted in the completion and/or submission of the documents required for the Department to make a determination whether to continue/renew CSHCS coverage during the fiscal year. "Assisted" refers to help provided either over the telephone or in person with the client. 2. Quarterly Care Coordination and Case Management Logs Submitthe Care Coordination and Case Management Logs electronically via the Children's Healthcare Automated Support Services (CHASS) Billing Module to the Contract Manager. The quarterly logs will be submitted no later than thirty (30) days after the close of the quarter. Unless otherwise stated, all reports and information shall be submitted electronically via the secure electronic method of communication for sharing of Protected Health Information (PHI) designated by CSHCS: Bruce Turnbull Contracts and Clinic Development Analyst Policy and Program Development Section Children's Special Health Care Services The Contract Manager shall evaluate the reports submitted as described in A above, for their completeness and adequacy. The Contract Manager will conduct case management and care coordination log audits on a quarterly basis. i Grant End Date 9/30/2019 Grant Contract Administrator Contact Info .(phone & email) Reimbursement Method Grant Start Date Lorraine L. Cameron 517-284-4795; cameronL©michigan.gov Subrecipient, Contractor, or Recipient (non-federal) Fesignation-- 11 CLIMATE HEALTH ADAPTATION Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS The Grantee will collaborate with the Departments Michigan Climate and Health Adaptation Program and partners to develop and conduct a needs assessment of Detroit communities which have been impacted by repeated flooding. The purpose of the needs assessment is to document the scope and nature of adverse health impacts in these communities, and to record local knowledge, needs and suggested remedies from these impacted citizens. This information is expected to be used to inform activities by the city and others to respond to this ongoing issue, and more generally, to build capacity for the Grantee to adapt to climate related health risks in the city. The following activities are required: 1. Develop a cross-sector working group led by the Grantee to leverage resources and information relevant to this issue. 2. Collaborate/engage with the working group and other partners to identify impacted communities to be targeted and develop an advisory group to provide input into the project. The advisory group will include representatives from the impacted communities. 3. Develop needs assessment methodology with partners, and with technical assistance from the Department as stated below. 4. Engage members of the impacted communities in the needs assessment by recruiting interviewers from the communities and in other ways. 5. Field the needs assessment and collect the information, compile and analyze. 6. Summarize results and provide for review/feedback from advisory group/communities, and cross-sector working group. 7. Write final report incorporating feedback and recommendations. DEPARTMENT REQUIREMENTS 1. The Departments - Michigan Climate and Health Adaptation Program (MICHAP) will provide technical assistance as needed, including reviews of methodology and data collection tools and quality assurance. 2. MICHAP will conduct at least one site visit to observe project activities and progress towards goals. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS A final report is required at the end of the project, to include a description of the needs assessment methodology, its results and conclusions/recommended next steps. Reimbursement Method Footnotes key: (1) Program element or funding source as applicable. (2) Refer to the master Local Health Department agreement and the program and budget instructions package for further explanation of applicability of these reimbursement methods. (3) Allocation to be reflected in individual programs during budgeting process. (4) Funding Source (not a single element). Hearing and Vision are single elements. (5) Subject to statewide maintenance of effort requirement for Title X. (6) State funding is first source (after fees and other earmarked sources) (7) Fixed unit rate subject to actual costs. (6) The performance reimbursement target will be the base target caseload established by the Department. (9) Subject to a match requirement (hard or in-kind) of $1 for each $3 of the Department agreement funding for coordination. (10) Fixed rate limited to contract amount. (11) Up to 6 visits per family. (12) Non-categorically funded Health Departments will be reimbursed at $11.00 per HIV test conducted up to a maximum of $2,000 annually. (13) Each delegate agency must serve a minimum percentage of Title X users to access their total allocated funds. Semi-annual FPAR data will be used to determine total Title X users. (14) Public Health Emergency Preparedness funding for October 1-June 30, and July 1-September 30 is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHDs must submit a nine-month and three-month budget and quarterly Financial Status Reports (FSR) for this program element. (16) Project meets the Research and Development Criteria as defined by Title 2 CFR Section 200.87. (17) Not Applicable. (18) Subject to match requirement as specified in Attachment III — Program Assurances and Specific Requirements. PUBLIC HEALTH EMERGENCY PREPAREDNESS (PHEP) Special Requirements Grant Start bate 10/1/2018 Grant End Date 9/30/2019 Grant Contract Administrator Contact Info (phone & Reimbursement Method Patrick Guysky 517-335-8150; GuyskyP1@michigan.gov Staffing (6) (14) (18) Subrecipient, Contractor, Subrecipient or Recipient (non-federal) Desolation Performance Level 1 N/A Performance Target N/A If Applicable) Output Measure BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Grantee Reauirements (Base/ CRI1 The Public Health Emergency Preparedness section of Attachment III is effective from October 1, 2018 through June 30, 2019. Funds are provided by the Department for nine months based on the Department's fiscal year. As a Grantee of funding provided through the Centers for Disease Control and Prevention (CDC) National Bioterrorism Hospital Preparedness Program (HPP) and Public Health Emergency Preparedness (PHEP) Cooperative Agreement, each Grantee shall conduct activities to build preparedness and response capacity and capability. These activities shall be conducted in accordance with the HPP/PHEP Cooperative Agreement guidance for 2018-2019 plus any and all related guidance from the CDC and the Department that is issued for the purpose of clarifying or interpreting overall program requirements. All Grantee activities shall be consistent with all approved Budget Period 1 Supplemental (BP1S) work plan(s) and budget(s) on file with the Department through the MI E-Grants system. In addition to these broad requirements, the Grantee will comply with the following: 1. One (1) full time equivalent (FTE) emergency preparedness coordinator (EPC), as a point of contact. In addition to the Grantee health officer, the EPC shall participate in collaborative capacity building activities of the HPP/PHEP Cooperative Agreement, all required reporting and exercise requirements and in regional Healthcare Coalition (HCC) initiatives. Any changes to this staffing model must be approved by the Public Health Emergency Preparedness Program Manager at the Division of Emergency Preparedness and Response (517-335-8150). 2, Under the alignment of the HPP and PHEP cooperative agreements, Grantee's must partner with the Regional Healthcare Coalition (HCC) and support HCC initiatives to ensure that healthcare organizations receive resources to meet medical surge demands. Working well together during a crisis is facilitated by meeting on a regular basis. To this end, EPCs, supported by CDC PHEP are required to participate in and support regional HCC initiatives. In addition, the EPC or designee is required to attend regional HCC planning or advisory board meetings. 3. There are a number of special initiatives, projects, and/or supplemental funding opportunities that are facilitated under this cooperative agreement. For example, the Cities Readiness Initiative (CRI) performance and evaluation initiatives. Each Grantee that is designated to participate in any of these types of supplemental opportunities is required to comply with all CDC and the Department Division of Emergency Preparedness and Response (DEPR) guidance, and all accompanying work plan and budgeting requirements implemented for the purpose of subrecipient monitoring and accountability. Some or all supplemental opportunities may require separate recordkeeping of expenditures. If so, this separate accounting will be identified in separate project budgets in the MI E-Grants system. These supplemental opportunities may also require additional reporting and exercise activities. 4. Recipients are required to submit a 9-month (October 1 to June 30) budget and a 3-month (July 1 to Sept 30) for both Base PHEP and CRIfunding, including the 10% MATCH for those periods (see #14 below for detail regarding Match). Submitted to MDHHS-BETP-DEPR-PHEPamichigan.gov by May 1, 2018. 5. ALL activities funded through the PHEP cooperative agreement must be completed between July 1, and June 30, and all BP1S funding must be obligated by June 30, 2019 and activity completed by the August 15, 2019 FSR submission deadline. 6. All budget amendments to the Division of Emergency Preparedness and Response (DEPR) for review prior to submitting them in the MI E-Grants system. Budget amendments that contain line items deviating more than 15% or $10,000 (whichever is greater) from the original budgeted line item must be approved by DEPR prior to implementation via email to Patrick Guysky at guyskviD(&.michician.gov. 7. The final Financial Status for funding period ending June 30 reports MUST be submitted in the MI E- Grants system for this funding source no later than August 15, 2019. 8. Supplantation is the replacement of non-federal funds with federal funds to support the same activities. The Public Health Service Act, Title I, Section 319(c) specifically states, "SUPPLEMENT NOT SUPPLANT, — Funds appropriated under this section shall be used to supplement - not supplant - other federal, state, and local public funds provided for activities under this section." This law strictly and expressly prohibits using cooperative agreement funds to supplant any current state or local expenditures. 9. Unallowable Costs: • Recipients may not use funds for research. • Recipients may not use funds for clinical care. • Recipients may only expend funds for reasonable program purposes, including personnel, travel, supplies, and services, such as contractual. • Recipients may not generally use HHS/CDC/ATSDR funding for the purchase of furniture or equipment. Any such proposed spending must be identified in the budget. • The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project objectives and not merely serve as a conduit for an award to another party or provider who is ineligible. Other than for normal and recognized executive-legislative relationships, no funds may be used for: publicity or propaganda purposes, for the preparation, distribution, or use of any material designed to support or defeat the enactment of legislation before any legislative body the salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or Executive order proposed or pending before any legislative body. • The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project outcomes and not merely serve as a conduit for an award to another party or provider who is ineligible. • Recipients may not use funds for construction or major renovations. • Recipients may supplement but not supplant existing state or federal funds for activities described in the budget. • Payment or reimbursement of backfilling costs for staff is not allowed. • None of the funds awarded to these programs may be used to pay the salary of an individual at a rate in excess of Executive Level ll or $187,000 per year. • Recipients may use funds only for reasonable program purposes, including travel, supplies, and services. • Recipients may purchase basic (non-motorized) trailers with prior approval from the CDC OGS. • HPP and PHEP funds may not be used to purchase clothing such as jeans, cargo pants, polo shirts, jumpsuits, sweatshirts, or T-shirts. Purchase of items that can be reissued, such as vests, may be allowable. • HPP and PHEP funds may not be used to purchase or support (feed) animals for labs, including mice. Any requests for such must receive prior approval of protocols from the Animal Control Office withTh CD sequent approvaI C-0-GS—a-S10 allowability of costs. • Recipients may not use funds to purchase a house or other living quarters for those under quarantine. • HPP and PHEP recipients may (with prior approval) use funds for overtime for individuals directly associated (listed in personnel costs) with the award. • PHEP recipients cannot use funds to purchase vehicles to be used as means of transportation for carrying people or goods, such as passenger cars or trucks and electrical or gas-driven motorized carts. • PHEP recipients can (with prior approval) use funds to lease vehicles to be used as means of transportation for carrying people or goods, e.g., passenger cars or trucks and electrical or gas-driven motorized carts. • PHEP recipients can (with prior approval) use funds to purchase material-handling equipment (MHE) such as industrial or warehouse-use trucks to be used to move materials, such as forklifts, lift trucks, turret trucks, etc. Vehicles must be of a type not licensed to travel on public roads. • PHEP recipients can use funds to purchase caches of medical or non-medical Counter measures for use by public health first responders and their families to ensure the health and safety of the public health workforce. • PHEP recipients can use funds to support appropriate accreditation activities that meet the Public Health Accreditation Board's preparedness-related standards.10, 11. Recipients must maintain National Incident Management System (NIMS) compliance as detailed in the LHD work plan and submit annually to the Department — DEPR per the LHD BP1S work plan. 12. Each subrecipient Grantee must retain program-related documentation for activities and expenditures consistent with Title 2 CFR Part 200; Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards, to the standards that will pass the scrutiny of audit. 13. Audit Requirement - A grantee may use its Single Audit to comply with 42 USC 247d — 3a(j)(2) if at least once every two years the awardee obtains an audit in accordance with the Single Audit Act (31 USC 7501 — 7507) and Title 2 CFR, Part 200 Subpart F; submits that audit to and has the audit accepted by the Federal Audit Clearinghouse; and ensures that applicable PHEP CFDA number 93.069 are listed on the Schedule of Expenditures of Federal Awards (SEFA) contained in that audit. 14. Recipients provide the required 10% MATCH for July 1, 2018 through September 30, 2018 and October 1, 2018 through June 30, 2019, Recipients are required to submit a letter (on agency letterhead) stating the source, calculation and narrative description of how the match was achieved, unless said match is met using local dollars. This was due with the narrative budget submission to the Department — DEPR. 15. Administrative preparedness - During BPI S, Recipients must continue to strengthen and test its administrative preparedness plan, to include written policies, procedures, and/or protocols that address the following: a. Expedited procedures for receiving emergency funds during a real incident or exercise; b. Expedited processes for reducing the cycle time for contracting and/ or procurement during a real emergency or exercise; c. Internal controls related to subrecipient monitoring and any negative audit findings resulting from suboptimal internal controls; and d. Emergency authorities and mechanisms to reduce the cycle time for hiring and/ or reassignment of staff (workforce surge). All administrative preparedness planning activities should be considered in coordination with healthcare systems, law enforcement, and other relevant stakeholders as appropriate. 16. The Pandemic and All Hazards Preparedness Reauthorization Act (PAHPRA) of 2013 requires the withholding of amounts from entities that fail to achieve PHEP benchmarks. The following PHEP benchmarks have been identified by CDC and the Department -DEPR for the Fiscal Year: a. Demonstrated adherence to all PHEP application and reporting deadlines. Recipients must submit required PHEP program data and reports by the stated deadlines. This includes, but is not limited to, progress reports, performance measure data reports, National Incident Management System (NIMS) compliance reports, updated emergency plans, budget narratives, Financial Status Reports (FSR), etc. Failure to do so will constitute a benchmark failure. All deliverables must be submitted by the designated due date in the Grantee BP1S work plan. b. Demonstrated capability to receive, stage, store, distribute, and dispense medical countermeasures (MGM) I during a public health emergency, per the BP1S Grantee Work Plan. c. Pandemic Influenza Preparedness plans: Further guidance will be included in the Grantee PHEP Work Plan. 17. In response to repeated communications from CDC strongly urging states to ensure all funds are spent each year a threshold has been established to limit the amount of unspent funds. A maximum of 2% of the Grantee allocation or $3,000 (whichever is greater) of unspent funds is allowable each budget period. Failure to meet this requirement, or misuse of funds, will affect the amount that is allocated in subsequent budget periods. 18. Benchmark Failure - Awardees are expected to "substantially meet" the PAHPRA benchmarks. Per the Cooperative Agreement, failure to do so constitutes a benchmark failure, which carries an allowable penalty withholding of funds. Failure to meet any one of the two benchmarks and/or the spending threshold is considered a single benchmark failure. Any awardee (or sub-awardee) that does not meet a benchmark and/or the spending threshold will have an opportunity to correct the deficiency during a probationary period. If the deficiency is not corrected during this period the awardee is subject to a 10% withholding of funds the following budget period. Failure to meet the pandemic influenza plan requirement constitutes a separate benchmark failure and is also subject to a 10% withholding. The total potential withholding allowable is 20% the first year. If the deficiency is not corrected, the allowable penalty withholding increases to 30% in year two and 40% in year three. Reaional Edidemioloav Support: 1. For those Recipients receiving additional funds to provide workspace for Regional Epidemiologists, the grantee must provide adequate office space, telephone connections, and high-speed Internet access. The position must also have access to fax and photocopiers. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A N/A Performance Target Output Measure N/A Performance Level Alf Applicable) Grant Contract AdtpirliStratOr Contact info: lphOneil4 eine ReiMbtirseMent:: Method: Patricia K. Smith 517-335-9703; smithp40@michigan.gov Staffing (6) $1.113rec i pie nt, Contractor, Subrecipient or Recipient (non-federal) Designation 9/30/2019 Grant End Date 10/112018 Grant Start Date COMMUNITIES UNITING FOR SUICIDE PREVENTION (CUSP) Special Requirements BUDGET AND AGREEMENT REQUIREMENTS Purpose: To develop a replicable model for a comprehensive rural youth suicide prevention community, as presented in the plan submitted to the Department. GRANTEE REQUIREMENTS In project year four, the grantee will 1. Continue to implement the plan of activities identified through the needs assessments. 2. Continue conducting comprehensive community suicide prevention programs in two high-risk Marquette County communities with school-based health clinics, Gwinn and Ishpeming. 3. Continue the development and implementation of a seamless system of care for Marquette County youth and young adults identified at risk of suicide and those otherwise impacted by suicide. 4. Continue implementation of the Zero Suicide model in all Marquette County Health Department clinics, as well as one hospital and 25% of the county's outpatient primary care clinics. 5. Continue expansion of Dial Help's Suicide Risk Follow-Up Program to all 15 Upper Peninsula counties. 6. Continue implementation of Dial Help's Bereavement Support Follow-up Program for all 15 UP counties. 7. Conduct and support ASIST train ings as needed. 8. Begin or enhance suicide prevention work in 10 Communities That Care across the U.P. 9. Conduct awareness and education activities in Marquette County, including one Out of Darkness Community Walk, media education, dissemination of education/awareness media messages, social media initiatives, and two community forums. 10. Continue support and expansion of the Marquette County Suicide Prevention Coalition membership. 11. Send at least one representative to the state Suicide Prevention Community Technical Assistance Meeting. 12.Work with the Department's Project Officer and the state's youth suicide prevention TYSP-Mi2 Program Evaluator to develop and carry out an evaluation of the CUSP program and fulfill all of the SAMHSA national cross-site evaluation requirements. 13 Submit all reports as required. DEPARTMENT REQUIREMENTS 1. Provide technical as requested and as needed for program development, implementation, and evaluation. 2. Conduct at least one site visit at the beginning of the program and one at the end of the fiscal year. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS In addition to the quarterly and year-end progress reports submitted through the MI-E-g rants system, submit additional quarterly and year-end information using the reporting forms supplied by the Department's Project Officer, Patricia Smith. These reports can be faxed to her attention at 517-335-9397 or emailed to smithp40(&.michigan.qov. The reports are due no later than 15 days after the end of each quarter. COMPREHENSIVE CANCER CONTROL (CCC) COMMUNITY IMPLEMENTATION PROJECT Special Requirements Grant Start Date 10/1/2018 Grant End Date 9/30/2019. Grant Contract Angela McFall Administrator Contact Info 517-335-9420; mcfalla@michigan.gov (phone & email) Reimbursement Staffing (6) Method Performance Level N/A (if Applicable) Subrecipient, Contractor, or Recipient (non-federal) Designation Subrecipient Performance Target N/A Output Measure BUDGET AND AGREEMENT REQUIREMENTS Program Purpose: The purpose of this project is to increase local implementation activities for Cancer Prevention and Control. Projects must include at least one and preferable two evidence-based strategies from the Cancer Plan for Michigan and/or the Community Guide. GRANTEE REQUIREMENTS 1. Any print or media materials produced by the grant must be reviewed by the Department prior to products being finalized and distributed. 2. Any print or media material produced by the grant must include CDC credit language: "This publication (journal, article, etc.) was supported by the Cooperative Agreement NU58DP006334 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention." 3. Institutional Review Board approval must be considered for focus groups, surveys and other similar activities. This should be factored into the project timeline and the Department should be involved and kept apprised, N/A N/A Performance Level (If Applicable) I 10/1/2018 Performance Target Output Measure .Grant Start Date • Martha Stanbury iContact info , mined): pr)6i4:::' 517-284-4820; stanburym@michigan.gov Reimbursement Method Fixed Unit Rate (2) Subreciplent, Contractor, Recipient (non.federal Designation Subredpient il CSHCS - MEDICAID ELEVATED BLOOD LEAD - CASE MANAGEMENT Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS All Local Health Departments in Michigan are eligible to participate in this program. The grantee will complete in-home elevated blood lead (EBL) case management (CM) services, with parental consent, for all children less than age 6 in their jurisdiction enrolled in Medicaid with a blood lead level equal to or greater than 5 micrograms per deciliter (=>5 pg/dL) as determined by a venipuncture test. EBL CM will be conducted according to the "Case Management Guide for Children with Elevated Blood Lead Levels" that is provided by the Department's Childhood Lead Poisoning Prevention Program (CLPPP). For each child eligible for EBL CM, efforts to contact the family to provide CM services and specific services provided must be documented in the child's electronic record in the Healthy Homes and Lead Poisoning Prevention (HHLPPS) database maintained by CLPPP- MDHHS. Enabling authority for this project is in the Department's Medicaid State Plan page 478 section A.1. Project Maximum Reimbursement li..Grantee DEPARTMENT REQUIREMENTS CLPPP-MDHHS shall provide the Grantee with 1. Weekly list of children in their jurisdiction with a laboratory report received in the prior week and a faxed report for children with blood lead levels =>20 pg/dI the day the report is received at MDHHS. 2. Written Case Management protocol. 3. instructions for billing and documentation of services for participation in this project. 4. Spreadsheet template for log of CM activities. 5. Access to HHLPPS database. 6. Access to the CLPPP FTP site for secure file transfer. 7. Training in the basics of lead exposure and poisoning, conduct of CM, use of the HHLPPS database, and use of FTP site for transmission of confidential information. 8. On-going technical support and consultations from an MDHHS CLPPP nurse. GRANTEE SPECIFIC REQUIREMENTS The Grantee shall: 1. Have home case management conducted by a registered nurse trained by the Departments CLPPP. Training addresses general principals of lead poisoning and lead poisoning prevention, the Case Management protocol and the use of the HHLPPS database. 2. Sign up for the secure FTP site maintained by the Department's CLPPP, to be used for data sharing of confidential information. 3. Have an agreement with all Medicaid Health Plans in their jurisdiction that allows for sharing of Personal Health Information regarding the Plan's children with EBLLs. 4. Identify and Initiate contact with families of all Medicaid venous-confirmed EBLL children from the lists provided by the Department's CLPPP to the grantee. 5. Complete case management activities according to requirements in the Department's CLPPP Case Management Guide. 6. Document all case management activities in the child's electronic file in the HHLPPS database. 7. Provide quarterly summaries of case management activities for all eligible EBLL children using a spreadsheet template provided by the Department's CLPPP. 8. Submit request for reimbursement through the EGrAMS system based on the "fixed unit rate" method. The fixed rate for case management services is $201.58 per home visit, for up to 6 home visits. 9. Grantee maximum reimbursement: Barry-Eaton District Health Department $ 24,190 Bay County Health Department $ 21,771 Benzie-Leelanau District Health Department $ 2,419 Berrien County Health Department $ 30,237 Branch-Hillsdale-St. Joseph Community $ 14,514 Health Agency Calhoun County Health Department $ 62,893 Central Michigan District Health Department $ 4,838 Chippewa County Health Department $ 2,419 Detroit Health Department $ 1,423,558 Dickinson-Iron District Health Department $ 2,419 District Health Department 10 $ 15,723 District Health Department 2 $ 2,419 District Health Department 4 $ 2,419 Grand Traverse County Health Department $ 8,466 Health Department of Northwest Michigan $ 2,419 Huron County Health Department $ 2,419 Ingham County Health Department $ 62,893 Jackson County Health Department 45 , 960 Kalamazoo County Health Department $ 33,865 Kent County Health Department $ 152,394 Lapeer County Health Department $ 2,419 Lenawee County Health Department $ 25,399 Livingston County Health Department $ 2,419 Macomb County Health Department $ 26,609 Marquette County Health Department $ 6,047 Midland County Health Department $ 3,628 Mid-Michigan District Health Department $ 2,419 Monroe County Health Department $ 3,628 Muskegon County Health Department $ 64,102 Oakland County Health Department $ 71,359 Ottawa County Health Department $ 8,466 Public Health Delta & Menomenee Counties $ 10,885 Saginaw County Health Department $ 21,771 Sanilac County Health Department $ 2,419 Shiawassee County Health Department $ 7,257 St. Claire County Health Department $ 13,304 Tuscola County Health Department $ 4,838 Van Buren-Cass District Health Department $ 14,514 Washtenaw County Health Department $ 18,142 Wayne County Health Department $ 183,841 Western Upper Penninsula District Health Department $ 18,142 REPORTING REQUIREMENTS The Grantee shall submit: 1. Annual Narrative Progress Report A brief annual narrative report is due by November 15 following the end of the fiscal year. The reporting period for FY18 is October 1 - September 30. The annual report shall include: a. Number of children eligible for EBL CM. b. Number of children provided CM. c. Summary of reasons why eligible but unserved children were not served. d. Summary of EBL CM successes and challenges. e. Technical assistance needs the Grantee is requesting the Department to address. Reporting Time Period October 1 — December 31 January 1— March 31 April 1 — June 30 July 1 — September 30 Quarterly LOCIS Due Date January 31 April 30 July 30 October 30 f. Recommendations for changes in the program. 2. Quarterly Case Management (CM)Logs A log of CM activities for is due quarterly, submitted electronically through the CLPPP's secure File Transfer Site, using a spreadsheet template provided by CLPPP that specifies the information to be provided on each child for which reimbursement is being requested on the quarterly Supplemental Attachment to the CPBC FSR. The quarterly logs will be submitted no later than thirty (30) days after the close of the quarter. Quarter 1st 2nd 3rd 4th The CLPPP EBL CM Project Manager will review the logs for their completeness and adequacy and provide approval for payment within 30 days of receipt. CLPPP Statewide Medicaid EBL CM Project Manager: Angela Medina Childhood Lead Poisoning Prevention Program Division of Environmental Health, MDHHS CSHCS MEDICAID OUTREACH Special Requirements Grant Start Date 10/1/2018 Grant End Date 9/30/2019 Grant Contract Bruce Turnball Administrator Contact Info (phone & 517-241-5183; TurnbuilB@michigan.gov email) f ' Reinibursement_Method_ Staffing (6) L Subrecipient, Contractor, of Recipient (non-federal) 1 Designation Performance Level (if N/A Performance Target Output Applicable) Measure BUDGET AND AGREEMENT REQUIREMENTS See Attachment I for details regarding Budgeting requirements. GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A EAT SAFE FISH Special Requirements Grant Start Date 10/1/2018 Grant End Date Grant Contract Administrator Contact Info (phone & email). Reimbursement Method Performance Level (if Applicable) Jennifer Gray 517-281-3483; grayj@michigan.gov Subrecipient,...Contractor,. or Recipient (non.federal) Desigligtion _ Performance large Output Measure Staffing_(6) N/A Subrecipient N/A BUDGET AND AGREEMENT REQUIREMENTS The Grantee will collaborate with the Department and the EPA Region V Saginaw Community Information Office to deliver a uniform message for the Saginaw River and connected waters regarding the fish and wild game consumption advisories within the tri-county area (Midland, Saginaw, and Bay). Bay County Health Department (BCHD) will develop a plan to distribute that message using existing health department programs, the medical community, special events, and community service providers to communicate with the at-risk population. BCHD will get approval from the Department program manager and for any changes to the Saginaw and Bay County Cooperative Agreement Scope of Work including budget and budget narratives. GRANTEE REQUIREMENTS The Grantee will provide appropriate staff to fulfill the following objectives and outputs as detailed; 1. Comply with the Saginaw and Bay County Cooperative Agreement budget and budget narratives as describe in the scopes of work provided to the BCHD program manager as applicable from October 1 to September 30. 2. Provide 30 hours of health education and community outreach per week. a. Conduct health education and community outreach in Saginaw, Midland, and Bay Counties. Activities will include, but not be limited to, internal BCHD distribution, health care provider outreach, and key event participation. b. Track hours to comply with cost recovery requirements. 3. Development, Printing, and Distribution of Outreach Materials and implementation of Display Booth. a. Identify, track, and record of materials distributed at additional locations within Midland, Bay, and Saginaw Counties. b. Make payment for the replacement of signage on the Tittabawasse and Saginaw Rivers. 4. Conduct Capacity Building in Saginaw, Midland and Bay Counties a. Actively seek out new community partners in Saginaw, Midland and Bay Counties. 5. Participate in monthly SBCA teleconference. 6. Track and report output measures. 7. Write and Submit quarterly reports and an annual report to the Department. a. Submit draft quarterly reports within 15 days after the end of each quarter. b. Annual reports upon request. 8. Provide Presentation of display booth at select community events in coordination with EPA Region V Saginaw Community Information Office. 9. Conduct Outreach though existing BCHD Programs such as WIC, Immunizations, programs for young mothers, or other programs reaching the target population. 10. Assist the EPA Region V Saginaw Community Information Office with community outreach. 11. Outreach to Health Care Providers. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIRC-REQU1REM N/A REPORTING REQUIREMENTS N/A Grant Contract Administrator Reimbursement Method Orlando Todd Staffing (6) II ESSENTIAL LOCAL PUBLIC HEALTH SERVICES (ELPHS) Special Requirements Grant Start Date 10/1/2018 Grant End Date 9/30/2019 MI Department of Health and Human Services (MDHHS) ELPHS Other Performance Level N/A (if Applicable) Contact Info (phone & email) Subrecipient, Contractor, or Recipient (non-federal) Designation Performance Target Output Measure 517-284-4021 toddo@michigan.gov Recipient N/A MI Department of Health and Human Services (MDHHS) HIV & STD Testing and Prevention (DHIV-ELPHS) Grant Contract Administrator Jennifer Linzmeier Contact Info (phone & email) 517-241-5861 linzmeierj@michigan.gov Reimbursement Staffing (6) Method Performance Level N/A (if Applicable) Subrecipient, Recipient Contractor, or Recipient (non-federal) Designation Performance Target N/A Output Measure MI Department of Health and Human Services (MDHHS) Vision Program Grant Contract Administrator Rachel Schumann Contact Info (phone & email) 517-335-6596 schumannr@michigan.gov Reimbursement Staffing (6) Method Performance Level N/A (if Applicable) Subrecipient, Recipient Contractor, or Recipient (non-federal) Designation Performance Target N/A Output Measure MI Department of Agriculture and Rural Development (MDARD) Food Grant Contract Administrator Adam Christenson Contact Info (phone & email) 517-284-5706 christensona@michigan.gov Reimbursement Method Performance Subrecipient, Contractor, or Recipient (non-federal) Designation Performance Target Output Measure Recipient % of Food Service Licensees received required inspections Performance Level (if Applicable) 75% MI Department of Agriculture and Rural Development (MDARD) Food and Water Lead Safety Inspections — -- _ Staffing (6) Reimbursement Method -r- Subrecipient, Contractor, or Recipient (non-federal) Designation Recipient Performance Level (if Applicable) N/A MI Department of Environmental Private & Type III On-site Wastewater Performance Target Output Measure Quality (MDEQ) Water Supply Treatment N/A Grant Contract Administrator Dana DeBruyn Contact Info (phone & email) 517-930-6463 debruynd@michigan.gov Reimbursement Method Staffing (6) Subrecipient, Contractor, or Recipient (non-federal) Desiqqation Recipient Performance Level (if Applicable) N/A Performance Target Output Measure N/A BUDGET AND AGREEMENT REQUIREMENTS 1. State funding for ELPHS shall support and the Grantee shall provide for all of the following required services in accordance with P.A. 368, of 1978 and P.A. 92 of 2000, as amended, Part 24 and Act No. 336, of 1998 Section 909: Infectious/Communicable Disease Control Sexually Transmitted Disease Immunization On-Site Wastewater Treatment Management Drinking Water Supply Food Service Sanitation Hearing Vision State funding for ELPHS can support administrative cost for the eight required services including allowable indirect cost, or a Grantee's cost allocation plan. 2. ELPHS funding can also be used to fund other core health functions including; Community Health Assessment & Improvement, Public Policy Development, Health Services Administration, Quality Assurance, Creating & Maintaining a Competent Work Force and Local Public Health Accreditation. These services may be budgeted separately as part of the Administrative Budget element. 3. Net allowable expenditures are the authorized actual/allowable expenditures (total costs less specified exclusions). Available funding is also limited by state appropriations. 4. First and second party fees earned in each required service program may be used only in that required service program. 5. State ELPHS funding is subject to local maintenance of effort compliance. Distribution of state ELPHS funds shall only be made to agencies with total local general fund public health services spending in FY 18/19 of at least the amount expended in FY 92/93. To be eligible for any of the State funding increases from FY 94/95 through FY 18/19, the FY 92/93 Local Maintenance of Effort Level must be met. 6. Local maintenance of effort reports are due: Projected Current Fiscal Year — October 30 Prior Fiscal Year Actual — March 31 7 A final statewide cost settlement will be performed to assure that all available ELPHS funds are fully distributed and applied for required services. GRANTEE REQUIREMENTS 1. Assure the availability and accessibility of services for the following basic health services: Prenatal Care; Immunizations; Communicable Disease Control; Sexually Transmitted Disease (STD) Control; Tuberculosis Control; Health/Medical Annex of Emergency Preparedness Plan. 2. Fully comply with the Minimum Program Requirements for each of the required services. 3. Grantee will be held to accreditation standards and follow the accreditation process and schedule established by the Department for the required services to achieve full accreditation status. Grantees designated as not accredited" may have their Department allocations reduced for Departmental costs incurred in the assurance of service delivery. The accreditation process is based upon the Minimum Program Standards and scheduled on a three-year cycle. The Minimum Program Standards include the majority of the required Department reviews. Some additional reviews, as mandated by the funding agency, may not be included in the Program Standards and may need to be scheduled at other times. DEPARTMENT REQUIREMENTS Whenever the Department delivers direct services within the Grantee's area, it shall give prior notification and provide summary reports of those activities upon the request of the Grantee health officer. GRANTEE SPECIFIC REQUIREMENTS Grantee Specific Reauirernents — HIV & STD Testina and Preventiori 1. The Grantee will adhere to applicable federal and state laws, as well as policies and program standards issued by the Department. See 'Applicable Laws, Rules, Regulations, Policies, Procedures, and Manuals." The Department may update and/or add guidance within the contract year. The Department will supply any new additions to the organization/agency. Grantees should adhere to: a. All federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non- discrimination, and confidentiality. b. All Michigan Public Health Accreditation Standards. c. Procedures for the confidentiality and security of client information. d. All federal and state issued guidance(s) and policy(ies) for services provided. 2. The Grantee will ensure that records are available for review by the Department auditors, staff and federal government agencies, if applicable, to monitor performance. Maintain and provide access to primary source documentation. 3. Implement program standards and practices to ensure the delivery of culturally, linguistically, and developmentally appropriate services. Standards and practices must address sexual minorities. 4. Participate in technical assistance/capacity development, quality assurance, and program evaluation activities as directed by Division of HIV and STD Programs/Sexually Transmitted Disease Program --(DHSPISTD). 5. The Grantee may enter into subcontracts or vendor agreements to fulfill the service delivery expectations of this agreement. a. The Grantee will assure that all subcontracts issued under this funding agreement are subject to the same requirements as outlined in this agreement and subject to prior approval by the Department. b. The Grantee will monitor subcontractors annually to assess compliance with the subcontract; take primary responsibility to monitor follow-up and remediate in cases where the subcontracted entity is not in compliance with the contract; report the results of all contract monitoring activities to the Department. c. The Grantee will provide, upon request, a copy of all fully signed subcontracts, memorandums of understanding (MOUs) or letters of agreement related to the services in this agreement. d. If the subcontractor conducts HIV testing using rapid HIV testing, the Grantee will assure compliance with guidelines and standards issued by the Department and: i) Conduct quality assurance activities, guided by written protocol and procedures. Protocols and procedures, as updated and revised Quality assurance activities are to be responsive to: the Department's Quality Assurance for Rapid HIV Testing. ii) Ensure provision of current Clinical Laboratory Improvement Amendments (CLIA) certificate. iii) Report discordant test results to the Division of HIV and STD Programs. iv) Submit quality control, daily client logs, and test inventory on a monthly basis to Department staff. This information may be emailed to ctrsupplies@michidan.cov, faxed to 517-241-5922, or mailed via US Postal Service to: HIV Prevention Unit, 109W. Michigan Ave., 10° Floor, Lansing, MI 48913, ATTN: CTR Coordinator. v) Ensure that staff performing counseling and/or testing with rapid test technologies has completed, successfully, rapid test counselor certification course or Information Based Training (as applicable), test device training, and annual proficiency testing. vi) Ensure that all staff and site supervisors have completed, successfully, appropriate laboratory quality assurance training, blood borne pathogens training and rapid test device training and reviewed annually. vii) Develop, implement, and monitor protocol and procedures to ensure that patients receive confirmatory test results. 6. The Grantee and its subcontractors are required to use Evaluation Web (EvalWeb) to enter HIV client and service data into the centrally managed database on a secure server. 7. The Grantee will receive a condom and lubrication allowance. The Grantee must: a. Distribute condoms and lubrication b. Place orders for condoms/lubrication c. Order condoms/lubrication by emailing ctrsupplies@michigan.gov d. Report its condom distribution monthly using EvalWeb. 8. The Grantee will have each employee funded in whole or in part with federal funds must record time and effort spent on the project(s) funded. The Grantee must: a. Have policies and procedures to ensure time and effort reporting. b. Assure the staff member clearly identifies the percentage of time devoted to contract activities in accordance with the approved budget. c. Denote accurately the percent of effort to the project. The percent of effort may vary from month to month, and the effort recorded for funds must match the percentage claimed on the FSR submitted for the same period. d. Submit a budget modification to the Department in instances where the percentage of effort of contract staff changes (FTE changes) during the contract period. 9. The Grantee will provide immediate notification to the Department, in writing, in the event of any of the following: -----Arry-fcyrrrrat-grievarrce initiated-by-a-sentice-recipient-and-subsequent-resoluton_oftlaat_grievance_ b. Any event occurring or notice received by the Grantee or subcontractor, that reasonably suggests that the Grantee or subcontractor may be the subject of, or a defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or Grantee or subcontractor employees. c. Provide immediate notification to the Department, in writing, of any staff vacancies funded for this project and/or that exceed 30 days. d. This information should be emailed to MDHHS-HIVSTDoperations@michigan.gov . 10. The Grantee will submit all educational materials (e.g., brochures, posters, pamphlets, and videos) used in conjunction with program activities to the Department for review and approval prior to their use, regardless of the source of funding used to purchase these materials. Materials may be emailed to MDHHS- HIVSTDoperations@michigan.gov. 11. The Grantee will maintain, for a minimum of five (5) years after the end of the grant period, program, fiscal records, including documentation to support program activities and expenditures, under the terms of this agreement, for clients residing in the State of Michigan. Please refer to Michigan's Record Retention policies (http://www.michioan.00v/documents/hal mhc rms local os7 106287 7.pdf) for further details. 12. The Grantee will participate in monitoring site visits including review of fiscal and programmatic compliance with Department policies and contract requirements. 13. The Grantee will participate in the Department needs assessment and planning activities, as requested. 14. The Grantee will participate in regular Grantee meetings which may be: face-to-face, teleconferences, webinars, etc. The Grantee is highly encouraged to participate in other training offerings and information- sharing opportunities provided by the Department. 15. The Grantee must use the Department's standardized Technical Assistance (TA) Request Form when requesting TA. See Department website (http://www.michioanoov/hivstd) to download the form. Department Requirements 1. The Department will provide rapid HIV test devices and external controls in sufficient quantity to ensure that HIV testing is provided as a standard of care to clients seeking HIV testing. 2. The Department will provide training and technical assistance (TA) in support of implementation of HIV testing as a standard of care and use of rapid HIV tests. The Department's standardized Technical Assistance (TA) Request Form is available online at httb://www.michigan.qov/hivstd. 3. The Department will provide Grantees with a condom and lubrication allowance. The Department will: a. Notify the Grantee of its condom/lubrication allowance on or before January 1. b. Place all Grantees' condom/lubrication orders with the condom vendor between January and September 10 (the Grantee should email ctrsuppliesa.michigan.oro to order condoms). c. Track the Grantees' orders. 4. The Department will monitor Grantee performance throughout the contract year, which may include a review of financial status reports (FSRs), EvalWeb data entries, quarterly progress reports, and site visits. For site visits: a. Monitoring will include a review of fiscal, program, administrative, quality assurance, and client records to ensure compliance with federal, Department, and contract requirements. b. The Department will provide 30 calendar days written notice of the site visit, including an agenda and the assessment tool to be used. c. The Department will provide a written report post-site visit, including a Corrective Action Plan (CAP) template, if warranted, within 45 calendar days. d. The Grantee must complete the CAP template and submit to the Department within 30 calendar days of receipt of the report. e. The Department will monitor Grantee's completion of the CAP items and provide written documentation when all CAP items have been successfully fulfilled. The Department will review quarterly reports and -pro-vide-written-feedback within JO calendar days of submission due date. 5. The Department will review quarterly reports. Questions or clarifications, if any, will be requested within 30 calendar days of submission due date. 6. The Department will review EvalWeb data, on a quarterly basis, at minimum. Questions or clarifications, if any, will be requested within thirty (30) calendar days of submission due date. Reporting Requirements 1. The Grantee will adhere to reporting deadlines update progress toward the following: Program Objectives: 1. By April 30, complete a 3-year strategic planning process with community partners, to develop program focus areas and activities. 2. By April 30, review and update health threat to others (HTTO) policy and procedures, in conjunction with the Department's STD Program/DIS staff. 3. By September 30, provide at least six (6) community outreach forums to focus populations. 4. By September 30, develop and update the STD/HIV Prevention web page to include a section for consumers, and a section for health care providers. 5. By September 30, distribute $5,000 worth of condoms, lube, dental dams, and display equipment/materials. 6. By September 30, develop and begin distribution of PrEP advertising/marketing, Sub-Recipient Objectives: 1. By October 1, have sub-recipient contracts complete and active for fulfillment. 2. Henry Ford Health Systems STD Testing a. By September 30, provide STD education and testing for students at three (3) or more high schools located in Detroit. i. Report positive cases in Michigan disease surveillance system (MOSS) to include known information about the individual, specifically: demographics, site of specimen (urine), treatment, any known case management information, and co-infection when applicable. ii. Provide treatment for positives within one week of test for all students available for follow-up, and documentation of efforts for any that are lost to follow-up in MOSS. b. Provide monthly reports to the Detroit Health Department within ten (10) days into the following month, documenting: i. The number of tests performed, ii. The number of positive cases treated, iii. The number of education activities completed, and iv, Narrative of successes/challenges or other relevant issues pertinent to the purpose of this funding. 3. Wayne State University School of Medicine Routine ER HIV Testing a, By December 31, finalize policies and procedures (including linkage for positives) for routine HIV testing in St. John Hospital and Medical Center's emergency room. b. Link 100% of newly and previously diagnosed persons with HIV to care within 30 days. c. Refer persons with HIV negative results, who are at increased risk for exposure to HIV, to STD screening/treatment, PrEP and other prevention services. d, By July 30, 2019, WSUSOM/St. John will have analyzed outcomes to determine successes/challenges and the feasibility/value of continuing the program over time. e. By September 1, 2019, based on item "c." above, WSUSOM/St. John will submit a sustainability plan to phase out of support from the Detroit Health Department based on known funding availability for FY2020 and estimated amounts for FY2021. f. Provide monthly reports to the Detroit Health Department within ten (10) days into the following month, documenting: i. The number of tests performed, ii. The number of positives linked to care, iii. The number referred to prevention services, iv. Narrative of successes/challenges or other relevant issues pertinent to the purpose of this funding. 4. UNIFIED HIV Testing in DHealth Pop-Ups and Community a. Link 100% of newly and previously diagnosed persons with HIV to care within 30 days. b. Refer persons with HIV negative results, who are at increased risk for exposure to HIV, to STD screening/treatment, PrEP and other prevention services. 5. The Grantee and sub-recipients will enter condom distribution data in Eval Web by the 10th day after the end of each calendar month. Grantee Snecific Reauirements — Food Service Sanitation Dudaet and Aareement Reauirements Michigan Department of Agriculture and Rural Development (MDARD) Agrees to: Food Service Establishment Licensing 1. Furnish pre-printed food service establishment license applications and pre-printed licenses to the Grantee for each licensing year (May 1 through April 30) using previous year active license data. 2. Provide a count of all licenses sent to the Grantee titled "Record of Licenses Received." 3. Reprint any licenses requiring correction and send corrected copies to the Grantee. 4. Bill the local health department for state fees upon notification by Grantee that the license has been approved and issued. Temporary Food Service Establishment Licensino Furnish blank temporary food service license application forms (forms Fl-231, Fl-231A) and blank Combined License/Inspection forms (Fl-229) upon request from the local health department. a. Furnish a "Record of Licenses Received" with each order of Combined Licenses/Inspection forms. b. Periodically reconcile temporary food service establishment licenses sent to the Grantee with the licenses that have been issued (copy returned to MDARD), c. Bill the local health department for state fees upon notification by the Grantee that the license has been approved and issued. Grantee Specific Reouirements The Grantee agrees to: Food Service Establishment Licensing 1. Accept responsibility for all licenses specified in the "Record of Licenses Received." 2. Issue licenses in accordance with the Michigan Food Law 2000, as amended. 3. Provide updates to MDARD on the 1 st and 15th of each month, as necessary to: a. Provide a list of food service establishments approved for licensure/license issued. b. Provide a list of food service establishment licenses that have not been approved for licensure and are considered voided or deleted. C. Return the actual licenses to MDARD that are to be voided or deleted. d, Return renewal license applications and licenses that require correction. Mark the corrections on the renewal application. Temporary Food Establishment Licensing 1. Upon receipt, sign and return the "Record of Licenses Received" to MDARD. 2. Issue licenses in accordance with the Michigan Food Law 2000, as amended. 3. Make every effort to issue temporary food establishment licenses in numerical order. 4. Provide updates to MDARD on the 1 st and 15th of each month, as necessary, to provide: a. A copy of each temporary food establishment license issued. b. A list of lost or voided licenses by license number. Grantee Saecific Reauirernents — Private and Tyne HI Drinkina Water_Sunnlv_Renuirements The Grantee shall perform the following services including but not limited to: 1. Perform water well permitting activities, pre-drilling site reviews, random construction inspections, and water supply system inspections for code compliance purposes with qualified individuals classified as sanitarians or equivalent. 2. Assign one individual to be responsible for quarterly reporting of the data and to coordinate communication with the assigned State staff. Reports shall be submitted no later than fifteen (15) days following the end of the quarter on forms provided by the State. The report form EQP 2057(8/2014) is available on the MDEQ website, All quarterly reports are submitted directly to the MDEQ address noted on the form. 3. Perform Minimum Program Requirements (MPRs) activities and associated performance indicators. These are available on the MDEQ website. Guidance regarding the MPRs and indicators in available in the "Local Health Department Guidance Manual for the Private and Type ill Drinking Water Supply Program." The guidance manual is available online at www.michigan.gov/waterwellconstruction Grantee Snecific Reauirenients — Private On-Site Wastewater Treatment_Manaaement Praaram Reauirements The Grantee shall perform the following services for private single- and two-family homes and other establishments that generate less than 10,000 gallons per day of sanitary sewage: 1. Maintain an up-to-date regulation for on-site wastewater treatment systems (Systems). The regulation shall be supplemented by established internal policies and procedures. Technical guidance for staff that defines site suitability requirements, the basis for permit approval and/or denial, and issues not specifically addressed by the regulation shall be provided. 2. Evaluate all parcels to determine the suitability of the site for the installation of initial and replacement Systems in accordance with applicable regulation(s). These evaluations shall be conducted by a trained sanitarian or equivalent and shall consist of a review of the permit application for the installation of a System and a physical evaluation of the site to determine suitability. 3. Accurately record on the permit to install the initial or replacement System or on an attachment to the permit the site conditions for each parcel evaluated including soil profile data, seasonal high-water table, topography, isolation distances, and the available area and location for initial and replacement Systems. The requirement for identifying a replacement System applies to issuance of new construction permits only. 4. Issue a permit, prior to construction, in accord with applicable regulation(s) for those sites that meet the criteria for the installation of a System. The permit shall include a detailed plan and/or specification that accurately define the location of the initial or replacement System, System size, other pertinent construction details, and any documented variances. 5. Provide and keep on file formal written denials, stating the reason for denial, for those applications where site conditions are found to be unsuitable. 6 aondi ring each System to confirm that the completed System complies with the requirements of the permit that has been issued. Maintain, on file, an accurate individual record of each inspection conducted during construction of each system. In limited circumstances where constraints prohibit staff from completing the required construction inspection in a timely manner, an effective alternate method to confirm the adequacy of the completed System shall be established. The effective alternative method shall be utilized for no more than 10 percent of the total number of final inspections unless specific authorization has been granted by the State for other percentage. The results of all such inspections or an alternate method shall be clearly documented. 7. Maintain an organized filing system with retrievable information that includes documentation regarding all site evaluations, permits issued or denied, final inspection documentation, and the results of any appeals. 8. Conduct review and approval or rejection of proposed subdivisions, condominiums and also land divisions under one acre in size for site suitability according to the statutes and Administrative Rules of the Michigan Department of Environmental Quality (MDEQ). 9. Utilize the State's "Michigan Criteria for Subsurface Sewage Disposal" (Criteria) for Systems other than private single- and two-family homes that generate less than 10,000 gallons per day. Systems treating less than 1,000 gallons per day may be approved in accordance with the Grantee's regulation, Advise the State prior to issuance of a variance from the Criteria. Variances are only to be issued by the Director of Environmental Health of the Grantee after consultation with the State. Appeals of any decision of the Grantee pursuant to the Criteria including systems treating less than 1,000 gallons evaluated in accordance with the Grantee's regulation shall only be made to the State. 10. Maintain quarterly reports that summarize the total number of parcels evaluated, permits issued, alternative or engineered plans reviewed, and number of appeals, number of inspections during construction, number of failed systems evaluated, and number of sewage complaints received and investigated. The report form EQP 2057a is available on the MDEQ website. All quarterly reports are to be submitted directly to MDEQ to the address noted on the form within 15 days following the end of each quarter to the address noted on the form, 11. Review all engineered or alternative System plans, Conduct adequate inspections during the various phases of construction to ensure proper installation. 12. Collect data at the time of permit issuance when a System has failed to document the System age, design, site conditions, and other pertinent factors that may have contributed to the failure of the original System. Evaluations shall record information indicated on the MDEQ Residential and Non- Residential Failed System Data Collection forms. The results for all failed Systems evaluated shall be maintained in a retrievable file or database and summarized in an annual calendar year data report. Annual summaries of failed system data shall be provided to the MDEQ for input into the state-wide failed system database. MDEQ Failed System Data Submission Forms (Non-Residential and Residential) shall be provided to the State no later than February 1st of the year following the calendar year for which the data has been collected. 13. Provide training for staff involved in the Program as necessary to maintain knowledge of current regulations and internal policies and procedures and to keep staff informed of technological improvements and advancements in Systems. 14. Establish and maintain an enforcement process that is utilized to resolve violations of the Local Entity and/or State's rules and regulations. 15. Maintain complaint forms and a filing system containing results of complaint investigations and documentation of final resolution. Investigate and respond to all complaints related to Systems in a timely manner. Grantee Requirements - School Based Hearing & Vision Swial-Rettuirements Grantees must adhere to established Minimum Program Requirements for School Based Hearing & Vision Services as outlined in the Michigan Local Public Health Accreditation Program 2018 MPR Indicator Guide. Work Plan Requirements: 1. Upon initiation of the FY18 Agreement, Grantees must submit a School Based Hearing and Vision Screening work plan to MDCHHearinqVisionmichidan.gov The work plan must include: a. Outcome Objectives-a goal of program improvement (%) for screening services and follow-up b. The 6 pre-populated Activities as well as a minimum of 2 additional Activities, with corresponding comments describing how the activity was/is/will be accomplished by the school- based Hearing Screening Program. c. The 6 pre-populated Activities as well as a minimum of 2 additional Activities, with corresponding comments describing how the activity was/is/will be accomplished by the school- based Vision Screening Program. 2. Work plans must be approved by the Department Hearing & Vision Coordinator for their respective program. 3. Changes to the work plan throughout the year can occur with prior approval from the Department Hearing and Vision State Coordinators. Reporting Requirements: 1. All activities, as specified in the final approved work plan, shall be implemented and a six month and final narrative report submitted by the grantee to the Department. The reports are due 30 days after the six month and year end, and include the following timeframes: a. initial Work Plan is due August 1 b. Six-month report, covering the reporting period of October 1 — March 31, is due April 30th• c. Final year-end report, covering the reporting period of April 1-September 30, is due October 30th. 2. The Department will provide specific instructions and a template for reporting on the work plan objectives and activities. 3. The Department staff shall evaluate the reports for their completeness and adequacy. Grantee Specific Requirements - Food and Water Lead Safety Inspections Purpose Grantee activities funded by the Department are: $150,000 GF/GP for increased funding to Genesee County Health Department Food Safety Division for inspections of food service establishments for water sampling and safety, including restaurants, schools, hospitals, etc. The purpose is to assure safe water is being used in Flint food service establishments throughout the City of Flint, with special attention to areas identified with a medium to high lead in water risk. Continued funding is contingent on completion of the required activities. Grantee Requirements 1. Maintain the FY16 increase in food safety supervision and food safety field staff, up to $150,000 for FY17. This will be specifically to provide for portions of an Environmental Health Director, Food Program Supervisor and one additional food safety Field Inspector. 2. Continue to conduct increased numbers of inspections, compliance assistance visits, water sampling and enforcement, as needed to assure Flint food service establishments are providing safe water to customers per Michigan Department of Agriculture and Rural Development (MDARD) requirements document date 1/13/16, or any subsequent updates. 3. Proactively provide information and respond to inquiries from public regarding the safety of the water in Ise re sh merits. 4. Train professional staff, as needed, in general food safety and in the specifics of addressing Flint lead in water compliance assistance for food service establishments. 5. Coordinate with MDARD and Michigan Department of Environmental Quality to assure seamless coordination of ongoing response and recovery efforts for both MDARD retail and food processing establishments and local health inspected food service establishments. 6. Required reporting due 30 days after the end of each six months: Reporting Time Period Due Date 10/1-3/31 5/1 4/1-9/30 11/1 Reports shall include number of inspections, compliance visits, samples collected, and field and administrative hours spent. 7. Prohibited expenditures a. These funds may not be used to fund other local public health operations. REPORTING REQUIREMENTS N/A FAMILY PLANNING-PREGNANCY PREVENTION Special Requirements Grant Start Date 10/1/2018 Grant End Date 9/30/2019 Grant Contract Steve Utter Administrator Contact Info _ (phone & email) R eimbursernent_ Method 517-241-0114; utter@michigan.gov Performance (5) (8) (13) Subrecipient, Contractor, Subrecipient or Recipient (non-federal) Designation Performance Target # Unduplicated Clinic Output Measure Users Served Performance Level 95% (if Applicable) BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS All Grantees must follow the program assurances and requirements, as prescribed below: Program Specific Assurances and Requirements i. Each grantee must serve a minimum of 95% of proposed Title X users to access its total amount of allocated funds. Semi-annual FPAR data will be used to determine total Title X users served. Each grantee will be required to adhere to Federal Statue and Regulations for Title X Family Planning Programs, including legislative mandates. 3. Each grantee will be required to adhere to the Michigan Title X Family Planning Program 2018-2019 Standards and Guidelines Manual. 4 Each grantee will be required to participate in program planning and evaluation, including the completion of a Family Planning Annual Plan, consisting of a needs assessment, health care plan, and work plan as detailed in the 2018-2019 Standards and Guidelines Manual. 5. Each grantee will provide family planning clients (including adolescents) with a broad range of effective Food and Drug Administration approved family planning methods and services, including natural family planning methods, and temporary or permanent contraception either on-site or by referral. 6. Each grantee will provide family planning services on a voluntary basis, without coercion to accept services or any particular method of family planning, and without making acceptance of services a prerequisite to eligibility for any other service or assistance in another program. 7. Each grantee will provide confidential family planning and related preventive health services to adolescents and will not require written consent of parents or guardians for the provision of services to minors. 8. Each grantee will encourage family participation in the decision of minors to seek family planning services and must provide counseling to minors on how to resist efforts to coerce the minor into engaging in sexual activities. 9. Each grantee will comply with state laws requiring notification or reporting of child abuse, child molestation, sexual abuse, rape, or incest. No provider of services under Title X is exempt from any laws requiring mandatory reporting. io. Each grantee will provide family planning services in a manner which protects the dignity of the individual. 1. Each grantee will provide family planning services without regard to religion, race, color, national origin, creed, handicap, sex, number of pregnancies, marital status, age, sexual orientation, and contraceptive preference. 12. Each grantee will not provide abortion as a method of family planning. Pregnant wamewwill be offere_d_th_e_aportunity to be provided neutral, factual information and nondirective counseling regarding the following options: (A) Prenatal care and delivery; (B) Infant care, foster care, or adoption; and (C) Pregnancy termination. 13. Each grantee will ensure that low-income clients are given priority to receive family planning services. 14. Each grantee will have a sliding fee schedule, based on current Federal Poverty Guidelines, to determine a client's ability to pay for family planning services. 15 Each grantee will have a schedule of fees designed to recover the reasonable cost of providing services to clients whose income exceeds 250% of poverty. Grantees must document their process for determining how the schedule of fees is designed to recover the reasonable cost of providing services. If a grantee chooses to set their fee schedule below what would recover the actual cost of providing services, there must be a policy in place that identifies the percentage of costs the fee schedule is designed to recover and the policy must be approved by the grantee's administrative board. 16 Each grantee where there is legal obligation or authorization for third party reimbursement, including public or private sources, all reasonable efforts must be made to obtain third party payment without application of any discounts (42 CFR 59.5(a)(9)). 17. Each grantee will convene a Family Planning Advisory Council that will serve as their governing board, which will be broadly comprised of the population served and will meet at least once a year. 18. Each grantee will convene an Information and Education Committee comprised of five to nine members who are broadly representative of the population served or community that meets at least once a year to review and approve all informational and educational materials prior to its distribution. 19. Each grantee will have written clinical protocols that are in accordance with nationally recognized standards of care, signed and approved by the medical director overseeing family planning. zo. Each grantee will have a quality assurance system in place for ongoing evaluation of family planning services, including a tracking system for clients in need of follow-up or continued care, medical audits conducted quarterly, chart audits/record monitoring to determine the accuracy of medical records conducted quarterly, and a process to implement corrective actions for deficiencies. 21. Each grantee will have a current list of social services agencies and medical referral resources that is reviewed and updated annually, 22. Each grantee will provide for coordination and use of referral arrangements with other providers of health care services, local health and welfare departments, hospitals, voluntary agencies, and health services projects supported by other federal programs. 23. Each grantee will offer education on HIV and AIDS, risk reduction information, and either on-site testing, or provide a referral for this service. 24. Each grantee will offer client-centered counseling services on-site or by referral and ensure the information is medically accurate, balanced, provided in a non- judgmental manner, and is non-coercive. 25. Each grantee will have a separate budget for Title X funds and maintain a financial management system that meets the standards specified in 45 CFR 74 and 45 CFR 92 and is in compliance with federal standards. 26. Each grantee will comply with the Office of Population Affairs (OPA) Family Planning Annual Reports (FPAR) requirements, as well as MDHHS required FPAR Tables, for the purposes of monitoring and reporting performance. 27. Each grantee will have a data collection system in place to assure accurate FPAR reporting, and will be responsible for updating their system, as needed, to be in compliance with OPA and MDHHS FPAR reporting standards. 28. Each grantee will comply with the MDHHS Medicaid Cost-Based Reimbursement (MCBR) reporting requirements, and attach the MCBR Tracking Form to their final financial status report. The MCBR Tracking Form must be completed in its entirety and include Family Planning MCBR and Other Medicaid MCBR financial information for all programs. 29. The funds appropriated in the current State Public Health Appropriations Act for pregnancy prevention programs shall not be used to provide abortion counseling, referrals or services, unless contradicts Title X Federal Law (Title X of the Public Health Service Act). 30. Pursuant to Public Act (PA) 360 (2002) Section 333.1091, grantees qualify as priority family planning providers who do not engage in any activities outlined in PA 360 (2002) Section 333.1091. 31. Grantee funding cannot be used to supplant funding for an existing program supported with another source of funds. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS 1. Each Grantee shall submit the required reporting on the following dates: Work Plan Needs Assessment & Health Care Plan FPAR Mid-Year Report FPAR Year-End Report October 1 — September 30 January 1 — June 30 January 1 — December 31 September 13 September 13 July 12 January 11 Judy Stiles stilesj@nnichigan.gov Judy Stiles stilesj@nnichigan.gov Judy Stiles stilesj@michigan.gov Judy Stiles stilesj@michigan.gov Medicaid Cost-Based Reimbursement Tracking Form October 1 — September 30 November 29 Steve Utter utters@rnichigan.gov 2. Each Grantee shall indicate the following project outputs: Total Performance Expectation State Funded Minimum Performance Expected Target Measure Unduplicated Number of Clinic Users 95% Percent Number FETAL ALCOHOL SPECTRUM DISORDER (FASD) PROJECTS Special Requirements Grant Start Date 10/1/2018 Grant End Date 9/30/2019 Grant Contract Administrator Paulette Dunbar Contact Info (phone & email) 517-335-8903 Dunbarp@michigan gov Reimbursement Method Staffing (6) Subrecipient, Contractor, or Recipient (non- federal) Designation Subrecipient Performance Level (if Applicable) N/A Performance Target Output Measure N/A OBJECTIVE For the project period of October 1 to September 30, the Grantees will collaborate with the Department to assist local communities with evidence-based activities identified in the FASD Interagency Strategic Plan, to implement alcohol screening and prevent prenatal alcohol exposure among women of reproductive age and to refer affected children, birth to 18 years of age, and their families to an FASD Diagnostic Center for evaluation and intervention for the purpose of improving care and services for women, infants and families. GRANTEE REQUIREMENTS 1. FASD project coordinator (or designee) must participate/attend semi-annual FASD Grantee Conference Calls provided by the department during FY 18/19. 2. Implement the FASD Interagency Strategic Plan, activities as approved by the department. 3. Produce quarterly and year-end reports using the Uniform Data Collection Evaluation Tool (UDCT) form provided by the department that provides documentation of the types, numbers and demographic data including racial data of contacts for screening, motivational interviews and/or referrals from the grantee's FASD community based program. The UDCT form is available on the MI E-Grants system. The FASD UDCT quarterly reports are to be submitted via the MI E-Grants system attached to the FSR. The 4th quarter report, due October 15, will serve as the year-end report. DEPARTMENT REQUIREMENTS 1. Convene FASD Grantees semi-annual conference calls during FY 18/19 to discuss progress toward community project goals outlined in the cooperative agreement and provide technical assistance questions/answers as outlined in the cooperative agreement. 2. Describe and provide resources and updates for the evidence-based interventions required by this contract. 3. Provide technical assistance for each requirement of this contract. 4 Provide reporting formats for data collection and deliverables. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 1. Deliverables are due QUARTERLY and a YEAR-END REPORT will summarize the results of the contract year. The Grantee shall submit the following reports within 15 days after the end of each quarter on the following dates: Quarter End Date Report Due Date Reporting Time Period Due Date October 1 – December 31 January 15 January 1– March 31 April 15 April-1—June_30 ,11-141-1 July 1 September 30 October 15 Quarter 181 2nd 3rd 4th 2. The Grantee will collect data using the Uniform Data Collection Tool (UDCT) project evaluation/data tracking forms to monitor the FASD community program effectiveness. The Uniform Data Collection Tool (UDCT) is available on MI E-Grants. 3. The Grantee shall submit the following information electronically to the Department FASD Program via the MI E-Grants system attached to FSR a. The Grantee must provide documentation that FASD services are tracked for all individuals referred through the FASD community project program and shall submit a UDCT Data Tracking Form to be sent at the end of each quarter. Submit Work Plan and UDCT Evaluation Form quarterly & year-end reports via the MI E-Grants system. Program Contact Information: Paulette Dunbar, Women and Maternal Health Section MDHHS, Division of Maternal and Infant Health P.O. Box 30195, Lansing, Nil 48909 Phone 517-335-8379 Fax 517-335-8822 Dunbarp(&.michidanmov 11 FETAL INFANT MORTALITY REVIEW CASE ABSTRACTION SPECIAL REQUIREMENTS Grant Start Date 111)111Ifl Grant End Date 1 9/30/2019 I Grant Contract Dawn Shanafelt Administrator Contact Info (phone & 517-373-4411 shanafeltd@michigan.gov Reimbursement Method Fixed Unit Rate (2) (11) Subrecipient, Contractor, or Recipient (non-federal) Designation Subrecipient I Performance LeVel (1 n/a i Applicable) Performance Target n/a Output Measure Budget and agreement requirements Qualified individuals will perform medical record case abstraction for Fetal Infant Mortality Review to include the following: 1. Review of medical records involved in fetal and infant death to include, but not limited to: hospital records, prenatal records, pediatric records, emergency and medical examiner's records. 2. Interact with other agencies and service providers involved in infant's death (Child Protective Services, local health department, law enforcement). 3. Develop case summaries from the above abstracted information, as well as the Maternal Interview, using Michigan FIMR Network tools and guidelines. 4. Attend the review team meetings to facilitate the presentation of the cases. 5. Enter cases into the FIMR database at the National Center for Fatality Review and Prevention. GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS Provide technical assistance and consultation to the grantee. GRANTEE SPECIFIC REQUIREMENTS 1. Each completed case abstraction will be compensated at $270.00 per case. 2. FIMR team recommendations and information will be used to inform the State of Michigan infant mortality reduction efforts. Maximum Program Reimbursement Grantee Maximum Reimbursement Amount Berrien County Health Department $ 4,050 Calhoun County Health Department $ 3,240 Detroit Health Department $ 2,700 Genesee County Health Department $ 3,240 Ingham County Health Department $ 3,240 Kalamazoo County Health and Community Services Department $ 6,480 —Mac-am-b-county-Healt-h-Department Muskegon County Health Department $ 5,400 Oakland County Department of Health and Human Services/Health Division $ 6,480 Saginaw County Health Department $ 4,860 REPORTING REQUIREMENTS Quarterly progress reports following the template supplied by the contractor manager. Quarterly reports are due the 15th of the month following the end of the quarter and are submitted to the contract manager via email. End of FY final report on cases completed and team findings are submitted to the State coordinator. I st 2116 3rd 4th Reporting Time Period October 1 - December 31 January 1- March 31 April 1 - June 30 July 1 - September 30 Due Date January 15 April 15 July 15 October 15 FETAL INFANT MORTALITY REVIEW INTERVIEWS SPECIAL REQUIREMENTS Grant Start Date, 10/1/2018 Grant Contract Administrator Contact Info (phone & email) Reimbursement Method Performance Level (if n/a Applicable) Budget and agreement requirements Grant End Date 9/30/2019 Subrecipient, Subrecipient Contractor, or Recipient (on-federal) Designation Performance Target n/a Output Measure Dawn Shanafelt 517-373 -4411; Sha nafeltD@ michiga n.gov Fixed Unit Rate (2) (11) Conduct Fetal Infant Mortality (FIMR) interviews with the intent of informing the F1MR case abstraction process and informing the infant mortality reduction efforts both locally and statewide. DEPARTMENT REQUIREMENTS Provide payment of $125 for each Fetal Infant Mortality interview, A maximum of 6 visits are reimbursable per fetal/infant death up to the contract allocation. REPORTING REQUIREMENTS Mid-year progress report and final report using the Fl MR Interviews template, which will address what is learned about preventability at the individual, clinical care, health system, community, and policy level are due April 15 and final report due October 15 submitted to the contract manager via email. Grant Start Date 10/1/2018 Grant Contract Linda Scarpetta Administrator Grant End Date 9/30/2019 GETTING TO THE HEART OF THE MATTER - PROJECT MANAGEMENT Special Requirements Contact Info (phone & email) 517-373-3267 scarpettal@michigan.gov Reimbursement Method a ing 6) 1 1—S-rihrgwirsion4 Sub-reel-pi Contractor, or Recipient (non-federal) Designation Performance Level N/A Performance Target N/A (if Applicable) Output Measure BUDGET AND AGREEMENT REQUIREMENTS No funds may be expended for lobbying as defined in Act No. 472 of the Public Acts of 1978, being sections 4.411 to 4.431 of the Michigan Compiled Laws. GRANTEE REQUIREMENTS Complete project management for Getting to the Heart of the Matter initiative and comply with evaluation requirements, which may include periodic data collection and submission. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Submit progress and final reports according to MDHHS guidance. If the report due date falls on a weekend or holiday, you have until the next business day to submit. Progress Report Period Covered Report Due Dates October 1 — December 31 January 1 - March 31 April 1 - June 30 July 1 - September 30 Year End Report — Total Grant Period January 31 April 30 July 31 October 31 November 15 Kris Judd-Tuinier _Grant Enci Date 10/1/2018 9/30/2019 Grant Start Date Grant Contract Ad m in istrator •Subrecipient, Contractor, or Recipient (non-federal) Subrecipient Performance Target N/A Output Measure GONOCOCCAL ISOLATE SURVEILLANCE PROJECT (OAKLAND) Special Requirements • Contact Info (phone & Reimbursement Staffing (6) Method Performance Level (if N/A 1 Applicable) 313-456-4426, judd-tuinierk@michigan.gov BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS C. Grant Program Operation 1. To monitor trends in antimicrobial susceptibilities in N. gonorrhoeae. 2. To characterize patients with gonorrhea (GC), particularly those infected with N. gonorrhoeae that are not susceptible to recommended antimicrobials. 3. To phenotypically characterize antimicrobial-resistant isolates to describe the diversity of antimicrobial resistance in N. gonorrhoeae. 4. To monitor trends in sexually transmitted N. Meningitidis 5. For each male STD clinic patient suspected of having GC (symptoms, known partner etc.), collect a urogenital sample using a Modified Thayer Martin (MTM) plate. 6. For male and female STD clinic patient suspected of having oral GC (symptoms, known partner etc.), collect a pharyngeal sample using a Modified Thayer Martin (MTM) plate. 7. For each male STD clinic patient who reports same sex partners, collect sample using a MTM plate from extragenital sites of exposure (rectal, pharyngeal), regardless of symptoms. 8. For clients with positive isolates, submit specimen to CDC assigned Regional Laboratory for further testing; and associated demographic and behavioral data to the CDC and MDHHS at agreed intervals. D. Reporting Report Period Due Date(s) How to Submit Report On a quarterly basis, extract from EMR, and submit to MDHHS, the number of culture specimens collected and number of presumptive positive GC and suspected N.Men specimens forwarded Quarterly January 15, April 15, July 15, October 15 Written report submitted to kenti3(nnichig an.gov; cc: petersona7©m ichigan.gov to CDC and their designated laboratories for further testing. On a quarterly basis, for clients with GC positive isolates, or suspected N. Men, submit demographic and behavioral data to MDHHS utilizing the CDC required format. Quarterly January 15, April 15, July 15, October 15 Written report submitted to kentj3a.michiq an.dov. cc: petersona7@nn ichigan.gov DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A 11 HEALTH EDUCATION COMMUNICATION (HEC) Special Requirements Grant Start Date 10/1/2018 Grant End Date 9/30/2019 Grant Contract Administrator Contact Orlando Todd 517-284-4021, toddo©rnichigan gov Info (phone & email) . - — Reimbursement Method Staffing (6) Subrecipient, Contractor, or Recipient (non- federal) Designation Subrecipient Performance Level (if Applicable) N/A Performance Target Output Measure N/A BUDGET AND AGREEMENT REQUIREMENTS Funds for this project will be utilized to supplement cost for (1) F.T.E. (Health Educator) and (1) (Staff support) for health education activities. Eligible Activities include: a) Meeting activities, community presentations and travel costs b) Supplies and materials c) IT cost related to the function of the position GRANTEE REQUIREMENTS Submission of quarterly FSR's that detail cost allotment of funds. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Genesee Health Department will submit monthly reports of Activities and objectives that were completed by this position. Items of completion (Deliverables) can be listed in bulleted format and listed as "Accomplishments" or "Outcomes.'' Monthly reports are due by 10' day of each month. HEPATITIS A RESPONSE Special Requirements 1 Grant Sthrt Date 10/112018 Grant End Date 9/30/2019 Grant Contract Administrator Orlando Todd -----i-Reimbursement---- Contact info Method Performance Level (if Applicable" I._ (phone & email) (517) 284-4021, toddo@michigan.gov - - . becpientont - ctor Contractor or Recipient (non-federal) Designation Performance Target Output Measure ___i . N/A _ N/A _ _ _ ___ Budget and agreement requirements Budget requirement: LHDs will budget for recommended amount Program Purpose: The purpose of this project is to provide education and to conduct vaccination outreach to Michigan residents at high risk of contracting Hepatitis A. The purpose of the project is to also conduct epidemiological investigation into the Hepatitis A outbreak, and to provide post-exposure prophylaxis. Activities and target populations will be driven by epidemiological data of the outbreak. Budget requirement: LHDs will budget for recommended amount of Immunoglobulin for post-exposure prophylaxis purposes, as communicated in the Notice of Award or subsequent amendments. Other questions regarding permissible expenditures should be directed to the Office of Local Health Services at delaRambelieL@michigan.gov or Tocld0@michigan.gov . GRANTEE REQUIREMENTS NIA DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Reporting for outbreak LHDs will be conducted through the Community Health Emergency Coordination Center (CHECC) Situation Reports and Vaccination Grid. Reporting for non-outbreak LHDs will be conducted through submission of the Vaccination Grid to the CHECC at checcdeptcoormichician.gov . HIV/AIDS LINKAGE TO CARE Special Requirements Grant Start Date Grant Contract Administrator Contact info Ipt)one & email) Reimbursement : Method I 10/1/2018 Jennifer Linzmeier 1 - -- I Grant End Date 9/30/2019 517-241-5861; linzmeier@michigan.gov Staffing (6) Subrecipient,•Contractor, Subrecipient or Recipient (non-federal) Designation Performance Level N/A Alf Appticable) PerforMance Target Output Measure N/A BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Grantee must enter Not in Care (N IC) lists into CAREWare for sharing with agencies 2. Grantee must maintain password protected NIC lists on secure server locations and not in any portable storage devices 3. Grantee must store NIC lists on shared servers and not on desktop or personal computers 4. Grantee and Community-based Organizations must not email NIC lists or individual health information contained on NIC lists either internally or externally 5. Grantee and Community-based Organizations must transmit updated surveillance data to MDHHS in pre- approved secure manners (e.g. DCH file transfer) 6. Grantee and Community-based Organizations must keep all printed materials in locked storage cabinets in locked rooms 7. If NIC lists or partial lists are sent via US Mail, list size must not exceed 10 individuals in a given mailing and words indicated HIV infection must not be contained in the sent documents 8. Grantee and Community-based Organizations will document all data sharing agreements and share a copy with MDHHS. The data sharing agreements may be emailed to MDHHS- HIVSTDoperationsmichioan.gov . 9. Grantee and Community-based Organizations must provide written documentation of annual Security and Confidentiality training for all staff that have access to NIC lists. 10. Grantee and Community-based Organizations will maintain the standards of CDC's Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs, https://www.cdc.qovinchhstp/prooramintegration/docs/pcsidatasecuritvouidelines.pdf DEPARTMENT REQUIREMENTS 1. The Department will provide Technical Assistance (TA), as requested, on the implementation of the Ryan White program. This may include issues related to; CAREWare, Quality Management, Programs, Budget/Fiscal, Grants and Contracts, ADAP, or other activities related to carrying out Ryan White Part B activities. Please see Grantee Specific Requirements, item 15 for information on how to request TA. 2. The Department will monitor Grantee performance throughout the contract year, which may include a review of financial status reports (FSRs), CAREWare data entries, quarterly progress reports, and site visits. GRANTEE SPECIFIC REQUIREMENTS 1. The Grantee should adhere to: a. All federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non- discrimination, and confidentiality. b. Procedures for the confidentiality and security of client information 2. Ryan White is payer of last resort; as such, the Grantee must adhere to the Ryan White HIV/AIDS reatrnent Extension Act. See-"Applicable-Laws, Rules, Regulations, PoliciesiElt ocedu es, and Manuals:' 3. The Grantee will provide immediate notification to the Department, in writing, in the event of any of the following: a. Any formal grievance initiated by a client and subsequent resolution of that grievance. b. Any event occurring or notice received by the Grantee or subcontractor, that reasonably suggests that the Grantee or subcontractor may be the subject of, or a defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or Grantee or subcontractor employees. c. Any staff vacancies funded for this project that exceed 30 days. 4. When issuing statements, press releases, requests for proposals, bid solicitations and other documents describing projects or programs funded in whole or in part with Federal money, the Grantee receiving Federal funds, including but not limited to State and local governments and recipients of Federal research grants, shall clearly state: a. The percentage of the total costs of the program or project that will be financed with Federal money. b. The dollar amount of Federal funds for the project or program. c. Percentage and dollar amount of the total costs of the project or program that will be financed by non- governmental sources. 5. The Grantee will participate in the Department needs assessment and planning activities, as requested. 6. Each employee funded in whole or in part with federal funds must record time and effort spent on the project(s) funded. The Grantee must: a. Have policies and procedures to ensure time and effort reporting. b. Assure the staff member clearly identifies the percentage of time devoted to contract activities in accordance with the approved budget. c. Denote accurately the percent of effort to the project. The percent of effort may vary from month to month, and the effort recorded for Ryan White funds must match the percentage claimed on the Ryan White FSR for the same period. d. Submit a budget modification to the Department in instances where the percentage of effort of contract staff changes (FTE changes) during the contract period. 7. If applicable, the Grantee and its subcontractors are required to use the HRSA-supported software CAREWare to enter client and service data into the centrally managed database on a secure server. The Grantee must: a. Enter all Ryan White services delivered to HIV-infected and affected clients. b. Enter all data by the 10th of the following month. c. Complete collection of all required data variables and the clean-up of any missing data or service activities by the 10th of the following month. 8. The Grantee will participate in regular Grantee meetings which may be face-to-face, teleconferences, webinars, etc. The Grantee is highly encouraged to participate in other training offerings and information- sharing opportunities provided by the Department. 9. The Grantee must establish written procedures for protecting client information kept electronically or in charts or other paper records. Protection of electronic client-level data will minimally include: a. Regular back-up of client records with back-up files stored in a secure location. b. Use of passwords to prevent unauthorized access to the computer or Client Level Data program. c. Use of virus protection software to guard against computer viruses. d. Provide annual training to staff on security and confidentiality of client level data and sharing of electronic data files according to MDHHS policies concerning Sharing and Secured Electronic Data. arel-O-re-C-ard-prog ram activities, e ran ee mus inc u e e allowing language in all— Client Consent and Release of Information forms used for services in this agreement: "I also understand that some limited information in the electronic data may be shared with other agencies if they also provide me with services and are part of the same care and data network. [AGENCY] is mandated to collect certain personal information that is entered and saved in a database system called CAREWare. CAREWare records are maintained in an encrypted and secure statewide database. The CAREWare database program allows for certain medical and support service information to be shared among providers involved with your care, this includes but is not limited to medical visits, lab results, medications, case management, transportation, substance abuse, and mental health counseling. REPORTING REQUIREMENTS 1. The Grantee must assure that all CAREWare data is complete, cleaned, and entered into CAREWare by the 10th of the following month. 2. The Grantee will submit quarterly progress report and must provide the following: a. Detail progress made on work plan objectives and activities during the reported quarter. b. Respond to any questions or clarifications of the quarterly progress report that the Department requests. c. The report should be emailed to MDHHS-HIVSTDoperationsAmichioan.00v on or before the due dates: Report Period Covered Report Due Dates October 1 – December 31 January 31 January 1 - March 31 April 30 April 1 - June 30 July 31 July 1 - September 30 October 31 3. The Grantee must respond to any questions or clarifications of the quarterly progress report that the Department requests. II HIV DATA TO CARE SPECIAL REQUIREMENTS t_Grant_Start_Date 10/1/2018 Grant Contract Jennifer Linzmeier Administrator Contact Info lphone & email) t4mbursement_ Staffing (6) Method Performance Level N/A Applicable) Grant End Date 9/30/2019 Subrecipient, Contractor, Subrecipient or Recipient (non. feder4Designation Performance Target N/A Output Measure 517-241-5861 linzmeieri(&_michiqan.qov BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS A. Publication Rights When issuing statements, press releases, requests for proposals, bid solicitations and other documents describing projects or programs funded in whole or in part with Federal money, the Grantee receiving Federal funds, including but not limited to State and local governments and recipients of Federal research grants, shall clearly state: 1. The percentage of the total costs of the program or project that will be financed with Federal money. 2. The dollar amount of Federal funds for the project or program. 3. Percentage and dollar amount of the total costs of the project or program that will be financed by non- governmental sources. B. Fees Ryan White is payer of last resort; as such, the Grantee must adhere to the Ryan White HIV/AIDS Treatment Extension Act and bill for services that are billable. C. Grant Program Operation 1. Grantees must enter Not in Care (NIC) lists into CAREWare for sharing with agencies 2. Grantees must maintain password protected NIC lists on secure server locations and not in any portable storage devices 1 Grantees must store NIC lists on shared servers and not on desktop or personal computers 4. Grantees and Community-based Organizations must not email NIC lists or individual health information contained on NIC lists either internally or externally 5. Grantees must transmit updated surveillance data to MDHHS in pre-approved secure manners (e.g. DCH file transfer) 6. Grantees must keep all printed materials in locked storage cabinets in locked rooms 7. If NIC lists or partial lists are sent via US Mail, list size must not exceed 10 individuals in a given mailing and words indicated HIV infection must not be contained in the sent documents 8. Grantees and Community-based Organizations will document all data sharing agreements and share a copy with the Department. The data sharing agreements may be emailed to MDHHS- HIVSTDoperationsAmichiqan.qov. 9. Grantees and Community-based Organizations must provide written documentation of annual Security and Confidentiality training for all staff that have access to NIC lists 10. Grantees and Community-based Organizations will maintain the standards of CDC's Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs, https://www.cdc.dovinchhstp/orogramintearation/docs/pcsidatasecuritvouidelines.pdf 11. The Grantee will participate in the Department needs assessment and planning activities, as requested. 12. The Grantee will participate in regular Grantee meetings which may be face-to-face, teleconferences, webinars, etc. The Grantee is highly encouraged to participate in other training offerings and information-sharing opportunities provided by the Department. 13, If using CAREWare to report program activities, the Grantee must include the following language in all Client Consent and Release of Information forms used for services in this agreement: "I also understand that some limited information in the electronic data may be shared with other agencies if they also provide me with services and are part of the same care and data network. fAGENCYl_is_mandated_rollecf_certain information that is entered and saved in a database system called CARE Ware. CARE Ware records are maintained in an encrypted and secure statewide database. The CARE Ware database program allows for certain medical and support service information to be shared among providers involved with your care, this includes but is not limited to medical visits, lab results, medications, case management, transportation, substance abuse, and mental health counseling." 14. The Grantee will complete the collection of all required data variables and clean-up any missing data or service activities by the 10th day after the end of each calendar month. D. Reporting 1. The Grantee shall submit the following reports on the following dates: Report• :Period . :Due Date(s) HoWl to Submit Report Ryan White services to delivered to HiV-infected Monthly 10th of the following month Enter into CAREWare 2. The Grantee shall permit the Department or its designee to visit and to make an evaluation of the project as determined by the Contract Manager. E. Record Maintenance/Retention The Grantee will maintain, for a minimum of five (5) years after the end of the grant period, program, fiscal records, including documentation to support program activities and expenditures, under the terms of this agreement, for clients residing in the State of Michigan. J. Software Compliance 1. The Grantee and its subcontractors are required to use the HRSA-supported software CAREWare to enter client and service data into the centrally managed database on a secure server. The Grantee must: a. Enter all Ryan White services delivered to HIV-infected and affected clients. b. Enter all data by the 10th of the following month. c. Complete collection of all required data variables and the clean-up of any missing data or service activities by the 10th of the following month. 2. The Grantee must establish written procedures for protecting client information kept electronically or in charts or other paper records. Protection of electronic client-level data will minimally include: a. Regular back-up of client records with back-up files stored in a secure location. b. Use of passwords to prevent unauthorized access to the computer or Client Level Data program. c. Use of virus protection software to guard against computer viruses. d. Provide annual training to staff on security and confidentiality of client level data and sharing of electronic data files according to MDHHS policies concerning Sharing and Secured Electronic Data. L. Mandatory Disclosures 1. The Grantee will provide immediate notification to the Department, in writing, in the event of any of the following: a. Any formal grievance initiated by a client and subsequent resolution of that grievance. b. Any event occurring or notice received by the Grantee or subcontractor, that reasonably suggests that the Grantee or subcontractor may be the subject of, or a defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or Grantee or subcontractor employees. c. Any staff vacancies funded for this project that exceed 30 days. 2. This information may be emailed to MDHHS-HIVSTDoperationsgmichidan.dov. DEPARTMENT REQUIREMENTS H. Technical Assistance The Depawill pr videle-chnicarassistdme (TA), as requested, on the implementation ol theRyan White program. This may include issues related to: CAREWare, Quality Management, Programs, Budget/Fiscal, Grants and Contracts, ADAP, or other activities related to carrying out Ryan White activities. To request TA, please send an email to MDHHS-HIVSTDoperationsamichican.dov. ASSURANCES A. Compliance with Applicable Laws 1. The Grantee should adhere to all Federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination, and confidentiality. 2. Ryan White is payer of last resort; as such, the Grantee must adhere to the Ryan White HIV/AIDS Treatment Extension Act. 3. Procedures for the confidentiality and security of client information. II HIV PREP DATA COLLECTION Special Requirements Grant Start Date 10/1/2018 Grant End Date -79J30/2019 Grant Contract Administrator Jennifer Linzmeier Contact Info (phone & email) Reimbursement Method Staffing (6) 517-241 -5861 linzmeier@michigan.gov Subrecipient Subrecipient, Contractor, or Recipient (non- federal)pesignation -- - Performance Level (if Applicable) [...___ '--- -- N/A Performance Target Output Measure N/A BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS E. Grant Program Operation 1. The Grantee shall track referral to Pre-exposure Prophylaxis (PrEP) and report it monthly to the Department. D. Reporting Report Period Due Date(s) How to Submit Report Provider PrEP Referral Log Monthly 10th of the following month ctrsupolies@mi ch'g L. Mandatory Disclosures 1. The Grantee will provide immediate notification to the Department, in writing, including but not limited to the following events: a. Any formal grievance initiated by a client and subsequent resolution of that grievance. b. Any event occurring or notice received by the Grantee or subcontractor, that reasonably suggests that the Grantee or subcontractor may be the subject of, or a defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or Grantee or subcontractor employees. c. Any staff vacancies funded for this project that exceed 30 days. 2. All notifications should be made to the Department by MDHHS-HIVSTDoperations@michiqan.qov. DEPARTMENT REQUIREMENTS A. Report Forms 1. The Department will provide the agency with a MDHHS PrEP referral Excel spreadsheet. C. Technical Assistance 1. The Department will provide technical assistance (TA), as requested, on the implementation of the HIV PrEP program. This may include issues related to: PrEP tracking and referral, Budget/Fiscal, Grants and Contracts, Training, or other activities related to carrying out HIV PrEP activities. To request TA, please send an email to MDHHS-HIVSTDoperationsftmichigan.dov. ASSURANCES — CATEGORICAL A. Compliance with Applicable Laws 1. The Grantee should adhere to all Federal and Michigan laws pertaining to H1V/AIDS treatment, disability accommodations, non-discrimination, and confidentiality. I I HIV PREVENTION PROGRAM Special Requirements Grant Start Date 1011/2018 Grant End Date -- 9/30/2019 Grant Contract Administrator Contact Info (phone & email) Jennifer Linzmeier Categorical Staffing (6) 517-241-5861 linzmeier@michigan.gov Reimbursement II' IIIII Subrecipient, Contractor, or Recipient n n-f - der . I Subrecipient Desi • nation Performance Level (if Applicable) _ .. Reimbursement Method N/A Non-Categorical Fixed Unit Rate (7) 11g1 Performance Target Output Measure N/A Recipient Subrecipient, Contractor, or Recipient (non-federal) Designation Performance Level (if Applicable) N/A Syringe Services Department, Chippewa De artment #2, Marquette Staffing (6) Performance Target Output Measure N/A Health District Health _ Subrecipient N/A Program (Central Michigan District County Health Department, County Health Department) Subrecipient, Contractor, or Recipient (non- federaILDesignation Performance Target Output Measure Reimbursement Method Performance Level (if Applicable) N/A BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS - CATEGORICAL Grantees will provide HIV Counseling, Testing, and Referral (CTR) and, if applicable, Partner Services (PS) within their jurisdiction, pursuant to applicable federal and state laws; and policies and program standards issued by the Department. See "Applicable Laws, Rules, Regulations, Policies, Procedures, and Manuals." F. Publication Rights When issuing statements, press releases, requests for proposals, bid solicitations and other documents describing projects or programs funded in whole or in part with Federal money, the Grantee receiving Federal funds, including but not limited to State and local governments and recipients of Federal research grants, shall clearly state: 1. The percentage of the total costs of the program or project that will be financed with Federal money. 2. The dollar amount of Federal funds for the project or program. 3. Percentage and dollar amount of the total costs of the project or program that will be financed by non- governmental sources. E. 10th of the following month Quality Control Reports Monthly F. Grant Program Operation 1. The Grantee will participate in the Department needs assessment and planning activities, as requested. 2. The Grantee will participate in regular Grantee meetings which may be face-to-face, teleconferences, webinars, etc. The Grantee is highly encouraged to participate in other training offerings and information-sharing opportunities provided by the Department. 3. Each employee funded in whole or in part with federal funds must record time and effort spent on the project(s) funded. The Grantee must: a. Have policies and procedures to ensure time and effort reporting. b. Assure the staff member clearly identifies the percentage of time devoted to contract activities in accordance with the approved budget. c. Denote accurately the percent of effort to the project. The percent of effort may vary from month to month, and the effort recorded for funds must match the percentage claimed on the FSR for the same period. d. Submit a budget modification to the Department in instances where the percentage of effort of contract staff changes (FTE changes) during the contract period. 4. The Grantee will receive a condom and lubrication allowance. The Grantee must: a. Distribute condoms and lubrication b. Place orders for condoms/lubrication by emailing c. Report its condom distribution monthly using EvalWeb. 5. If conducting HIV testing using rapid HIV testing, the Grantee will comply with guidelines and standards issued by the Department and: a. Conduct quality assurance activities, guided by written protocol and procedures. Protocols and procedures, as updated and revised Quality assurance activities are to be responsive to: Quality Assurance for Rapid HIV Testing, MDHHS. See "Applicable Laws, Rules, Regulations, Policies, Procedures, and Manuals." i. Ensure provision of Clinical Laboratory Improvement Amendments (CLIA) certificate. ii. Report discordant test results to the Division of HIV & STD Programs. iii. Ensure that staff performing counseling and/or testing with rapid test technologies has completed, successfully, rapid test counselor certification course or Information Based Training (as applicable), test device training, and annual proficiency testing. iv. Ensure that all staff and site supervisors have completed, successfully, appropriate laboratory quality assurance training, blood borne pathogens training and rapid test device training and reviewed annually. v. Develop, implement, and monitor protocol and procedures to ensure that patients receive confirmatory test results. 6. If conducting PS, the Grantee will comply with guidelines and standards issued by the Department. See "Applicable Laws, Rules, Regulations, Policies, Procedures, and Manuals." The Grantee must: a. Provide Confidential PS follow-up to infected clients and their at-risk partners to ensure disease management and education is offered to reduce transmission. b. Effectively link infected clients and/or at-risk partners to HIV care and other support services. c. Work with Early Intervention Specialist to ensure infected clients are retained in HIV care. 7. The Grantee shall permit the Department or its designee to visit and to make an evaluation of the project as determined by the Contract Manager. How to Submit Report Department Staff Daily Client Logs Reactive Results Monthly As 10th of the Department following month Staff Within 48 hours EvalWeb needed of test Non-Reactive Results As needed Within 7 days of test EvalWeb Linkage to Care and Partner Services Interview (e.g. client attended a medical care appointment within 30 days of diagnosis, and was interviewed by Partner Services within 30 days of diagnosis) As needed Within 30 days of service EvalWeb, PSWeb Condom Distribution Data Monthly 10th of the following_ month Eva Disposition on Partners of HIV Ongoing Within 30 days of service _PSWeb Cases 1. The Grantee will clean-up missing data by the 10th day after the end of each calendar month. 2. The Quality Control and Daily Client Logs may be sent to the Contract Manager via: • Email - rsuppliesamiehig g • Fax - (517) 241-5922 • Mailed - HIV Prevention Unit, Attn: CTR Coordinator, 109 W. Michigan Ave., 10 th Floor, Lansing, MI 48913 3, The Contract Manager shall evaluate the reports submitted as described in Attachment III, Item D. for their completeness and accuracy. E. Record Maintenance/Retention The Grantee will maintain, for a minimum of five (5) years after the end of the grant period, program, fiscal records, including documentation to support program activities and expenditures, under the terms of this agreement, for clients residing in the State of Michigan. J. Software Compliance 1. The Grantee and its subcontractors are required to use Evaluation Web (EvalWeb) to enter HIV client and service data into the centrally managed database on a secure server. 2. The Grantee and its subcontractors are required to use Partner Services Web (PSWeb) to enter Partner Services interview and linkage to care data, where appropriate. M. Mandatory Disclosures 1. The Grantee will provide immediate notification to the Department, in writing, including but not limited to the following events: a. Any formal grievance initiated by a client and subsequent resolution of that grievance. b. Any event occurring or notice received by the Grantee or subcontractor, that reasonably suggests that the Grantee or subcontractor may be the subject of, or a defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or Grantee or subcontractor employees. c. Any staff vacancies funded for this project that exceed 30 days. 2. All notifications should be made to the Department by MDHHS-HIVSTDoberationsArnichigan.gov . DEPARTMENT REQUIREMENTS — CATEGORICAL B. Payment 1. The Department will provide rapid HIV test devices and external controls in sufficient quantity to ensure that HIV testing is provided as a standard of care to clients seeking HIV testing. 2. The Department will provide Grantees with a condom and lubrication allowance. The Department will: a. Notify the Grantee of its condom/lubrication allowance on or before February 1. Quality Control Reports Monthly Due Date(s) 10th of the following month b. Place all Grantees' condom/lubrication orders with the condom vendor between February and September 1. C. Grantee should email ctrsu michi an.o to order condoms. d. Track the Grantees' orders. D. Technical Assistance 1. The Department will provide technical assistance (TA), as requested, on the implementation of the HIV Prevention program. This may include issues related to: EvalWeb, PSWeb, Programs, Budget/Fiscal, Grants and Contracts, Risk Reduction Activities, Training, or other activities related to carrying out HIV prevention activities. To request TA, please send an email to MDH1-1S- HIVSTDoperationsmichiclan.qov. 2. The Department will provide training and technical assistance (TA) in support of implementation of HIV testing as a standard of care and use of rapid HIV tests. ASSURANCES — CATEGORICAL B. Compliance with Applicable Laws 1. The Grantee should adhere to all Federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination, and confidentiality. GRANTEE REQUIREMENTS — NON-CATEGORICAL Grantees that do not receive categorical HIV prevention funds and that elect to conduct HIV testing may request reimbursement for performing HIV tests. C. Grant Program Operation 1. The Grantee will provide HIV CTR services pursuant to statute and the Michigan Public Health Accreditation Standards. 2. The Grantee will submit client-level service data to the Department via EvalWeb. The time line and procedures for submitting these data are to conform to guidelines issued by the Department. How to Submit Report Department Staff Daily Client Logs Monthly 10th of the Department following month Staff Reactive Results Non-Reactive Results Condom Distribution Data As needed As needed Monthly Within 48 hours of test Within 7 days of test 10th of the following month Eva! Web EvalWeb EvalWeb 1. The Grantee will clean-up missing data by the 10th day after the end of each calendar month. 2. The Quality Control and Daily Client Logs may be sent to the Contract Manager via: • Email - ctfieicjgajg • Fax - (517) 241-5922 • Mailed - HIV Prevention Unit, Attn: CTR Coordinator, 109 W. Michigan Ave., 10 th Floor, Lansing, MI 48913 3. The Contract Manager shall evaluate the reports submitted as described in Attachment 111, Item D. for their completeness and accuracy. DEPARTMENT REQUIREMENTS — NON-CATEGORICAL A. Payment 1. The Department will reimburse Grantees at a rate of $11.00 per test, not to exceed $2,000 for FY-19. C. Technical Assistance 1. The Department will provide technical assistance (TA), as requested, on the implementation of the HIV Prevention program. This may include issues related to: EvalWeb, PSWeb, Programs, Budget/Fiscal, Grants and Contracts, Risk Reduction Activities, Training, or other activities related to carrying out HIV prevention activities. To request TA, please send an email to MDRHS- HIVSTDo erations rnichidan,qov. 2. The Department will provide training and technical assistance (TA) in support of implementation of HIV testing as a standard of care and use of rapid HIV tests. ASSURANCES — NON-CATEGORICAL A. Compliance with Applicable Laws 1, The Grantee should adhere to all Federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination, and confidentiality. BUDGET AND AGREEMENT REQUIREMENTS— SYRINGE SERVICES PROGRAM N/A GRANTEE REQUIREMENTS— SYRINGE SERVICES PROGRAM G. Grant Program Operation 1. Grantees will develop programs using MDHHS guidance documents and will address issues such as identification and registration of clients, exchange protocols, education and trainings for staff, and referrals. F. Reporting 1. Grantees will submit a monthly electronic report with data such as needles distributed, educational messages given, clients served and other variables to be assessed by MDHHS. Please email the report to MDHHS-HIVSTDoperations(a.michigan.CIOV. 2. Grantees will participate on quarterly conference calls to discuss best practices and identify barriers. DEPARTMENT REQUIREMENTS— SYRINGE SERVICES PROGRAM E. Technical Assistance 1. The Department will provide technical assistance (TA), as requested, on the implementation of the SSP. To request TA, please send an email to MDHHS-HIVSTDooerations(a.michigan.qov. HIV RYAN WHITE PART B HIV RYAN WHITE PART B MAI Special Requirements Grant Start Date 10/1/2018 Grant End Date 9/30/2019 Grant Contract Administrator Jennifer Linzmeier 517-241-5861 linzmeier(&michidan.gov Contact Info (phone & email) Staffing (6) Subreciplent, Contractor, or Recipient (non- federal) Designation Reimbursement Method Subrecipient Performance Level (if N/A Applicable)• Performance Target Output Measure N/A BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS G. Publication Rights When issuing statements, press releases, requests for proposals, bid solicitations and other documents describing projects or programs funded in whole or in part with Federal money, the Grantee receiving Federal funds, including but not limited to State and local governments and recipients of Federal research grants, shall clearly state: 1. The percentage of the total costs of the program or project that will be financed with Federal money. 2. The dollar amount of Federal funds for the project or program. 3. Percentage and dollar amount of the total costs of the project or program that will be financed by non- governmental sources. H. Fees Ryan White is payer of last resort; as such, the Grantee must adhere to the Ryan White HIV/AIDS Treatment Extension Act and bill for services that are billable. I. Grant Program Operation 1. The Grantee will participate in the Department needs assessment and planning activities, as requested. 2. The Grantee will participate in regular Grantee meetings which may be face-to-face, teleconferences, webinars, trainings, etc. The Grantee is responsible for ensuring that staff are proficient in Ryan White- funded service delivery in their respective roles within the organization. The Grantee is highly encouraged to participate in other training offerings and information-sharing opportunities provided by the Department. 3. Each employee funded in whole or in part with federal funds must record time and effort spent on the project(s) funded. The Grantee must: a. Have policies and procedures to ensure time and effort reporting. How to Submit Report Due Date(S) Report b. Assure the staff member clearly identifies the percentage of time devoted to contract activities in accordance with the approved budget. c. Denote accurately the percent of effort to the project. The percent of effort may vary from month to month, and the effort recorded for Ryan White funds must match the percentage claimed on the Ryan White FSR for the same period. d. Submit a budget modification to the Department in instances where the percentage of effort of contract staff changes (FTE changes) during the contract period. 4. The Grantee must include the following language in all Client Consent and Release of Information forms used for services in this agreement: "Consent for the collection and sharing of client information to providers for persons living with HIV under the Ryan White Program provided through (grantee name) is mandated to collect certain personal information that is entered and saved in a database system called CAREWare. I understand that some limited information in the electronic data-may-be-shared-with-other-agencies-if-they-also provide me with services-and are_- part of the same care and data network for the purpose of informing and coordinating my treatment and benefits that I receive under this Program. CAREWare records are maintained in an encrypted and secure statewide database. The CAREWare database program allows for certain medical and support service information to be shared among providers involved with my care, this includes but is not limited to health information, medical visits, lab results, medications, case management, transportation, substance abuse, and mental health counseling. I acknowledge that if I fail to show for scheduled medical appointments, I may be contacted by an authorized representative of (grantee name) in order to re-engage and link me back to care." 5. The Grantee will complete the collection of all required data variables and clean-up any missing data or service activities by the 10th day after the end of each calendar month. 6. Grantee quality management activities should: a. Incorporate the principles of continuous quality improvement, including agency leadership and commitment, staff development and training, participation of staff from all levels and various disciplines, and systematic selection and ongoing review of performance criteria, including consumer satisfaction; and b. Include consumer engagement which includes, but is not limited to, agency-level consumer advisory board, participation on quality management committee, focus groups and consumer satisfaction surveys. 7. In accordance with continuous quality improvement principles, the Grantee shall conduct at least one quality improvement project throughout the year, using the Plan-Do-Study-Act method to document progress. J. Reporting 'I. The Grantee shall submit the following reports on the following dates: All Agencies: Ryan White Monthly 10th of the following Enter into services delivered to HIV- month CARE Ware infected and affected clients All Ryan White federally Annual funded agencies: Ryan White Services Report (RSR) All Ryan White federally Annual Generally, Grantee Enter into submission will open CAREWare in early February and close early March. December 31, 2018 Email report to .Report. Period Due Date( s) How to Submit. Regert - MDHHS- HIVSTDoperations@ michigan.gov funded agencies providing at least one core medical service: Quality Management Plan All Ryan White federally 10/1/18- As completed over Email report to funded agencies: Complete and submit at least one Plan- Do-Study-Act worksheets correlated to Quality 9/30/19 contract year MDHHS- HIVSTDoperations@ michigan.gov Management Plan All Ryan WhItiPthfB federally funded agencies: 10/1/18 - 9/30/19 -November 30, 20113--Ernal1 report to MDHHS- Planned Allocation by Service Category H1VSTDoperations@ michigan.gov All Ryan White federally 10/1/18 - April 30, 2019 Email report to funded Part B agencies: 3/31/19 MDHHS- Allocation of Actual Expenditures by Service HIVSTDoperations© michigan.gov Category All Ryan White B federally 4/1/19 - November 30, 2019 Email report to funded agencies: Allocation of Actual Year End Expenditures by Service 9/30/19 MDHHS- HIVSTDoperations@ michigan.gov Category All Ryan White federally Quarterly January 30, 2019 Attach to Financial funded agencies: April 30, 2019 Status Report in Administrative Costs and July 30, 2019 EGrAMS Program Income December 15, 2019 All Ryan White federally funded agencies: RW Form Annually December 31, 2018 Uploaded to EGrAMS Portal Agency Profile 2100 and RW Form 2300 2. To complete the Ryan White Services Report (RSR), a Health Resources and Services Administration (HRSA) required annual data report, the Grantee must assure that all CAREWare data is complete, cleaned, and entered into an online form via the HRSA Electronic Handbook. RSR submission requirements include: a. The RSR shall have no more than 5% missing data variables. b. Exact dates for the Grantee submission will be provided by the Department each reporting year. c. The Department validates the data within the Grantee's RSR submission before receipt by HRSA. 3. Reports and information shall be submitted to the Contract Manager. Please refer to the table in Section A for where to submit reports and information. 4. The Contract Manager shall evaluate the reports submitted for their completeness and accuracy. 5. The Grantee shall permit the Department or its designee to visit and to make an evaluation of the project as determined by the Contract Manager. 6. If the Grantee is federally funded for Ryan White services and provides at least one core medical service, the Grantee will develop a Quality Management (QM) Plan and submit no later than December 31, 2018. QM Plans must contain the eleven required components: a. Quality statement b. Quality infrastructure C. Annual quality goals d. Capacity building e. Performance measurement f. Quality improvement g. Engagement of stakeholders h. Procedures for updating the QM plan Communication Evaluation k. Work plan K. Record Maintenance/Retention The Grantee will maintain, f6Thiiiimum of five (b) years aftertlie-erid of the grant perioch,rogram, fiscal records, including documentation to support program activities and expenditures, under the terms of this agreement, for clients residing in the State of Michigan. K. Software Compliance I. The Grantee and its subcontractors are required to use the HRSA-supported software CAREWare to enter client and service data into the centrally managed database on a secure server. The Grantee must: a. Enter all Ryan White services delivered to HIV-infected and affected clients. b. Enter all data by the 10th of the following month. c. Complete collection of all required data variables and the clean-up of any missing data or service activities by the 10th of the following month, II. The Grantee must establish written procedures for protecting client information kept electronically or in charts or other paper records. Protection of electronic client-level data will minimally include: a. Regular back-up of client records with back-up files stored in a secure location. b. Use of passwords to prevent unauthorized access to the computer or Client Level Data program. c. Use of virus protection software to guard against computer viruses. d. Provide annual training to staff on security and confidentiality of client level data and sharing of electronic data files according to MDHHS policies concerning Sharing and Secured Electronic Data. III. Provide annual training to staff on security and confidentiality of client level data and sharing of electronic data files according to MDHHS policies concerning sharing and Secured Electronic Data, IV. New staff needing access to CAREWare are required to email a form to MDHHS- CAREWarpSu art michi an. ov. The Grantee shall deactivate CAREWare users who are terminated or who have separated from the agency within 30 days, or notify MDHHS within this time frame. M. Mandatory Disclosures 1. The Grantee will provide immediate notification to the Department, in writing, in the event of any of the following: a. Any formal grievance initiated by a client and subsequent resolution of that grievance. b. Any event occurring or notice received by the Grantee or subcontractor, that reasonably suggests that the Grantee or subcontractor may be the subject of, or a defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or Grantee or subcontractor employees. c. Any staff vacancies funded for this project that exceed 30 days. 2. This information may be emailed to MDHHS-HIVSTIDo erations • michi an. ov. DEPARTMENT REQUIREMENTS H. Technical Assistance The Department will provide technical assistance (TA), as requested, on the implementation of the Ryan White program. This may include issues related to: CAREWare, Quality Management, Ryan White B services, Ryan White Part B MAI services, Budget/Fiscal, Grants and Contracts, ADAP, or other activities related to carrying out Ryan White activities. To request TA, please send an email to MDHHS- HIVSTDoperationsPrnichigansiov. ASSURANCES A. Compliance with Applicable Laws I. The Grantee should adhere to all Federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination, and confidentiality. Ryan White is payer of last resort; as such, the Grantee must adhere to the Ryan White HIV/AIDS Treatment Extension Act. Performance Level (if N/A Applicable) HIV/STD PARTNER SERVICES PROGRAMS Iltt111111111111 I Grant Start Date Grant Contract Administrator Contact Info (phone & email) _ Reimbursement Method 10/1/2018 1 Grant End Date Jennifer Linzmeier 517-241-5861 linzmeier©nnichigan.gov Staffing (6) 9/30/2019 Subrecipient, Contractor, Subrecipient or. Recipient (non-federal) Designation Performance Target N/A Output Measure BUDGET AND AGREEMENT REQUIREMENTS N/A STATEMENT OF WORK Central Michigan District Health Department will provide STD and HIV partner services (PS) for select low morbidity health departments within the State of Michigan in accordance with program standards and Department oversight. GRANTEE REQUIREMENTS L. Publication Rights 1 When issuing statements, press releases, requests for proposals, bid solicitations and other documents describing projects or programs funded in whole or in part with Federal money, the Grantee receiving Federal funds, including but not limited to State and local governments and recipients of Federal research grants, shall clearly state: a. The percentage of the total costs of the program or project that will be financed with Federal money. b. The dollar amount of Federal funds for the project or program, c. Percentage and dollar amount of the total costs of the project or program that will be financed by non-governmental sources. 2. The Grantee will submit all educational materials (e.g., brochures, posters, pamphlets, and videos) used in conjunction with program activities to the Department for review and approval prior to their use, regardless of the source of funding used to purchase these materials. These materials should be emailed to MDHHS-HIVSTDOperationsAmichiqan.qov. M. Grant Program Operation 1. Pursuant to a protocol established by the Department, the Grantee will provide positive test notification, HIV/STD and syphilis partner counseling and referral services, victim notification and recalcitrant investigation for the following local health departments: Bay County Health Department, Benzie- Leelanau District Health Department, Central Michigan District Health Department, Chippewa County Health Department, Dickinson-Iron District Health Department, District Health Department # 2, District Health Department #4, District Health Department #10, Grand Traverse County Health Department, Luce-Mackinac-Alger- Schoolcraft District Health Department, Marquette County Health Department, Mid- Michigan District Health Department, Midland County Health Department, Northwest Michigan Community Health Agency, Public Health, Delta and Menominee Counties, and Western Upper Peninsula District Health Department. 2. The Grantee will establish, maintain and document (e.g., via MOU or MOA) linkages with community resources that are necessary and appropriate to addressing the needs of clients and that are essential to the success and effectiveness of services supported under this agreement. 3. The Grantee will provide these services fifty-two weeks a year. 4. The Grantee will participate in the Department needs assessment and planning activities, as requested. 5. The Grantee will participate in regular Grantee meetings which may be face-to-face, teleconferences, webinars, etc, The Grantee is highly encouraged to participate in other training offerings and information-sharing opportunities provided by the Department. 6. Each employee funded in whole or in part with federal funds must record time and effort spent on the project(s) funded. The Grantee must: a. Have policies and procedures to ensure time and effort reporting. _Ja_Assam the staff member clearly identifies the percentage of time devoted to contract activities in accordance with the approved budget. c. Denote accurately the percent of effort to the project. The percent of effort may vary from month to month, and the effort recorded for Ryan White funds must match the percentage claimed on the Ryan White FSR for the same period. d. Submit a budget modification to the Department in instances where the percentage of effort of contract staff changes (FTE changes) during the contract period. 7. The Grantee will complete the collection of all required data variables and clean-up any missing data or service activities by the 10th day after the end of each calendar month. D. Reporting 1. The Grantee shall submit the following reports on the following dates: Report- . P 1 d - Due Date(s): . How to Submit Report , Enter in EvalWeb HIV testing notification/services to delivered to individuals Monthly lOth of the followina - month Partner Services delivered to individuals Within 72 hours 10th of the following month Enter in PSWeb Syphilis Partner Counseling and Referral Within 72 hours Within 72 hours MDSS 2. The Contract Manager shall evaluate the reports submitted for their completeness and accuracy. 3. The Grantee shall permit the Department or its designee to visit and to make an evaluation of the project as determined by the Contract Manager. E. Record Maintenance/Retention 1. The Grantee will maintain, for a minimum of five (5) years after the end of the grant period, program, fiscal records, including documentation to support program activities and expenditures, under the terms of this agreement, for clients residing in the State of Michigan. 2. The Grantee will maintain client records of HIV Positive or Negative with Syphilis diagnosis. MDHHS recommends that this information be retained indefinitely or until it is determined the client is deceased. J. Software Compliance 1. The Grantee will adhere to reporting deadlines for all contractual Grantee Reporting requirements. 2. The Grantee is required to use the following data systems to enter HIV and Syphilis case investigation data: EvalWeb, PSWeb, Michigan Disease Surveillance System (MDSS) a. All reactive results must be entered into EvalWeb within 48 hours b. All non-reactive results must be entered into EvalWeb within seven days C. All EvalWeb/PSWeb must be entered and missing variables entered by the 10th day after the end of each calendar month. 3. The Grantee must establish written procedures for protecting client information kept electronically or in charts or other paper records. Protection of electronic client-level data will minimally include: e. Regular back-up of client records with back-up files stored in a secure location. f. Use of passwords to prevent unauthorized access to the computer or Client Level Data program. g. Use of virus protection software to guard against computer viruses. h. Provide annual training to staff on security and confidentiality of client level data and sharing of electronic data files according to MDHHS policies concerning Sharing and Secured Electronic Data. N. Mandatory Disclosures 1. The Grantee will provide immediate notification to the Department, in writing, in the event of any of the following: a. Any formal grievance initiated by a client and subsequent resolution of that grievance. b. Any event occurring or notice received by the Grantee or subcontractor, that reasonably suggests that the Grantee or subcontractor may be the subject of, or a defendant in, legal action. This incluAes but is not limited to, events or notices related to grievances by service recipients or Grantee or subcontractor employees. c. Any staff vacancies funded for this project that exceed 30 days. 2. This information may be emailed to MDHHS-HIVSTDoperations@michioan.qov. DEPARTMENT REQUIREMENTS F. Monitor Compliance The Department will review EvalWeb, PSWeb, and/or MDSS database entries on a quarterly basis, at minimum. Questions or clarifications, if any, will be requested within thirty (30) calendar days of submission due date. H. Technical Assistance The Department will provide technical assistance (TA), as requested. TA requests may include issues related to: EvalWeb, PSWeb, MDSS, Quality Assurance, Programs, Budget/Fiscal, Grants and Contracts, or other activities related to carrying out HIV Prevention activities. To request TA, please send an email to MDHHS- HIVSTDoberationsmichiqanoov. ASSURANCES B. Compliance with Applicable Laws I. The Grantee should adhere to all Federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination, and confidentiality. INFANT SAFE SLEEP SPECIAL REQUIREMENTS Grant Start Date Grant Contract Administrator 10/1/2018 Colleen Nelson Grant End Date 9/30/2019 Contact Info (phone & email) Reimbursement Method - Performance Level (if •1 Applicable4 517-335-1954; nelsonc7@michigan.gov Subrecipient or Contractor I Subrecipient .1 Designation F j. nO • ram Performance Target Output N/A Staffing (6) N/A Budget and agreement requirements 1 The grantee must provide educational activities, conduct community outreach efforts and/or expand community awareness of infant safe sleep. These efforts must adhere to the updated policy statement titled "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment" issued by the American Academy of Pediatrics in October, 2016. Activities are to be culturally relevant to at-risk, high-risk families in the community and reflect diversity in terms of race, ethnicity, language, and socioeconomic status. 2. The grantee must participate in and/or coordinate a local advisory team or regional group to coordinate efforts to promote infant safe sleep and reduce infant deaths related to unsafe sleep environments. 3. Funds may be used for the purchase of demonstration and/or educational items. Additionally, a maximum of 15% of the funding may be used for giveaway items that are directly related to infant safe sleep such as cribs, pack-and-plays, and/or sleep sacks. A maximum of 15% of the funding may be used for advertising, including billboards, bus signage and the purchase of radio, TV, and/or print media. 4. The grantee must adhere to the approved work plan. GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS Provide technical assistance and consultation to the grantee. The Contract Manager will review reports, described under reporting requirements, for their completeness and adequacy. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 1. LHD will attach completed "Infant Safe Sleep Mini-Grant Work Plan" to the indirect cost line of the budget for review and approval by the Infant Safe Sleep program. 2. Prior to the submission of the proposed work plan, LHD will participate in a meeting (by person or phone) with all mini-grantees facilitated by the Infant Safe Sleep Program to review current data, discuss infant safe sleep best practices and answer any questions related to mini grant requirements. 3. LHD will attach "Infant Safe Sleep Mini-Grant Work Plan" with reporting column completed and completed "Infant Safe Sleep Mini-Grant Report Grid" to the indirect cost line of the 2nd quarter FSR. The reporting period will cover October 1, 2018-March 31, 2019. The reports are due by April 30, 2019. 4. LHD will participate in a technical assistance call with the Infant Safe Sleep Program to review progress to date. 5. LHD will attach "Infant Safe Sleep Mini-Grant Work Plan" with reporting column completed and completed "Infant Safe Sleep Mini-Grant Report Grid" to the indirect cost line of the final FSR. The reporting period will cover April 1, 2019-September 30, 2019. The reports are due by October 31, 2019. N/A N/A Performance Target Output Measure Performance Level -- Of Applicable) Grant Start Date Grant Contract Administrator Contact Info (phone & email) 10/1/2018 Grant End Michelle Woolfe 517-335-1380; wollfm@michigan.gov Subrecipient, Contractor, Subrecipient___ or Recipient (non-federal) Designation • • Rei burs-errient Method ;-taffing--(&) 9130/2019 ... HOUSING OPPORTUNITIES FOR PERSONS LIVING WITH HIV/AIDS (HOPWA) Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS The grantee shall undertake, perform, and complete activities and services for the program as outlined in the Housing Opportunities for Persons with AIDS (HOPWA) Program Manual provided by the Department's Housing and Homeless Services Division. In addition, the grantee is expected to adhere to applicable federal laws, regulations, and notices including, but not limited to, the AIDS Housing Opportunity Act and 24 CFR Part 574 — Housing Opportunities for Persons with AIDS. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A Subrecipient, Contractor, Subrecipient or Recipient (non-federal) Desianatic • Performance Target Output Measure N/A IMMUNIZATION - FIELD SERVICE REPRESENTATIVES Special Requirements [Grant Start Date 10/1/2018 Grant End Date Grant Contract Robert Swanson Administrator Contact Info 517-335-8159; swansonr@michigan.gov 9/30/2019 • (phone & email). Reimbursement Staffing (6) Method Performance Level N/A (if Applicable) BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Field Representative Roles and Responsibilities- pistrict #10. Mara uette. and St. Clair Counties This position serves as a liaison, resource person and as a regional expert for local health jurisdictions regarding all the Department immunization programs and initiatives. 1. PROGRAM SUPPORT: A. Assist with the regional MCIR activities and act as a regional resource on MCIR processes and assessment protocols. B. Assist with the local implementation and monitoring of all state programs at the regional level- including IAP implementation, VFC, AFIX, Accreditation, Perinatal Hepatitis B, School / Childcare reporting, special projects and the INE program. C. Participate in planning for regional conferences, IAP Coordinator meetings, and other the Department programs and initiatives as needed. D. Assist state, regional and local epidemiologists and communicable disease staff as needed with VPD surveillance and outbreak control. 2. PROGRAM QUALITY ASSURANCE: A. Assist in the orientation of new IAP Coordinators. B. Work with local health departments to assess and increase immunization levels for all age groups, especially identifying and targeting pockets of need. C. Identify evidence-based strategies that support improved coverage levels in the region, including use of recall, coordination of LHD services, and provider and LHD staff education. D. Consult with the local health department on the immunization component of the accreditation process, including preparation for reviews and conducting a walk through or mock accreditation review. E. Consult with local coalitions and private stakeholders to promote immunizations and ensure consistent messages are relayed to the public. F. Consult with local health departments on the school and day care assessment process. G. Encourage or provide educational updates and interventions on all immunization issues with staff at local health departments, healthcare providers, school and childcare staff and other stakeholders. 3. PROGRAM COMPLIANCE: A, Monitor compliance with policies/legislation at national/state and local levels such as: 1. VFC program requirements and vaccine distribution 2. VAERS program 3. Public Health Code 4. Administrative Rules a. School and childcare legislation and reporting requirements b. MCIR legislation and rules C. Communicable Disease Rules 4. PROGRAM OVERSIGHT and PROGRAM REVIEW: 1. Perform oversight of the following programs with assigned local health departments. 2. Accreditation-Conduct reviews, and monitor corrective actions. 3. VFC including orientation to annual VFC site visit process, monitoring of VFC vaccine losses, submission of mandatory reports, annual LHD VFC site visits and quality assurance review of all provider public vaccine orders. 4. AFIX—including the required AFIX follow-up with VFC providers, and full implementation of recommendations. 5. Perinatal Hepatitis B-regional birth dose levels and universal vaccine program. 6. Review and summarize LHD IAP Annual Plans and Biannual IAP Reports. 7. Monitor LHD compliance with Comprehensive agreements and special requirements relating to the Immunization program. 8. Subrecipient monitoring of funds. DEPARTMENT REQUIREMENTS 1. As financially feasible, provide necessary adjunct clerical services to the Immunization Field Representatives for the duplicating/printing of materials and the packaging and distribution of these materials. 2. Provide program direction, responsibilities and definition of Immunization Field Service Representative responsibilities. 3. Support or solicit the Immunization Field Service Representative input into policy-making decisions. GRANTEE SPECIFIC REQUIREMENTS pistrict #10, Marauette and St. Clair Counties 1. Employ and oversee a full-time Immunization Field Representative for the Immunization Program who shall be acceptable to the Department and who shall be supported by this agreement, understanding that their full time is to be devoted for regional immunization related activities. 2. Provide the Immunization Field Representative with permanent office space and supplies, including, but not limited to: a telephone, general office supplies, a computer with high speed internet capabilities, a printer, a cellular telephone and a use of vehicle or reimbursement mechanism for transportation unless otherwise arranged. 3. Ensure the Immunization Field Representative will be available to all local health departments in the assigned regions to provide Immunization Program activities equitable and at the direction of the Department. Refer to field representative responsibilities as defined by the Department and distributed to the Grantee. 4. Provide for reimbursement for reasonable telephone charges incurred in the conduct of business by the Immunization Field Representative unless otherwise arranged. 5. Provide reasonable reimbursement for any travel and subsistence expenses incurred by the Immunization Field Representative necessary to the conduct of the Immunization Program. Travel could include the annual National Immunization Conference or other professional immunization related conferences, attendance at the Department Immunization staff meetings and trainings, and accreditation visits made in other areas of the state. Sent. Livingston and Monroe Counties 1. Provide adequate office space, telephone connections, and high-speed Internet access. Also provide access to fax and photocopiers. 2. Provide feedback to Division Director as needed, on employee work related conduct. IMMUNIZATION ACTION PLAN Special Requirements Grant Start Date Grant Contract Administrator. Contact Info (phone & emaft_ Reimbursement Method 10/1/2018 Grant End Date Robert Swanson 517-335-8159; swansonr@michigan.gov Staffing (6) S brecipient, Contractor, Subrecipient or Recipient (non-federal) resignation 9/30/2019 Performance Level N/A Performance Target N/A (:_f Applicable) Output Measure BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Service Delivery: Offer immunization services to the public. A. Collaborate with public and private sector organizations to promote childhood, adolescent and adult immunization activities in the county including but not limited to recall activities. B. Educate providers about vaccines covered by Medicare and Medicaid. C. Provide and implement strategies for addressing the immunization rates of special populations (i.e., college students, educators, health care workers, detention centers, homeless, tribal and migrant and child care employees). D. Develop mechanisms to improve jurisdictional and LHD immunization rates for children, adolescents and adults. E. Ensure clinic hours are convenient and accessible to the community, operating both walk-in and scheduled appointment hours. F. Coordinate immunization services, including WIC, Family Planning, and STD, developing plans or memorandums of understanding. G. Collaboratively work with regional MCIR staff to ensure providers are using MCIR appropriately. H. Develop strategies to identify and target local pocket of need areas. 2. Adhere to federal and state appropriation laws pertaining to use of programmatic funds. See Immunization Allowable Expenditures in Attachment I for appropriate use of Federal Funds. 3. Adhere to requirements set forth in the Omnibus Budget Reconciliation Act of '1993, section 1928 Part IV — Immunizations and the most current CDC Vaccines for Children Operations Manual, Michigan Resource Book for VFC Providers, and documents that are updated throughout the year pertaining to the Vaccines For Children (VFC) Program. 4. Ensure that federally procured vaccine is administered to eligible children only and is properly documented per VFC guidelines. A. The VFC Program provides VFC vaccine to only eligible children who meet the following criteria: are Medicaid eligible, have no health insurance, are American Indian or Alaskan Native, are served at a Federally Qualified Health Center (FQHC), a Rural Health Center (RHC) or a public health clinic affiliated with a FQHC and are also under-insured. B. Ensure state-supplied vaccines provided in the jurisdiction are administered only to eligible clients as determined by the state. This program allows for the immunization of select populations who are underinsured and not served at a FQHC, RHC, or a public health immunization clinic affiliated with a FQHC as defined by current state program requirements. C. Ensure that all providers receiving vaccine from the state screen children for VFC eligibility for children D. Fraud or abuse of federally procured vaccine should be monitored and reported. 5. Adhere to all Federal and Michigan Laws pertaining to immunization administration and reporting including reporting to the MCIR, VAERS and schools and daycare reporting nonrclinafe! the, suhmission of immuni7ation data from schools and child care centers in your jurisdiction and follow-up with programs providing incomplete or inaccurate data. Assure compliance levels are adequate to protect the public. 7. Provide education to the parents of children seeking a non-medical exemption in your jurisdiction. 8. Monitor any provider receiving federally procured vaccine including but not limited to VFC/AFIX site visit. 9. Ensure on-site attendance of at least 1 LHD immunization program staff to two (2) Immunization Action Plan (IAP) meetings each year. 10. Submit original FSR's to the Department on a quarterly basis. 11. IAP Reports are submitted electronically in accordance with due dates set by the Department. 12. IAP Plan will be submitted electronically using a template provided by the Department, in accordance with due dates set by the Department. 13. By April 1, of each year provide one copy of the provider enrollment form which includes a profile for each provider who receives vaccine from the state. These documents must be postmarked or filed electronically no later than April 1. 14. Implements Perinatal Hepatitis B program activities to prevent the spread of Hepatitis B Virus (HBV) from mother to newborn. A. Verify pregnancy status on all hepatitis B surface antigen (HBsAg) positive pregnant women of childbearing years (10-60 years of age.) B. Ensure HBsAg positive pregnant women are reported to the Perinatal Hepatitis B case manager and according to the Public Health Code. C. Coordinate Perinatal Hepatitis B case management activities between local health department, provider, and Perinatal Hepatitis B Case Manager to: 1. Ensure that all infants, born to women who are HBsAg positive receive hepatitis B vaccine and hepatitis B immune globulin (HB1G) within 12 hours of life, a complete hepatitis B vaccine series with post vaccination serology testing and program support services. 2. Ensure that all susceptible household and sexual contacts associated with HBsAg positive women receive appropriate testing, vaccination, and support services. D. Ensure birthing hospitals are able to offer hepatitis B vaccine to all newborns prior to hospital discharge by enrolling them in the Universal Hepatitis B Vaccination Program for Newborns. 15. Surveillance of vaccine preventable disease (VPD) activities: A. Ensure that all reportable diseases are reported to the Department in the time specified in the public health code and appropriate case investigation is completed. B. Conduct active surveillance when indicated (i.e. during an outbreak) and contact hospitals, laboratories, and/or other providers on a regular basis, C. Utilize VAERS to report all adverse vaccine reactions. DEPARTMENT REQUIREMENTS 1. The department will develop templates for submission of IAP reports and the annual lAP plan and provide feedback to the local health departments. 2. Provide technical assistance in establishing and operating immunization action plans. 3. Provide technical assistance in MCIR activities through regional coordinators. 4. Provide supportive services and resource identification when needed. 5. Provide financial support for Grantee and Community / Migrant Health Centers for Immunization in pocket of need (PON) areas. 6. Each LHD will have an annual VFC/AFIX site visit at each clinic by the Department. 7. Develop pre- ormattea tOOISA I I I IT GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A Grant Start Date Grant Contract Administrator . Contact Info (phone & Reimbursement Method Performance Level Appiicab19) Grant End Date • 9/30/2019 Robert Swanson I 517-3.35-8159; swansonr@michigan.gov Fixed Unit Kate or Recipient (non-federal) Designation: PerforthanCS:Targe OUtputMeatOre 10/112018 ..... N/A N/A IMMUNIZATION ASSESSMENT FEEDBACK INCENTIVE EXCHANGE (AFIX) FOLLOW-UP SITE VISIT Special Requirements BUDGET AND AGREEMENT REQUIREMENTS The rate of reimbursement per AFIX follow-up visit is $100 for an on-site personal visit to the provider office or $50 for a follow-up conducted through email or a phone call, with information e-mailed to the provider office, the Department AFIX staff must be 'copied' on these emails. GRANTEE REQUIREMENTS 1, Conduct AFIX follow-up with all VFC providers that receive an AFIXNFC site visit during the current year/cycle. 2. AFIX follow-up visits are required to occur within 3 — 6 months from date of VFC/AFIX site visit. Subsequent AFIX follow-up visits must continue using current Department guidelines. 3. Document all AFIX follow-up visit information in the AFIX Online Tool using current Department AFIX guidelines within 10 days of the AFIX follow-up visit. DEPARTMENT REQUIREMENTS 1. The Department will provide payment quarterly based on the fixed unit rate reimbursement mechanism upon completion and timely submission of the required documents mentioned above. 2. The Department will develop pre-formatted tools. The Department will provide support to the Grantees. 3. The Department will provide AFIX training webinar upon request by the LHD, will provide AFIX guidance at monthly VMC calls, IAP meetings and through the Department Immunization field representatives. 4. The Department will provide written AFIX guidance to agencies on current requirements to complete AFIX site visits. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS NA Performance Target Output Measure N/A N/A Performance Level A,pplicable) • II IMMUNIZATION VFC/AFIX SITE VISIT Special Requirements Grant _Start Date Grant Contract Administrator _ Contact Info (phone 8, email) Reimbursement 1 Method 10/1/2018 ._GrAntEnd Date. Robert Swanson 517-335-8'159; swansonr@michigan.gov Fixed Unit Rate (2) (7) • Subrecipient, Contractor, I Subrecipient or Recipient (non-federal) BUDGET AND AGREEMENT REQUIREMENTS 1. The rate of reimbursement is $150 for a VFC Enrollment or a VFC Only visit, $350 for a combined VFC/AFIX or birthing hospital visit. An enrollment visit is required for all new VFC enrolled provider sites. All LHD staff involved with any AFIX site visits must complete the Department AFIX training module, presented by the Department AFIX Coordinator, prior to conducting any AFIX visits. Annual VFC and AFIX visit guidance and review will be provided to each LHD at the 1AP Meetings and consult will be conducted by the Department Immunization Field Representative for each Grantee. 2. Local health departments must visit complete a VFC or VFC/AFIX site visit for every VFC provider every two years, using the date of their previous visit as a starting point. Visits must not exceed the two year time frame. Annual visits are encouraged, but must not be conducted sooner than 12 months from the previous visit date. Detroit Department of Health and Wellness Promotion Immunization Program is required to complete visits annually to 100% of the VFC providers in accordance with the SEMHA Quality Assurance Specialist (OAS) contractual obligations. Combined VFC/AFIX site visits will be conducted using registry based AFIX reports and AFIX tools developed by the Department. Follow-up of outstanding issues must be completed within CDC guidelines. 3. All reimbursement requests should be submitted on the quarterly Comprehensive Financial Status Report (FSR). The submission should include, as an attachment, detail all of the visits during the quarter using the spreadsheet information provided by the Department. The format of the site visit will be based on the complete site visit questionnaire and AFIX Online Tool reviewed at the most recent Fall 1AP meeting and the site visit guidance documents (VFC and AFIX) provided by the department and the CDC. All site visit information shall be entered into the appropriate database as required by CDC (PEAR and AFIX Online Tool) within 10 days of the site visit by the individual who conducted the site visit. IMMUNIZATION MICHIGAN CARE IMPROVEMENT REGISTRY (MCIR) REGIONAL Special Requirements 10/1/2018 Robert Swanson Grant End Date :1 9130/2019 Grant Start Date Grant Contract Administrator Contact info (phone & email 517-335-8159; swansonr@michigan.gov Reimbursement 'Staffing Method --Subreci-pient, Gentreeter; •.r€IEFFeefi3fe-F or Recipient (non-federal) Designation Performance Target N/A Output Measure Performance Level N/A (if Applicable) BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS The Grantee shall ensure the performance of the following activities on behalf of the Department to support the MC1R: 1. Promote and train providers and Health Care Organizations (HC0s) on all features of the MCIR Web application. 2. Support regional MC1R users by operating the regional help desk in accordance with Department approved procedures. 3. Monitor and develop strategies to increase private provider and HCO enrollment and participation in the MCIR which includes development of strategies to encourage all providers to fully participate with the MCIR, (such as sites of excellence awards). 4. Process all user/usage agreements, according to the Department's approved procedures, to create user accounts. 5. Implement and update marketing plans in support of increased provider and parent acceptance and use of the MCIR. 6. Keep regional users updated on MCIR status and system changes. 7. Conduct ad hoc reporting and querying on behalf of MCIR users. 8. Work with local health departments to establish a mechanism and internal process to assure persons who have died within their county are appropriately flagged in the MCIR. 9. Maintain a listing of HCO private and public immunization providers. This listing should be as comprehensive as possible and should include all providers in the region. 10. Conduct regular de-duplication activities to assure that duplicate records are removed from the MCIR as quickly as possible. 11. Process user petitions to change MC1R data according to Department approved procedures. 12. Monitor ongoing immunization data submission for all local health departments and private providers. 13. Conduct training functions as needed to assure that local health department staff can train and educate providers on how to access and submit data into MCIR. 14. Maintain a policy/procedure manual, approved by the Department. 15. Process and file all "opt out forms according to the Department approved procedures. 16. Attend regular MCIR regional Grantee/coordinator meeting. 17. Conduct Onboarding activities as required for providers submitting immunization data via 1-11.1 messaging to MCIR. 18. Perform quality assurance checks on the MCIR data for the region as prescribed by the Department. A i I h h•-•,•111 -• -as • • 0 - • •lethadologies_talclean p" thRir data. B. Provide assistance to the Department on User Acceptance Testing (UAT) when required to verify MCIR system releases of bug fixes and enhancements. C. Attend all UAT training sessions as required by the Department. 18. The Grantee shall provide to the MCIR Regional Coordinator: a) permanent office space; b) general office supplies; c) a land based telephone; d) a computer with high speed Internet capabilities; e) a printer; f) a cellular telephone; and g) use of a vehicle or in the alternative reimbursement mechanism for transportation unless otherwise arranged. 19. When sufficient funding is available, provide to the MCIR Regional Coordinator reimbursement for travel to attend the National Registry related meetings if approved by the Department. This includes travel related expenses concerning air fare, lodging, baggage processing, taxi services, etc. 20. Consult with the Department on any personnel or performance issues that could affect the above mentioned contract requirements. 21. Facilitate the Department's attendance in the interview process for hiring of a MCIR Regional Coordinator / MCIR staff. This process includes consultation with the Department regarding selection of interview candidates as well as participation in the hiring determination. DEPARTMENT REQUIREMENTS 1. Provide support and technical assistance to Regional staff. 2. Provide initial training and support to a MCIR Regional Coordinator 3. The Department shall evaluate submitted reports as described above for their completeness and adequacy. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 1. Ensure the quarterly submission of status reports on work plan progress. Reports are due within 30 days of the end of each quarter: Report Period Covered Report Due Dates October 1 — December 31 January 31 January 1 - March 31 April 30 April 1 - June 30 July 31 July 1 - September 30 October 31 2. Final quarterly report shall be an annual report. The annual report will be distributed to the Department and shall include: A. Summary of provider enrollment (breakdown by role); The amount of data submitted to the region during the fiscal year; C. Summary of staff resources; D. Sites of excellence award recipients. 3. Any other information as specified in the special requirements shall be developed and submitted by the Grantee as required by the Department. Reports and information should be submitted to: Bea Salada, MCI R Coordinator Michigan Department of Health & Human Services IMMUF11Zd 1011 Division P.O. Box 30195 Lansing, MI 48909 Phone: (517) 335-9340 The Grantee shall permit the Department or its designee to visit and to evaluate on an as- needed basis. Grant Start Date' Grant Contract 'AdMinistrattiri: 10/112018 Robert Swanson Grant End Date 1 9/30/2019 Contact Info (phone & email) Reimbursement hIVIethod 517-335-8159; swansonr@michigan.gov Staffing (6) Recipient BUDGET AND AGREEMENT REQUIREMENTS N/A N/A Performance Target Output Measure Performance Level (if Applicable) N/A Subrecipient Contractor, or Recipient (n6ii4e eral) Designation IMMUNIZATION - VACCINE QUALITY ASSURANCE PROGRAM Special Requirements GRANTEE REQUIREMENTS 1. Follow-up on vaccine losses and replacement for compromised vaccines for immunization providers within the jurisdiction. 2. Monitor and approve all temperature logs, doses administered reports, and ending inventory reports received from participating VFC providers within the jurisdiction, 3. Monitor and approve vaccine orders for participating VFC providers within the jurisdiction 4. Act as the Primary Point of Contact (PPOC) for VFC providers within the jurisdiction. 5. Provide education and intervention on inappropriate use of publicly purchased vaccine. 6. Follow-up on VFC site visit non-compliance issues. Assist VFC providers within the jurisdiction on issues related to balancing vaccine inventories. 8. Assist with the redistribution of short dated vaccine for providers within the jurisdiction. 9. Assist with the equitable allocation of vaccines to providers in the jurisdiction during a vaccine shortage. DEPARTMENT REQUIREMENTS 1. Monitor and approve all temperature logs, doses administered reports and ending inventory reports received from Grantees. 2. Monitor and approve vaccine orders for Grantees. 3. Consult with Local Health Departments on vaccine losses and assist as needed. 4. Act as the PPOC to Grantees. 5. Assist Grantees on education and intervention on the inappropriate use of publicly purchased vaccine. 6. Assist Local Health Departments on issues related to MC1R functionality and operation. 7. Assist Grantees with the redistribution of short dated vaccine. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A Grant Contract Administrator _ _ Contact Info (phone & email) Reimbursement Fixed Unit Rate (2) (7) Subreciplent, Contractor, Recipient or Recipient (non-federal) Designation Performance Level N/A Performance Target N/A (if Applicable) Output Measure Orlando Todd 517-284-4722; toddo@michigan.gov II INFORMED CONSENT Special Requirements Grant Start Date 10/1/2018 I Grant End Date 9/30/2019 1 BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS The following requirements apply to all Grantees, whether the Grantee operates a Family Planning Clinic or not: 1. When a woman states that she is seeking an abortion and is requesting services for that purpose the Grantee will provide: A pregnancy test with a determination of the probable gestational stage of a confirmed pregnancy. Note: The Grantee must destroy the individual "informed consent" files containing identifying information (Name, Address, etc.) after 30 days. 2. When a woman seeks a pregnancy test and does not explicitly state that she is doing so for the purpose of obtaining an abortion, she should be directed to a family planning clinic or to her primary care provider for a pregnancy test. Services to comply with PA 345 of 2000 should not be provided to a woman in a Title X funded family planning clinic. DEPARTMENT REQUIREMENTS The Department will provide funding, at the fixed rate of $50 per woman served, for each woman that expressly states that she is seeking a pregnancy test or confirmation of a pregnancy for the purpose of obtaining an abortion and is provided the services noted in item 1 above, The number of services, rate per service and total amount due must be noted as a funding source, under the element where the staff providing the services are funded, on the FSR through the Ml E-Grants system. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A Grant Start pate Grant Contract Administrator. 913012019 .. 517-335-8058; adawem@michigan.gov Subrecipient, Contractor, Subrecipient or Recipient (non-federal) Designation - Performance Target N/A Output Measure_ Performance Level N/A if Applicable) : LABORATORY SERVICES Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS A. Meet established standards of performance and objectives in the following areas: 1. Public Health Emergency Preparedness: a. Maintain a current list of contact information for local community hospital laboratories to facilitate communication. b. Facilitate response with local community hospital laboratories in preparation for and during public health threats. c. Coordinate and facilitate specimen collection and transport with facilities within jurisdiction. This may include specimen packaging and shipping and coordination with the courier service. d. Provide 24/7 contact information to hospital partners and BOL. e. Participate in and provide support for Department PHEP exercises with community hospital laboratories within jurisdiction. B. Provide the Bureau of Laboratories records and reports as required. The Grantee will designate one staff member as a liaison to the Bureau of Laboratories. Each Grantee must designate appropriate staff to take part in LI MS training activities. C. Provide information on specimen submission to local health jurisdictions to assure that specimens are submitted to the BOL LRN laboratory, or other appropriate LRN laboratory as determined by the Department. DEPARTMENT REQUIREMENTS Department Requirements -All Grantees: A. The Department will provide notifications and explicit instruction for stop and start days to Grantee laboratory regarding this contractual arrangement prior to its implementation. The Department will provide access to LIMS, support for LIMS hardware and software, user training for LIMS utilized for testing performed under contract, advanced training for LIMS liaisons for test master and Grantee specific data. The Department will maintain the sole contract with LIMS vendor. Backups and maintenance of all module(s)/customization(s) will be performed by the Department staff. C. Analyze data from reports submitted from Grantee. Supply timely feedback of statistical analysis and other data related to ongoing program activities. D. Assist in technical training of personnel and computer software utilization. E. Supply Grantee with a copy of the contracts associated with this program. Department Requirements - for Kalamazoo County Health & Community Services, Kent County Health Department and Saginaw County Department of Public Health only A. The Department: 1. Designate and assign personnel who meet the qualifications required as a high complexity laboratory director in CL1A 1988. 2. Laboratory Directors will: a. Sign the appropriate CMS paperwork for CLIA certification for their region as needed. b. Perform annual site visit of the Grantee high complexity laboratory and assist in CL1A surveys.• c. Be available for consultation to the Grantee laboratory by telephone, email, and other communication methods. d. Provide technical consultation for laboratory guidelines, testing procedures, quality control methods or quality assurance in accordance with CLIA requirements. e. Review Quality Assurance program with attention to effective quality control activity and corrective action. f. Review and sign training records and competency evaluations, g. Review and sign external proficiency testing results in a timely manner, h. Review and sign procedure manual(s) annually, and any new procedure prior to its implementation. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A Grant Start Date Grant Contract 10/1/2018 Grant End Date ,! 9/30/2019 Marji Cyrul 517-373-6486 CyrulM@michigan.gov ---I—Staffing-(6) (14)-(-1-8)-- Subrecipient, —Recipient_ Contractor, Of Recipient (non-federal Designation N/A • Performance..Targe. N/A Output Measure : Administrator Contact info .(phone.8, email) Method Performance Level Applicable) LACTATION CONSULTANT Special Requirements Budget and agreement requirements N/A GRANTEE REQUIREMENTS 1. Upon initiation of the FYI 8 contract, grantees must submit a Lactation Consultant work plan to CvrulM@michidan.dov. The work plan must include: a. Outcome objectives (a minimum of 2) for improved breastfeeding rates in Genesee County. b. Activities (a minimum of 3 per objective) that include names and numbers of specific populations targeted for interventions. c. The estimated cost, person responsible and deliverable quantifiable outcomes for each activity. 2. Work plans must be approved by the MDHHS State Breastfeeding Coordinator. 3. Changes to the work plan throughout the year can occur with prior approval from the MDHHS State Breastfeeding Coordinator. 4. All activities, as specified in the initial approved work plan, shall be implemented. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS Work plan submission required by 8/1/2018 REPORTING REQUIREMENTS 1. Work plan narrative reports must be submitted quarterly. The reports are due 30 days after each quarter and year end and include the following timeframes: a. Initial work plan due August 1, 2018. b. First quarter (covering period October 1, 2018 through December 31, 2019) is due January 30th• c. Second quarter report (covering period January 1, 2019 through March 31, 2019) is due April 30 th. d. Third quarter report (covering period April 1, 2019 through June 30, 2019) is due July 30th. e. Fourth quarter report (covering period July 1, 2019 through September 30, 2019) is due October 30, 2019. 2. MDHHS will provide specific instructions and a template for reporting on the work plan objectives and activities. 3. MDHHS State Breastfeeding Coordinator will evaluate the reports for their completeness and accuracy. LOCAL HEALTH DEPARTMENT (LHD) SERVICE SHARING SUPPORT Special Requirements .. . . . Grant Start Date Grant Contract Administrator Contact Info Vc.11..10 Reimbursement Method . Performance Level --AP_Vicabt.q Y. 10/1/2018 Grant End Date Orlando Todd 517-284-4021; toddo@michigan.gov Staffing (6) Subretipient or Contractor Designation . Performance Target Output I N/A 9/30/2019 Subrecipient Budget and agreement requirements Local health departments participating in the project will utilize funds to support activities pertinent to the exploration, preparation, planning, implementing, and improving sharing of local health department services, programs or personnel, GRANTEE REQUIREMENTS Local health departments must submit a continuation workplan and budget for continuation funding of the project 'Local Health Department Collaboration and Exploration of Shared Approach to Delivery of Services," Eligible Activities: A. Meeting activities, including time and travel costs B. Cost of research activities C. Supplies and presentation materials D. Legal fees and other professional services related to the project E. IT cost related to service sharing (grant funds may not be used to reimburse equipment costs) REPORTING REQUIREMENTS Grantees will receive notification of reports along with reporting templates. Reporting is twice per year based on reporting dates required by the CDC. 10/1/2018 r. Grant End Date Trudy Esch and Robin L. Orsbom 517-241-3593 (Trudy) 517-335-8976 (Robin) Maternal-Child-Health@michigan.gov Grant Start Date Grant Contract Administrator Contact Info (phone & email Reimbursement Staffing (6) Method . . .. ... . Performance Level if N/A pplicable) BObrOcipienti:: Contractor, or jerd400.44q40.0)„._. Dea:igtiatiO0 Performance Target :QUtptit, Measure Subrecipient N/A MDHHS- 9/30/2019 LOCAL MATERNAL AND CHILD HEALTH (MCH) PROGRAM Special Requirements Budget and agreement requirements 1. Projects to be supported by Local MCH in the Electronic Grants Administration and Management System (EGrAMS/MI E-Grants) are as follows: • Direct Services Children — MCH • Enabling Services Children — MCH • Direct Services Women — MCH • Enabling Services Women - MCH • Public Hith Functions & Infrastruct — MCH 2, The Local MCH Plan submission and due date will be communicated through a notification mailing. The department will provide the format for the LMCH Plan. The Local MCH Plan, approved by the department, is to be uploaded with the budget application. 3. Local MCH funding must be used to address the unmet needs of the maternal child health population and based on data and need identified through the Local Health Department community assessment process. 4. Activities and programs supported with Local MCH funds must be evidence based or evidence informed. Exceptions must be submitted in writing and pre-approved by MDHHS. 5. Local MCH funding cannot be used under the WIC element, except in extreme circumstances where a waiver is requested in advance of the expenditures and evidence is provided that the expenditures satisfy all funding requirements. 6. Local MCH funds may not be used to supplant available/billable program income such as Medicaid or Healthy Michigan Plan fees or additional funding under the Medicaid Cost-Based Reimbursement process. 7. Local Health Departments should leverage all other funding sources, especially third party payers (Medicaid, private insurers) before utilizing LMCH MCH block grant funds. LMCH funds are to be used for those services that cannot be paid for through other sources or for gap filling services. GRANTEE REQUIREMENTS LOCAL MATERNAL AND CHILD HEALTH A. Local MCH funds are available to support one or more of the Title V Maternal Child Health Block Grant national and state performance measures. B. Grantees must follow the FY 2019 Local MCH Plan Instructions to prepare the agency's Local MCH Plan. C. Grantees must follow the FY 2019 Local MCH Year-End Report Instructions to prepare the agency's Local MCH Year-End Report DEPARTMENT REQUIREMENTS The Department will develop templates for submission of LMCH year end reports and the annual local MCH plan, and provide feedback to the local health departments. The Department will provide technical assistance, as requested, in establishing local MCH action plans. The Department will monitor Grantee performance throughout the contract year, which will include a review of financial status reports, budget details, program plans and reports. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS The FY19 LMCH Year-End Report submission and due date will be communicated through a notification mailing. The department will provide the format for the LMCH Year-End Report. The Local MCH Year-End, approved by the department, is to be uploaded in EGrAMS with the final FSR. Grant Sta Date:' Subrecipient, Contractor, Subrecipient TOTRecti—Vertl-rizin:fetimi)- t Designation Performance Target. Output Measure N/A II LOCAL TOBACCO PREVENTION Special Requirements Grant Contract Administrator Contact Info (phone & email) Reimbursement Method ..PerforrlianCe.Levet.H.. (if Appticablel • I N/A 10/1/2018 Molly Cotant Grant End Date 9/30/2019 989-619-1304; cotantm@michigan,gov .! Staffing (6) BUDGET AND AGREEMENT REQUIREMENTS No funds may be expended for lobbying as defined in Act No. 472 of the Public Acts of 1978, being sections 4.411 to 4.431 of the Michigan Compiled Laws. GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Reports are due on a quarterly basis. Submit reports by the 15th of the month following the end of the quarter via email to Consultant (email to be provided) and a hard copy to MDHHS Tobacco Section (address listed below). Due Date: January 15 April 15 July 15 October 15 November 1 Report Period: October 1 — December 31 January 1 — March 31 April 1 — June 30 July 1 — September 30 Complete a narrative final report Mail a hard copy of the Report to: MDHHS Tobacco Control Program Washington Square Building, 8th Floor 109 West Michigan Avenue Lansing, MI 48913 MATERNAL INFANT CHILDHOOD HOME VISITING PROGRAM (MIECHVP) HEALTHY FAMILIES AMERICA EXPANSION Special Requirements Grant Start Date Grant Contract Administrator I 10/1/2018 Charisse Sanders Grant End pate I 9/30/2019 Sandersc2@michigan.gov / 517-241-1676 Staffing (6) SUbrepipient,-.. Stibrecipierit Contractor, or . Recipient (non federal) DeSignatton _ . Performance Level Of N/A Performance Target N/A ApplicabiA Output Measure Budget and agreement requirements N/A GRANTEE REQUIREMENTS Maintain Fidelity to the Model The Local Implementing Agency (LIA) shall adhere to the Healthy Families America (HFA) Best Practice Standards. P.A. 291 The LIA shall comply with the provisions of Public Act 291 of 2012. See the Michigan Home Visiting Initiative (MHVI) Guidance Manual for requirements related to PA 291. Staffing The LIA's HFA home visiting staff will reflect the community served. The LIA will provide documentation to demonstrate due diligence if unable to fully meet this requirement within 90 days of a MHVI site visit in which this was a finding. See the MHVI Guidance Manual for requirements related to program staffing. Comply with MHVI Program Requirements The LIA shall operate the program with fidelity to the requirements of the Michigan Department of Health and Human Services (MDHHS), as outlined in the MHVI Guidance Manual. Program Monitoring, Assessment, Support and Technical Assistance (TA): The LIA shall fully participate with the Department and the Michigan Public Health Institute (MPH1) with regards to program development and monitoring (including annual site visits), training, support and technical assistance services. See the MHVI Guidance Manual for requirements related to program monitoring, assessment, support and TA. Professional Development and Training: All of the LIA's HFA program staff associated with this funding will participate in professional development and training activities, as required by both HFA and the Department. All LIA HFA program staff must receive HFA- specific training from a Michigan-based approved HFA training entity. See the MHVI Guidance Manual for requirements related to professional development and training activities. Supervision: The LIA shall adhere to the HFA supervision requirements of weekly 1.5-2 hour individual supervision per 1.0 FTE and pro-rated as allowed by the Best Practice Standards. Engage and Coordinate with Community Stakeholders: The LIA shall assure that there is a broad-based community advisory committee that is providing oversight for HFA. The LIA shall build upon and maintain diverse community and target population collaboration and support. The LIA shall participate in the Local Leadership Group (LLG) (if not the HFA community advisory committee) or, if none, in the Great Start Collaborative. See the MHVI Guidance Manual for requirements related to engagement and coordination with community stakeholders. Data Collection: The LIA shall comply with all HFA and MDHHS data training, collection, entry and submission requirements. See the MHV1 Guidance Manual for requirements related to data collection. Continuous Quality Improvement (CQI): The LiA shall participate in all HFA quality initiatives including: research, evaluation and continuous quality improvement. The LIA shall participate in all State and local Home Visiting CQI activities as required by MDHHS. Required activities include, but are not limited to: a. QI team participating in one Quality Improvement (QI) Learning Collaborative per fiscal year, with all required training, reporting requirements and deliverables. b. Conducting and completing two LIA-specific PDSA cycles per fiscal year, with all required reporting and —deliverable-s-. See the MHVI Guidance Manual for requirements related to CQI. Work Plan Requirements: Upon initiation of the contract, the LIA must submit a Work Plan (inclusive of an Outreach Plan and outlining all program activities) to the MHVI mailbox at MDHHS-HVInitiativemichioan.00v. See the MHVI Guidance Manual for information related to Work Plan requirements. Promotional Materials: If the LIA wishes to produce any marketing, advertising or educational materials, using contract funds, they must follow the requirements outlined in the MHVI Guidance Manual. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS The LIA shall serve the target population approved by the MDHHS, which supports the findings of their community's Needs Assessment. a. The Kalamazoo County Health And Community Services Dept. HFA program will serve 60 families with children who are at high risk in the areas of Comstock Township, City of Kalamazoo-Arcadia, Vine, Eastside neighborhoods, Richland Township, City of Portage, Texas Township, Oshtemo and Galesburg. b. The Wayne County Babies HFA program will serve 50 families who are young parents, through age 24, living in the cities of Hamtramck, Highland Park, Redford, Inkster, Taylor, Romulus, Van Buren Township and Westland, See the MHVI Guidance Manual for requirements related to the development of a Work Plan and the timeframe for reaching full caseloads. REPORTING REQUIREMENTS The LIA shall submit all required reports in accordance with the Department reporting requirements. See MHVI Guidance Manual for details about what must be included in each report. a. Staff Roster: within 30 days of the beginning of each fiscal year and within 30 days of a staffing change. b. HFA Work Plan that includes a community Outreach Plan: within 30 days of the beginning of each fiscal year. c. Family Stories: at a minimum, one home visiting experience, as told from the perspective of a currently enrolled family, within 30 days of the end of each quarter (January 30, April 30, July 30 and October 30). d. Work Plan Reports: must be submitted within 30 days of the end of each quarter (January 30, April 30, July 30 and October 30) and include detailed and specific activities that have taken place during the quarter including updates regarding the Outreach Plan. All reports (a-d) and information shall be submitted electronically to the MHVI mailbox at MDHHS- HVInitiativeAmichiciansiov. e. Implementation Monitoring Date and HRSA data collection requirements on the 5th business day of each month, f. Continuous Quality Improvement reporting for the Learning Collaborative due on the 15th of each month. g. Continuous Quality improvement reporting for LA-specific projects due by the 15 th-of the .month following the end of the quarter (January 15, April 15, July 15 and October 15), All reports (e-g) shall be submitted to the appropriate MPHI staff as designated in the MVHI Guidance Manual. 10/112018 Charisse Sanders Grant End Date 9/30/2019 517-241-1676; sandersc2@michigan.gov --Staffing -(6) - —Subrecipient-,—Gontracter r •Subrecipient or Recipient (non-federal) Designation Contact Info (phone & email) RWlinburserrieb-r Method Performance Target Output Measure N/A Grant Start Date Grant Contract Administrator Perforrnance Level -(if Applicable) . N/A MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING INITIATIVE (MIECHV) LOCAL HOME VISITING LEADERSHIP GROUP Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Comply with MHVI Program Requirements: The Grantee shall operate the program with fidelity to the requirements of the Department, as outlined in the Michigan Home Visiting Initiative (MHV1) Guidance Manual. 1. The Local Leadership Group (LLG) will work with the MDHHS contractors: Early Childhood Investment Corporation (ECIC) and the Michigan Public Health Institute (MPH l). See the MHVI Guidance Manual for details related to working with EC1C and MPHI. 2. The LLG will continue efforts started in years one, two and three. a. Continue to ensure recruitment and participation of both required and strongly encouraged LLG representatives. b. Continue to implement one strategy from the respective community's local home visiting continuum of models project plan c. Continue to participate in the LLG Quality Improvement Learning Collaborative to identify strategies and activities for the purposes of improving outreach and enrollment in evidence- based home visiting. d. Develop a sustainability plan in order to continue the work of evidence-based home visiting in the future. 3. In year four, the LLG will begin to develop a sustainability plan. See the MHVI Guidance Manual for requirements related to LLG membership/participation, development of a continuum and CQI as well as development of a sustainability plan. Funding Requirements: The funding can be used to: 1. Enable the LLG to pay for staff support. 2. Financially support LLG members, including parent leaders, to be a part of the LLG. 3. Carry out the MHVI activities, as specified in this agreement. Promotional Materials If the LLG wishes to produce any marketing, advertising or educational materials, using contract funds, they must follow the requirements, as outlined in the MHVI Guidance Manual. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS The Grantee shall submit the following reports: 1. All activities as specified in the work plan shall be implemented and quarterly narrative reports submifted to the MHVI Mailbox at MDHHS-HVInitiativ@michigan.gov . See the MHVI Guidance Manual for specific detail about what must be provided in the reports. 2. Any such other information as specified in the work plan shall be developed and submitted by the Grantee, as required by the Contract Manager. 3. See the MHVI Guidance Manual for specific CQI reporting requirements, to include: monthly data tracking and Plan, Do, Study, Act (PDSA) cycle updates (due the 15 th of each month), Story Board and Team Charter submissions. 4. Any other required reports or information are to be submitted electronically to the MHVI MHVI Mailbox at MDHHS-HVInitiativ@michigan.gov . 5. The Contract Manager shall evaluate the reports submitted as described for their completeness and adequacy. 6. The Grantee shall permit the Department or its designee to visit and to make an evaluation of the project, as determined by the Contract Manager. :F9/30/2019 Grant End Da e 10/1/2018 G rant Start iDate Griaot.cootrA4 Administrator 51.7-2414676 sandersa@mialigan.gov Subrecipient, Contractor, or Recipient (non-federal) Designation 'Contact Info (phone 8, email) Reimbursement I Method Subrecipient MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING INITIATIVE (MIECHV) RURAL LOCAL HOME VISITING LEADERSHIP GROUP (MHVRLH) MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING INITIATIVE (MIECHV) RURAL LOCAL HOME VISITING LEADERSHIP GROUP 3 (MHVRLH3) Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS Comply with MHVI Program Requirements: The grantee shall operate the program with fidelity to the requirements of the Michigan Department of Health and Human Services (MDHHS), as outlined in the Michigan Home Visiting Initiative (MHVI) Guidance Manual. '1. The Local Leadership Group (LLG) will work with the MDHHS contractors: Early Childhood Investment Corporation (ECIC) and the Michigan Public Health Institute (MPH). See the MHVI Guidance Manual for details related to working with ECIC and MPHI. 2. The LLG will continue efforts started in previous years. a. Continue to ensure recruitment and participation of both required and strongly encouraged LLG representatives. b. Continue to implement one strategy from the respective community's local home visiting continuum of models project plan c. Continue to participate in the LLG Quality Improvement Learning Collaborative d. Develop a sustainability plan in order to continue the work of evidenced-based home visiting in the future. See the MHVI Guidance Manual for requirements related to LLG membership/participation, development of a continuum and CQI as well as development of a sustainability plan. Funding Requirements: The funding can be used to: 1. Enable the LLG to pay for staff support. 2. Financially support LLG members, including parent leaders, to be a part of the LLG. 3. Carry out the MIECHV activities, as specified in this agreement. Promotional Materials If the LLG wishes to produce any marketing, advertising or educational materials, using contract funds, they must follow the requirements, as outlined in the MHVI Guidance Manual. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS The Grantee shall submit the following reports: All activities as specified in the work plan shall be implemented and quarterly narrative reports submitted to the MHVI mailbox at MDHHS-HVInitiativemichioan.gov . . See the Guidance Manual for specific detail about what must be provided in the reports. 2. Any such other information as specified in the work plan shall be developed and submitted by the Contractor, as required by the Contract Manager. 3. See the MHVI Guidance Manual for specific CQI reporting requirements, to include: monthly data tracking and Plan, Do, Study, Act (PDSA) cycle updates (due the 15 th of each month), Story Board and Team Charter submissions. 4. Any other required reports or information are to be submitted electronically to the MHVI mailbox at MDHHS-HVInitiative@michioan.gov 5. MHVI staff shall evaluate the reports submitted as described for their completeness and adequacy. 6. The Grantee shall permit the Department or its designee to visit and to make an evaluation of the project, as determined by the MHVI staff. 9/30/2019 Grant End Date 10/1/2018 Robin L. Orsborn MDHHD- 517-335-8976 / orsbornr@michigan.gov/ Medicaid-Outreach@michi9an.gov Staffing (6) Subrecipient, Contractor, or Recipient (non -federal) Designation 'Perfortnan CeLeVet(ifi: •,•••••••••:.:- •••• • •• • • • . Applicable); MEDICAID OUTREACH Special Requirements Budget and agreement requirements Medicaid Outreach activities are performed to inform Medicaid beneficiaries or potential beneficiaries about Medicaid, enroll individuals in Medicaid and improve access and utilization of Medicaid covered services. All outreach activities must be specific to Medicaid. Additional instructions can be found in Attachment I. GRANTEE REQUIREMENTS Submit quarterly reports no later than 1 month after the end of the quarter. The exception is the 4th quarter report which is due at the time as the final FSR. If the report due date falls on a weekend or holiday, you have until the next business day to submit. Quarter 1 St 2nd 3rd 4th Reporting Period October 1 — December 31 January 1 — March 31 April 1 — June 30 July 1 — September 30 Due Date January 31 April 30 July 31 December 15 The department will provide the format for the quarterly report. The quarterly report can be submitted to MDHHS-Medicaid-OutreachaMichigan.00v OR attached to a source of funds line in MI E-Grants system (EGrAMS). The quarterly reports, however, must be submitted before the FSR will be approved. • Reimbursements occur based on actual expenditures reported on Financial Status Reports (FSR) using the reporting format and deadlines as required by the Department through EGrAMS. DEPARTMENT REQUIREMENTS 1. The Department will provide the template for submission of Medicaid Outreach quarterly reports. 2. The Department will provide technical assistance, as requested. 3. The Department will monitor Grantee performance throughout the contract year, which will include a review of financial status reports, budget details, and quarterly reports. N/A Performance Target Output Measure N/A Performance Level Applicable) Grant Start Date Grant Contract Administrator Contact Info (phone & email) 10/1/2018 , Grant End Date Hillary Brandon 517-335-5928; brandonh@michigan.gov 9/30/2019 Reimbursement Method Staffing (6) Subrecipient, Contract() or Recipient (non-federal Designation Subrecipient MICHIGAN ADOLESCENT PREGNANCY & PARENTING PROGRAM (MI- APPP) Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 2. Implement approved Adolescent Family Life Project-Positive Youth Development (AFLP-PYD) case management program for pregnant and parenting teens and fathers 15-19 years of age. Activities that are solely recreational or social shall not be included. 2, Develop and/or maintain a local steering committee representative of the diversity of the community, including pregnant/parenting mothers and fathers, who are instrumental in all phases of the program planning, implementation and evaluation. The steering committee must meet at least quarterly throughout the funding period. 3 If programming will be provided by a subcontractor, a Letter of Understanding (LOU) detailing the responsibilities to which both parties agree must be completed. 4. Secure local matching funds (either cash or in-kind resources) totaling 20% or more of the amount requested. 5. In addition to those mentioned here, the Grantee must adhere to its approved program work plan and all of the MI-APPP Minimum Program Requirements (MPRs). 6. A minimum of 90% of the proposed users must be served to access the total amount of allocated funds. 7. Information provided must be medically accurate, age appropriate, culturally relevant and up to date. 8. Programs must complete, following the approved implementation guidelines, the MI-APPP participant tracking database and submit to MPHI quarterly. a Programs must administer, following the approved implementation guidelines, the MI-APPP youth intake and exist forms and enter required information into MI-APPP database and submit to MPH] quarterly. 10. Pregnancy prevention education must be delivered separate and apart from any religious education or promotion. MI-APPP funding cannot be used to support inherently religious activities including but not limited to, religious instruction, worship, prayer or proselytizing (45 CFR Part 87). 11. Family planning drugs and/or devices cannot be prescribed, dispense or otherwise distributed on school property as part of the pregnancy prevention education funded by MI-APPP as mandated in the Michigan School Code. 12. Abortion services, counseling and/or referrals for abortion services cannot be provided as part of the pregnancy prevention education funded under MI-APPR 13. MI-APPP funding cannot be used to supplant funding for an existing program supported with another source of funds. 14. All program and financial reports must be submitted by the deadlines specified by the Department in the report face sheet. DEPARTMENT REQUIREMENTS 1. Provide administrative professional and technical consultation to the program. 2. Provide two, two-day MI-APPP sponsored learning collaborative two times per year. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 1. The Grantee shall submit program and evaluation progress reports on the following dates: Type of Report and Timeframe Due Date Quarterly Report, Narrative (October 1 — December 31) January 30 Quarterly Report, Narrative (January 1 — March 31) April 30 Quarterly Report, Narrative (April 1 — June 30) July 30 Quarterly Report, Narrative (July 1 — September 30) October 30 Program Participant Data (Monthly) Submit the 7th of the Following Month 2. Any such information as specified in the contract requirements and MI-APPP Report Fact Sheet shall be developed and submitted by the Grantee as required by the Contract Manager. 3. Reports and information shall be submitted to the Contract Manager at Hillary Brandon, MI-APPP Program Coordinator Michigan Department of Health & Human Services 109W. Michigan Ave., 1st Floor P.O. Box 30195 Lansing, MI 48913 4. The Contract Manager shall evaluate the reports submitted for their completeness and adequacy. 5. The Grantee shall permit the Department or its designee to visit and to make an evaluation of the projects as determined by the Contract Manager. MI HOME VISITING INITIATIVE RURAL EXPANSION GRANT MI HOME VISITATION INITIATIVE RURAL EXPANSION GRANT REGION 3 SPECIAL REQUIREMENTS Grant Start Date —I 10/1/2018 Grant End•Date t 9130/2919 Grant Contract Administrator Contact Info i_(phone & email) Charisse Sanders Sandersc2@michigan gov / 517-241 -1676 Rehnbursement Method Staffing (6) Subrecipient, Contractor, or —Recipient (non-federal).— Designation Subrecipient • Performance Level (if N/A [ Applicable) • Performance Target N/A Output Measure Budget and agreement requirements N/A GRANTEE REQUIREMENTS Maintain Fidelity to the Model The Local Implementing Agency (LIA) shall adhere to the Healthy Families America (HFA) Best Practice Standards. PA. 291 The LIA shall comply with the provisions of Public Act 291 of 2012. See the Michigan Home Visiting Initiative (MHVI) Guidance Manual for requirements related to PA 291, Staffing The LIA's HFA home visiting staff will reflect the community served. The LIA will provide documentation to demonstrate due diligence if unable to fully meet this requirement within 90 days of a MHVI site visit in which this was a finding. See the MHVI Guidance Manual for requirements related to program staffing. Comply with MHVI Program Requirements The LIA shall operate the program with fidelity to the requirements of the Michigan Department of Health and Human Services (MDHHS), as outlined in theIVIHVI Guidance Manual. Program Monitoring, Assessment, Support and Technical Assistance (TA): The LIA shall fully participate with the Department and the Michigan Public Health Institute (MPHI) with regards to program development and monitoring (including annual site visits), training, support and technical assistance services. See the MHVI Guidance Manual for requirements related to program monitoring, assessment, support and TA. Professional Development and Training: All of the LIA's HFA program staff associated with this funding will participate in professional development and training activities, as required by both HFA and the Department. All LIA HFA program staff must receive HFA- specific training from a Michigan-based approved HFA training entity. See the MHVI Guidance Manual for requirements related to professional development and training activities. Supervision: The LIA shall adhere to the FHA supervision requirements of weekly 1.5-2 hour individual supervision per 1.0 FTE and pro-rated as allowed by the Best Practice Standards. Engage and Coordinate with Community Stakeholders: The LIA shall assure that there is a broad-based community advisory committee that is providing oversight for HFA. The LIA shall build upon and maintain diverse community and target population collaboration and support. The L1A shall participate in the Local Leadership Group (LLG) (if not the HFA community advisory committee) or, if none, in the Great Start Collaborative. See the MHVI Guidance Manual for requirements related to engagement and coordination with community stakeholders. Data Collection: The LIA shall comply with all HFA and MDHHS data training, collection, entry and submission requirements. See the MHVI Guidance Manual for requirements related to data collection. Continuous Quality Improvement (CQ11: The L1A shall participate in all HFA quality initiatives including: research, evaluation and continuous quality improvement. The LIA shall participate in all State and local Home Visiting CQI activities as required by MIDIIHS. Required activities include, but are not limited to: c. 01 team participating in one Quality Improvement (01) Learning Collaborative per fiscal year, with all required training, reporting requirements and deliverables. d. Conducting and completing two LIA-specific PDSA cycles per fiscal year, with all required reporting and deliverables. See the MHVI Guidance Manual for requirements related to CQI. Work Plan Requirements: Upon initiation of the contract, the LIA must submit a Work Plan (inclusive of an Outreach Plan and outlining all program activities) to the MHVI mailbox at MDHHS-HVinitiativeamichiqan.gov . See the MHVI Guidance Manual for information related to Work Plan requirements. Promotional Materials: lf the LIA wishes to produce any marketing, advertising or educational materials, using contract funds, they must follow the requirements outlined in the MHVI Guidance Manual. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS The LIA shall serve the target population approved by the MDHHS, which supports the findings of their community's Needs Assessment. c. The Health Department of NWMI HFA Program (Region 2) will serve 20 families with pregnant women per 1.0 FTE home visitor. d. The Health Department of NWM1 HFA Program (Region 3) will serve 20 families with pregnant women per 1.0 FTE home visitor. e. The Luce-Mackinac-Alger-Schoolcraft Health Department HFA Program (Region 1) will serve 20 families with pregnant women per 1.0 FTE home visitor. See the MHVI Guidance Manual for requirements related to the development of a Work Plan and the timeframe for reaching full caseloads. REPORTING REQUIREMENTS The LIA shall submit all required reports in accordance with the Department reporting requirements. See MHVI Guidance Manual for details about what must be included in each report. h. Staff Roster: within 30 days of the beginning of each fiscal year and within 30 days of a staffing change. I. HFA Work Plan that includes a community Outreach Plan: within 30 days of the beginning of each fiscal year. Family Stories: at a minimum, one home visiting experience, as told from the perspective of a currently enrolled family, within 30 days of the end of each quarter (January 30, April 30, July 30 and October 30). k. Work Plan Reports: must be submitted within 30 days of the end of each quarter (January 30, April 30, July 30 and October 30) and include detailed and specific activities that have taken place during the quarter including updates regarding the Outreach Plan. All reports (a-d) and information shall be submitted electronically to the MHVI mailbox at MDHHS- HVInitiative@michloan.00v. I. Implementation Monitoring Date and HRSA data collection requirements on the 5th business day of each month m. Continuous Quality Improvement reporting for the Learning Collaborative due on the 15th of each month. n. Continuous quality Improvement reporting for LIA specific projects due by the 15 th of the next month following the end of the quarter (January 15, April 15, July 15 and October 15). All reports (e-g) shall be submitted to the appropriate MPHI staff as designated in the MVHI Guidance Manual. Grant End Date Contact info (phone & email) Reim bu rseinent Method 517-335-9729; hagerp@michigan.gov --] Su breci pient, Contractor, or Recipient (non-federal) Designation 90% 11 MICHIGAN COLORECTAL CANCER EARLY DETECTION PROGRAM Special Requirements BUDGET AND AGREEMENT REQUIREMENTS N/A 9/30/2019 Subrecipient Number of women and men that complete a screen test GRANTEE REQUIREMENTS The Michigan Colorectal Cancer Early Detection Program (MCRCEDP) provides colorectal screening services to program eligible men and women: 1. Aged 50-64 years 2. Average risk for colorectal cancer— screened by Fecal Immunochemical Test (FIT) or colonoscopy Increased risk for colorectal cancer screened by colonoscopy 4. Low income (up to 250% of the Federal poverty level) 5. Who have inadequate or no health insurance For specific MCRCEDP requirements please refer to the most current MCRCEDP manual available at http://www.michigancancer.orq/Colorectal/. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A Performance Level (if N/A Applicable) Sandersc2@michigan.gov / 517-241-1676 Staffing (6) 10/1/2018 Charisse Sanders Grant End Date 9/30/2019 Grant Start Date Grant Contract Administrator Contact Info (phone & email) Reimbursement Method Subreciplent, Contractor, or Recipient (non federal) __Desivation Performance Target Output Measure Subrecipient N/A NURSE FAMILY PARNERSHIP (NFP) SERVICES Special Requirements Budget and agreement requirements N/A GRANTEE REQUIREMENTS Maintain Fidelity to the Model: The Local Implementing Agency (LIA) shall adhere to the Nurse Family Partnership (NFP) National Service Office (NSO) program standards and operate the program with fidelity to the NSO Application Review Team approved Implementation Plan. P.A. 291: The LIA shall comply with the provisions of Public Act 291 of 2012. See the MHVI Guidance Manual for requirements related to PA 291. Comply with MHVI Program Requirements: The LIA shall operate the program with fidelity to the requirements of the Michigan Department of Health and Human Services (MDHHS) as outlined in the MHVI Guidance Manual. Staffing: The LIA's NFP home visiting staff will reflect the community served. The LIA will provide documentation to demonstrate due diligence if unable to fully meet this requirement, within 90 days of a MHVI site visit in which this was a finding. See the MHV1 Guidance Manual for requirements related to program staffing. Target Population: Michigan is using NFP as a specialized home visiting service strategy for low income, first-time mothers whose population group contributes to the community's excess pre-term births (based on the Kitagawa analysis provided by MDHHS). This specialized service strategy is a focused way of using limited resources, directing them to the most at-risk populations. The LIA will conduct outreach activities to the population group identified in their Kitagawa analysis, in order to enroll families from those outreach efforts. See the MHVI Guidance Manual for requirements related to development of an outreach plan and timeframe for reaching full caseloads Program Monitoring, Assessment, Support and Technical Assistance (TA): The LIA shall fully participate with the NFP NSO, the Department and the Michigan Public Health Institute (MPH I) with regards to program monitoring (including annual site visits), assessment, support and technical assistance services. See the MHVI Guidance Manual for requirements related to program monitoring, assessment, support and TA. Professional Development and Training: All of the LIA's NFP staff associated with this funding will participate in professional development and training activities, as required by both NFP and the Department. See the MHVI Guidance Manual for requirements related to professional development and training activities. Supervision: The LIA shall adhere to the NFP supervision requirements. Engage and Coordinate with Community Stakeholders: The LIA shall assure that there is a broad-based community advisory committee that is providing oversight for NFP. The LIA shall build upon and maintain diverse community and target population collaboration and support. The LIA shall participate in the Local Leadership Group (LLG) (if not the NFP community advisory body) or, if none, at the Great Start Collaborative. See the MHVI Guidance Manual for requirements related to engagement and coordination with community stakeholders. Data collection: The LIA shall comply with all NFP and MDHHS data training, collection and entry, and submission requirements. See the MHVI Guidance Manual for requirements related to data collection. Continuous Quality Improvement (CQI): The LIA shall participate in all NFP quality initiatives including: research, evaluation and continuous quality improvement. The [IA shall participate in all State and local Home Visiting CQI activities, as required by MDHHS. Required activities include, but are not limited to: 1. QI team participates in one Quality Improvement (QI) Learning Collaborative per fiscal year, with all required training, reporting requirements and deliverables. 2. Conduct and complete two L1A specific PDSA cycles per fiscal year, with all required reporting and deliverables. See the MHVI Guidance Manual for requirements related to 001. Work Plan Requirements: Upon initiation of the FY19 contract, the LIA must submit a work plan (outlining all program activities) to the MHVI mailbox at MDHHS-HVInitiativeRmichioan.gov . See the MHVI Guidance Manual for requirements related to work plans. Promotional Materials: If the LIA wishes to produce any marketing, advertising or educational materials, using contract funds, they must follow the requirements outlined in the MHVI Guidance Manual. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS The LIA shall submit all required reports in accordance with the Department reporting requirements. See the MHVI Guidance Manual for details about what must be included in each report. 1. Staff Roster: within 30 days of the beginning of each fiscal year an4 Within 30 days ora staffing change. 2. HFA Work Plan that includes a community Outreach Plan: within 30 days of the beginning of each fiscal year. 3. Family Stories: at a minimum, one home visiting experience, as told from the perspective of a currently enrolled family, within 30 days of the end of each quarter (January 30, April 30, July 30, and October 30). 4. Medicaid Outreach Report (Berrien, Calhoun, Kalamazoo and Kent only): within 30 days of the end of each quarter. 5. Work Plan Reports: must be submitted within 30 days of the end of each quarter (January 30, April 30, July 30 and October 30) and include detailed and specific activities that have taken place during the quarter including updates regarding the Outreach Plan. All reports (1-5) and information shall be submitted electronically to the MHVI mailbox at MDHHS- HVInitiative©michician.qov. 6. Implementation Monitoring Date and HRSA data collection requirements on the 5t h business day of each month. 7. Continuous Quality Improvement reporting for the Learning Collaborative due the 15t h of each month. 8 Continuous Quality Improvement reporting for LIA specific projects due by the 15 th of the next month following the end of the quarter (January 15, April 15, July 15 and October 15). All reports (6-8) shall be submitted to the appropriate MPHI staff, as designated in the MHVI Guidance Manual. PUBLIC HEALTH EMERGENCY PREPAREDNESS (PHEP) Special Requirements Grant Start Date 10/1/2018 Grant End Date 9/30/2019 Grant Contract Administrator Patrick Guysky 517-335-8150; GuyskyP1@michigan.gov Contact Info (phone & email) _ReimIaursemiknt Staffing (6) (14) (18) Method Performance Level N/A (if Applicablel_ BUDGET AND AGREEMENT REQUIREMENTS N/A Subrecipient, Contractor, Subrecipient 6r RecipWitTn5tRederal) Designation Performance Target N/A Output Measure GRANTEE REQUIREMENTS Grantee Requirements (Basel CRI1 The Public Health Emergency Preparedness section of Attachment III is effective from October 1, 2018 through June 30, 2019. Funds are provided by the Department for nine months based on the Department's fiscal year. As a Grantee of funding provided through the Centers for Disease Control and Prevention (CDC) National Bioterrorism Hospital Preparedness Program (HPP) and Public Health Emergency Preparedness (PHEP) Cooperative Agreement, each Grantee shall conduct activities to build preparedness and response capacity and capability. These activities shall be conducted in accordance with the HPP/PHEP Cooperative Agreement guidance for 2018-2019 plus any and all related guidance from the CDC and the Department that is issued for the purpose of clarifying or interpreting overall program requirements. All Grantee activities shall be consistent with all approved Budget Period 1 Supplemental (BPI S) work plan(s) and budget(s) on file with the Department through the MI E-Grants system. In addition to these broad requirements, the Grantee will comply with the following: 1. One (1) full time equivalent (FTE) emergency preparedness coordinator (EPC), as a point of contact. In addition to the Grantee health officer, the EPC shall participate in collaborative capacity building activities of the HPP/PHEP Cooperative Agreement, all required reporting and exercise requirements and in regional Healthcare Coalition (HCC) initiatives. Any changes to this staffing model must be approved by the Public Health Emergency Preparedness Program Manager at the Division of Emergency Preparedness and Response (517-335-8150). 2. Under the alignment of the HPP and PHEP cooperative agreements, Grantee's must partner with the Regional Healthcare Coalition (HCC) and support HCC initiatives to ensure that healthcare organizations receive resources to meet medical surge demands. Working well together during a crisis is facilitated by meeting on a regular basis. To this end, EPCs, supported by CDC PHEP are required to participate in and support regional HCC initiatives. In addition, the EPC or designee is required to attend regional HCC planning or advisory board meetings. 3. There are a number of special initiatives, projects, and/or supplemental funding opportunities that are facilitated under this cooperative agreement. For example, the Cities Readiness Initiative (CRI) performance and evaluation initiatives. Each Grantee that is designated to participate in any of these types of supplemental opportunities is required to comply with all CDC and the Department — Division of Emergency Preparedness and Response (DEPR) guidance, and all accompanying work plan and budgeting requirements implemented for the purpose of subrecipient monitoring and accountability. Some or all supplemental opportunities may require separate recordkeeping of expenditures. If so, this separate accounting will be identified in separate project budgets in the MI E-Grants system. These supplemental opportunities may also require additional reporting and exercise activities. 4. Recipients are required to submit a 9-month (October 1 to June 30) budget and a 3-month (July 1 to Sept 30) for both Base PHEP and CRI funding, including the 10% MATCH for those periods (see #14 below for detail regarding Match). Submitted to MDHHS-BETP-DEPR-PHEPAmichigan.gov by May 1, 2018. 5. ALL activities funded through the PHEP cooperative agreement must be completed between July 1, and June 30, and all BP1S funding must be obligated by June 30, 2019 and activity completed by the August 15, 2019 FSR submission deadline. 6. Al! budget amendments to the Division of Emergency Preparedness and Response (DEPR) for review prior to submitting them in the MI E-Grants system. Budget amendments that contain line items deviating more than 15% or $10,000 (whichever is greater) from the original budgeted line item must be approved by DEPR prior to implementation via email to Patrick Guysky at guyskyp@michican.qoy. 7. The final Financial Status for funding period ending June 30 reports MUST be submitted in the MI E- Grants system for this funding source no later than August '15, 2019. 8. Supplantation is the replacement of non-federal funds with federal funds to support the same activities. The Public Health Service Act, Title I, Section 319(c) specifically states, "SUPPLEMENT NOT SUPPLANT. — Funds appropriated under this section shall be used to supplement - not supplant - other federal, state, and local public funds provided for activities under this section." This law strictly and expressly prohibits using cooperative agreement funds to supplant any current state or local expenditures. 9. Unallowable Costs: • Recipients may not use funds for research. • Recipients may not use funds for clinical care. • Recipients may only expend funds for reasonable program purposes, including personnel, travel, supplies, and services, such as contractual. • Recipients may not generally use HHS/CDC/ATSDR funding for the purchase of furniture or equipment. Any such proposed spending must be identified in the budget. • The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project objectives and not merely serve as a conduit for an award to another party or provider who is ineligible. Other than for normal and recognized executive-legislative relationships, no funds may be used for: publicity or propaganda purposes, the preparation, distribution, or use of any material designed to support or defeat the enactment of legislation before any legislative body the salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or Executive order proposed or pending before any legislative body. O The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project outcomes and not merely serve as a conduit for an award to another party or provider who is ineligible. O Recipients may not use funds for construction or major renovations. O Recipients may supplement but not supplant existing state or federal funds for activities described in the budget. O Payment or reimbursement of backfilling costs for staff is not allowed. O None of the funds awarded to these programs may be used to pay the salary of an individual at a rate in excess of Executive Level II or $187,000 per year. O Recipients may use funds only for reasonable program purposes, including travel ; supplies, and services. O Recipients may purchase basic (non-motorized) trailers with prior approval from the CDC OGS. O HPP and PHEP funds may not be used to purchase clothing such as jeans, cargo pants, polo shirts, jumpsuits, sweatshirts, or T-shirts. Purchase of items that can be reissued, such as vests, may be allowable. O HPP and PHEP funds may not be used to purchase or support (feed) animals for labs, including mice. Any requests for such must receive prior approval of protocols from the Animal Control Office within CDC and subsequent approval from the CDC OGS as to the allowable of costs. O Recipients may not use funds to purchase a house or other living quarters for those under quarantine. O HPP and PHEP recipients may (with prior approval) use funds for overtime for individuals directly associated (listed in personnel costs) with the award. O PHEP recipients cannot use funds to purchase vehicles to be used as means of transportation for carrying people or goods, such as passenger cars or trucks and electrical or gas-driven motorized carts. o PHEP recipients can (with prior approval) use funds to lease vehicles to be used as means of transportation for carrying people or goods, e.g., passenger cars or trucks and electrical or gas- driven motorized carts. O PHEP recipients can (with prior approval) use funds to purchase material-handling equipment (MHE) such as industrial or warehouse-use trucks to be used to move materials, such as forklifts, lift trucks, turret trucks, etc. Vehicles must be of a type not licensed to travel on public roads. O PHEP recipients can use funds to purchase caches of medical or non-medical Counter measures for use by public health first responders and their families to ensure the health and safety of the public health workforce. o PHEP recipients can use funds to support appropriate accreditation activities that meet the Public Health Accreditation Board's preparedness-related standards.10. 11. Recipients must maintain National Incident Management System (NIMS) compliance as detailed in the LHD work plan and submit annually to the Department — DEPR per the LHD BP1S work plan. 12. Each subrecipient Grantee must retain program-related documentation for activities and expenditures consistent with Title 2 CFR Part 200; Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards, to the standards that will pass the scrutiny of audit. 13. Audit Requirement - A grantee may use its Single Audit to comply with 42 USC 247d — 3a(j)(2) if at least once every two years the awardee obtains an audit in accordance with the Single Audit Act (31 USC 7501 — 7507) and Title 2 CFR, Part 200 Subpart F; submits that audit to and has the audit accepted by the Federal Audit Clearinghouse; and ensures that applicable PHEP CFDA number 93.069 are listed on the Schedule of Expenditures of Federal Awards (SEFA) contained in that audit. 14. Recipients provide the required 10% MATCH for July 1, 2018 through September 30, 2018 and October 1,2018 through June 30, 2019. Recipients are required to submit a letter (on agency letterhead) stating the source, calculation and narrative description of how the match was achieved, unless said match is met using local dollars. This was due with the narrative budget submission to the Department — DEPR. 15, Administrative preparedness - During BP1S, Recipients must continue to strengthen and test its administrative preparedness plan, to include written policies, procedures, and/or protocols that address the following: Expedited procedures for receiving emergency funds during a real incident or exercise; Expedited processes for reducing the cycle time for contracting and/ or procurement during a real emergency or exercise; Internal controls related to subrecipient monitoring and any negative audit findings resulting from suboptimal internal controls; and Emergency authorities and mechanisms to reduce the cycle time for hiring and/ or reassignment of staff (workforce surge). All administrative preparedness planning activities should be considered in coordination with healthcare systems, law enforcement, and other relevant stakeholders as appropriate, 16. The Pandemic and All Hazards Preparedness Reauthorization Act (PAHPRA) of 2013 requires the withholding of amounts from entities that fail to achieve PHEP benchmarks. The following PHEP benchmarks have been identified by CDC and the Department -DEPR for the Fiscl Ye-a-r: — Demonstrated adherence to all PHEP application and reporting deadlines. Recipients must submit required PHEP program data and reports by the stated deadlines. This includes, but is not limited to, progress reports, performance measure data reports, National Incident Management System (NIMS) compliance reports, updated emergency plans, budget narratives, Financial Status Reports (FSR), etc. Failure to do so will constitute a benchmark failure. All deliverables must be submitted by the designated due date in the Grantee BP1S work plan. Demonstrated capability to receive, stage, store, distribute, and dispense medical countermeasures (MCM) I during a public health emergency, per the BP1S Grantee Work Plan. Pandemic Influenza Preparedness plans: Further guidance will be included in the Grantee PHEP Work Plan. In response to repeated communications from CDC strongly urging states to ensure all funds are spent each year a threshold has been established to limit the amount of unspent funds. A maximum of 2% of the Grantee allocation or $3,000 (whichever is greater) of unspent funds is allowable each budget period. Failure to meet this requirement, or misuse of funds, will affect the amount that is allocated in subsequent budget periods. Benchmark Failure - Awardees are expected to "substantially meet" the PAHPRA benchmarks. Per the Cooperative Agreement, failure to do so constitutes a benchmark failure, which carries an allowable penalty withholding of funds. Failure to meet any one of the two benchmarks and/or the spending threshold is considered a single benchmark failure. Any awardee (or sub-awardee) that does not meet a benchmark and/or the spending threshold will have an opportunity to correct the deficiency during a probationary period. If the deficiency is not corrected during this period the awardee is subject to a 10% withholding of funds the following budget period. Failure to meet the pandemic influenza plan requirement constitutes a separate benchmark failure, and is also subject to a 10% withholding. The total potential withholding allowable is 20% the first year. lf the deficiency is not corrected, the allowable penalty withholding increases to 30% in year two and 40% in year three. Reaional Epidennioloa4r Support: 2. For those Recipients receiving additional funds to provide workspace for Regional Epidemiologists, the grantee must provide adequate office space, telephone connections, and high-speed Internet access. The position must also have access to fax and photocopiers. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A REGIONAL PERINATAL QUALITY COLLABORATIVE — REGION 4 Special Requirements Grant Start Date Grant Contract Administrator _ _ Contact Info (phone & email) 10/1/2018 Grant End Date I 9/30/2019 Emily Goerge 517-241-4816; GoergeEgmichigan.gov Reimbursement Staffing (6) Performance Level (if N/A Applicable) Subreclpient, Subrecipient Contractor, or _ Recipient (non-federal) Designation Performance Target N/A Output Measure Budget and agreement requirements Purpose: Coordinator for Regional Perinatal Quality Collaborative — Region 4 GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS a. Regional collaborative membership must be comprised of a multi-stakeholder and diverse membership, ensuring to recruit faith-based organizations, 'consumers', business partners, and etcetera; The names and titles of the project team leads for fiscal year 2019 must be identified on the submitted work plan in EGrAMS; c. Chosen quality improvement objective(s) and corresponding strategies must align with the Infant Mortality Advisory Council (IMAC) priorities under the guidance of MDHHS; i. As the Regional Perinatal Quality Collaborative (RPQC) is a conduit to the community, the region needs to provide consistent representation at the IMAC meetings. RPQC — Region 4 membership (i.e. at minimum one person from the leadership team and one additional member) are required to attend all quarterly IMAC meetings in-person ii. Each region will be required to report on their quality improvement measures and outcomes at one of the quarterly IMAC meetings d. Budget Allowances i. Budgets line items for external consultants must be capped at 25% for contractors/consultants, who have been hired as subject matter experts ii. Budgets must be capped at 75% or $75,000, whichever is greater, for contractors hired to carry out the quality improvement tasks of the collaborative, e. All quality improvement efforts must be inclusive of addressing equity and specifically the social determinants of health; f. RPQC membership is required to provide representation at other infant mortality related MDHHS meetings; i. Each region must send a team to the Statewide Learning Collaborative sponsored by MDHHS and Michigan State University's Institute for Health Policy, focusing on either low birth weight (LBW) or early entry into prenatal care ii. At least two members of the regional collaborative leadership team are required to attend the bi-annual Day of Learning and Sharing meetings g. Regional collaborative leadership is expected to work and collaborate with the assigned State consultant h. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS A. Report on Aim statement, measures and corresponding outcomes, as identified by the grantee and department on a quarterly basis; B. Submit narrative work plan report regarding the status of department requirements detailed above on a quarterly basis C. Reports shall be submitted to the Contract Manager, Emily Goerge, via email at: GoerdeEmichidan.qov Staffing (6) SAFER OPIOID PRESCRIBING PRACTICES AND DATA COLLECTION: MACOMB COUNTY Special Requirements Grant Start Date Grant Contract Administrator Contact Info (phone & email) Reimbursement Method Performance Level KApplicabIeL_ 10/1/2018 Grant End Date 9/30/2019 Chelsea Walker I 517-335-3921 walkerc23michigan.gov N/A Subrecipient, Contractor, Subrecipient ff-orRecipient-tnon-fede-ralf--- 1 Designation Performance Target N/A Output Measure, BUDGET AND AGREEMENT REQUIREMENTS GRANTEE REQUIREMENTS 1. Continue to develop and manage an integrated opioid surveillance system (ongoing). 2. Provide educational sessions for providers on MAPS and prescribing practices (ongoing). 3. Assess opioid abuse in Macomb County through a community needs assessment (ongoing). 4. Promote community education on opioids (ongoing). 5. Restrictions which must be taken into account while writing the budget are as follows: a. Recipients may not use funds for purchasing naloxone, implementing or expanding drug "take back" programs, or directly funding or expanding substance abuse treatment programs. b. Recipients may not use funds for research. c. Recipients may not use funds for clinical care. d. Recipients may only expend funds for reasonable program purposes, including personnel, travel and supplies. e. Awardees may not generally use CDC funding for the purchase of furniture or equipment. Any such proposed spending must be identified in the budget. f. Recipients may not use funds for fund-raising activities or lobbying. g. Recipients may not use funds for reimbursement of pre-award costs. h. Recipients may supplement but not supplant existing state or federal funds for activities described in the budget. i. Payment or reimbursement of backfilling costs for staff is not allowed. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A Reporting Requirements The grantee shall complete and submit monthly progress reports electronically to their contract manager in addition to the monitoring and evaluation activities during the monthly technical assistance conference calls. Financial Status Reports must be submitted electronically no later than 30 days after the close of the fiscal quarters through MiEgrams. The due dates are as follows: 1st Quarter (October 1 through December 31) due January 30 2ncl Quarter (January 1 through March 31) due April 30 3rd Quarter (April 1 through June 30) due July 30 4th Quarter (July 1 through September 30) due October 30 Final Report due on December 15 FSR's must report total actual program expenditures regardless of the source of funds. The Department will reimburse the Grantee for expenditures in accordance with the terms and conditions of this agreement Failure to comply with the reporting due dates will result-in the deferral of the Grantee's monthly prepayment. Quarterly Tracking Reports for Work plans must be submitted electronically via Egrams on the 15th of the month following the close of the quarter (these quarters may differ from FSR quarter dates in order to align with the grant funding fiscal year), The due dates are as follows: 1st Quarter (September 1 through November 30) Due December 15 2" Quarter (December 1 through February 28) Due March 15 3r8 Quarter (March 1 through May 31) Due June 15 4th Quarter (June 1 through August 31) Due September 15 Any such other information as specified in the Grantee Requirements section shall be developed and submitted by the Grantee as required by the Contract Manager. SAFER OPIOID PRESCRIBING PRACTICES AND DATA COLLECTION: MARQUETTE COUNTY Special Requirements Grant Start Date 10/1/2018 Grant Contract Amber Daniels Administrator Contact Info Aphone 84 email) Reimbursement Staffing (6) Method Performance Level N/A (if 4plicable) BUDGET AND AGREEMENT REQUIREMENTS 1 I Grant End Date 9/3012019 Sutrecipient, -Contractor, Subrecipient or Recipient (non-federal) Designation Performance Target N/A Output Measure 517-241-9107 danielsa3michioan.qov GRANTEE REQUIREMENTS 6. Continue to develop and manage an integrated opioid surveillance system (ongoing). 7. Provide educational sessions for providers on MAPS and prescribing practices (ongoing). 8. Assess opioid abuse in Macomb County through a community needs assessment (ongoing). 9. Promote community education on opioids (ongoing). 10 Restrictions which must be taken into account while writing the budget are as follows: a. Recipients may not use funds for purchasing naloxone, implementing or expanding drug "take back programs, or directly funding or expanding substance abuse treatment programs. b. Recipients may not use funds for research. c. Recipients may not use funds for clinical care. d. Recipients may only expend funds for reasonable program purposes, including personnel, travel and supplies. e. Awardees may not generally use CDC funding for the purchase of furniture or equipment. Any such proposed spending must be identified in the budget. f. Recipients may not use funds for fund-raising activities or lobbying. g. Recipients may not use funds for reimbursement of pre-award costs. h. Recipients may supplement but not supplant existing state or federal funds for activities described in the budget. i. Payment or reimbursement of backfilling costs for staff is not allowed. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A Reporting Requirements The grantee shall complete and submit monthly progress reports electronically to their contract manager in addition to the monitoring and evaluation activities during the monthly technical assistance conference calls. Financial Status Reports must be submitted electronically no later than 30 days after the close of the fiscal quarters through MiEgrams. The due dates are as follows: 1st Quarter (October 1 through December 31) due January 30 2nd Quarter (January 1 through March 31) due April 30 3rd Quarter (April 1 through June 30) due July 30 41h Quarter (July 1 through September 30) due October 30 Final Report due on December 15 FSR's must report total actual program expenditures regardless of the source of funds. The Department will reimburse the Grantee for expenditures in accordance with the terms and conditions of this agreement. Failure to comply with the reporting due dates will result in the deferral of the Grantee's monthly prepayment. Quarterly Tracking Reports for Work plans must be submitted electronically via Egrams on the 15t h of the month following the close of the quarter (these quarters may differ from FSR quarter dates in order to align with the grant funding fiscal year). The due dates are as follows: 1st Quarter (September 1 through November 30) Due December 15 rd Quarter (December 1 through February 28) Due March 15 3rci Quarter (March 1 through May 31) Due June 15 4th Quarter (June 1 through August 31) Due September 15 Any such other information as specified in the Grantee Requirements section shall be developed and submitted by the Grantee as required by the Contract Manager. II SEAL! MICHIGAN DENTAL SEALANT PROGRAM Special Requirements Grant Start Date —1- 10/1/2018 I Grant End Date _______ _______ _ ..._____ 9/30/2019 Grant Contract Contact info "phone & email) Administrator Jill Moore 517-373-4943; MooreJ14@Michigan.gov ___.. Reimbursement Method Staffing (6) Subrecipient, -C-ontractor, or Recipient (non-federal) Designation Performance Target Output Measure SObrecipient Performance Level (if Applicablq N/A N/A BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Administer screening, oral health education and dental sealant applications to all eligible children with a signed consent form in schools that have a minimum of 50% students participating in the Free and Reduced Lunch Program. Families will not be charged for sealant applications, as sealants, screenings, and education are provided free. All applicable insurances (Medicaid, Healthy Kids Dental, Healthy Kids, private insurances etc.) must be billed for services rendered. 2. Provide oral health promotion of dental sealants through literature and/or presentations to parents/guardians of children that are culturally and linguistically sensitive. 3. Provide instruction on oral health and sealant placement to children targeted for the SEAL! Michigan program prior to sealant placement. 4. Measure quality control of the sealant program through the Department SEAL! Michigan Student Data Form and the Department SEAL! Michigan Event Data Form and provide hard copy forms to the Department by October 15, 2019 and upon request. 5. Ensure all staff have received training in the SEAL! Michigan Program provided by the Department, which includes the Department data form training. Note: even if training has been completed by grantees in previous years, attendance for the current grant cycle is required. 6. Adhere to CDC, OHSA and MIOSHA Standards and the State of Michigan Administrative Rules. 7. Ensure sealant material is approved by ADA, is non-expired, has no more than 20% filler, and is applied according to manufacturer's specifications. 8. Demonstrate activity in establishing a dental home or referral network for children referred for dental treatment. Grantees must document that personal contact via phone or letter is made to the parent/guardian of child with urgent dental care needs. (Urgent means care needed within 24 hours). Grantee must have a mechanism to track the children receiving emergency dental restorative emergency services within 20 miles of the sealant site and provide the tracking information to the Department upon request. 9. Provide details on how the program is working toward sustainability beyond the grant. Grantees must provide documentation on how sustainability is taking place, for example: Medicaid, 3rd party billing protocols or in-kind contributions. 10. Grantees must utilize experienced and competent staff to accomplish program goals. 11. Grantees must track separately the amount of schools they serve, how many children received dental sealants, and how many dental sealants have been placed separately from SEALS and be able to provide this information upon request and at a minimum quarterly. 12. Retention checks must be performed on 20% of children serviced and achieve 90% or better retention rates on occlusal surfaces and 65% retention rates on buccal pits. If retention is found to be less than 90% (meaning more than 10% of dental sealants are falling out) then 40% of students must be checked for sealant retention. Any dental sealants which have fallen out upon the retention check must be replaced immediately free of charge and then rechecked for retention. 100% of retention must be checked when sealant is placed by dental or dental hygiene student. Any time that retention does not meet the program goals (90% occlusal or 65% buccal pits) then the Department will be immediately notified. 13. Grantees shall be compliant with sub-recipient grantee meetings quarterly. A minimum of two on- site visits will be required yearly, remaining two will take place via optional conference call. 14. At least one member of sealant program will attend the annual SEAL! MI Workshop, and any other trainings offered. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS The Grantee shall submit the following reports within 15 days as stated on the following dates: Quarter End Date Report Due Date 1st Quarter (December 31) January 15 2nd Quarter (March 31) April 15 3rd Quarter (June 30) July 15 4th Quarter (September 30) October 15 1 The Quarterly Dental Sealant Tracking Data Form shall be completed quarterly and provided to the Department Dental Sealant Coordinator. Reports are due within 15 days after the end of the quarter. The work plan must be evaluated and noted on each Quarterly Dental Sealant Tracking Data Form. The work plan should include an update on all of the Grantee requirements. All line items on the Quarterly Dental Sealant Tracking Data Form shall be completed with accuracy and signed. 2. Provide documentation that emergency dental restorative services are tracked for children referred through the SEAL! Michigan dental sealant program within a 20 mile radius of the sealant program. 3. All requirements of the program, as listed in individual funding proposals shall be honored and addressed. Any barriers that may affect overall quality and quantity of the program will be brought to the attention of the Dental Sealant Coordinator. Funds may be adjusted and amended according to program outcomes throughout the year according to work plan goals and objectives. 4. Send reports to: Jill Moore, School Oral Health Consultant Oral Health Program — SEAL! Michigan MDHHS, Division of Child and Adolescent Health P.O. Box 30195, Lansing MI 48909 Phone: (517) 373-4943 Fax: (517) 335-9461 MooreJ14@michigan.qov SEXUAL VIOLENCE PREVENTION Special Requirements Grant Start Date, Grant Contract Administrator Contact Info (phone & email) Reimbursement Method 10/1)2018 Jessica Grzywacz Staffing (6) Grant End Date 9/30/2019 • Subrecipient, Contractor, Subrecipient or Recipient (non.fecleral) Designation 517-335-8627; grzywaczj@michigan.gov Performance Level N/A lif Applicable) Performance Target Oulput Measure N/A BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. Strengthen individual knowledge in Kent County (Ongoing). 2. Promote community education in Kent County (Ongoing). 3. Educate Kent County Providers (Ongoing). 4 Foster coalitions and networks in Kent County (Ongoing). 5. Work with local businesses to change organizational practices (Ongoing). 6. Educational local/state policy makers about sexual violence prevention (Ongoing). 7. Restrictions, which must be taken into account while writing the budget, are as follows: a. Recipients may not use funds for research. b. Recipients may not use funds for clinical care. c. Recipients may only expend funds for reasonable program purposes, including personnel, travel, and supplies. d. Awardees may not generally use CDC funding for the purchase of furniture or equipment. Any such proposed spending must be identified in the budget. e. Recipients may not use funds for fund-raising activities or lobbying. f. Recipients may not use funds for construction or major renovations. 9. Recipients may not use funds for reimbursement of pre-award costs. h. Recipients may supplement but not supplant existing state or federal funds for activities described in the budget. Recipients may not use funds for indirect costs. Payment or reimbursement of backfilling costs for staff is not allowed. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS The Grantee shall submit the following reports on the following dates: Quarterly Proiect Reports 1st Quarter (October 1 through December 31) due January 15 2nd Quarter (January 1 through March 31) due April 15 3rd Quarter (April 1 through June 30) due July 15 4th Quarter (July 1 through September 30) due October 15 Quarterly Check-in Calls Check-in calls will be scheduled and conducted by MPHI staff. Any other information specified in the Grantee Requirements section will be developed and submitted by the Grantee as required by the Contract Manager. Reports and information will be submitted to the Contract Manager at: grzwaczi@michigan.qov. SEXUALLY TRANSMITTED DISEASE (STD) CONTROL Special Requirements Grant Start Date • 1-1-(r—IT2-0-18 --FG–rant End Date 9/30/2019 Grant Contract Jennifer Linzmeler I Administrator _ _ Contact Info 517-241 -5861 linzmeier@michigan.gov (phone & email) ff ------ . Reimbursement i Staffing (6) Bubrecipient, SubrecipieTit Method Ccrut.n,»Ii** (c'' Recipient (non-federal) Designation Performance Level N/A Performance Target N/A (if Applicable) Output Measure BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS H. Grant Program Operation 1. For medical providers that identify 5% or more of the County's gonorrhea, chlamydia, and/or syphilis morbidity, the local STD program will contact them at least annually to review provider screening, reporting, treatment, and partner management methods. 2. Participate in technical assistance/capacity development, quality assurance, and program evaluation activities as directed by Division of HIV and STD Programs/Sexually Transmitted Disease (DHSP/STD). 3. Implement program standards and practices to ensure the delivery of culturally, linguistically, and developmentally appropriate services. Standards and practices must address sexual minorities. 4. For gonorrhea and chlamydia cases in the Michigan Disease Surveillance System, 50% shall be completed within 30 days and 60% within 60 days from the date of specimen collection. 5 For gonorrhea and chlamydia cases, develop plans to respond to issues in quality, completeness, and timeliness. 6. If funded with Preventive Block Grant funds, the health department: a. Between October 1 and September 30, will conduct STD presentations to adolescents and young adults in area middle schools and high schools. b. Between October 1 and September 30, will conduct provider outreach and training. This activity will help reduce syphilis, gonorrhea, and chlamydia through improved client adherence to provider messages about testing, treatment, risk reduction, and partner management. c. MDHHS will determine the number of presentations per health department. I. Reportin Report Period Due Date(s) How to Submit Report Clinic Activity Report Quarterly 10 days after the end of the quarter STD Section Report Period Due Date(s) How to Submit Report STD 340B Tracking Report Quarterly 10 days after the end of the quarter STD Section N. Mandatory Disclosures 1. Inform DHSP/STD at least two weeks prior to changes in clinic operation (hours, scope of service, etc.). DEPARTMENT REQUIREMENTS N/A ASSURANCES N/A STD NEISSERIA GONORRHOEAE ENHANCED SURVEILLANCE PROJECT (GC SURVEILLANCE FOR KALAMAZOO HCSD) Special Requirements •Grant Start Date Grant Contract Administrator Contact Info (phone emailL Reimbursement Method Performance Level (if Applicable) 10/1/2018 LGrant End Date _I_ 9/30/2019 Kris Judd-Tuinier 313-456-4426, judd-tuinierk@michigan.gov Staffing (6) Subrecipient, Contractor, Subrecipient or Recipient (non-federal) Desig_nation N/A Performance Target Output ; N/A I Measure BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS J. Grant Program Operation 1. To monitor trends in antimicrobial susceptibilities in N. gonorrhoeae. 2. To characterize patients with gonorrhea (GC), particularly those infected with N. gonorrhoeae that are not susceptible to recommended antimicrobials. 3. To monitor trends in sexually transmitted N. Meningitidis 4. Assess each STD patient presenting Monday — Wednesday for possible gonococcal infection. 5. For each STD clinic patient suspected of having GC (symptoms, known partner etc.), collect a urogenital sample using a Modified Thayer Martin (MTM) plate. 6. For each male STD clinic patient who reports same sex partners, collect sample using a MTM plate from all sites of exposure (rectal, pharyngeal, urethral), regardless of symptoms. 7. For clients with GC positive isolates, or suspected N. Men, submit specimen to MDHHS Bureau of Laboratories for further testing. K. Reporting Report Period Due Date(s) How to Submit Report On a quarterly basis, extract from StarLIMS, and submit to MDHHS, the number of culture specimens collected and number of presumptive positive GC and N. Men specimens sent to MDHHS for susceptibility testing. Q uarterly January 15, April 15, July 15, October 15 Written report submitted to kenti3Amichigan. qov; cc: petersona7@mich igan.gov On a quarterly basis, for clients with GC positive isolates, or suspected N. Men, submit demographic and behavioral data to MDHHS utilizing the CDC required format. Quarterly January 15, April 15, July 15, October 15 Written report submitted to kentj3gmichician. goy, cc: petersona7@mich igan.gov DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A 248 424-7913: brandtm4@michigan.gov HIV SURVEILLANCE SUPPORT PROGRAM Special Requirements I Grant Start Date 10/1/2018 Grant Contract Mary-Grace Brandt Administrator Contact Info iphone & email) Reimbursement Staffing (6) I Method Performance Level N/A atiVplicablq BUDGET AND AGREEMENT REQUIREMENTS N/A j_ Grant End Date 9/30/2019 Subrecipient, Contractor, Subrecipient or Recipient (non-federal) Designation _ Performance Target N/A Output Measure GRANTEE REQUIREMENTS Provide the resources necessary to house the Department's HIV Surveillance Staff at the South Oakland Health Center, 27725 Greenfield Road, Southfield, MI 48076. Support includes overhead costs for the office space and includes costs and technical support for phone and technology lines. DEPARTMENT REQUIREMENTS Reimburse the Grantee for costs associated with the location of the State HIV Office in the South Oakland Health Center as reflected in the attachment to the Comprehensive Agreement. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A TAKING PRIDE IN PREVENTION (TPIP) Special Requirements Kara Anderson Performance (8) (18) Grant Start Date 1011/2018 Grant Contract Administrator Contact Info (phone & Reimbursement Method Performance Level (if 90% Applicable) Grant End Date• Subrecipient, Contractor, or ---Recipientition-federalh Designation Performance Target Output Measure 9/30/2019 Subrecipient 68 unduplicated youth complete at least 75% of program intervention each fiscal year andersonk10@michigan.gov 517-335-1158 Budget and agreement requirements Secure local matching funds (either cash or in-kind) totaling at least 35 percent (35%) of the state allocation. GRANTEE REQUIREMENTS 1. Comprehensive pregnancy prevention (abstinence and contraception) programming must be taught using an evidence-based intervention approved by MDHHS and address the following three adulthood preparation subjects: parent-child communication, healthy relationships, and adolescent development. 2. Information provided must be medically accurate, age-appropriate, culturally relevant, and up-to-date. 3. TPIP grantees must track participant, cohort, parent programming and community awareness activities, as well as administer the required state pre/post-tests and federal entry/exit surveys, following the approved implementation guidelines, and enter the data into ODE quarterly. 4. Pregnancy prevention programming must be welcoming and accessible to LGBTQ youth. Within 30 days of grant award, TPIP grantees must have in place or plan to have in place, policies prohibiting harassment based on race, sexual orientation, gender, gender identity (or expression), religion, and national origin. 5. Pregnancy prevention programming must be strengths-based and target risk and protective factors, in addition to primary prevention of pregnancy, STDs and HIV. 6. Pregnancy prevention programming must be delivered separate and apart from any religious education or promotion. TPIP funding cannot be used to support inherently religious activities including, but not limited to, religious instruction, worship, prayer, or proselytizing (45 CFR Part 87.2). 7 Family planning drugs and/or devices cannot be prescribed, dispensed, or otherwise distributed on school property as part of the pregnancy prevention education funded by TPIP as mandated in the Michigan School Code (380.1507, 388.1766). 8. Abortion services, counseling and/or referrals for abortion services cannot be provided as part of the pregnancy prevention education funded under TPIP. 9. TPIP funding cannot be used to supplant funding for an existing program supported with another source of funds. 10. TPIP grantees must adhere to all of the TPIP Minimum Program Requirements (MPRs). DEPARTMENT REQUIREMENTS 1. Provide ongoing program monitoring and technical assistance to funded grantees and program partners. 2. Provide two, two-day TPIP-sponsored learning Institutes each fiscal year. GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS 1. The Grantee shall submit the following reports via the appropriate electronic reporting method on the dates specified below: Report Time Period „Due Date• Submit To Program Narrative October 1 - December 31, 2018 January 31, 2019 Email to MDHHS andersonk1O©michigan.gov January 1 - March 31, 2019 April 15, 2019 April 1 - June 30, 2019 July 31, 2019 July 1 - September 30, 2019 October 15, 2019 Work Plan Report October 1 - December 31, 2018 January 31, 2019 Email to MDHHS andersonklOPmichidan.aoy January 1 - March 31, 2019 April 15, 2019 April 1 - June 30, 2019 July 31, 2019 July 1 - September 30, 2019 October 15, 2019 Local Match Report October 1 - December 31, 2018 January 31, 2019 Email to MDHHS andersonk10©michigan.gov January 1 - March 31, 2019 April 15, 2019 April 1 - June 30, 2019 July 31, 2019 July 1 - September 30, 2019 October 15, 2019 Program & Participant Data October 1 - December 31, 2018 January 31, 2019 ODE https://toip.mihealth.org January 1 - March 31, 2019 April 15, 2019 April 1 - July 31, 2019 July 31, 2019 August 1 - September 30, 2019 October 15,2019 , Fidelity Checklists January 1-31, 2019 February 28, 2019 Email to MDHHS andersonk10(amichigan.gov May 1-31, 2019 June 30, 2019 Youth Surveys October 1 - December 31, 2018 January 31, 2019 ODE httos://tpip.mihealth.orc January 1 - March 31, 2019 April 30, 2019 April 1 - July 31, 2019 August 5,2019 August 1 - September 30, 2019 October 31, 2019 Structure & TA Survey October 1, 2018 - September 30, 2019 August 15, 2019 Qualtrics Survey link will be sent to grantees in late July/early August 2. Any such other information as specified in the Statement of Work and TPIP Report Fact Sheet shall be developed and submitted by the Grantee as required by the Contract Manager. 3. The Contract Manager shall evaluate the reports submitted as described in items 1 and 2 for their completeness and adequacy. 4. The Grantee shall permit the Department or its designee to visit and to make an evaluation of the projects as determined by the Contract Manager. Grant Start Date 1011/2018 Grant End Date 9/30/2019 Grant Contract Administrator Julia Hitchingham Contact info (phone & email) 517-335-8381 HitchinghamJ@michigan.gov Reimbursement Method Performance Level (if Applicable) Staffing (6) N/A Subrecipient, Contractor, or I Recipient (non-federal) Designation Performance Target Output Measure Subrecipient N/A TOBACCO CESSATION - DENTAL CLINIC Special Requirements BUDGET AND AGREEMENT REQUIREMENTS No funds may be expended for lobbying as defined in Act No. 472 of the Public Acts of 1978, being sections 4.411 to 4.431 of the Michigan Compiled Laws. GRANTEE REQUIREMENTS Complete Dental Clinic Tobacco Cessation Project program and Getting to the Head of the Matter initiative evaluation requirements, which may include periodic data collection and submission. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Submit progress and final reports according to MDHHS guidance. If the report due date falls on a weekend or holiday, you have until the next business day to submit. PROGRESS REPORT October 1 — December 31 January 1 - March 31 April 1 - June 30 July 1 - September 30 Year End Report — Total Grant Period DATE DUE January 31 April 30 July 31 October 31 November 15 TOBACCO DEPENDENCE TREATMENT Special Requirements Grant Start Date 10/1/2018 Grant End Date 9/30/2019 Grant Contract Administrator Julia Hitchingham Contact info (phone 8, email) 517-335-8381; HitchinghamJ@michigan.gov Subrecipient Reimbursement Staffing (6) Method Performance Level N/A (if Applicable) Subrecipient, Contractor, or Recipient (non-federal) Designation Performance Target N/A Output Measure BUDGET AND AGREEMENT REQUIREMENTS No funds may be expended for lobbying as defined in Act No. 472 of the Public Acts of 1978, being sections 4.411 to 4,431 of the Michigan Compiled Laws. GRANTEE REQUIREMENTS Complete Tobacco Dependence Treatment program and Getting to the Heart of the Matter initiative evaluation requirements, which may include periodic data collection and submission. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Submit progress and final reports according to MDHHS guidance. If the report due date falls on a weekend or holiday, you have until the next business day to submit, Progress Report Period Covered October 1 — December 31 January 1 —March 31 April 1 —June 30 July 1 —September 30 Report Due Dates January 31 April 30 July 31 October 31 Year End Report — Total Grant Period November 15 TOBACCO REDUCTION IN PEOPLE LIVING WITH HIV/AIDS Special Requirements Grant Start Date 10/1/2017 Grant Contract Administrator Contact Info (phone & tRelmblirsement----- Method Staffing (6) Performance Level N/A Of Applicable) Grant End Date 1 9/30/2018 L_Subrecipient, Contracto_r„4 Subrecipient or Recipient (non-federal) Designation Performance Target N/A Output Measure Lynne Stauff Lynne Stauff, 517-335-1818; stauffl@michigan.gov BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS 1. If funding is available, implement annual work plan that describes the objectives, activities, and measures for work to be performed under this contract. The work plan will include measurable outcomes for services provided for each funded service. 2. Ryan White is the payer of last resort; as such, the Grantee must adhere to Ryan White HIV/AIDS Treatment Extension Act. 3. The Department will monitor the Grantee performance throughout the contract year, which may include a review of financial status reports (FSRs), CAREWare data entries, quarterly reports, and site visits. For site visits: a. Monitoring may include a review of fiscal, program, administrative, quality management, and client health records to ensure compliance with Federal, Department, and contract requirements. b. The Department will provide 30 calendar days written notice of the site visit, including an agenda and the assessment too to be used. c. The Department will provide a written report post site visit, including a Performance Improvement Plan (PIP) template, if warranted, within 45 days. 4. The Grantee will ensure that records are available for review by the Department auditors, staff, and Federal government agencies, if applicable, to monitor performance. Maintain and provide access to primary source documentation. 5. The Grantee may enter into subcontracts or vendor agreements to fulfill the service delivery expectations of this agreement. a. The Grantee will assure that all subcontracts issued under this funding agreement are subject to the same requirements as outlined in this agreement and subject to prior approval by the Department. b. The Grantee may monitor subcontractors annually to assess compliance with the subcontract; take primary responsibility to monitor follow-up and remediate in cases where the subcontracted entity is not in compliance with the contract; report the results of all contract monitoring activities to the Department. c. The Grantee will provide, upon request, a copy of all fully signed subcontracts, Memorandums of Understanding (MOUs), or letters of agreement related to the services in this agreement. 6. The Grantee will provide immediate notification to the Department, in writing, in the event of any of the following: a. Any formal grievance initiated by a client and subsequent resolution of that grievance. b. Any event occurring, or notice received by the Grantee or subcontractor, that reasonably suggests that the Grantee or subcontractor may be the subject of, or defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or Grantee or subcontract employees. c. Any staff vacancies funded for this project that exceed 30 days. 7. When issuing statements, press releases, requests for proposals, bid solicitations, and other documents describing projects of programs funded whole or in part with Federal money, the Grantee receiving Federal Funds, including but not limited to State and Local governments and recipients of Federal research grants, shall clearly state: a. The percentage of the total costs of the program or project that will be financed with Federal money. b. The dollar amount of Federal funds for the project or program. c. Percentage and dollar amount of the total costs of the project or program that will be financed by non-governmental sources. 8. The Grantee will participate in the Department needs assessment and planning activities, as requested. 9. The Grantee will maintain, for a minimum of four years after the end of the budget period, program fiscal records and files including documentation to support program activities and expenditures, under the terms of this agreement. 10. Each employee funded in whole or in part with Federal funds must record time and effort spent on the project(s) funded. The Grantee must: a. Have policies and procedures to ensure time and effort reporting. b. Assure the staff member clearly identifies the percentage of time devoted to the contract activities in accordance with the approved budget. c. Denote accurately the percent of effort to the project. The percent of effort may vary from month to month, and the effort recorded for Ryan White funds must match the percentage claimed on the Ryan White FSR for the same period. d. Submit a budget modification to the Department in instances where the percentage of effort of contract staff changes (FTE changes) during the contract period. 11. The Grantee and its subcontractors are required to use the HRSA-supported software CAREWare to enter client and service data into the centrally managed database on a secure server. The Grantee must: a. Enter all Ryan White services delivered to HIV-infected clients. b. Enter all data by the 10th of the following month. c. Complete collection of all required data variables and the clean-up of any missing data or service activities by the 10th of the following month. 12. The Grantee will participate in regular Grantee meetings which may be face-to-face, teleconferences, webinars, etc. The Grantee is highly encouraged to participate in other training offerings and information-sharing opportunities provided by the Department. 13. Submit Quarterly Progress Reports to the contract manager: Period Covered October 1 -December 31 January 1 -March 31 April 1 -June 30 July 1 -September 30 Reports Due January 12 April 13 July 13 October 15 a. The Grantee will collaborate with the Tobacco Section staff to accomplish goals through, at the most, monthly call, annual site visits, and other grant monitoring tools and technical assistance activities. b. Performance will be measured on progress toward meeting the overall Tobacco Use Reduction in PLWH work plan objectives. c. Failure to comply with these requirements may result in punitive consequences such as denial of future funding or other consequences as appropriate. DEPARTMENT REQUIREMENTS 1. The Department will monitor Grantee performance throughout the contract year, which may include review of FSRs, CAREWare data entries, quarterly progress reports, and site visits. For site visits, the Department will: a. Include a review of fiscal, program, administrative, quality management, and client health records to ensure compliance with Federal, Department, and contract requirements. b. Provide 30 calendar days written notice of the site visit, including an agenda and the assessment tool to be used. c. Provide a written report post-site visit, including a Performance Improvement Plan (PIP) template, if warranted, within 45 calendar days. d. Verify that the Grantee completed a response to the PIP template and submitted it to the Department within 30 calendar days of receipt of the report. e. Monitor Grantee's completion of the PIP items and provide written documentation when all PIP items have been successfully fulfilled. f. The Department will review quarterly reports and provide written feedback within 30 days of submission due date. GRANTEE SPECIFIC REQUIREMENTS: N/A REPORTING REQUIREMENT: Complete and send quarterly CAREWare reports on the same period covered on the reporting dates a s mentioned above. Reports should be sent in electronically to your contract manager. Complete the progra m report provide to you, which will entail responsible staff, timeline, expected outcome and measurement. TUBERCULOSIS CONTROL AND ELIMINATION Special Requirements Grant Start Date 10/1/2018 Grant Contract Peter Davidson Administrator Contact Info (phone & em) Reimbursement Staffing (6) -Method-- - Performance Level N/A [(if AppcabIej. BUDGET AND AGREEMENT REQUIREMENTS N/A Grant End Date 9/30/2019 Subrecipient, Contractor, Subrecipient or Recipient (non-federal) Designation Performance Target N/A Output Measure 517-284-4922; davidsonp@michigan.gov GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS Each Grantee as a sub-recipient of the CDC Tuberculosis Elimination Cooperative Agreement shall conduct activities for the purposes of tuberculosis control and elimination. Funds may be used to support personnel, purchase equipment and supplies, and provide services directly related to core TB control front-line activities, with a priority emphasis on DOT (Directly Observed Therapy) and electronic DOT, case management, completion of treatment and contact investigations. Funds may also be used to support incentive or enabler offerings to mitigate barriers for patients to complete treatment. Disallowed Costs: Federal (CDC) guidelines prohibit the use of these funds to purchase anti-tuberculosis medications or to pay for inpatient services. Examples of appropriate incentive/enabler offerings include retail coupons, public transit tickets, food, non- alcoholic beverages, or other goods/services that may be desirable or critical to a particular patient. For more information and suggested uses of incentive/enabler options, refer to CDC's Self-Study Module #9, Enhancing Adherence to Tuberculosis Treatment at http://www.cdc.gov/tb/education/ssmodules/module9/ss9reading3.htm. GRANTEE SPECIFIC REQUIREMENTS 1. Utilize DOT as the standard of care to achieve at minimum 80% of TB cases enrolled in DOT or electronic DOT (Jan 1- Dec 31). 2. Document in Michigan Disease Surveillance System ( MDSS) all changes to treatment regimen using the Report of Verified Case of Tuberculosis (RVCT) comments field (pg. 12), and completion of therapy using RVCT Follow-Up 2 (pg. 7). 3. Maintain evidence of monthly DOT logs on site (to be made available if needed). Monthly submission of DOT logs is no longer required. 4. Achieve at least 94% completion of treatment within 12 months for eligible TB cases. The determination of treatment completion is based on the total number of doses taken, not solely on the duration of therapy. Consult the most current ATS document Treatment of Tuberculosis for guidance in the number of doses needed and the length of treatment required following any interruptions in therapy. 5. Maintain appropriate documentation on site (to be made available if needed). Document the appropriate use of expenditures for incentive and enablers for clients to best meet their needs to complete appropriate therapy. 6. Ensure >90% completion of RVCT pages 1 - 6 in MDSS within one month of diagnosis. 7. Unallowable Costs per federal guidelines: Funds cannot be used for procurement of anti-tuberculosis medications. Funds cannot be used for research. Funds cannot be used for inpatient services 8. Ensure that confidential public health data is maintained and transmitted to the Department in compliance with applicable standards defined in the "CDC Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Programs" httd://www.cdc.qovinchhstp/prooraminteqration/docs/PCSIDataSecuritvGuidelines.pdf REPORTING REQUIREMENTS DOT Logs are maintained on site and available if needed. All other data must be entered into MDSS as stipulated in contract specific requirements. VAPOR INTRUSION RELOCATION Special Requirements Grant Start Date 10/1/2018 Grant End Date 1 9/30/2019 Grant Contract Contact Info LAp_h.o.ne & ernaill Reimbursement Method Administrator Orlando Todd (517) 284-4021, toddo@michigan.gov - _ Staffing (6) Subrecipient, Contractor, or Recipient (non-federal) Contractor -Designation Performance Level (if Applicable' N/A Performance Target Output Measure N/A Budget and agreement requirements Program Purpose: The purpose of this project is to provide emergency relocation assistance (alternative housing, meals, and incidentals) to Michigan residents affected by vapor intrusion, until such time as remediation is completed. GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS N/A Reimbursement Method Staffing (6) Performance Level N/A Applicablq WATER RECOVERY (PFAS) GRAYLING WATER REPSONSE VVURTSMITH WATER RECOVERY Special Requirements Grant Start Date Grant Contract Administrator Contact Info (phone & email) 10/1/2018 Grant End Date Orlando Todd (517) 284-4021, toddo@michigan.gov 9/30/2019 Subrecipient, Contractor, Subrecipient or Recipient (non.federal) Designation Performance Target N/A Output Measure Budget and agreement requirements Program Purpose: Water Recovery PFAS response capacity encompasses educational outreach regarding testing and results, and provision of filtration systems until a permanent solution can be identified and implemented. GRANTEE REQUIREMENTS N/A DEPARTMENT REQUIREMENTS N/A REPORTING REQUIREMENTS 1. Grantees are required to report by Thursday at noon each week the number of filtration systems installed, number of water cooler systems installed, number of municipal water hookups, and number of filter replacements/cooler extensions that are paid under this contract. Submit reports to Sue Manente, IVIDHHS Division of Environmental Health via email at ManenteSmichician.qov When providing temporary water assistance to residents, Grantees are asked to obtain acknowledgement of receipt of assistance from the resident. Sample acknowledgement language available from MDHHS Division of Environmental Health. If the resident's acknowledgement cannot be obtained, Grantees are required to record the following information, where available: • Name of water assistance recipient • What type of assistance was provided to the recipient • Name of grantee employee who spoke with assistance recipient • Address of residence with PFAS detection • Time and date of delivery Please note that an acknowledgement form or tracking of filter receipt is NOT intended to be a barrier to provision of water assistance. 2. All agencies are responsible for keeping track of expenses that occur for each PFAS site location in their county. A summary of the expenses for the sites need to be attached to the quarterly FSR's in EGrAMS. II WEST NILE VIRUS COMMUNITY SURVEILLANCE Special Requirements — --- - Grant Start Date .. Grant Contract Administrator 5/1/2019 — 1 Grant End Date 9/30/2019 Erik Foster, Kimberly Signs Contact Info (phone a email) 517-284-4961; fostere@michigan.gov 517-284-4951, signsk • michigan,gov Staffing (6) (Erik) (Kimberly) Subrecipient, Contractor, or Recipient (non-federal) _Desjgnatism Subrecipient Reimbursement Method Performance Level (if Ap_pljeable) N/A Performance Target Output Measure N/A BUDGET AND AGREEMENT REQUIREMENTS This agreement is intended to support the development of a low cost surveillance system for the early detection of West Nile virus in mosquitoes at the community level, for the purpose of educating the public and healthcare providers, and preventing outbreaks. This information can be utilized by participating local health departments to notify its citizens and healthcare providers of any local transmission risk using education campaigns, press-releases and other means, and to potentially work with local municipalities to conduct mosquito population mitigation activities such as drain management, scrap-tire campaigns, breeding site removal, larviciding, and adulticiding. Requirements for participation in this program include providing for the placement of a minimum number of mosquito traps, operating for at least two "trap nights" per week, identifying mosquitoes, and weekly reporting to the Department of surveillance results ($8,000). GRANTEE REQUIREMENTS Each Grantee as a sub-recipient of the Centers for Disease Control and Prevention (CDC) Epidemiology and Laboratory Capacity Cooperative Agreement shall conduct activities for the purposes of West Nile virus (WNV) surveillance among mosquito populations in their jurisdiction. Funds may be used to support personnel, to purchase equipment and supplies related to conducting mosquito surveillance in areas of historically high incidence of WNV, and to produce and/or distribute educational and other materials related to West Nile virus prevention and control. DEPARTMENT REQUIREMENTS The Department's Emerging & Zoonotic Infectious Diseases (EZID) Section will provide the Grantee with the following support: 1. Training for staff associated with the project (Spring 2019) 2. Trapping equipment necessary to collect mosquitoes (traps, batteries, chargers) 3. VecTOR test kits for the rapid, field detection of WNV 4. Entomologic and epidemiologic support to guide trapping efforts GRANTEE SPECIFIC REQUIREMENTS Mosquito Surveillance ($8,000): 1. Minimum recommended mosquito traps for this project is 5 traps utilized per county, operating 2 nights per week for a total of 10 "trap nights" per week for approximately 16 weeks. 2. Provide weekly reporting of surveillance results to the Department EZID Section (see contact information below). 3. Use surveillance data to notify the public and healthcare providers of any risk related to WNV in mosquitoes in the jurisdiction. 4. The total funds ($8,000) allocated for this project to participating local health departments must be utilized prior to September 30. REPORTING REQUIREMENTS _ Quarterly financial status reports (FSR's) will be required for this new project. Due dates and periods covered are listed below: Activity Period FSR Due Jan 1 — March 31 April 15 April 1 — June 30 July 15 July 1 — Sept 30 October 15 The Grantee shall submit weekly tables of surveillance data (template provided) documenting trap rates and disease detections to Erik Foster (fosteremichician.qov) and Kim Signs (signskmichigan.gov ) at the MDHHS EZID Section. Grant Start Date Grant Contract Administrator Contact Info (phone & email) Reimbursement Method Performance Level (if Applicable) WISE CHOICES Special Requirements 10/1/2017 grant End Date 9/30/2018 Polly Hager 517-335-9729; HaaerPamichiaan.gov Staffing (6) Subrecipient, Contractor, Subrecipient or Recipient (non-federal) -Designation N/A Performance Target N/A Output Measure BUDGET AND AGREEMENT REQUIREMENTS No funds may be expended for lobbying as defined in Act No. 472 of the Public Acts of 1978, being sections 4.411 to 4,431 of the Michigan Compiled Laws. GRANTEE REQUIREMENTS Complete Wise Choices program and Getting to the Heart of the Matter initiative evaluation requirements, which may include periodic data collection and submission. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS N/A REPORTING REQUIREMENTS Submit progress and final reports to the Department. If the report due date falls on a weekend or holiday, you have until the next business day to submit. Report Period Covered Due Dates October 1 - December 31 January 31 January 1 - March 31 April 30 April 1 - June 30 July 31 July 1 - September 30 October 31 Year End Report - Total Grant Period November 15 Grant Start Date • Grant Contract Administrator 9/30/2018 Reimbursement Method Performance (8) (9) 95% Subrecipient, Contractor, or Subrecipient Recipient (non-federal) Designation # Clients Screened for Cardiovascular Disease Risk Factors WISEWOMAN: WELL-INTEGRATED SCREENING AND EVALUATION FOR WOMEN ACROSS THE NATION PROJECT Special Requirements 10/1/2017 Robin Roberts Contact Info (phone & 517-335-1178 robertsr6@michigan.gov email) BUDGET AND AGREEMENT REQUIREMENTS N/A GRANTEE REQUIREMENTS WISEWOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation) is a program designed to screen women for chronic disease risk factors, counsel them about lifestyle changes to reduce risk factors, and refer them for medical treatment of hypertension, hyperlipidemia, and/or diabetes mellitus. This program will be based within Michigan's Breast and Cervical Cancer Control Program. For specific WISEWOMAN Program requirements, refer to the most current WISEWOMAN Program Policies and Procedures Manual. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS Entrepreneurial Gardening Project The WISEWOMAN Entrepreneurial Gardening Project will work with current entrepreneurial gardeners to plan for coming year, and recruit new participants into the program. The program will train participants in gardening skills and garden design, assist in the purchase of garden materials and supplies based on appropriated project budget, and coordinate trainings that strengthen participants understanding of sales and marking skills at area farm markets for greatest impact. The WISEWOMAN Entrepreneurial Gardening Project will be subject to a 100% performance requirement. The Department will only reimburse for clients enrolled and participating in the Gardening Project. Any unused funds will be returned to the Department. Entrepreneurial Gardeninq Project Coordinator The WISEWOMAN Program will fund Caitlin Hills, Community Navigator, to coordinate the Entrepreneurial Gardening Project in the Northern Lower Peninsula WISEWOMAN Counties, The Entrepreneurial Gardening Project Coordinator will train participants in gardening skills and garden design, assist in the purchase of garden materials and supplies based on appropriated project budget, and coordinate trainings that strengthen participants understanding of sales and marking skills at area farm markets for greatest impact. The WISEWOMAN Entrepreneurial Gardening Project Coordinator funds will not be subject to the caseload performance requirement. Therefore, these funds will not be included in the settlement that may be required if screening levels do not meet the caseload performance requirement. Community Advancement Project Through the WISEWOMAN Community Advancement project, agencies are required to conduct one low cost systems, environmental change, or health equity/social justice intervention that will benefit WISEWOMAN participants and the communities where they live. The WISEWOMAN Community Advancement Funding will not be subject to the caseload performance requirement. Therefore, these funds will not be included in the settlement that may be required if screening levels do not meet caseload performance requirement. REPORTING REQUIREMENTS All Grantees implementing WISEWOMAN: Quarterly Quality Improvement phone calls with the Community Navigator and the Department WISEWOMAN staff members to discuss progress toward meeting performance measures. All Grantees implementing WISEWOMAN: Quarterly Progress Reports Covering: Period Covered Report Due Dates October 1 — December 31 January 31 January 1 — March 31 April 30 April 1 — June 30 July 31 Final Progress Report covering the fiscal year through September 30 October 31 Reports shall be submitted to the Contract Manager at: Robin Roberts, Program Director MDHHS - WISEWOMAN Program P.O. Box 30195 Lansing, MI 48909 Phone: 517-335-1178; E-mail: robertsr6@michigan.gov Entrepreneurial Gardening Program Grantees: Monthly calls as needed to discuss program requirements. Final progress report (May 1 — September 30) due October 20 (template provided) Entrepreneurial Gardening Program Coordinator Grantees: Monthly calls to report on activities, discuss problems, and brainstorm solutions. Final Progress Report (October 1 — September 30) due October 20 (template provided) Community Advancement Project Grantees: Quarterly Progress Reports Covering: Period Covered Report Due Dates October 1 — December 31 January 15 January 1 — March 31 April 15 April 1 —June 30 July 15 Final Progress Report covering the entire project through September 30 October 20 (May be submitted sooner if project is completed earlier) Reports shall be submitted to the Contract Manager at: Robin Roberts, Program Director MDHHS - WISEWOMAN Program P.O. Box 30195 Lansing, MI 48909 Phone: 517-335-1178; E-mail: robertsr6@michigan.gov WOMEN INFANT CHILDREN (WIC) Special Requirements Grant Start Date Grant Contract Administrator Contact Info (phone & email) Grant End Date Brittany LaRue 517-335-8625; larueb@michigan.gov WIC — Breastfeeding and WIC — Migrant 9/30/2019 eirribUrsement Staffing (6) Method Performance Level N/A (if Applicable) WIC — Resident Reimbursement Staffing (6) Method Performance Level N/A (if Applicable) BUDGET AND AGREEMENT REQUIREMENTS N/A 1 Subrecipient-, Contractor -1 Subrecipient or Recipient (non-federal) Designation Performance Target N/A Output Measure Subrecipient, Contractor, Subrecipient or Recipient (non-federal) Designation Performance Target N/A Output Measure GRANTEE REQUIREMENTS 1. Provide for security of Project FRESH coupons and WIC EBT cards stored in the local Grantee prior to issuance. The Grantee must notify the WIC Division in writing of any lost, stolen, inappropriately issued or otherwise unaccounted for Project FRESH coupons or EBT cards, immediately upon recognition of such condition. 2. Comply with the requirements of the WIC program as prescribed in the Code of Federal Regulations (7 CFR, Part 246) including the following special provisions: If a local Grantee operates a WIC Program within a hospital or has a cooperative agreement with one or more hospitals, the hospital is required to advise the potentially eligible individuals that receive inpatient or outpatient prenatal, maternity, or postpartum services or accompany a child under age 5 years who receives well-child services, of the availability of WIC benefits [246.6(F)(1)]. 3. Maintain an inventory of all equipment purchased with WIC program funds and maintain such inventory at each WIC clinic location. 4. Assure each Grantee employee authorized for or requesting access to the automated WIC system complete and sign a security agreement. 5. The Grantee in accordance with the general purposes and objectives of this agreement, will comply with the federal regulations requiring that any individual that embezzles, willfully misapplies, steals or obtains by fraud, any funds, assets or property provided, whether received directly or indirectly from the USDA, that are of a value of $100 or more, shall be subject to a fine of not more than $25,000. 6. The Grantee is responsible for installation and maintenance of WIC hardware according to guidance provided by the Department WIC Program. 7, The Grantee is required to abide by the Dissemination License Agreement between Michigan State University and Michigan Department of Health and Human Services for "Mothers in Motion." Any use of these licensed materials in the provision of program related services is subject to the terms and conditions outlined in the licensure agreement, which is included in Addendum 1, as reference. DEPARTMENT REQUIREMENTS N/A GRANTEE SPECIFIC REQUIREMENTS Soecial Reauirements for the WIC Breastfeedina Peer Counseling Proaram Funds allocated for the Breastfeeding Peer Counseling Program are exempt from the WIC Nutrition Education and Breastfeeding Time Study. The Grantee may only charge certain allowed expenses to the Peer Counselor Grant. Expenses for Breastfeeding education and supplies must be charged to the normal WIC budget; not the Peer Counselor Grant. See "Allowable Expenses". Financial Reporting A Financial Status Report (FSR) must be submitted to the Department on a quarterly basis. To meet USDA grant reporting deadlines, the Grantee shall submit program expenditures to the State WIC Division using DCH-0386 Attachment B.2 Program Budget Cost Detail Schedule Attachment B.2. Send to the attention of the State WIC Breastfeeding Coordinator. Reports are due by the 15th day of: January, March, July and October. Allowable Expenses The primary purpose of these funds is to provide breastfeeding support services through peer counseling to WIC participants. Expenses may include: 1. Supervisor and/or mentor staff time 2. Materials that educate/advertise to WIC clients about the Peer Counseling Program 3. Educational resources for Peer 4. Voicemail, cell phones or phone-line expenses 5. Equipment or office furniture 6. Indirect costs The Grantee, however, must not charge a disproportionate amount of funds for these above noted items when compared to funds spent on direct service delivery by the Peer Counselor. Other Reporting The Grantee shall maintain monthly records for each individual Peer Counselor. Specific supplemental reporting forms will be provided by the State WIC Office. Reports are due to the State WIC Office by the 15 th day of: January, March, July and October Training and Education Designated Grantee staff are required: 1. To attend Supervisory training. 2. To attend a minimum of two program updates. 3. To train the peer counselors per standards set forth by USDA and the State WIC Division. Designated Peer Counselors are required to attend specific training that includes, but is not limited to: 1. Breastfeeding Basics Training 2. State WIC Peer Counselor Meetings 3. Annual WIC Conference Staff Training and Education for WIC Resident Services Designated Grantee staff (at minimum the agency WIC Coordinator or designated WIC agency representative) are required: _ 1. To attend Annual WIC Training & Educational Conference. 2. To attend the Michigan WIC Coordinator Summit. Other Grantee Obligations The following requirements apply to the Grantee receiving a special allocation for the Breastfeeding Peer Counseling Program. USDA and the Department WIC program requires the Grantee to comply with the following nine components: 1. Hire staff that meet the definition of Peer Counselor. 2. Designate a Breastfeeding Peer Counselor Manager at the local level. 3. Establish job parameters and a description for the peer counselor that is consistent with State WIC policy. 4. Establish compensation and reimbursement rates for peer counselors. 5. Train appropriate WIC local peer counseling management and clinic staff. 6. Establish standardized breastfeeding peer counseling program procedures at the local level as part of the Grantee's WIC Nutrition Services Plan. 7. Supervise and monitor the peer counselor(s). Establish community partnerships to enhance the effectiveness of the WIC peer counseling program. 8. To include designated State Lactation Consultants (LC) as part of the peer counselor recruitment and applicant interview team, 9. Provide: a. timely access to breastfeeding coordinators/lactation experts for assistance outside the peer counselor scope of practice; b. regular, systematic contact with the supervisor; c. participation in clinic staff meetings and breastfeeding in-services as part of the WIC team opportunities to meet regularly with other peer counselors. 10. Provide training and continuing education of the peer counselor(s). 11. Provide access to Peer Counselor outside of normal business hours via a cell phone or direct line with voicemail that can be accessed after hours. REPORTING REQUIREMENTS Grantees shall (when requested) annually report expenditures related to nutrition education and breastfeeding promotion and support, on a supplemental form, if needed and required, to be provided by the Department and attached to the final Financial Status Report (FSR) which is due on November 30 after the end of the fiscal year through the MI E-Grants system. The supplemental form will focus on expenditures related to Travel, Equipment, Subcontract and Other Expense categories and will not include expenditures related to salaries, wages and fringe benefits. Additionally, only expenditures suimorted by reaular WIC funds should be reflected on this supplemental form, Grantees shall report nutrition education and breastfeeding promotion and support expenditures by completing the WIC Nutrition Education and Breastfeeding Time Study as required by the Department. Breastfeeding Peer Counseling Program expenditures are not to be included. The 116th nutrition education requirement and breasffeeding target must still be met with regular WIC/NSA funds. Expenditures incurred that are related to general nutrition education -and for the promotion and-support of - breastfeeding are to be summarized as: 1. Nutrition Education 2. Breasffeeding Allowable Nutrition Education (NE) Expenses are: 1. Costs for procuring equipment for NE (as approved by the State WIC Program). 2. Interpreter or translator services to facilitate NE. 3. Evaluation or monitoring of NE. 4. NE material costs. 5. Costs of training nutrition educators, including costs related conducting training sessions and purchasing & producing training materials. 6. Costs for clinic space devoted to NE activities. 7. Travel and related expenses incurred by WIC staff to conduct any NE activity. 8. Costs of reimbursable agreements with other organizations, public or private, to provide NE to WIC participates. Allowable Breastfeedinq (BF) Promotion & Support Expenses are: 1. Peer counseling if supported with funds allocated through the WIC funding formula. (Report as time study data.) 2. Cost of procuring BF educational materials. 3. Interpreter or translator services to facilitate BF promotion and support. 4. Costs of training BF promotion & support educators, including costs related to conducting training sessions and purchasing and producing training materials. 5. Costs of clinic space devoted to BF promotion & support educational and training activities, including space set aside for BF WIC infants. 6. BF aids which directly support the initiation and continuation of BF, as purchased with WIC funds allocated through the funding formula. 7. Costs of documenting, monitoring and/or evaluating BF promotion and support staff, activities, methods and materials. This includes the cost of collecting, analyzing and evaluating data concerning WIC participant's opinions on the effectiveness of the BE promotion and support they received. (Report as time study data.) 8. Travel and related expenses incurred by WIC staff to conduct any BF promotion and support activity, 9. Costs of reimbursable agreements with other organizations, public or private, to undertake training and direct service delivery to WIC participants concerning BF promotion and support. The examples above are not all inclusive. In-kind support can also be included, if other non-WIC resources are used for those costs. Please note that costs for data processing, communications, postage, freight, rent and utilities necessary to conduct NE and BF activities must be prorated to the applicable functional category (NE/ BE promotion and support). The Grantee is required to complete the NE and BE staff time study survey as instructed by the Department VVIC Program. ADDENDUM Dissemination LicenseAgreementfor'Mothers in Motion" Between Michigan State University And Michigan Department of Health and Human Services This License Agreement ("Agreement"), effective as of October 16,2015 ("Effective Date'), is made by and between Michigan State University, having offices at 325 E. Grand River, Suite 350, East Lansing, MI 48823 ("Licensor") and State of Michigan Department of Health and Human Services Women, Infants and Children, having offices at 320 S. Walnut, Lansing, MI 48913 ("Licensee") (individually a "Party" and collectively, the 'Parties"). WHEREAS, Licensor has created the "Mothers in Motion" materials (herein, "Physical Materials"), MSU reference number TEC2015-0036 utilizing funds from a grant from the National Institutes of HealthiNi H), _grant number 1RIB- DK083934-01A2 ("Grant). WHEREAS, Licensor isthe owner of certain rights, title and interest in the Physical Materials and has the right to grant licenses thereunder. WHEREAS, Licensee wishes to license the Physical Materials for dissemination purposes and Licensor, in orderto meet its obligations underthe I\IIH grant, desires tograntsuch license to Licensee on the terms and conditions herein, WHEREAS, Licensee wishes to obtain this Agreement in order to carry outthe intent of their master agreement between Licensee and Licensor with an effective date of FY 2015-2016. NOW THEREFORE, the parties agree as follows: I. Definitions. a. 'Physical Materials" shall mean all physical items listed in ScheduleA. b. "Sublicenseable Materials" shall mean one electronic copy of the Physical Materials. c. 'Materials Modification Guide" shall mean the specifications outlined in Schedule B. d. 'Derivative Works" means all works developed by Licensee or Sublicensee which would be characterized as derivative works of the Physical Materials and/or Sublicenseabie Materials under the United States Copyright Act of 1976, or subsequent revisions thereof, specifically including, but not limited to, translations, abridgments, condensations, recastings, transformations, or adaptations thereof, or works consisting of editorial revisions, annotations, elaborations, or other modifications thereof. The term "Derivative Work" shall not include those derivative works which are developed by Licensor. e. 'Sublicense"means an agreement which may take the form of, but is not limited to, a sublicense agreement, memorandum of understanding, or special provisions added as an amendment to an existing agreement between Licensee and a Sublicensee in which Licensee grants or otherwise transfers any of therights licensed to Licensee hereunder or other rig hts that are relevant to using the Sublicenseable Materials. AGR2015-01 146 TEC2015-0036 f. "Sublicensee" means any entity to which a Sublicense is granted. 1. Grant of License 1.1 Subject to the terms and conditions of this Agreement, to the extent that Licensee's rights to Physical Materials as a result of Licensor's grant of rights to the Federal Government in accordance with the terms and conditions of the Grant are insufficient for Licensee's activities hereunder, Licensor hereby grants to Licensee a nonexclusive, nontransferable, worldwide, license to use, perform, reproduce, publically display and create Derivative Works (as outlined in the Physical Materials Modification Guide) of the Physical Materials. Notwithstanding the foregoing, Licensee may only distribute the Physical Materials within Licensee managed locations within the state of Michigan. Licensee is not permitted to sell or receive consideration for any of the Physical Materials or reproductions of the Physical Materials. 1.2. Licensor grants Licensee the right to grant Sublicenses of its rights under Section 1.1 of the Sublicensable Materials to Sublicensee for the sole purpose of placing the content contained in the Sublicenseable Materials on a website that is controlled by Sublicensee and that is access limited, password protected. Any Sublicense shall be in accordance with Article 3 below. Sublicensee may be granted the right to create Derivative Works of the Sublicenseable Materials limited to that which is described in the Materials -M odificati on Guide and on4y to ensure that the e Sublicenseable Mater1a Is meet- technical specifications necessary to place the content contained in the Sublicenseable Materials on Sublicensee's controlled website. Notwithstanding the foregoing, Sublicensee may create split-up lessons (meaning placing the content of a full-length lesson into multiple videos) of the full-length lessons contained in the DVD portion of the Sublicenseable Materials only in order to conform to the technical format of Sublicensee's website platform; the content, however, shall not be modified. Sublicensee is not permitted to sell or receive consideration for the Sublicenseable Materials in any format. Any content created solely by Sublicensee that supports the implementation of the Sublicensable Materials shall be owned by Sublicensee. If a Derivative Work is created by Sublicensee, Sublicensee shall own their creative contribution to the Derivative Work and Licensor retain all copyright rights to the original Sublicensable Materials contained in such Derivative Work. Licensee and Sublicensee may address ownership of Sublicensee's creative contribution to Derivative Works in the Sublicense agreement. 1.3 In such incidences where, for financial reasons, Licensee is not able to reproduce the label displayed on the original master copy of the DVD portion of the Physical Materials, Licensee must ensure that the entire content of the DVD portion of the Physical Materials are reproduced in its entirety so that the inclusion of the copyright notice, Licensor owned logos (including wordmark), grant number information, title of each lesson, and acknowledgements are maintained. 1.4 Except as provided in Section 1.2 and 1.3, Licensee will refrain, and shall require Sublicensees to refrain, from using the name of the Licensor in publicity or advertising without the prior written approval of Licensor. Notwithstanding the foregoing, Licensee may, without prior approval from Licensor, use Licenser's name in a manner that is (a) informational in nature (i.e. describes the existence, scope and/or nature of the relationship of the Parties and/or the fact that the Physical Materials were developed by Licensor), (b) does not suggest Licenser's endorsement of Licensee or its goods or services, (c) does not create the appearance that the source of the communication is Licensor or any party other than Licensee, and (d) otherwise consistent with the terms of the Agreement. AGR2015-01 146 2 TEC2015-0036 Except as described in Section 1.2 and 1.3 and this Section 1.4, the use of the name of the Licensor does not extend to any trademark, logo, or other name or unit of Licensor. 1.5 Licensor shall provide Physical Materials to Licensee by October 31, 2015. Licensor assumes no responsibility for distributing Physical Materials to the state of Michigan Licensee locations. 2. Licensor's Rights 2.1 Notwithstanding the rights granted in Article I hereof, Licensee acknowledges that all right, title and interest in the Physical Materials, including any copyright applicable thereto, shall remain the property of Licensor and/or the third party rights holders. With the exception of the portion contributed by Licensee or Sublicensee in a Derivative Work of the Physical Materials, Licensee or Sublicensee shall have no right, title or interest in the Physical Materials, including any copyright applicable thereto, except as expressly set forth in this Agreement. 2.2 Any rights not granted hereunder are reserved by Licensor and/or the third party rights holders. 2.3 As of Licensor's present knowledge, MSU Extension (which is a unit within Licensor) is the copyright holder of the pizza recipe included in the Physical Materials. If Licensor is notified that a third party is the copyright holder to the pizza recipe, Licensor will in good faith attempt to secure the copyright rights from the third party rights holder in order for Licensor, Licensee and Sublicensee to maintain using the Physical Materials as described in the Agreement herein. In the event Licensor is unable to secure such rights, Licensor will use reasonable efforts to identify a replacement for such third party material. 3. Sublicense 3.1 (a) Any Sublicense entered into hereunder (i) shall contain terms no less protective of Licensor's rights than those set forth in this Agreement, (ii) shall not be in conflict with this Agreement, and (iii) shall identify Licensor as an intended third party beneficiary of the Sublicense. Licensee shall provide Licensor with a complete electronic or paper copy of each Sublicense within thirty (30) days after execution of the Sublicense. Licensee shall provide Licensor with a copy of each report received by Licensee pertinent to any data produced by Sublicensee that would pertain to the report due under Section 4. Licensee shall be fully responsible to Licensor for any breach of the terms of this Agreement by a Sublicensee. Licensee and Sublicensee may address ownership of Sublicensee's creative contribution to Derivative Works in the Sublicense agreement. (b) Upon termination of this Agreement for any reason, all Sublicenses shall terminate. if a Sublicensee was in compliance with the terms of its Sublicense in effect on the date of termination, Licensor may grant such Sublicensee that so requests, a license with terms and use _rights as are acceptable to Licensor. In no event shall Licensor have any obligations of any nature whatsoever with respect to (i) any past, current or future obligations that Licensee may have had, or may in the future have, for the payment of any amounts owing to any Sublicensee, (ii) any past obligations whatsoever, and (iii) any future obligations to any Sublicensee beyond those set forth in the new license between Licensor and such Sublicensee. AG R2015-01146 3 TEC2015-0036 4. Consideration In consideration of the rights granted herein, Licensee will provide to Licensor two effectiveness and utilization data reports based on the use of the Physical Materials. One data report shall include: a) number of clients who access the Physical Materials lessons; h) number of times specific lessons are completed; c) number of unique users; d) client perceptions for useful ness and helpfulness of lessons; and e) client beliefs in relation to ability to make changes based on lesson completion and shall be due to Licensor two years from the Effective Date and one data report containing the same data as described above shall be due thirty (30) days after the end of the five (5) year term. The reports shall be sent to Mci-Wei.Chang@.ht,msu.edu and msulagrr@msu.edu . 5, Diligence Licensee shall use its reasonable efforts to disseminate the Physical Materials in a fashion that Licensee determines aliens with its mission in order to provide public benefit. 6. Term and Termination 6.1 This Agreement shall commence as of the Effective Date and shall extend for a period of five (5) years unless earlier terminated in accordance with paragraph 6.2 hereof. 6.2. lnthe event that either Party believes that the other has materially breached any obligation under this Agreement, such Party shall so notify the breaching Party in writing. The breaching Party shall have thirty (30) days from the receipt of notice to cure the a lleged breach and to notify the non-breaching Party in writing that said cure has been affected. If the breach is not cured within said period, the non- breaching Party shall have the right to terminate the Agreement without further notice. 1.3 Effect of Termination. _6.31 Upon termination, Licensee shall cease using, distributing and displaying the Physical Materials, and shall confirm in writing to Licensor that the Physical Materials have eitnerbeen returned to Licensor or have been destroyed (in Licensor's sole discretion). All Sublicenses shall terminate upon termination of this Agreement pursuant to Section 3(b). 6.3.2 Upon termination, the following provisions shall survive and remain in effect; 2.1; 4; 6.3; 8. 7. Representations and Warranties 7.1 Licensor and third parties hereby represent that it has. full right, power and authority to enter into this Agreement and to provide the license of rights granted under this Agreement. 7.2 LICENSOR, INCLUDING ITS TRUSTEES, OFFICERS AND EMPLOYEES, MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE PHYSICAL MATERIALS AND SUBLICENSEABLE MATERIALS AND HEREBY DISCLAIMS ALL REPRESENTATIONS AND WARRANTIES, EXPRESS OR IMPLIED, INCLUDING. WITHOUT LIMITATION, ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR NONINFRINGEMENT. LICENSEE ASSUMES THE ENTIRE RISK AGR2015-01 146 4 TEC1015-0036 AND RESPONSIBILITY FOR THE SAFETY, EFFICACY, PERFORMANCE, DESIGN, MARKETABILITY AND QUALITY OF THE PHYSICAL MATERIALS AND SUBLICENSEABLE MATERIALS. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, THE PARTIES, INCLUDING THEIR OFFICERS AND EMPLOYEES, ACKNOWLEDGE THAT (A) THE PHYSICAL MATERIALS AND SUBLICENSEABLE MATERIALS AND DERIVATIVE WORKS ARE PROVIDED "AS IS":(B) NEITHER THE PHYSICAL MATERIALS NOR SUBLICENSEABLE MATERIALS MAY BE FUNCTIONAL ON EVERY MACHINE OR IN EVERY ENVIRONMENT; AND (C) THE PHYSICAL MATERIALS AND SUBLICENSEABLE MATERIALS ARE PROVIDED WITHOUT ANY WARRANTIES THAT IT IS ERROR-FREE OR THAT LICENSOR IS UNDER ANY OBLIGATION TO CORRECT SUCH ERRORS. 8. Limitation of Liability 8.1 Each Party acknowledges and represents that it will be responsible for any claim for personal injury or property damage asserted by a third party and arising out of or related to its acts or omissions in the performance of its obligations hereunder to the extent that a court of competent jurisdiction determines such Party to be at fault or otherwise legally responsible for such claim. 8.2 In no event shall either Party be liable to the other Party or to any third party, whether under theory of contract, tort or otherwise, for any indirect, incidental, punitive, consequential, or special damages, whether foreseeable or not and whether such Party is advised of the possibility of such damages. 9. Assignment and Transfer Neither Party may assign, directly or indirectly, all or part of its rights or delegate its obligations under this Agreement without the prior written consent of the other Party. 10. Dispute Resolution 10.1 In the event of any dispute or controversy arising out of or relating to this Agreement or the subject matter hereof, the Parties shall use their best efforts to resolve the dispute as soon as possible. The Parties shall, without delay, continue to perform their respective obligations under this Agreement which are not affected by the dispute. 10.2 This Agreement and any disputes arising out of or relating to this Agreement shall be governed by and —construed in accordance with the laws-of-the State of Mictvigan without _regard to the conflicts_of_law_provisions_ thereof. In any action to enforce this Agreement, the prevailing Party will be entitled to recover reasonable costs and attorneys' fees. 11. Force Majeure Neither Party shall be liable for damages or subject to injunctive or other relief, or have the right to terminate this Agreement, for any delay or default in performance hereunder if such delay or default is caused by conditions beyond its control including, but not limited to, Acts of God or force majeure, government restrictions (including the denial or cancellation of any necessary license), wars, insurrections and/or any other cause beyond the reasonable control of the Party whose performance is affected. AGR2015-01 146 5 TEC2015-0036 12. Entire Agreement This Agreement constitutes the entire agreement of the Parties and supersedes all prior communications, understandings and agreements relating to the subject matter hereof, whether orator written. 13. Amendment No modification or claimed waiver of any provision of this Agreement shall be valid except by written amendment signed by authorized representatives of Licensor and Licensee. 14 Severability If any provision of this Agreement is determined to be invalid or unenforceable under applicable law, it shall not affect the validity or enforceability of the remainder of the terms of this Agreement, and without further action by the Parties hereto, such provision shall be reformed to the minimum extent necessary to make such provision valid and enforceable. IS Waiver Waiver of any provision herein .shall not be deemed a waiver of any other provision herein, nor shall waiver of any breach of this Agreement be construed as a continuing waiver of other breaches of the same or other provisions of this Agreement. 16. Notices All notices given pursuant to this Agreement shall be in writing and may be hand delivered, or shall be deemed received within three (3) days after mailing if sent by registered or certified mail, return receipt requested. If any notice is sent by facsimile, confi rmation copies must be sent by mail or hand delivery to the specified address. Either party may from time-to-time change its notice address by written notice to the other Party. If to Licensor: Licensing Notices: MSU Technologies Attention: Agreement Coordinator AGR2015-01146 325 E. Grand River Suite 350 City Center Building East Lansing, MI48823 517-884.1605 msutagr@.msu.edu AGR201 5-01146 6 TEC2015-0036 If to Licensee: Michigan Department of Health and Human Services, WIC Division Attn: Kristen Hanulcik Manager, Consultation and Nutrition Services Unit 320 S. Walnut, Lewis Cass Bldg., 6 th Floor Lansing, MI 48913 517-335-8545 hanulcikk@michigan.gov 17. Article Headings The Parties have carefully considered this Agreement and have determined that ambiguities, if any, shall not be construed or enforced against the drafter. Furthermore, the headings of Articles have been inserted forconvenience of reference only and shall not oontrol or affect the meaning or construction of any oftheagreements, terms, covenants or conditionsofthisAgreementi n any manner. la Relationship of Pa rties Licensor and Licensee each acknowledge pnd agree that the other is an independent contractor in the performance of each and every part of this Agreement and is solely responsible for all of its employees and students and such Party's labor costs and expenses arising in connection therewith, The Parties are not partners, joint venturers or otherwise affiliated, and neither has any right or authority to make any statements, representations or commitments of any kind, or to take any action, which shall be binding on the other Party, without the prior written consent of such other Party. (remainder of page intentionally left blank) AG R2015-01 146 7 TEC201 5-0036 IN WITNESS WHEREOF, the Parties have executed this Agreement by their respective, duly authorized representative as of the date first above written. LICENSOR: Michigan State University Signature on file Date: 10/15/15 By: Dr. Richard W. Chylla Executive Director, MSU Technologies LICENSEE: State of Michigan Department of Health and Human Services Women; Infants & Children Signature on file BY: Kim Stephen Date: 10/16/15 Bureau of Purchasing Michigan Department of Health and Human Services stephenk@michigan.gov 517-241-1196 Signature on file By: Stan Bien, Director Date: 10116115 WIC Division Michigan Department of Health and Human Services 320 S. Walnut, Lewis Cass Bldg., 6th Floor Lansing, MI 48913 biens@michigan.gov 517-335-8448 AGRZO 15-Q1 146 8 TEC2Q15-0036 Schedule A Physical Materials I. Client Materials A. Mothers in Motion intervention materials I. 260 sets packaged in Mothers in Motion bag. One set includes: a. I Mothers in Motion DVD set (I set is comprised of 3 DVDs) b. I looped DVD of Mothers in Motion Overview and Introduction c. Folder containing Mothers in Motion worksheets (e.g., "Goal and Plans" and 'Where Do I Go from Here?" worksheets, and stress log) and reference/guidance sheet detailing contents of each Mothers in Motion lesson (Total of 11Iessons) d. 1 CD containing PDF formatted documents of Mothers in Motion worksheets to accommodate additional printing needs. 2. All Mothers in Motion intervention materials listed above will also be saved on 2 external drives provided by WIC. II. Staff Materials A. 'Rethinking How We Listen and Respond in WIC" Videos/DVDs I. 260 "Rethinking How We Listen and Respond in WIC" DVDs [included in Mothers In Motion bag described above (I DVD per bag)] 2. "Rethinking How We Listen and Respond in VVIC" contents saved in video format on 2 external drives provided by WIC **All Items listed above will be saved on total of 4 external drives, provided by WIC** AGR2015-01146 9 TEC2015-0036 Schedule B Materials Modification Guide . I. Client Matenals 1 A. Mothers In Motion DVD I. The following Items are NOT permitted to be altered on DVDs a. DVD content I. MSU and Mothers in Motion logo ii. Grant number (N1H-NIDDK, 1R18-DK083934-01A2) iii. All lesson module and intervention content [exception: food label reading if contents become outdated] iv. Acknowledgement section v. Copyright notice b. Label on Disks* i. MSU and Mothers in Motion logo ii. Grant number (N1H-NIDDK, 1R18-DK083934-01A2) iii. Title of each lesson iv. Copyright notice 2. Items that may be reproduced a. Mothers in Motion DVDs b. CD contains all Mothers in Motion worksheets B. Mothers In Motion Worksheets I. The following items are NOT permitted to be altered on worksheets a. Grant number (NIH-NIDDK, 1R18-DK083934-01A2) b. Mothers In Motion logo c. Title of each lesson d. Copyright notice 2. The following items are permitted to be altered on Worksheets A. Contents in the worksheets 3. Items that may be reproduced a. All worksheets b. Reference/guidance sheet detailing contents of each Mothers In Motion lesson 1 II. Staff Materials A. "Rethinking How We Listen and Respond in WIC" Videos/DVD 1. permitted to be altered on DVD a. DVD content i. MSU and Mothers in Motion logo H. Grant number (NIH-NI DDK, 1R18-DK083934-01A2) iii. Acknowledgement section iv. Video/DVD Contents v. Copyright notice b. Label on Disks* i. MSU and Mothers in Motionlogo ii. Grant number (N1H-NIDDK, 1R1S-DK083934-01 A2) iii. Title of each lesson iv. Copyright notice Items that are NOT AGR2015-01 146 10 TEC2015-0036 *WIC is allowed to duplicate DVDs without label orgrant number on thedisks, ifnecessary. 1 Sublicensee may create contentthatsupportsthe implementation of the content contained inthe Mothers in Motion DVDs, Mothers in Motion Worksheets and "Rethinking How We Listen and Respond in WIC" Videos/DVD. Any content created solely by Sublicensee shall be owned in accordance with Section 1.2 and Section 3.1(a). Implementation of the content contained in the Mothers in Motion DVDs, Mothers in Motion Worksheets and "Rethinking How We Listen and Respond inWIC"Videos/DVD shall be in accordancewith Section 1.2. AGR2015-01146 11 TEC2015-0036 A nncearto 111/I 1 r11.31.-k 1 - 't91 a Dissinninadan Liceneo Agreement for "Cemottesicate So Naivete" Among MIchipm Stele Univeraity, Ohio State Inuoveilon Foundation And 34kbigao Deplitilitt* of Health and Humes Services This Wan Agreement ("Agreement", elfeetive as of kattutry 1,2017 ("Motive Date), is made by and among Miehigatt Slate 'University, hewing ofRues tit 32$ R. Omni Rivet, Suite 350, Eat Lansing, MI 4if123 Mgr), Ohio State Innovation Foundetion, liming offices at 1524 N IBgh Sheet, Coluenhui, OH 43201 cowl (together "Licensee) and State of Mithiptt Dcptuttnent of He.alth and Human Services Women, lauds and Children, having offices at 320 & %dm% Lansing, MI 48913 nicenseel (individually a "Petty and collectively, the *Parties"), WHEREAS, LietilS01 Ito buena:KW property rights in the "Communlesge to Motivate" materials (haelt4 "Physical Meterielsli MO reference weber M2016-0178, 051/ reference number T2017.- 132, developed utilizing funds from a grant fkom the Nationsi Institutes of Health (MIA vont munhes R180K-013934-01 (40rant"). WHEREAS, Licensor lo the owner Orcertsin rightly tido end inkiest in the Physical katerialz and has Uhe 0010 vast licenses thereunder, mom% Licensee Mikes to Vomit the Physicist Materiais for dissemination purposes and Licensor desires toping such license to Licensee me the tenns end conditions hereto NOW THEREFORE, the Pieties epee as follows: I. Definitkurts. s. 'Physical !Asterisk" shall MOM all physical items listed in Sc/tedule b. "Sublicensehle Materiel." shall mean one electronic copy of the Physical Menerlals, c. 'Mood& Modification Oulde"sheil mesas the speollifestdons outlined In Schedule B. Merivative Works" aeons all %mks developed by Licensee or Sublicentet which would be ehmarderited is detivetee works of the Physical Materlsis suldfce Subliccosehle Meteriele ander um! TANA gleam Nowieht Act of 1976. or subsequent revisions thereof, specifically including, C of Limn 1.1 Sublet' to the timer and conditions of din Agreement, to the talent that Lieentee's rights to Physical Meted& as a rod' of Litensor's grant of rights to the federal °overarmed in neconiencs with the terms and canlidons of the ONO ate insufficient for IACONSEe'S' activities hereunder. Lleensor Welty grants- to Ltembree a nonexclusive, nonosourferable, woridu4de, theme to ant, pettormi reproduce, publicelty display the Physical Kat/Jets, Licensee Ii granted the limited right to creme Derivetive Works of the Physical Materials, speedo* Licensee Shull have des right to creme Derivelivis Worts which era (a) compenton guidance Widows tote Nodal Mated& thr educational lw hemmers In the &twee of outploylog Myriad Materials, (b) nomads for pmniotioe of the ausilabillty of educational opportunities employin the Physical_ Materials, and (e) instruments for cawing evaluations end feedback home come pidicipents. Notwithstanding the finegoint, Limner* may only distribute the Physical Materiels whittle Licensee.meneged locations within the state of —Michigan. Licensee is not pennittedeatelliat reedit_ comideratian tor any of the PhYsleal Matedals or rep4uUomftherhyalmi Mater 1.4conior pais Licensee the right to went Strbileenses dill rights ender 8Cethriik 1.1 of the Soblicensable Meted* to Sublicansee for the tole purpose of planing the content contained in the thrbileensetic Walsh (Including the videorr) on a websita that is controlled by &Women and that is mom Bathed, password protected Any tlittilkenett thedi be hi accordance with Mick 3 below. Sithlicensee is not permitted to sell or receive tansklerstion for the Subilconsable Materials in any roma Any content created solely by Sublioensec that supports the implementation of the Subticeneable Materials shell be owned by Sublicensee. 1.3 ln such laddontoo whom frit finocial teuatte,. ItAceneee is not etie to reproduce the label displayed on the original muter copy of the MO portion or the Physical Materielsi Licensee most Orme diet the entire coolant tithe DVD portion of the Physical Wert* ere reproduced in ks colitetY no that the inclusion of this copyright notice, grant number Informution, tide of each lesson, end acknowledgements are mekriained. 14 Licensee win retrain, and *ell require &Micron** to meals, from using the nem of the Lieeesor or The Ole State tiniverslty 1`031) in publicity or aductilsing %Idiom the prior 'mitten aggitnrel of Litrensor. LS Licerrior shall provide Physical Ideterlais to Lictartee hy May 1OI2. Licenor use es 0 eadleixlintang Physical hlaterisis to the stoteoflidichigan Licensee locations. iLiteesor's Rights 2„1 Notvdthstanding d* rights grained in Arilete I bereot Licensee ltohnowletl* dud 111 tight, tido and fame' in the Pbytiesi Mikterinb, inetens any copyright applicable *woo , Mgt remain the property of Litman Menne or Subduers* shah have no right, We or interest In the Physical Moeda* including any copyright applicable thereto„ except us expressly set forth in this Agreement 22 Any rights not granted hereunder we reserved by Licensor. 311blicarm 3.1 (s) My Sublicense entered into hereunder (1) shell contain terms no ten protective of Llettuor's rights that those set Sink itt this Asteentent o (I1) shall not be in =Mid with this A0112011.00413 2 O5UA20I7.1172 TEC201641111 Algoma* rod (iil) shell identify Licensor as en intended. third party beneficial, of** Sablieense. Licensee shett provide licensor with * omplete *male or peper copy of eadt Sublicense within thirty (30) days alter esecolion of the Sublicense. Licensee shell provide Lioenect with a copy attach tepon receivedly Licensee pati'nent loamy data yenduced by Stiblicentee that meld pertain WI die Merl tint under Seedon 4. Licensee shall be fully teepernible le Limner tbr any bawds °Me tonne of thitAgrament by aSublicense* (b) Upon termination of this Agreement thr my reason, all Schlicenses shell iemodnete, ir a Subilleertsee wee in compliance with the terms of Its Sul:llama in effect en the date of tenntomion, Licensor may gram such Sublicense* that itt tapas, a fleeing With tante and use rights a ere ecceptalde to Llowteor. In no swot shell ,Literser twee any obligations of any nature Whatsoever with respect to (I) any past, cane* 01 fistme obligation that Lieensee may have hal, or may ha thchttanittweilor the payment oho entoonit owing W neY Sublicense* (ii) any pat obligations whatsoever, and (lit) any Mute obligations to any Subleases beyond those set guilt in the new ilesese between Licensor•end such Sublicense*, Cooshloratlun LftcosMcinibndfthe rights lanai hinds, Lieensee, wW.presvide to Licensor two effectiveness and utilization data tepotts based on the use of the Physical WOW* One dela report shell Include: e) umber of clients who soma the Physical 64Metiels imam b) number online specific lenette are complettak c) amber of unique oak- d) client peterokna for usellaltwas and helpfulness °flames; end tt) Client beliefs in relation to, ability. le nuke chops based en Wean eeenpletiese and Audi be due to Licensor two years him the Effective Dote and one data report containing the sense dale ite described *hove shell be tkie thirty (3O) days ates the-Weirdos:five (5) year term. Such dale reports shell asap% the ineortnition provided in ti,o by CM (dietitians end tam* or bran Weeding peer seueselots, 'Ow *Vane Shell be sent to clutagt5n.oisletio, InocveUan@oeuedu and insategy@ntstreda. • Licensee shit tree its resseniible east; to diteteminte thoPhysieel fotanacielett *Mon Llecoare &thinning* aligns with itS Wain in rade to provide pablie benefit. Tientand Tertaloatien 6.1 Thie Agreement shall comments a of the Elihelive bate end abaft Wend for *period of Olie (5) years onion earlier teentineied in madam with paragraph. 62 hereof, This Areement may be renewed or extended by 'mitten amendment signed by authorized Pepfeleniatives of Licenser and Llama ist accordance whit Artick 13. 62. %the event that Petty hot** that mother Party has materially betiehed enyobligelion under this Agnomen, each Party than so notillw the breeding Party in writing, The breadth* Pam shell have thItyQo4.yeomth.cfncatcioousdse alleged breach and to MOO the sion-hresehIng Party In writing that said cum hat been effected. irilmt bleach is riot awed within said period, the non breaching Petty *ell, lave the den to laminae the Agreement without Anther notice. 6,3 ittlitelofThiatinition. /401t201140413 OW Ale 1.1172 T200164171 43.1 Upon tennina ion, Licensee shall came min* attributing and dieptoldng the Physical Magri* and shall confirm in 'rotting to Licemor that the Physical Materiak have either been roma to Licensor or have been destroyed (in Menne* sole discretion), An Subliconsushail tonulnate upon terninallon oftbAs Aareamentrattumit tO SeCtion 3(4 412 Upon temeinations the following provisions shall twelve and tannin In offnet 241,4, 63; I, • Repsesauhrtions Ind Warnothes • Lioarnor mpresents that to rho knowledge of The Ohio Moat Univotalky's sad MEWS technology under offices that it has MI right, pm* and autionity to -color into this Agreement and to provide the limit of rights warded under this Armond. 7.2L LICENSOR AND OSU, INCLUDING. THEIR CREATORS, TRUSTEES, OFFICERS, EMPLOYEES. AGENTS Oft AFFILIATED ENTERPRISELMAKE 140 REPRESENTATIONS OR — WARRANTIES OF ANY KIND CONCERNING THE PHYSICAL MATERIALS AND SUBLICENSABLE MATERIALS AND HEREBY OISCIAIM ALL REPRESENTATIONS AND WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, Al4Y WARRANTIES OF MERCILANTABILITY OR FITNESS FOR A PARIICULAR PURPOSE, NONINFIUNCIEMENT, SAFETY, EFFICACY. AFFROVABILITY BY REGULATORY AUTHDIUTIES, TIME AND COST OF DEVELOPMENT, OR PATENTABILITY.. LICENSEE ASSUMES THE ENTIRE RISK AND RESPaNSIBILITY FOR THE SAFETY, EFFICACY, PERPORttANCE, DESIGN, MARRETABIL1TY AND QUALITY OF THE PHYSICAL MATERIALS AND SUBLICENSABLE MATERIALS WITHOUT LIMITING THE GENERALITY OF THE POREGOI140, THE PARTIES, INCUJOING THEIR OFFICERS AND EMPLOYEES, ACICHOWLEDOE THAT (A) THE PHYSICAL MATERIALS AND SUBLICENSAELE MATERIALS ARE PROVIDED *AS IS"; IX) NEITHER THE PHYSICAL MATERIALS NOR SUBLICINSABLE MATERIALS MAY BE FUNCTIONAL ON EVERY MACHINE OR IN EVERY ENVIRCfNMENf; AND (C) ITIE PHYSICAL MATERIALS AND SUELICENSABLE MATERIALS ARE PROVIDED WITHOUT ANY WARRANTIES THAT IT IS ERROR-FREE Oft THAT LICENSOR IS UNDER ANY OBLIGATION TO CORRECT SUCH ERRORS. LinkofLtblktv LI lefrett Partyaoknolvlerips and represents. that It Wilthanspondble Tor toty elelm fOr personal Injury Or property *nage paled by aihhd paw Mid alias out of or NNW to hr acts or omIssions In the perfoonanotOnSithligations kettuadatto Ate extern that a count of corepotentjuristlimion determines MO Party to beat fault Or othowise kplly respottsiblefor nunItnin* Nothing intim Attentions shall be deemed or infnied 41 any vetiverof my Pones sovereign immunity or inianitnily granted by IMMor. at iit*, if applimble, &2In lio wAnt shall a Pony boilable to anotherForty or to any *Mi.' patty, *ether under theory of carsick kid or otherwise, for any Indira!, incidental. punitive„ consequendal, Or spatial damages, whether foreseeable or not and ivhether sock Party Is advised of the PossibilkY of such chimuSst 9. Assignment *ad Tressefor No Party may oasign, dinaely or Indbeatly, ell or part of its tights or dring. h,ob4igetions under this Agreement without the prktr corium consom of the other Partin, •O120114003 11001‘41711 4 o A200417a 10. Dispute Resolution 10.1 In the event of any dispute or controversy wising out of or relating to dile Agreement or the iubject matter Med; the Parties shill use their best °flans Co motive the dispute as soon as possible. The Parties shall. without delay. confirm to perform their respective obligedeorm under this Agreement Which era not effected by the dispute 11. Porte Majeure He Perry Shell be liable kr deluges Or SI/Weal° 4u/relive cc other relit& or have the right to terminate this Agreelirialli, for any delay or de** in perbmwrice beremater Waugh delay or dam* 1$ caused by conditions beyond its control including but not limited to. Ads of Ood or tbrce megoure government ombietions (inclutiki the &mitt or conoeletion ahoy recomery Honse). ware latmections andlorany- other cause beyond the mama* control of the Party whose poribomence is affected. Elhdre Agri$1114111 This Agreement condones the entire qtement oflk Parties sod supersedes Ill prior COTIMItinicalions, understandings and agreements relating iodic tutjnel mew Urea, whether mai or written. It Amendment We modificatkon or claimed advet of any provision of this Agmemeni shell ho valid accept by volition amendment alined by euthorized tapresentatives onions:4r seul Licensee. 14, Severabitity gay provision of Oh Agreement is datanniscd to be invalid or uneameable under sopplicable law, it shall not *Met the validity or enthmeability of the reinsioder of the Isms of this Agreement, and without further otiose by the Parties IttAtto sndi prOVIBIDO eltell be redbmied to the minimum extent mosso to make sett provision valid and enforceable. 15, Walver Waiver of any provision heroin shall not be deemed a waiver of any other proviskm herein, 1107 shaft waiver el mly breach of this Ageeement be construv$ as a continuing waiver of other breaches of the seme or other provisions of this Agreement, U. Motleys All notices given meant to this Agreement shall be in writing and may be band delivered, or $1011 be deemed received within dun (I) days niter milk* Iliad by registered or certified mall, return receipt molested If ony notice is sent by thosiralle, onnflundion copies must be meat by mill or hand delivery to the speelikti address. Either patty may from tinse-to-tinto change its entice address by onion notice to the ether Party. 410,017.00453 5 e.2017-1 172 MC201E41741 if to Litman MK/ Technologies Attention!, Agreement Coordinator AGR2017-4104153 325 &Grand River Suite 39) City Cosier Building East Lensing, MI 411623 517-1184-1605 numiffiramstaki Ohio State Innovation Boundetion 1524 N HO Street -Columbus, OH 43201 6144924315 Irto Wanner blichigen Departmenrt olReidthintd Human Services, WIC Div . siert AtIrb: Mtn Hersulolk Mao" Consultation and nutrition Services Unit 320 S Wilma. Levvie Cass BIrk, dh Floor .Lansing, MI 48913 "17-3354545 hanulelitlentieltipmgov It Article Headings The Prudes have easefully considered this Agreement and hive detennined that ambiguities, if any, shall not be construed ot attrOmad egainst the droller. Furthermore, the headings or ,Artioles have been inserted for convenienoe or nelerenec only and shall not control or affect the meaning or comasuction or any of the agreements, terms, cOvantitit or conditions of this Agreement in any mem% IL !Relationship afParties Licensor and LAMM each acknowledge and agree that the otheris en independent connector in the .perronnenee .or tech and every part of this Agreement and Is solely responsible rar all or Its employees and Andante end web iPerlys Mar costs mad expenses aritringIn COMMUOTI .thmildu The Parties sue not partners, joint venturers or otherwise affiliated, and neither rime any tight or euthority to make eny statements, rep neSentetions Or cornardimonts deny Mark :Ditto take any action,. which shin be binding on the other Poly, iNithoat the prior 'minor consent or such other ?arty. A00.1011.004$3 USSJ A311174 In 1EC2616.0 ITS Dote: IN WITNE$S he Petrillo hove executed (16 Agrwreicot by theirre$pective, duiy attlioriztti represcrmives Its of the date l'irot above written. LICENSOR: Michigan Siam Univerotry By Date: g ..12 °(//` lereherd W. Ciiyi Exdcotive Directors NiStr Tcertriorogies Ohio Stete I o'atIon Rooddatloo • D[pargorb Nog Vic a Pmicient LICENSEE! Sidle a Chlidret itititpurDepatirtent. of Nee th foci Serviceo; Women, Infants Sy: — , . • • • • - - - • • Jeanette Hensler, Director Grants Division, Bureau of Purchasing By Sian Bien, Director WIC Diyistort Michigan Pep.ftrtrroortt or licalth mil Human Spriricgs 370 E.. Walnut, Lewis, Cass Bitts„ 6111 Floor 4U913 hicaggrnielagfili,gov 5171354448 R211 7,00433 TEC20113.01711 7 osu mon.-1 I 12 Sdnedule A ?bola' rastorials A communicate to Morita, videos —op eo 10 ais In IND format $5 knew 12 video lessons, reminder end gearel lIp Lesson, introd tad preview B. itahinting wire we think and respond in WIC video C. Tip Mews — 650 copies (color Om, learlinsted and coil) -1).-CUPs dint eenteke-tho following mamba related ne Comm /Ovate to MOM* tWU to 10 copies): a. Tip ahem; c. • Power point slides °fall 12 lessons, reminder rod mend tip lesson; Sommory of koy points irt each video lesson d. Instructions for ow of the videos. Ogitcnial bud drives (2) tho" contain dee foflow1gmatos: & CONnimmicare to Mbilvaie video& 15 video won% Ix Rethinking whit in 'hied and respond In WIC video; c, Tip Shoos 16.11011;, d. Pow point 'lidos orall 12 lesson% reminder and general tip lesson in PIN; • Stmentory of key plots In each video Item in PDF', t Instructions for use of tbe videos in PDT. AOR2017-00453 03U 1 1 TEC2016-01 7g Module Mitedela tbdifigation Guide 1Nooptos pnw1404. in Seaton . Jo motaaration. of PktoW Meth Isnot poratittea AOR1011410433 1=2016-0117$ 05111 A2017-1 In 9 FOOTNOTES: FY 2018/2019 (a) Refer to Plan and Budget Framework for element definitions. (b) Refer to master comprehensive agreement and program and budget instructions package for further explanation of applicability o these reimbursement methods. (c) Negotiated starting from the average of the past two complete years' actual number where available. (d) Calculated by multiplying the "Total Performance Expectation" column by the ratio of the elements total State funding (DCH 0410, Line 24) to "Total Expenditures" DCH 0410, Line 17). Prior to calculation, adjustments will be made for unallowable cost, equipment funded by local funds and MDHHS reimbursement not performance based (I.E., fixed unit rate, staffing). (e) Calculated by multiplying the "State Funded Element Target Performance" column by the "Percent" column. (f) Refer to master comprehensive agreement and budget instructions package for further explanation regarding these designations. (1) CSHCS Care Coordination 1. Case Management A. Maximum of six (6) services per year B. Reimbursement - $201.58 per service provided face-to-face in the home setting. 2. CARE COORDINATION A. LEVEL I PLAN OF CARE 1. Annual Plan of Care in the home or home-like setting that requires the Care Coordinator to travel to a non-LHD site $150 2. Annual Plan of Care over the telephone $100 B. LEVEL II CARE COORDINATION 1. Level II Care Coordination is reimbursed at $30.00 per unit 2. A maximum of 10 units per beneficiary per eligibility year will be reimbursed. (2) Reimbursement Chart for Fixed Rates AIDS/HIV Prevention Non- Categorical $11.00 per blood draw for non-categorical health departmentsi Limited annually to $2,000 Body Art $264.07/appl. annual license prior to 711; $132.04/appl. annual license after 711; I $117.53/appl. temporary license; $261.20/appl. renewal prior to 12/1; $396.11/appl. renewal after 12/1; $26.40duplicate license CSHCS-Medicaid Elevated Blood Lead Case Management $201.58 per home visit, for up to 6 home visits FDA Tobacco Retailer (A&L) Inspections - Oakland only $325.20 per inspection Fetal Infant Mortality Review (FIMR) Case Abstractions $270.00 per case, not to exceed the maximum set for each Grntee Immunization Assessment Feedback Incentive Exchange (AFIX) Follow-up $100 per personal visit or $50 for a phone call (with information office, not to exceed the maximum set for each individual contractor. mailed afterward) to the provider Immunization Nurse Education $200 per session except Vaccines Across the Lifespan, which session, upon completion and submission of Provider Contracts can only be made for one in-service module session per physician is to be reimbursed at $250 per and Report Forms. Reimbursement clinic site per year. Immunization VFC (only) Provider Site Visits $150 per site visit, not to exceed the maximum set for each individual Grantee Immunization VFC/AFIX Combined Provider Site Visits $350 per site visit, not to exceed the maximum set for each individual Grantee Informed Consent $50 per woman served, for each woman that expressly states or confirmation of a pregnancy for the purpose of obtaining an that she is seeking a pregnancy test abortion and is provided the services. Laboratory Services & STD See contract language for gonorrhea and chlamydia testing reimbursement performance requirements, AIDS SIDS (FIMR Interviews) $125 for each family support visit. A maximum of six (6) visits per infant death is reimbursable Original Notes FY 2019 (3) Allocation to be reflected in individual programs during budgeting process. (4) Funding Source (not a single element). Hearing and Vision are single elements. (5) Subject to Statewide Maintenance of Effort requirement for Title X. (6) State funding is first source (after fees and other earmarked sources). (7) Fixed unit rate subject to actual costs. (8) The performance reimbursement target will be the base target caseload established by MDHHS. (9) Subject to a match requirement (hard or in-kind) of $1 for each $3 of MDHHS agreement funding for Coordination. (10) Fixed rate limited to contract amount. (11) Up to six (6) visits per family. (12) Non-categorically funded Health Departments will be reimbursed at $11.00 per HIV test conducted up to a maximum of $2,000 annually. (13) Each delegate agency must serve a minimum percentage of Title X users to access their total allocated funds. Semi-annual FPAR data will be used to determine total Title X users. (14) Public Health Emergency Preparedness (PHEP) funding BP1 must be expended by June 30 and is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHDs must submit a nine-month budget and a q' arterly Financial Status Report (FSR) column for this program element. (15) Public Health Emergency Preparedness (PHEP) funding for October 1—June 30. and July 1—September 30, is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PREP) Cooperative Agreement Guidance. LHDs must submit a three-month budget nd a quarterly Financial Status Report (FSR) column for this program element. (16) Project meets the Research and Development criteria as defined by Title 2 CFR, Section 200.87. (17) Not Applicable (18) Subject to match requirement as specified in Attachment III - Program Assurances and Specific Requirements. NOTE: Some footnotes may not apply to this agency. Original Notes FY 2019 OAKLAND COUNTY, MICHIGAN GRANT AWARD HEALTH DIVISION CPBC GRANT SCHEDULE B FY19 Special Revenue Grant Positions , Position # Classification (FTE or PINE) Budgeted Position Title Notes 00674 Full-Time Eligible Auxiliary Health Worker 00752 Full-Time Eligible Public Health Nurse III 00866 Full-Time Eligible Office Assistant II Under-filled with PTNE Lactation Specialist 00906 Full-Time Eligible Public Health Nurse III 00912 Full-Time Eligible Public Health Nutritionist III 00958 Full-Time Eligible Office Supervisor I 01328 Full-Time Eligible Auxiliary Health Worker 01752 RIFT- ime-Eligibfe Auxittaryllealth Worker Under-filled with-PTNE 01865 Full-Time Eligible Public Health Nutrition Supervisor 02070 Full-Time Eligible Health Program Coordinator 02074 Full-Time Eligible Public Health Nutritionist II 02436 Full-Time Eligible Vaccine Supply Coordinator 02509 Full-Time Eligible Nutrition Technician - WIC 03073 Full-Time Eligible Office Supervisor ll 03094 Full-Time Eligible Health Program Coordinator 03107 Full-Time Eligible Public Health Nurse III 03183 Full-Time Eligible Public Health Nurse HI Under-filled with PHN il 03427 Full-Time Eligible Public Health Nurse III 04736 Full-Time Eligible Health Program Coordinator 04771 Full-Time Eligible Auxiliary Health Worker Under-filled with PTNE 04773 Full-Time Eligible Auxiliary Health Worker 05128 Part-time Non-Eligible Student 05129 Full-Time Eligible Office Assistant II 05130 Full-Time Eligible Supervisor Public Health Nursing 05131 Part-time Non-Eligible Public Health Nurse II 05163 Full-Time Eligible Public Health Nurse III Under-filled with PTNE PHN II 05204 Full-Time Eligible Office Assistant II Filled with 2 PTNE Lacation Specialists 05205 Full-Time Eligible Auxiliary Health Worker Filled with PINE 05233 Full-Time Eligible Public Health Nutritionist II Under-filled with Nutrition Technician - WIC 05234 Full-Time Eligible Public Health Nutritionist I Under-filled with Nutrition Technician - WIC 05235 Full-Time Eligible Public Health Nutritionist H Under-filled with Nutrition Technician - WIC 05246 Full-Time Eligible Office Leader Under-filled with AHW 05401 Full-Time Eligible Public Health Nutritionist II 05526 Full-Time Eligible Office Assistant I Filled with 3 PTNEs 05693 Full-Time Eligible Public Health Nutritionist II 06099 Full-Time Eligible Public Health Nurse HI 06100 Full-Time Eligible Public Health Nurse III Filled with PINE 06426 Full-Time Eligible Health Program Coordinator 06538 Full-Time Eligible Office Assistant II 06747 Full-Time Eligible Public Health Nurse III Under-filled with Technical Assistant 06824 Full-Time Eligible Auxiliary Health Worker Under-filled with Office Assistant II 07346 Full-Time Eligible Public Health Nutritionist II Filled with PTNE 07381 Full-Time Eligible Public Health Nutritionist III 07382 Full-Time Eligible Nutrition Technician - WIC 07384 Full-Time Eligible Auxiliary Health Worker 07413 Full-Time Eligible Public Health Nurse III Under-filled with PHN II 07414 Full-Time Eligible Office Leader 07415 Full-Time Eligible Office Assistant II 07416 Full-Time Eligible Public Health Educator HI Under-filled with PINE PHE il 07557 Full-Time Eligible Public Health Nurse ill Filled with 3 PTNEs 07559 Full-Time Eligible Vaccine Supply Coordinator OAKLAND COUNTY, MICHIGAN GRANT AWARD HEALTH DIVISION CPBC GRANT SCHEDULE B FY19 Special Revenue Grant Positions Position # Classification (FTE or FINE) , Budgeted Position Title Notes 07562 Full-Time Eligible Nutrition Technician - WIC 07563 Full-Time Eligible Auxiliary Health Worker 07565 Full-Time Eligible Public Health Nurse III Under-filled with PINE PHF III 07814 Full-Time Eligible Public Health Nurse III Under-filled with 2 PINE PHN I 07839 Part-time Non-Eligible Auxiliary Health Worker 09668 Full-Time Eligible Public Health Nurse III 09999 Full-Time Eligible Public Health Emergency Preparedness Specialist 11579 Full-Time Eligible Et-ation SpecialiSt- OAKLAND COUNTY, MICHIGAN GRANT AWARD HEALTH DIVISION CPBC GRANT SCHEDULE C Special Revenue Positions To Be Deleted Position * Classification (FTE or PINE) Budgeted Position Title 02091 Full-Time Eligible Auxiliary Health Worker 04737 Full-Time Eligible Public Health Nurse III 07564 Full-Time Eligible Office Assistant I 10012 Full-Time Eligible Medical Technologist REQUEST: 1. To accept the 2018-2019 Comprehensive Planning, Budget and Contracting (CPBC) Grant Agreement. 2. To continue fifty-nine (59) SR positions included in Schedule B. 3. To delete four (4) SR positions included in Schedule C and listed below. BOARD/COMMITTEE ACTION: General Government Committee: Human Resources Committee: Finance-Committee. Board of Commissioners: 08/28/2018 08/29/2018 081-30/20-1-8 09/05/2018 PROPOSED FUNDING: Michigan Department of Health and Human Services CPBC 2018-2019 Grant OVERVIEW: The Michigan Department of Health and Human Services CPBC Grant funds several programs administered by the Health Division. The amount of this grant is $10,206,073, which is a decrease of $136,021 from the previous year grant agreement. This agreement begins October 1, 2018 through September 30, 2019. The grant agreement and anticipated fiscal year 2019 contract amendments include sufficient funding for the fifty-nine (59) positions listed in Schedule B. The four (4) special revenue (SR) positions (listed below) are requested to be deleted. All four (4) positions are currently vacant. SPECIAL REVENUE POSITIONS TO BE DELETED Position # Status (FTE or PTNE) Classification 1060284-02091 FTE Auxiliary Health Worker 1060921-04737 FTE Public Health Nurse Ill 1060284-07564 FTE Office Assistant I 1060212-10012 FTE Medical Technologist This grant agreement has been submitted through the County Executive's Contract Review Process and is recommended for approval. Acceptance of this grant does not obligate the County to any future commitment and continuation of the special revenue position in the grant is contingent upon continued future levels of grant funding. COUNTY EXECUTIVE RECOMMENDATION: Recommended as Requested PROJECTED PERTINENT SALARIES 2019 Class Gr Period Base 1 Year 2 Year 3 Year 4 Year 5 Year Public Health EXC Annual 54,414 57,688 60,969 64,242 67,519 70,797 Nurse III Bi-wkly 2,092.85 2,218.77 2,344.98 2,470.83 2,596.88 2,722.97 Medical Gr Annual 52,259 55,408 58,565 61,716 64,867 68,017 Technologist 11 Bi-wkly 2,009.93 2,131 10 2,252.50 2,373.69 2,494.88 2,616.04 Auxiliary Health Worker Gr 06 Annual Bi-wkly 33,951 1,305.81 36,002 1,384.69 38,057 1,463.74 40,109 1,542.67 42,161 1,621.58 44,217 1,700.65 Office Assistant I Gr 03 Annual Bi-wkly 29,375 1,129.81 31,188 1,199.54 33,001 1,269.27 34,816 1,339.08 36,634 1,409.01 38,449 1,478.81 "Note: Annual rates are shown for illustrative purposes only. SALARY AND FRINGE BENEFIT COST: "Note: FY18 Fringe benefit rates displayed are County averages. Annual costs are shown for illustrative purposes only. Actual costs are reflected in the fiscal note. Annual Savings Delete one (1) FTE Public Health Nurse III position (#1060921-04737). Salary at 1 year step Fringes @ 35.77% Direct Contract Charge Savings one (1) Position Delete one (1) FIE Medical Technologist position (#1060212-10012). Salary at 1 year step Fringes @ 35.77% Direct Contract Charge Savings one (1) Position Delete one (1) FTE Auxiliary Health Worker position (#1060284-02091). Salary at 1 year step Fringes @ 35.77% Direct Contract Charge Savings one (1) Position Delete one (1) FTE Office Assistant I position (#1060284-07564). Salary at 1 year step Fringes @ 35.77% Direct Contract Charge Savings one (1) Position ($ 57 688) ($ 20,635) ($ 15,880) ($ 94,203) ($ 55,408) ($19,819) ($15880) ($91,107) ($ 36,002) ($ 12,878) ($15,880) ($ 64,760) ($31,188) ($11,156) ($ 15,880) ($ 58,224) Total Savings Four (4) Positions ($308,294)