HomeMy WebLinkAboutResolutions - 2002.09.19 - 27016September 19, 2002
REPORT (MISC. 102235)
BY: PERSONNEL COMMITTEE, NANCY DINGELDEY, CHAIRPERSON
RE: DEPARTMENT OF HUMAN SERVICES/HEALTH DIVISION — ACCEPTANCE
OF 2002/2003 COMPREHENSIVE, PLANNING, BUDGETING AND
CONTRACTING (CPBC) AGREEMENT AND PERSONNEL RELATED
ACTIONS
To the Oakland County Board of Commissioners
Chairperson, Ladies and Gentlemen:
The Personnel Committee, having reviewed the above mentioned resolution on
September 11, 2002, recommends the resolution be adopted.
Chairperson, on behalf of the Personnel Committee, I move the acceptance of the
foregoing report.
PERSONNEL COMMITTEE
Personnel Committee Vote:
Motion carried on a roll call vote
Coleman - No
Galloway and Gregory - absent
MISCELLANEOUS RESOLUTION 102235 September 19, 2002
BY: General Government Committee, William R. Patterson, Chairperson
IN RE: DEPARTMENT OF HUMAN SERVICES/HEALTH DIVISION - 2002/2003 COMPREHENSIVE,
PLANNING, BUDGETING AND CONTRACTING (CPBC) AGREEMENT ACCEPTANCE
To the Oakland County Board of Commissioners
Chairperson, Ladies and Gentlemen:
WHEREAS the Michigan Department of Community Health (MDCH) has awarded the
Oakland County Health Division funding in the amount of $7,489,764, which is a
7.51% ($608,267) decrease from the Fiscal Year 2001/2002 amended allocation of
$8,098,031; and
WHEREAS the budget detail for the various programs is a matter of
negotiation between the Health Division and MDCH; amendments will be recommended
to the FY 2003 Budget when details are finalized; and
WHEREAS this agreement is for the period of October 1, 2002 through
September 30, 2003; and
WHEREAS the grant includes funding for the creation of one (1) Special
Revenue position as follows:
One (1) Medical Technologist (full-time) - Laboratory
WHEREAS the CPBC Agreement has been submitted through the County Executive
Review Process, including Corporation Counsel and is recommended for approval.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of
Commissioners hereby accepts the 2002/2003 Comprehensive Planning, Budgeting, and
Contracting (CPBC) agreement for funding in the amount of $7,350,006 for the
period of October 1, 2002, through September 30, 2003.
BE IT FURTHER RESOLVED the Board approves the creation of one (1) Special
Revenue position in Human Services/Health/Laboratory (16212) as allowed for by
contract:
One (1) Medical Technologist (full-time) - Laboratory
BE IT FURTHER RESOLVED that the future level of service, including
personnel, be contingent upon the level of funding for this program.
BE IT FURTHER RESOLVED that the Board Chairperson is authorized to execute
this agreement, any changes and extensions to the agreement not to exceed fifteen
percent (15%), 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
Community Health, and that the failure of the Michigan Department of Community
Health 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.
GENERAL GOVERNMENT COMMITTEE
GENERAL GOVERNMENT COMMITTEE
Motion carried unanimously on a roll call vote.
COUNTY OF OAKLAND
DEPARTMENT OF HUMAN SERVICES
HEALTH DIVISION
FY 2002/2003 COMPREHENSIVE PLANNING, BUDGETING, AND
CONTRACTING AGREEMENT (CPBC) ACCEPTANCE
• The Oakland County Health Division (OCHD) is accepting funding through the CPBC
Agreement from the Michigan Department of Community Health (MDCH) in the total
amount of $7,489,764. The Agreement is for the period October 1, 2002 through
September 30, 2003.
• The Agreement provides for categorical grant funding and partial reimbursement for
services provided in accordance with the Public Health Code (P.A. 368 of 1978, as
amended). Changes included in the FY 2002/03 Agreement include:
• Funding for the Emergency Preparedness Specialist position has been continued in
the amount of $100,000. Other Bioterrorism-related funding from the previous
year was "one-time" in nature.
• Funding in the amount of $139,758 has been awarded to equip and staff the
laboratory to attain "Level B" status, which will allow the laboratory to examine
potential bioterrorism-related materials. One Medical Technologist position is
requested to assist the Laboratory. This position is 100% grant funded.
• Funding for Local Public Health Operations is unchanged from FY 2001/02.
Family Planning:
General Services
Model Project
Immunization Action Plan
Lead Hazard Remediation Program
222,949 0 (222,949) Program discontinued
217,775 217,775
515,418 514,475
80,000 80,000
0
(943)
0
(split below)
2,695,911 2,695,911
863,087 863,087
3,558,998 3,558,998
Does not include allocation for sewer &
O water which will be contained in separate
O agreement with MDEQ.
0
151,600 151,600 0
fixed unit rate fixed unit rate 0
260,925 260,925 0
332,964 332,964 0
745,489 745,489 0
215,794
0
109,696
65,591
0 139,758
93,698 103,789
0
(48,495) Funding discontinued
0
(4,229)
139,758
10,091
215,794
48,495
109,696
69,820
1,363,608 1,158,177 (205,431)
8,098,031 7,489,764 (608,267)
-7.51%
CPEIC AGREEMENT FUNDING ANALYSIS
FY 2002/03
Initial
Allocation Increase/
FY 02/03 (Decrease)
373,743 (15,058)
0
100,000
PROGRAM ELEMENT
AIDS/HIV Prevention
Bioterror Planning
Bioterror Coordinator
Bioterror EPC
Bioterror CO IT
Cardiovascular Disease Prevention
Childhood Lead
Community Health Assessment
Amended
Allocation
FY 001/02
388,801
270,349
30,000
10,000
3,000
47,725
40,000
66,416
NOTES
(270,349) One Time Funding FY 2001/02
70,000
0 (10,000) One Time Funding FY 2001/02
O (3,000) One Time Funding FY 2001/02
O (47,725) Funding discontinued
40,000
66,479 63
Local Public Health Operations:
MDCH
MDA
Subtotal LPHO
Maternal and Child Health Block Grant:
CSHCS Outreach & Advocacy
CSHCS Care Coordination
Maternal and Child Outreach and Advocacy
Local MCH
Subtotal MCH Block Grant
MIHAS
Minority Health
STD Control
TB Control
Laboratory Program
Vaccine Replacement/Handling
WIC:
Resident Services
GRAND TOTAL
Percentage Increase (Decrease)
cpbc03.xls 1 08/2212002
Helen Hanger
From:
Sent:
To:
Subject:
Jim VanLeuven [vanleuvenjaco.oakland.mi.us ]
Tuesday, August 20, 2002 11:52 AM
Helen Hanger; Sheryl Mitchell
FW: CONTRACT REVIEW - Health Division
James H. VanLeuven,
Jr..vct
Jim VanLeuven
phone:248.858.1701
fax: 248.858.1572
email: vanleuvenj@co.oakland.mi.us <mailto:vanleuvenj@co.oakland.mi.us >
Original Message
From: Greg Givens [mailto:givensg@co.oakland.mi.us]
Sent: Tuesday, August 20, 2002 9:59 AM
To: VanLeuvenj
Cc: Fockler, Tom; Pearson, Linda; Frederick, Candace
Subject: CONTRACT REVIEW - Health Division
RE: CONTRACT REVIEW - Health Division
GRANT NAME: FY 02/03 Comprehensive Planning, Budgeting and Contracting
Agreement (CPBC)
FUNDING AGENCY: Michigan Department of Community Health
DEPARTMENT CONTACT PERSON: Tom Fockler
STATUS: Acceptance
DATE: August 20, 2002
Pursuant to Misc. Resolution #01320, please be advised the captioned
grant materials have completed internal contract review. Below are the
comments returned by review departments.
Department of Management and Budget:
Approve - Laurie Van Pelt (7 August 2002)
Personnel Department:
I approve - Judy Eaton (16 August 2002)
Risk Management and Safety:
Approved. - Stan Fayne (6 August 2002)
Corporation Counsel:
I have reviewed this agreement with Tom Fockler and his staff and I
approve it for acceptance/signature. John Ross ( 13 August 2002)
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
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.
FYI
Greg Givens, Supervisor
Contract #
P.O. #
Agreement Between
Michigan Department of Community Health
hereinafter referred to as the "Department"
and
Oakland County Health Division (OCHD)
hereinafter referred to as the "Local Governing Entity"
1200 N. Telegraph Road, Dept. 432
Pontiac, Michigan 48341-0432
Federal I.D.#. 38-6004876
hereinafter referred to as the "Contractor"
for
The Delivery of Public Health Services under
the Comprehensive Planning, Budgeting and Contract (CPBC) Agreement
Part 1
1. Purpose:
This agreement is entered into for the purpose of setting forth a joint and
cooperative Contractor/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 Output Measures and Annual
Budget, established Minimum Program Requirements, and all other
applicable Federal, State and Local laws and regulations pertaining to the
Contractor and the Department.
Public health services to be delivered under this agreement include Local
Public Health Operations (LPHO) and Categorical Programs as specified in
the attachments to this agreement.
2. Period of Agreement: This Agreement shall commence on October 1,
2002 and continue through September 30, 2003. This agreement is full force
and effect for the period specified. The Department has the option to
assume no responsibility for costs incurred by the contractor prior to the
signing of this agreement.
MDCH/CMS
6102 Page 1 az)
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 shall be $7,350,006.
B. Equipment Purchases and Title
Any equipment purchases supported in whole or in part by the
Department with categorical funding must be specified in an
attachment to the Program Budget Summary. Equipment means
tangible, non-expendable, personal property having useful life of more
than one (1) year and an acquisition cost of $5,000 or more per unit.
Title to equipment having a unit acquisition cost of less than $5,000
shall vest with the Contractor upon acquisition. The Department
reserves the right to retain or transfer the title to all items of
equipment having a unit acquisition cost of $5,000 or more, to the
extent that the Department's proportionate interest in such equipment
supports such retention or transfer of title.
C. Budget Transfers and Adjustments
1. Transfers between categories within any program element
budget supported in whole or in part by state/federal
categorical sources of funding shall be limited to increases in
an expenditure budget category by $10,000 or fifteen percent
(15%) whichever is greater. This transfer authority does not
authorize establishment of new budget categories, 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 the above
provisions, including any related adjustment to the total state
amount of the budget, must be made in writing through a
formal amendment executed by all parties to this agreement in
accordance with Section VIII. A. of Part II.
3. The above 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
Contractor that, during the course of the agreement period,
chose to reduce or transfer local funds from the Family
Planning program.
MDCH/CMS
6/02 Page 2 of 2D
4. Agreement Attachments:
A. The following documents are attachments to this Agreement Part I
and Part II - General Provisions, which are hereby made part of this
agreement through reference:
1. Attachment I - Annual Budget
2. Attachment II - Output Measures
3. Attachment III - Program Specific Assurances and
Requirements
4. Attachment IV - Funding/Reimbursement Matrix •
5. Addendum A
B. The attachments are added into this Agreement as follows:
1. Original Agreement (Part I and Part II) - Attachment III, IV,
and Addendum A
2. First Amendment - Attachment I, ll and IV (Revised)
6. Statement of Work : The Contractor agrees to undertake, perform and
complete the services described' in Attachment III - Program Specific
Assurances and Requirements and the other applicable attachments to this
agreement which are hereby made a part of this agreement through
reference.
6. Method of Payments and Financial Reports : The payment procedures
shall be followed as described in Part ll and Attachment I - Annual Budget
and Attachment IV - Funding/Reimbursement Matrix, which are hereby made
a part of this agreement through reference,
7. Performance/Progress Report Requirements : The progress reporting
methods, as applicable, shall be followed as described in Attachments II -
Output Measures and IV - Funding/Reimbursement Matrix, which are hereby
made a part of this agreement through reference.
8. General Provisions : The Contractor agrees to comply with the General
Provisions outlined in Part II, which are hereby made part of this agreement
through reference.
9. Administration of Agreement :
The person acting for the Department in administering this Agreement
(hereinafter referred to as the Contract Consultant) will be :
Richard McCubbin
(Contract Consultant)
MDCii/CMS
6/02 Page 3 of 20
10. Special Conditions:
A. This agreement is valid upon approval by the State Administrative
Board as appropriate and approval and execution by the Department.
B. The Departmen1 and Contractor, under the terms of this agreement
shall, subject to availability of funding and other applicable conditions,
provide resources and continuous services throughout the period of
this agreement as shown in Attachment I - Annual Budget and in
Attachment II - Output Measures.
11. Special Certification :
The individual or officer signing this agreement certifies by his or her
signature that he or she is authorized to sign this agreement on behalf of the
responsible governing board, official or Contractor.
12. Signature Section :
For the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
Peter L. Trezise, Chief Operating Officer
For the LOCAL GOVERNING ENTITY/CONTRACTOR
Name and Title
Date
Signature Date
MDCH/CMS
6/02 Page 4 of 20
Part II
General Provisions
1. Responsibilities - Contractor
The Contractor in accordance with the general purposes and objectives of this
agreement will:
A. Publication Rights
Where activities supported by this agreement produce books, films, or other
such copyrightable materials issued by the Contractor, the Contractor may
copyright such but shall acknowledge that the Department reserves a royalty-
free, non-exclusive and irrevocable license to reproduce, publish and use
such materials and to authorize others to reproduce and use such materials.
This cannot include service recipient information or personal identification
data.
Any copyrighted materials or modifications bearing acknowledgment or the
Department's name must be approved by the Department prior to
reproduction and use of such materials.
The Contractor shall give recognition to the Department in any and all
publication papers and presentations arising from the program and service
contract herein; the Department will do likewise.
B. Fees
Make reasonable efforts to collect 1 and 3r d party fees, where applicable,
and report these as outlined by the Department's fiscal procedures. Any
underrecoveries of otherwise available fees resulting from failure to bill for
eligible services will be excluded from reimbursable expenditures.
C. Program Operation
Provide- the necessary administrative, professional, and technical staff for
operation of the program.
D. Reporting
Utilize all report forms and reporting formats required by the Department at
the effective date of this agreement, and provide the Department with timely
review and commentary on any new report forms and reporting formats
proposed for issuance thereafter.
E. Record Maintenance/Retention
Maintain adequate program and fiscal records and files including source
documentation to support program activities and all expenditures made
under the terms of this agreement, as required.
Assure that all terms of the agreement will be appropriately adhered to; and,
that records and detailed documentation for the project or program identified
in this agreement will be maintained for a period of not less than three (3)
years from the date of termination, the date of submission of the final
expenditure report or until litigation or audit findings have been resolved.
7
MDCH/CIVIS
6102 Pugs. 5 rf 20
F. Authorized Access
Permit upon reasonable notification and at reasonable times, access by
authorized representatives of the Department, Federal Grantor Agency,
Comptroller General of the United States and State Auditor General, or any
of their duly authorized representatives, to the extent authorized by
applicable state or federal law, rule or regulation, to records, files, and
documentation related to this agreement.
G. Single Audit
To comply with requirements of the Single Audit Act Amendments of 1996,
31 USC 7501 et seq, and Office of Management and Budget (OMB) Circular
A-133, "Audits of States, Local Governments, and Non-Profit Organizations",
and provide to the Department copies of any audits of the Contractor on any
program elements covered by this agreement. The audit reporting
package and management letter are required to be filed with the
Department even if there are no findings reported in the audit pertaining
to Department programs. The Contractor must also assure that each of its
subcontractors comply with the above audit requirements (i.e.,
Subcontractors expending $300,000 or more in federal awards during the
subcontractor's fiscal year are required to have audits performed in
accordance with Circular A-133, that should be provided to the Contractor).
Due Date: The audit reporting package is due nine months after the
end of the Contractor's fiscal year.
Where to Send: A copy of the audit reporting package should be
forwarded to:
Michigan Department of Community Health
Rate Development, Revenue Reimbursement and Payment
Settlement Bureau
P.O. Box 30479
Lansing, Michigan 48909-7979
H. Notification of Modifications
Provide timely notification to the Department, in writing, of any action by the
Contractor, its governing board or any other funding source which would
require or result in significant modification in the provision of services or
funding or compliance with operational procedures.
Year 2000 Compatibility
The Contractor must ensure year 2000 compatibility for any software
purchases related to this agreement. This shall include, but is not limited to:
data structures (databases, data files, etc.) that provide 4-digit date century;
stored data that contain date century recognition, including but not limited to,
data stored in databases and hardware device internal system dates;
calculations and program logic (e.g., sort algorithms, calendar generation,
event recognition, and all processing actions that use or produce date
values) that accommodates same century and multi-century formulas and
date values; interfaces that supply data to and receive data from other
systems or organizations that prevent non-compliant dates and data from
MUCH/CMS
6/02 Page 6 of 20
entering any State system; user interfaces (i.e., screens, reports, etc.) that
accurately show 4-digit years; and assurance that the year 2000 shall be
correctly treated as a leap year within all calculation and calendar logic.
The Department actively worked to ensure that computer applications used
by the contractor were Year 2000 compliant or operable by December 31,
1999. The applications include those that support the programs of
Immunization; Medicaid; Women, Infants, and Children; Public Health
Services; Maternal Health Services; Services to the Aging, and Substance
Abuse Services. The Department followed the requirements of Executive
Directive 1998-8 issued to the Executive Branch departments and agencies
in order to address the Y2K issues.
J. Human Subjects
The Contractor agrees to submit 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 Human Subjects Committee for approval prior to the initiation
of the research.
K. Terms
To abide by the terms of this agreement including all attachments.
L. Minimum Prooram Requirements
To comply with Minimum Program Requirements promulgated 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.
M. Annual Budget and Plan Submission
To submit an Annual Budget and Plan (Output Measures) request to the
Department, in accordance with instructions established by the Department,
to serve as the basis for completion of specific details for Attachments l, II,
and IV of this agreement via Contractor/Department negotiated
amendment(s). Failure to submit a complete Annual Budget and Plan by the
due date will result in the deferral of Department payments until these
documents are submitted.
N. Maintenance of Effort
All agencies shall comply with maintenance of effort requirements for LPHO
as defined in current Department appropriation act, and Family Planning in
accordance with federal requirements, except as noted in Section 3.C.3 of
Part I.
0. Accreditation
All agencies shall comply with the local public health accreditation standards
and follow the accreditation process and schedule established by the
Department to achieve full accreditation status. Agencies designated as "not
accredited" may have their Department allocations reduced for costs incurred
in the assurance of service delivery.
IVIDCH/CMS
6/02 Page 7 at 20
II. Responsibilities - Department
The Department in accordance with the general purposes and objectives of this
agreement will:
A. Payment
Provide payment in accordance with the terms and conditions of this
agreement based upon appropriate reports, records, and documentation
maintained by the Contractor.
B. Report Forms
Provide any report forms and reporting formats required by the Department
at the effective date of this agreement, and to provide the Contractor with
any new report forms and reporting formats proposed for issuance thereafter
at least ninety (90) days prior to required usage to afford the Contractor an
opportunity for review and commentary.
- C. Terms
Abide by the terms of this agreement including all attachments.
D. Notification of Modifications
To notify the Contractor in writing of modifications to Federal or State laws,
rules and regulations affecting this agreement.
E. Identification of Laws
To identify for the Contractor relevant laws, rules, regulations, policies,
procedures, guidelines and State and Federal manuals, and provide the
Contractor with copies of these documents to the extent they are not
otherwise available to the Contractor.
F. Modification of Funding
To notify the Contractor in writing within thirty (30) calendar days of
becoming aware of the need for any modifications in agreement funding
commitments made necessary by action of the Federal Government, the
Governor, the Legislature or the Department of Management and Budget on
behalf of the Governor or the Legislature. Implementation of the
modifications will be determined jointly by the Contractor and the
Department.
G. Monitor Compliance
To monitor compliance with all applicable provisions contained in federal
grant awards and their attendant rules, regulations and requirements
pertaining to program elements covered by this agreement.
H. Reimbursement
To reimburse local agencies for costs based upon timely, accurately
completed Financial Status Reports in accordance with Section IV.
Technical Assistance
To make technical assistance available to the Contractor for the
implementation of this agreement.
MDCFUCIVIS
6/02 Page Ei of 20
J. Health Insurance Portability and Accountability Act
The Department assures that it will be in compliance with the Health
Insurance Portability and Accountability Act.
III. Assurances
The following assurances are hereby given to the Department:
A. Compliance with Applicable Laws
The Contractor will comply with applicable federal and state laws, guidelines,
rules and regulations in carrying out the terms of this agreement. The
Contractor will also comply with all applicable general administrative
requirements such as OMB Circulars covering cost principles,
grant/agreement principles, and audits in carrying out the terms of this
agreement.
B. Anti-Lobbying Act
The Contractor 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 Appropriations Act (Public Law 104-208).
Further, the Contractor 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. The Contractor agrees not to discriminate against any employee or
applicant for employment or service delivery and access, with respect
to their hire, tenure, terms, conditions or privileges of employment,
programs and services provided or any matter directly or indirectly
related to employment, because of race, color, religion, national
origin, ancestry, age, sex, height, weight, marital status, physical or
mental disability unrelated to the individual's ability to perform the
duties of the particular job or position. The Contractor further agrees
that every subcontract entered into for the performance of any
contract or purchase order resulting here from will contain a provision
requiring non-discrimination in employment, service delivery and
access, as herein specified binding upon each subcontractor. This
covenant is required pursuant to the Elliot Larsen Civil Rights Act,
1976 PA 453, as amended, MCL 37.2201 et seq, and the Persons
with Disabilities Civil Rights Act, 1976 PA 220, as amended, MCL
37.1101 et seq, and any breach thereof may be regarded as a
material breach of the contract or purchase order.
2. Additionally, assurance is given to the Department that efforts will be
made to identify and encourage the participation of minority owned,
women owned, and handicapper owned businesses in contract
solicitations. The Contractor shall incorporate language in all
contracts awarded: (1) prohibiting discrimination against minority
owned, women owned, •and handicapper owned businesses in
subcontracting; and (2) making discrimination a material breach of
contract.
MDCH/CMS
6102 Page 9 of 20
D. Debarment and Suspension
Assurance is hereby given to the Department that the Contractor will comply
with federal regulation 45 CFR Part 76 and certifies to the best of its
knowledge and belief that the Contractor's local health department or an
official of the Contractor's local health department and the contractor's
subcontractors:
1. Are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transactions
by any federal department or Contractor;
2. Have not within a 3 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 b, and;
4. Have not within a 3 year period preceding this agreement had one or
more public transactions (federal, state or local) terminated for cause
or default.
E. Federal Requirement: Pro-Children Act
1. Assurance is hereby given to the Department that the Contractor 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 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 Contractor also assures that this language will be included
in any subawards which contain provisions for children's services.
IVIDCH/CMS
6/02 Pape 10 of 20
2. The Contractor also assures, in addition to compliance with Public
Law 103-227, any service or activity funded in whole or in part through
this agreement will be delivered in a smoke-free facility or
environment. Smoking shall not be permitted anywhere in the facility,
or those parts of the facility under the control of the Contractor. If
activities or services are delivered in facilities or areas that are not
under the control of the Contractor (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 Contractor will comply with the Hatch Political Activity Act 5, USC 1501-
1508 and the Intergovernmental Personnel Act of 1970, as amended by Title
VI of the Civil Service Reform Act, Public Law 95-454, Section 42 USC 4728.
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. Home Health Services
If the Contractor provides Home Health Services (as defined in Medicare
Part B), the following requirements apply:
1. The Contractor shall not use State LPHO or categorical grant funds
provided under this agreement to unfairly compete for home health
services available from private providers of the same type of services
in the Contractor's service area.
2. For purposes of this agreement, the term "unfair competition" shall be
defined as offering of home health services at fees substantially less
than those generally charged by private providers of the same type of
services in the Contractor's area, except as allowed under Medicare
customary charge regulations involving sliding fee scale discounts for
low-income clients based upon their ability to pay.
3. If the Department finds that the Contractor is not in compliance with
its assurance not to use state LPHO and categorical grant funds to
unfairly compete, the Department shall follow the procedure required
for failure by local health departments to adequately provide required
services set forth in Sections 2497 and 2498 of 1978 PA 368 as
amended (Public Health Code), MCL 333.2497 and 2498, MSA 14.15
(2497) and (2498).
H. Subcontracts
Assure for any subcontracted service, activity or product: •
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.
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.
MDCHICNIS
6/C2 Page 11 of 70
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 Contractor
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 Contractor in this
agreement.
3. That the subcontract does not affect the Contractor's accountability
to the Department for the subcontracted activity.
4. That any billing or request for reimbursement for subcontract costs is
supported by a valid subcontract and adequate source documentation
on costs and services.
5. That the Contractor 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 Contractor or Department to seek administrative,
contractual or legal remedies in instances in which the
contractor violates or breaches contract temis, and provide for
such remedial action as may be appropriate.
b. Provide for termination by the Contractor, including the manner
by which termination will be effected and the basis for
settlement.
7. That all subcontracts in support of programs or elements utilizing
funds provided by the Department, the State of Michigan or the
federal government of amounts in excess of $100,000 shall contain
a provision that requires compliance with all applicable standards,
orders or regulations issued pursuant to the Clean Air Act of 1970 (42
USC 1857(h)), Section 508 of the Clean Water Act (33 USC 1368),
Executive Order 11738 and Environmental Protection Agency
regulations (40 CFR Part 15).
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 Contractor 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).
MDCH/CMS
6/02 Page 12 of 20
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.
Procurement
Assure that all purchase transactions, whether negotiated or advertised, shall
be conducted openly and competitively in accordance with the principles and
requirements of OMB Circular A-102 (as revised), implemented through
applicable portions of the associated "Common Rule" as promulgated by
responsible federal Contractor(s), or OMB Circular A-110 as applicable and • that records sufficient to document the significant history of all purchases are,
maintained for a minimum of three years after the end of the agreement
period.
C. Health Insurance Portability and Accountability Act
To the extent that this Act is pertinent to the services that the Contractor
provides to the Department, the Contractor assures that it is in compliance
with the Health Insurance Portability and Accountability Act (HIPAA)
Requirements.
IV. Payment and Reporting Procedures
A. Operating Advance
Under the new pre-payment reimbursement method, no additional operating
advances will be issued.
B. Comprehensive Planning and Budgeting Contract (CPBC) 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
Department will send to the Contractor a worksheet itemizing the individual
program amounts included in the monthly prepayment within five working
days of processing the monthly prepayment.
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
Contractor adjustment requests per Department approval.
C. Prepayment Adjustments:
If the sum of the prepayments do not equal at least 90% of the Contractor's
expenditures for a quarter of the contract period, the Contractor may submit
documentation for an adjustment to the monthly prepayment amount via the
following process:
MDCH/CMS
6/02 Page 13 of 20
1. Submit a written request for the adjustment to the Department's
Accounting Division, Expenditure Operations Section.
2. The adjustment request must be itemized by program and must list
the amount received from the Department, the expenditure amount
reported per the quarterly Financial Status Report (FSR), and the
difference. The amount received from the Department and the
expenditures must be for the same reporting quarterly FSR period.
3. The Department will review the requests and if an adjustment is
approved, it will be included in the next scheduled monthly
prepayment.
4. Adjustment requests will not be accepted prior to submission of the
FSR for the quarter ending December 31. No adjustments will be
made prior to the February monthly prepayment.
5. The ability of the Department to approve adjustments may be limited
by the quarterly allotments of spending authority in the Department's
appropriation account mandated by the Office of the State Budget
Director. The quarterly allotment limits the amount of each account
(program) that the Department may expend during each fiscal quarter.
D. Financial Status Report Submission
A Financial Status Report (FSR) DCH-0411 must be submitted for all
programs listed on Attachment IV. All FSR's must be prepared in
accordance with the Department's FSR instructions and submitted not later
than thirty (30) days after the close of the first three fiscal quarters. The
reports are due 1130/XX, 4/30/XX, and 7/30/XX. All FSR's must be
submitted to: Michigan Department of Community Health, Bureau of
Finance, Accounting Division, P.O. Box 30720, Lansing, Michigan 48909-
8220. FSR's must report total actual program expenditures regardless of the
source of funds. The Department will reimburse the Contractor 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
Contractor's monthly prepayment.
E,. Reimbursement Method
The Contractor will be reimbursed in accordance with the reimbursement
mechanisms for applicable program elements described as follows:
1. Performance Reimbursement - A reimbursement mechanism by
which local health departments are reimbursed based upon the
understanding that a certain level of performance (measured by
outputs) must be met in order to receive full reimbursement of costs
(net of program income and other earmarked sources) up to the
contracted amount of State funds. Any local funds used to support
program elements operated under such provisions of this agreement
may be transferred by the Contractor within, among, to or from the
affected elements without Department approval, subject to applicable
provisions of Sections 3.B. and 3.C.3 of Part I and Section XIV of Part
II. If local health department
MOCK/CMS
6/02 P14o 20
performance falls short of the expectation by a factor greater than the
allowed minimum performance percentage, the State maximum
allocation will be reduced equivalent to actual performance in relation
to the minimum performance.
2. Staffing Grant Reimbursement - A reimbursement mechanism 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 mechanism is allocable as a source
before any local funding requirement unless a specific local match
condition exists.
3. Fixed Unit Rate Reimbursement - A reimbursement mechanism by
which local health departments are reimbursed a specific amount for
each output actually delivered and reported.
4. LPHO - A reimbursement mechanism by which local health
departments are reimbursed a share of reasonable and allowable
costs incurred for required services, as noted in the current
Appropriations Act.
F. Unobligated Funds
Any unobligated balance of funds held by the Contractor at the end of the
agreement period will be returned to the Department or treated in
accordance with instructions provided by the Department.
G. Fiscal Year-End Re_porting
A Preliminary Close Out Report is based on annual guidelines and due date
using the format provided by the Department. The Contractor must provide,
by program, an estimate of total expenditures for the entire agreement period
(October 1 through September 30). This report must represent the
Contractor'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
Contractor 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 contract amendments, the Contractor 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.
MDCH/CMS
6/02 Page 16 of 20
Within 120 days after the agreement fiscal year-end, the Contractor must
liquidate any unpaid year-end commitments and obligations. Any obligation
remaining unliquidated after 120 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. - -
H. Final Total Contractor FSR and Output Measure Report:
The final total contractor FSR and Output Measures report (H-977) is due
January 31, after the agreement period end date. Upon receipt of the final
FSR and output measures report including final actual service outputs, the
Department will determine by program, if funds are owed to the Contractor
or if the Contractor owes funds to the Department. If funds are owed to the
Contractor, payment will be processed. However, if the Contractor
underestimated their year-end obligations in the preliminary close out report
as compared to the final FSR and the total reimbursement requested does
not exceed the agreement amount that is due to the Contractor, the
Department will make every effort to process full reimbursement to the
Contractor 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
Contractor to send in a payment. Instead the Department will make the
necessary entries to offset other payments areas a result the Contractor
will receive a net monthly prepayment. When this does occur, clarifying
documentation will be provided to Contractor by the Department's
Accounting Division.
Penalties for Reporting Noncompliance
For failure to submit the final total Contractor FSR and Output Measures
report by January 31, after the agreement period end date, the Contractor
will be penalized with a one-time reduction in their current LPHO allocation
for noncompliance with the fiscal year-end reporting deadlines. Any penalty
funds will be reallocated to other CPBC contractors (local health
departments). Reductions will be one-time only and will not carryforward to
the next fiscal year as an ongoing reduction to a Contractor's LPHO
allocation. Penalties will be assessed based upon the postmark date of the
mailing envelope:
LPHO Penalties for Noncompliance with Reporting Requirements:
a. 1% - 1 day to 30 days late;
b. 2% - 31 days to 60 days late;
c. 3% - over 60 days late with a maximum of 3% reduction in the
Contractors LPHO allocation
MDCH/CMS
6/02 113 of 20
V. Agreement Termination
The Department may cancel this agreement without further liability or penalty to the
Department for any of the following reasons:
A. This agreement may be terminated by either party by giving thirty (30) days
written notice to the other party stating the reasons for termination and the
effective date.
B. This agreement may also be terminated on thirty (30) days prior written
notice upon the failure of either party to carry out the terms and conditions
of this agreement, provided the alleged defaulting party is given notice of the
alleged breach and fails to cure the default within the thirty (30) day period.
C. This agreement may be terminated immediately if the Contractor's local
health department, or an official of the Contractor's local health department,
is convicted of any activity referenced in Part II, Section III.D, of this
agreement during the term of this agreement or any extension thereof.
- VI. Final Reporting upon Termination
Should this agreement be terminated by either party, within thirty (30) days after the
termination, the Contractor shall provide the Department with all financial
performance, and other reports required as a condition of the agreement. The
Department will make payments to the Contractor for allowable reimbursable costs
not covered by previous payments, other state or federal programs. The Contractor
shall immediately refund to the Department funds not authorized for use and any
payments advanced to the Contractor in excess of allowable reimbursable
expenditures. Any dispute arising as a result of this agreement shall be resolved
in the State of Michigan.
VII. Severability
If any provision of this agreement or any provision of any document attached to or
incorporated by reference is waived or held to be invalid, such waiver or invalidity
shall not affect other provisions of this agreement.
VIII. Amendments
Any changes to this agreement will be valid only if made in writing and accepted by
all parties to this agreement.
A. This agreement, including attachments, may be amended by mutual written
consent of the Contractor and the Department. When submitting a proposed
agreement/budget amendment, the Contractor must also revise or amend its
related Output Measures (H-977) whenever the amendment results in a
significant change of program scope, and as specifically required by the
Department, and 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 Contractor's or Department's control, which reduce or
otherwise interfere with the Contractor'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.
MDCH/CMS
6/02 Paw:17 crf 20
C. Amendments to this agreement shall be made as follows:
1. Any change proposed by the Contractor 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 Contractor in writing of its determination.
Subsequently the Department will initiate any necessary formal
amendment to the agreement for execution by all parties to the
agreement.
Any changes proposed by the Department must be agreed to in
writing by the Contractor 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 Contractor at any time prior to July 15th. The
Department will provide a written response within thirty (30) calendar
days.
All amendments must be submitted to the Department by July 15th to
assure the amendment can be executed prior to the end of the
agreement period.
IX. Liability
A. All liability to third parties, loss, or damage as a result of claims, demands,
costs, or judgments arising out of activities, such as direct service delivery,
to be carried out by the Contractor in the performance of this agreement
shall be the responsibility of the Contractor, 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 Contractor, any subcontractor,
anyone directly or indirectly employed by the Contractor, provided that
nothing herein shall be construed as a waiver of any governmental immunity
that has been provided to the Contractor 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 Contractor, 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.
MDCH/C1VIS
6102 Page 16 of 20
C. In the event that liability to third parties, loss, or damage arises as a result of
activities conducted jointly by the Contractor and the Department in
fulfillment of their responsibilities under this agreement, such liability, loss,
or damage shall be boine by the Contractor 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 Contractor, the State, its agencies (the Department) or their
employees, respectively, as provided by statute or court decisions.
X. Conflict of Interest
The Contractor and the Department are subject to the provisions of 1968 PA 317,
as amended, MCL 15.321 et seq, MSA 4.1700(51) et seq, and 1973 PA 196, as
amended, MCL 15.341 et seq, MSA 4.1700(71) et seq.
XL State of Michigan Agreement
This is a State of Michigan Agreement and is governed by the laws of Michigan.
Any dispute arising as a result of this agreement shall be resolved in the State of
Michigan.
XII. Confidentiality -
Both the Department and the Contractor shall assure that medical services to and
information contained in medical records of persons served under this agreement,
or other such recorded information required to be held confidential by federal or
state law, rule or regulation, in connection with the provision of services or other
activity under this agreement shall be privileged communication, shall be held
confidential, and shall not be divulged without the written consent of either the
patient or a person responsible for the patient, except as may be otherwise required
by applicable law or regulation. Such information may be disclosed in summary,
statistical, or other form which does not directly or indirectly identify particular
individuals.
XIII. Waiver
Any clause or condition of this agreement found to be an impediment to the
intended and effective operation of this agreement may be waived in writing by the
Department or the Contractor, upon presentation of written justification by the
requesting party. Such waiver may be temporary or for the life of the agreement
and may affect any or all program elements covered by this agreement.
XIV. Funding
A. State funding for this agreement shall be provided from the applicable and
available Department appropriations for the current fiscal year. The
Department provided funds shall be as stated in the approved Annual
Budget- Attachment!, the Program Specific Assurances and Requirements -
Attachment III, and as outlined in the Funding/Reimbursement Matrix -
Attachment IV.
MDC1-1/CIVIS
6/02 Page 19 of 7.9
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 Contractor 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.
LPHO transfer requests between MDCH, MDA and MDEQ must also be
requested in writing by May I. All LPHO required services must be
maintained throughout the entire period of the agreement.
C. The Department may periodically redistribute funds between agencies during
the agreement period in order to ensure that funds are expended to meet the
varying needs for services. Such redistributions will be based upon
projections obtained in consultation with the Contractor. Any redistributions
will be effected through the established amendment process.
MDCH/CMS
6/02 Page 20 of 20
Version:CPBC
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
FY 02/03 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.
Version:CPBC
2. This addendum modifies the following sections of Part II, General Provisions:
Part II
I. Responsibilities-Contractor
I. Year 2000 Compatibility. This section will be deleted in its entirety
and replaced with the following language:
The Michigan Department of Community Health and the County of
Oakland will work together to determine and avoid potential Year 2000
computer systems 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.
VIII. Liability. Paragraph A. will be deleted in its entirety and replaced with the
following language.
A. Except as otherwise provided for in this Contract, all liability, loss, or
damage as a result of claims, demands, costs, or judgments arising
out of activities to be carried out pursuant to the obligations of the
Contractor under this Contract shall be the responsibility of the
Contractor and not the responsibility of the Department, if the liability,
loss, or damage is caused by, or arises out to the actions or failure to
act on the part of the Contractor, its employees, officers or agents.
Nothing therein shall be construed as a waiver of any governmental
immunity for the Contractor, its agencies, employees, or Oakland
County, as provided by statute or modified by court decisions.
Version:CPBC
1. This addendum modifies the following sections of Attachment III, Program Specific
Assurances and Requirements:
Attachment III.
1. CSHCS Outreach and Advocacy Requirements
Contractor Requirements
4. General Performance Requirements
The requirements that the County of Oakland enter into contracts with
CSHCS Special Health Plans will be modified by the following
language:
The Director of the MDCH, CSHCS program has agreed to accept a
Letter of Collaboration between Oakland County and each of th0
CSHCS Special Health Plans in lieu of a signed contractual
agreement as currently required by Attachment Ill.
2. Care Coordination Services
The obligation of Oakland County to continue providing care coordination
services if CPBC funds for those services become depleted will be removed
and the following language will apply:
If funding for direct reimbursement to local health departments for care
coordination services is depleted, in lieu of Oakland County obtaining the
reimbursement from the CSHCS Special Health Plans, MDCH will make
direct payments to Oakland County.
4. Special Certification:
The individual or officer signing this agreement certifies by his or her signature that
he or she is authorized to sign this agreement on behalf of the responsible
governing board, official or Contractor.
Version:CPBC
5. Signature Section:
For the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
Peter L. Trezise, Chief Operating Officer Date
For the CONTRACTOR
Name and Title
Signature Date
Version:CPBC
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
FY 02/03 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.
Version:CPBC
2. This addendum modifies the following sections of Part II, General Provisions:
Part II
Responsibilities-Contractor
I. Year 2000 Compatibility. This section will be deleted in its entirety
and replaced with the following language:
The Michigan Department of Community Health and the County of
Oakland will work together to determine and avoid potential Year 2000
computer systems 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.
VIII. Liability. Paragraph A. will be deleted in its entirety and replaced with the
following language.
A. Except as otherwise provided for in this Contract, all liability, loss, or
damage as a result of claims, demands, costs, or judgments arising
out of activities to be carried out pursuant to the obligations of the
Contractor under this Contract shall be the responsibility of the
Contractor and not the responsibility of the Department, if the liability,
loss, or damage is caused by, or arises out to the actions or failure to
act on the part of the Contractor, its employees, officers or agents.
Nothing therein shall be construed as a waiver of any governmental
immunity for the Contractor, its agencies, employees, or Oakland
County, as provided by statute or modified by court decisions.
Version:CPBC
1. This addendum modifies the following sections of Attachment Ill , Program Specific
Assurances and Requirements:
Attachment III.
1. CSHCS Outreach and Advocacy Requirements
Contractor Requirements
4. General Performance Requirements
The requirements that the County of Oakland enter into contracts with
CSHCS Special Health Plans will be modified by the following
language:
The Director of the MDCH, CSHCS program has agreed to accept a
Letter of Collaboration between Oakland County and each of the
CSHCS Special Health Plans in lieu of a signed contractual
agreement as currently required by Attachment III.
2. Care Coordination Services
The obligation of Oakland County to continue providing care coordination
services if CPBC funds for those services become depleted will be removed
and the following language will apply:
If funding for direct reimbursement to local health departments for care
coordination services is depleted, in lieu of Oakland County obtaining the
reimbursement from the CSHCS Special Health Plans, MDCH will make
direct payments to Oakland County.
4. Special Certification:
The individual or officer signing this agreement certifies by his or her signature that
he or she is authorized to sign this agreement on behalf of the responsible
governing board, official or Contractor.
Version:CPBC
5. Signature Section:
For the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
Peter L. Trezise, Chief Operating Officer Date
For the CONTRACTOR
Name and Title
Signature Date
k.
I.
m.
n.
o.
p.
cl.
r.
S.
MDCH/CMS
6/02
ATTACHMENT III
ATTACHMENT Ill
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
FY 02103 CPBC AGREEMENT
PROGRAM SPECIFIC ASSURANCES AND REQUIREMENTS
Local health service program elements funded under this agreement will be administered by the Contractor
and the Department in accordance with the Public Health Code (P.A. 368 of 1978, as amended), rules
promulgated under the Code, minimum program requirements and all other applicable Federal, State and
Local laws, rules and regulations. These requirements are fulfilled through the following approach:
A. Development and issuance of minimum program requirements, further describing the objective criteria
for meeting requirements of law, rule, regulation, or professionally accepted methods or practices for the
purpose of ensuring the quality, availability and effectiveness of services and activities.
B. Utilization of a Minimum Reporting Requirements Notebook listing specific reporting formats, source
documentation, timeframes and utilization needs for required local data compilation and transmission on
program elements funded under this agreement. -
C. Utilization of annual program and budget instructions describing special program performance and funding
policies and requirements unique to each State fiscal year.
D. Execution of an agreement setting forth the basic terms and conditions for administration and local service
delivery of the program elements.
E. Emphasis and reliance upon service definitions, minimum program requirements, minimum reporting
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 above referenced documents
including Minimum Program Requirements established for the following program elements as of October 1,
2002:
a. AIDS/HIV Prevention
b. Breast and Cervical Cancer Control
c. Childhood Lead
d. Childhood Immunization Registry
e. Family Planning
f. Food Service Sanitation
g. General Communicable Disease Control
h. Hearing
i. Immunization - (Local Public Health
Operations & Categorical)
j. LHD/CSHCS Services
Maternal and Child Outreach, Enrollment
and Coordination
Maternal and Infant Health
Advocacy Services (MI HAS)
Maternal and Infant Support
Oral Health
Primary Dental Care
Sexually Transmitted Disease
Vaccine Handling
Vision
WIC
Page 1 of 54
For FN 02103, special requirements are applicable for the remaining program elements and funding
'sources listed in the attached pages and checked below:
- AIDS/HIV CARE
- AIDS/HOPWA (Housing Opportunities for Persons Living with HIV/AIDS)
- AIDS/HIV Prevention Community Planning (Specific by Agency for Funded Agencies)
• - AIDS/HIV Prevention
- AIDS/HIV Provider Education -
- AIDS/HIV Special Prevention
• - CSHCS
• - Childhood Immunization Registry
• - Childhood Lead
- Community Health Assessment and Improvement
- Family Planning/BCCCP Joint Project
- Family Planning-Long-Term Contraceptive Distribution
- Family Planning-Pregnancy Prevention
- Family Planning-Special Project Special Requirements
•
- Hepatitis B
- Immunization-Field Service Representatives
•
- Immunization VFC and MI-VFC
- Immunization - Nurse Training Reimbursement-
- Indian Health
- Informed Consent
- Laboratory Services
•
- Lead Hazard Remediation Program
•
- Local MCH
• - Local Public Health Operations (LPHO)
- Local Tobacco Reduction
- Michigan Childhood Immunization Registry (MCIR)
- Minority Health
•
- Outreach for Medicaid and MI-Child
- Primary Care Dental Special Project
•
-SIDS
•
- TB Control (DOT)
- Teen Pregnancy Prevention
I - WIC Services
- 'MO Special Increased Participation
- WISEWOMAN
FORMAT
(PROGRAM/ELEMENT) SPECIAL REQUIREMENTS
I. Budget and Agreement Requirements -
Lists those special funding and agreement requirements applicable to the program/element
as a whole.
II. Contractor Requirements -
Lists those special requirements applicable to all agencies administering the program
element.
Ill. Department Requirements - Lists those special requirements applicable to the Department.
IV. Contractor Specific Requirements -
Lists those unique requirements applicable only to the single Contractor covered by this agreement.
MDCH/CMS
6/02 ATTACHMENT III Page 2 of 54
MDCH/CMS
6/02
ATTACHMENT III
AIDS/HIV CARE SPECIAL REQUIREMENTS (EXCLUDING NIARQUETTE COUNTY HEALTH
DEPARTMENT AND DISTRICT HEALTH DEPARTMENT #110)
Contractor Specific Requirements
1. Adhere to all Ryan White CARE Act Title II and MDCH/DHAS-HAPIS Continuum of Care Policies and
Guidelines, as identified in the current CPBC "Applicable Laws, Rules, Regulations, Policies, Procedures
and Manuals," or issued by MDCH/DHAS/HAPIS during the current contract year.
2. Adhere to all Federal and Michigan Laws pertaining to HIV/AIDS treatment, disability accommodations,
non-discrimination and confidentiality.
3. Assure Ryan White Title II and Michigan Health Initiative (MHI) resources are used as payor of last resort.
4. Collaborate with MDCH/DHAS-HAPIS to annually monitor compliance with contractual and programmatic
requirements as appropriate.
5. Monitor annually, subcontracted agencies 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 MDCH/DHAS-
HAPIS.
6. Participate in oversight of all remediation efforts for agencies found in non-compliance with established
MDCH/DHAS-HAPIS program and practice standards, policy directives and program guidance.
7. The following requirements must be included in all subcontracts with service providers. Contractors that
are direct service providers must also comply with the following:
A. Adhere to all policy directives, program guidance and practice and program standards as
established. by MDCH/DHAS-HAPIS.
B. Adhere to all Federal and Michigan HIV laws regarding treatment, non-discrimination, disability
accommodations, and confidentiality.
C. Adhere to the following additional requirements:
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 URS program; c) use of virus protection software to guard
against computer viruses; and d) storage of desktop computers and laptop computers in a secure
location, preferably a locked room or cabinet.
D. Provide immediate notification to the Department, in writing, of any formal grievance procedures
initiated by a service recipient and subsequent resolution of that grievance.
E. Provide immediate notification to the Department, in writing, of any event occurring, or notice
received by the contractor or subcontractor, that reasonably suggests that the contractor 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 contractor or subcontractor
employees.
F. Assure that clients who are employees are granted the same level of care and access to care as
non-employees..
G. Establish client-level outcome objectives for each service funded with Ryan White Title II and MHI
resources and conduct outcome evaluation based on those objectives.
H. Assess client satisfaction annually and use methods, instruments and analysis that minimize bias
and ensure confidentiality of responses.
Page 3 of 54
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6/02
ATTACHMENT III
I. Utilize results of 'client zatisfaction asseszimentsand other evaluation activities to inform program
development and implement program level changes.
J. Submit detailed expenditure reports (e.g. FSRs) to fiduciary at a minimum of every 3 months.
K. Demonstrate, as directed by the fiduciary, appropriate expenditure of funds consistent with the
contract, HRSA regulations and MDCH/DHAS-HAP1S regulations and guidelines.
L. Attend all mandatory training sponsored by MDCH/DHAS-HAPIS.
M. Demonstrate that the agency provides opportunity and fiscally supports on-going staff development
and training.
N. Submit progress reports to the fiduciary as requested and in accordance with the program portion
of the MHI/Title II progress reports.
0. Collect and report client-level Uniform Reporting System (URS) data, documenting services
delivered and describing the clients who received the services. Submit URS data quarterly, by the
151h of the month following the end of the quarter. Submit the Annual Administrative Report for the
period of January 1 through December 31 by January 15 th of each year.
P. Maintain appropriate relationships with entities in the area served that constitute .key points of
access to the health care system for individuals with HIV disease, in accordance with Section
2617(b)(6)(G) of the CARE Act. Key points of access include, but are not limited to, emergency
rooms, substance abuse treatment programs, STD clinics, HIV counseling and testing sites, mental
health programs, homeless shelters and community health centers.
Q. When issuing statements, press releases, requests for proposals, bid solicitations and other
documents describing projects or programs funded in whole or in part with Federal money, all
grantees receiving Federal funds, including but not limited to State and local governments and
recipients of Federal research grants, shall clearly state (1) the percentage of the total costs of the
program or project which will be financed with Federal money, (2) the dollar amount of Federal
funds for the project or program, and (3) percentage and dollar amount of the total costs of the
project or program that will be financed by non-governmental sources':
8. Assure that HIV secondary prevention practices are integrated into the delivery of HIV/AIDS care
services.
9. Utilize sound accounting methods to distribute and monitor expenditures of funds for HIV Care services,
ensuring allocation of funds are in accordance with the Ryan White Title II and MHI application as
submitted.
10. Submit separate budgets and financial status reports by funding sources.
11. Submit original FSR's to MDCH-Budget and Finance Administration, as detailed in Part II General
Provisions, and submit one copy to MDCH/DHAS-HAPIS.
12. Submit the, "Allocations and Expenditures by Service Category" table to ,MDCH/DHAS-HAPIS as
requested to meet HRSA deadlines.
13. Maintain secure records of the following at the fiduciary site:
A. Provider contracts.
B. Documentation of all quality assurance activities conducted by the fiduciary at the provider sites.
C. Copies of all quality assurance reports prepared by MDCH/DHAS-HAPIS.
D. All financial accounting records.
E. All expenditure reports submitted to MDCH by the fiduciary.
F. Copies of all fiscal audits of the fiduciary conducted either internally or externally.
Page 4 of 54
MDCH/CMS
6/02
ATTACHMENT III
14', Submit program Progress Reports in accordance with the following dates arid reporting format:
Period Covered Due to MDCH/DHAS-HAPIS
October 1, 2002- March 31, 2003 April 15, 2003
MDCH/DHAS-HAPIS reserves the right to require quarterly reporting from contractors not in
compliance with Progress Report requirements.
Progress ReDOrt Format
Submit a brief (3-5 page) progress report that includes all of the following components in the order
listed:
A. Fiscal Accountability and Contract Monitoring
1. Attach a revised "Allocations and Expenditures by Service Category" Table for the fiscal year,
if applicable (the original . was submitted with the region's care application).
2. Report on expenditures to date, according to the eligible service categories identified in the
above table.
3. Identify any cost saving efforts.
4. Summarize any contract monitoring, quality assurance and oversight activities conducted
during the report period. Attach relevant findings.
5. Provide updates on any remediation activities and/or corrective action plans initiated in this
report period.
6. List and attach copies of any newor amended subcontracts and/or formal vendor agreements
executed this report period.
B. Program
A. Provide the following information for each funded service provider: agency name, address,
telephone and fax number, name and title of contact person.
B. Identify any program level changes, including changes in staff, services, catchment area, etc.
C. Describe 2-5 program highlights for each funded service provider. (Attaching provider reports
does not meet this requirement.)
D. identify any new services provided during the report period, and/or new access points to
existing services.
E. identify any concerns related to program activities that were not identified in the Fiscal
Accountability/Contract Monitoring section above.
15. Ensure that all funded providers track clients and services through the client-level Uniform Reporting
System (URS) and that the URS data is submitted quarterly, according to the following schedule:
Page 5 of 54
MDCH/CMS
6/02
ATTACHMENT III
Quarter Covered ' Due to MDCH/DHAS-HAPIS
October 1 - December 31, 2002 January 15, 2003
January 1 - March 31, 2003 April 15, 2003
Ensure that the Annual Administrative Report (AAR) for the period of January 1 through December
31 is submitted by January 15 of each year.
16. Provide one copy of all fully-signed subcontracts to MDCH/DHAS-HAPIS, but no later than October 15,
2002.
17. Submit a consolidated list of all Ryan White Title 11 and MHI funded subcontracts to MDCH/DHAS-HAPIS
by October 15, 2002. Include the following information:
A. Corporate name, address, telephone, fax numbers and project director of each organization.
B. Amount awarded to each organization.
C. Type of service and the amount budgeted for each service to be provided.
D. Beginning and end dates of each contract and subcontract.
E. Amount and source of other federal, state and local funds for the same service.
F. Minority provider status.
18. By - April 15, provide to MDCH/DHAS-HAPIS a programmatic, categorical budget and narrative
justification (by funding source) for each contract and subcontract. Use these budget categories:
Personnel, Fringe Benefits, Travel, Supplies, Equipment, Contractual, Other and Indirect. Base the
budgets on the State Fiscal Year. Budgets should be prepared on MDCH Budget forms provided by
MDCH/DHAS-HAPIS. In the case of unit cost reimbursement contracts, the narrative justification should
describe how the unit cost was established, and the rationale for the number of clients proposed, unless
the Medicaid rate is being applied. MDCH/DHAS-HAPIS will provide forms for Unit Cost Budgets.
19. Certify by October 15, 2002, in a format provided by MDCH/DHAS-HAPIS, that administrative
expenditures have not exceeded the 10% cap authorized by HRSA for "first-line entities" receiving Ryan
White CARE Act Title 11 funds. If requested, document compliance with HRSAs "Issue Paper:
Administrative Costs."
20. When issuing statements, press releases, request for proposals, bid solicitations and other documents
describing projects or programs funding in whole or in part with Federal money, all grantees receiving
Federal funds, including but not limited to State and local governments and recipients of Federal
research grants, shall clearly state (1) the percentage of the total cost of the program or project which
will be financed with Federal money, (2) the dollar amount of Federal funds for the project or program,
and (3) percentage and dollar amount of the total cots of the project or program that will be financed by
non-governmental sources.
21. When issuing RFPs for HIV-related care services, include faith-based organizations as eligible entities
who may provide services.
AIDS/HIV CARE SPECIAL REQUIREMENTS (MARQUETTE COUNTY HEALTH DEPARTMENT AND
DISTRICT HEALTH DEPARTMENT #10)
Contractor Specific Requirements
1. Adhere to all Ryan White CARE Act Title II and MDCH/DHAS-HAP1S Continuum of Care Policies and
Guidelines, as identified in the current CPBC "Applicable Laws, Rules, Regulations, Policies, Procedures
and Manuals," or as issued by MDCH/DHAS-HAPIS during the current contract year.
2. Adhere to all federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations,
non-discrimination and confidentiality.
Page 6 of 54
MDCH/CMS
6/02
ATTACHMENT lU
• Assure Ryan White Title ft and Michigan He'alth initiative (MHI) resources are used as payor of last
resort.
4. Collaborate with iV1DCH/DHAS-HAPIS to annually monitor compliance with contractual and programmatic
requirements as appropriate.
5. Monitor annually, subcontracted agencies 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 MDCH/DHAS-
HAPIS.
6. Participate in oversight of all remediation efforts for agencies found in non-compliance with established
MDCH/DHAS-HAPIS program and practice standards, policy directives and program guidance.
7. The following requirements must be included in all subcontracts with service providers. Contractors that
are direct service providers must also comply with the following:
A. Adhere to all policy directives, program guidance and practice and program standards as established
by MDCH/DHAS-HAPIS.
B. Adhere to all federal and Michigan HIV laws regarding treatment, non-discrimination, disability
accommodations, and confidentiality.
C. Adhere to the following additional requirements: -
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 URS program; c) use of virus protection software to guard
against computer viruses; and d) storage of desktop computers and laptop computers in a secure
location, preferably a locked room or cabinet.
D. Provide immediate notification to the Department, in writing, of any formal grievance procedures
initiated by a service recipient and subsequent resolution of that grievance.
E. Provide immediate notification to the Department, in writing, of any event occurring, or notice
received by the contractor or subcontractor, that reasonably suggests that the contractor 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 contractor or subcontractor
employees.
F. Assure that clients who are employees are granted the same level of care and access to care as non-
employees.
G. Establish client-level outcome objectives for each service funded with Ryan White Title II and MHI
resources and conduct outcome evaluation based on those objectives.
H. Assess client satisfaction annually and use methods, instruments and analysis that minimize bias and
ensure confidentiality of responses.
I. Utilize results of client satisfaction assessments and other evaluation activities to inform program
development and implement program level changes.
J. Submit detailed expenditure reports (e.g. FSRs) to fiduciary at a minimum of every 3 months.
K. Demonstrate appropriate expenditure of funds consistent with the contract, HRSA regulations and
MDCH/DHAS-HAPIS regulations and guidelines.
L Attend all mandatory training sponsored by MDCH/DHAS-HAPIS.
M. Demonstrate that the agency provides opportunity and fiscally supports on-going staff development
and training.
N. Submit progress reports to the Contractor as requested and in accordance with the program portion
of the MHI/Title II progress reports and the MHIMtle II application.
Plgn 7 oi 54
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ATTACHMENT III
0. Collect and report client-leVel Uniform Reporting System (URS) data, documenting services delivered
and describing the clients who received the services. Submit URS data quarterly, by the 15' of the
month following the end of the quarter. Submit the Annual Administrative Report for the period of
January 1 through December 31 by January 15 th of each year.
P. Maintain appropriate relationships with entities in the area served that constitute key points of access
to the health care system for individuals with HIV disease, in accordance with Section 2617 (b)(6)(G)
of the CARE Act. Key points of access include, but are not limited to, emergency rooms, substance
abuse treatment programs, STD clinics, HIV counseling and testing sites, mental health programs,
homeless shelters and community health centers.
Q. When issuing statements, press releases, requests for proposals, bid solicitations and other
documents describing projects or programs funded in whole or in part with Federal money, all
grantees receiving Federal funds, including but not limited to State and local governments and
recipients of Federal research grants, shall clearly state (1) the percentage of the total costs of the
program or project which will be financed with Federal money, (2) the dollar amount of Federal funds
for the project or program, and (3) percentage and dollar amount of the total costs of the project or
program that will be financed by non-governmental sources.
8. Assure that HIV secondary prevention practices are integrated into the delivery of HIV/AIDS care
services.
9. Utilize sound accounting methods to distribute and monitor expenditures of funds for HIV Care services,
ensuring allocation of funds are in accordance with the Ryan White Title II and MHI application as
submitted.
10. Submit separate budgets and financial status reports by funding sources.
11. Submit original FSRs to MDCH-Budget and Finance Administration, as detailed in Part II General
Provisions, and submit one copy to MDCH/DHAS-HAP1S.
12. Submit the "Allocations and Expenditures by Service Category" Table to MDCH/DHAS-HAPIS as
requested to meet HRSA deadlines.
13. Maintain secure records of the following:
A. Provider contracts.
B. Documentation of all quality assurance activities conducted each provider.
C. Copies of all quality assurance reports prepared by MDCH/DHAS-HAPIS.
D. All financial accounting records.
E. All expenditure reports submitted to MDCH.
F. Copies of all fiscal audits conducted either internally or externally.
14. Submit program Progress Reports in accordance with the following dates and reporting format:
'Period Covered
October 1, 2002- March 31, 2003
April 1, 2003 - September 30, 2003
Due to MDCH/DHAS-HAPIS
April 15, 2003
October 15, 2003
MDCH/DHAS-HAPIS reserves the right to require quarterly reporting from contractors
not in compliance with Progress Report requirements.
Progress Report Format
Submit a brief (3-5 page) progress report that includes all of the following components in the order
listed:
A. Fiscal Accountability and Contract Monitoring
1. Attach a revised "Allocations and Expenditures by Service Category" table for the fiscal year,
if applicable (the original was submitted with the region's care application).
Page 8 at 54
2. Report on expenditures to date, acbording to the eligible service categories identified in the
above table.
3. Identify any cost saving efforts.
4. Summarize any contract monitoring, quality assurance and oversight activities conducted during
the report period. Attach relevant findings.
5. Provide updates on any remediation activities and/or corrective action plans initiated in this
report period.
6. List and attach copies of any new or amended subcontracts and/or formal vendor agreements
executed this report period.
B. Program
1. Provide the following information for each funded service provider: agency name, address,
telephone and fax number, name and title of contact person.
2. Identify any program level changes, including changes in staff, services, catchment area, etc.
3. Describe each program supported with Title II/MHI resources and describe significant
accomplishments; additionally, provide 2-5 program highlights for each funded service.
(Attaching provider reports does not meet this requirement.)
4. Identify any new services provided during the report period, and/or new access points to existing
services.
5. Identify any concerns related to program activities that were not identified in the Fiscal
Accountability/Contract Monitoring section above.
6. Describe how you will assess the needs of people in Continuum of Care and not in Continuum • of Care. •
7. Describe the status of the needs assessment/resource inventory.
8. Describe the progress made towards achieving goals, objectives, and service outcomes as
described in your Implementation Plan.
15. Ensure that all funded providers track clients and services through the client-level Uniform Reporting
System (URS) and that the URS data is submitted quarterly, according to the following schedule:
Quarter Covered Due to MDCH/DHAS-HAP1S
October 1 - December 31, 2002
January 1 - March 31, 2003
April 1 - June 30, 2003
July 1 - September 30, 2003
January 15, 2003
April 15, 2003
July 15, 2003
October 15, 2003
Ensure that the Annual Administrative Report (AAR) for the period of January 1 through December
31 is submitted by January 15 of each year.
16. Provide one copy of all fully-signed subcontracts to MDCH/DHAS-HAP1S with annual care application,
but no later than October 15, 2002. Include a listing of the following information:
A. Corporate name, address, telephone, fax numbers and project director of each organization.
B. Amount awarded to each organization.
C. Type of service and the amount budgeted for each service to be provided.
D. Beginning and end dates of each contract and subcontract.
E. Amount and source of other federal, state and locarfunds for the same service.
F. Minority provider status.
17. By October 15, 2002, provide to MDCH/DHAS-HAPIS a programmatic, categorical budget and narrative
justification (by funding source) for each contract and subcontract. Use these budget categories:
MDCH/CMS ATTACHMENT III
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Personnel, Fringe Benefits, Travel, Supplies, Equipment, Contractual, ,Other and Indirect. Base the
budgets on the State Fiscal year. Budgets should be prepared on MDCH budget forms. In the case
of unit cost reimbursement contracts, the narrative justification should describe how the unit cost was
established, and the rationale for the number of clients proposed, unless the Medicaid rate is being
applied. MDCH/DHAS-HAP1S will provide forms for unit cost budgets.
18. Certify by October 15, 2002, in a format provided by MDCH/DHAS-HAP1S, that administrative
expenditures have not exceeded the 10% cap authorized by HRSA for "first-line entities" receiving Ryan
White CARE Act Title II funds. If requested, document compliance with HRSAs "Issue Paper:
Administrative Costs."
19. When issuing statements, press releases, requests for proposals, bid solicitations and other
documents describing projects or programs funded in whole or in part with Federal money, all
grantees receiving Federal funds, including but not limited to State and local governments and
recipients of Federal research grants shall clearly state (1) the percentage of the total costs of
the program or project which will be financed with Federal money, (2) the dollar amount of
Federal funds for the project or program, and (3) percentage and dollar amount of the total costs
of the project or program that will be financed by non-governmental sources.
20. Implement goals and objectives as specified in a written workplan approved by MDCH/DHAS-HAPIS.
AIDS/HOPWA SPECIAL REQUIREMENTS
(Housing Opportunities for Persons Living with HIV/AIDS)
1. Budget and Agreement Requirements
A. HOP WA Eligibility
An eligible person means a person with acquired immunodeficiency syndrome or related diseases
who is below 80% median income. A family member regardless of income is eligible to receive
housing information services. Any person living in proximity to a community residence is eligible
to participate in that residence's community outreach and educational activities regarding AIDS or
related diseases.
Within the population eligible for this program, nondiscrimination and equal opportunity regulations
must be followed, including fair housing and affirmative outreach. A project sponsor and all
contractors and subcontractors must adopt procedures to ensure that all persons who qualify for
the assistance, regardless of their race, color, religion, sex, age, national origin, familial status, or
handicap, know of the availability of the HOPWA program, including facilities and services
accessible to persons with a handicap, and maintain evidence of implementation of the procedures.
B. Allowable Use of Funds
Funds may be used to assist all forms of housing designed to prevent homelessness. This
includes emergency housing, shared housing arrangements, apartments, single room occupancy
(SRO) dwellings, and community residences. It includes assistance to remain in current homes,
whether owned or rented, and assistance in relocating to another home, whether owned or rented.
The following activities may be carried out with HOPWA funds:
1. Housing information services including, but not limited to, counseling, information, and referral
services to assist an eligible person to locate, acquire, finance and maintain housing. This
may also include fair housing counseling for eligible persons who may encounter
discrimination on the basis of race, color, religion, sex, age, national origin, familial status, or
handicap.
2. -Resource identification to establish, coordinate and develop housing assistance resources for
eligible persons, including conducting prelithinary research and making expenditures
necessary to determine the feasibility of specific housing-related initiatives.
3. Permanent housing placement.
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ATTACHMENT Ill
4. Acquisition, rehabilitation, conversion, lease, and repair of facilities to provide housing and
services ( repairs require prior authorization from Housing and Urban Development (HUD)).
5. New construction [for single room occupancy (SRO) dwellings and community residences
only].
6. Project- or tenant-based rental assistance, including assistance for shared housing
arrangements.
7. Short-term rent, mortgage, and utility payments to prevent the homelessness of the tenant or
mortgagor of a dwelling.
•8. Operating costs for housing including maintenance, security, operation, insurance, utilities,
furnishings, equipment, supplies, and other incidental costs.
9. Technical assistance in establishing and operating a community residence, including planning
and other pre-development or preconstruction expenses and including, but not limited to, costs
relating to community outreach and educational activities regarding AIDS or related diseases
for persons residing in proximity to the community residence.
10. Supportive services including, but not limited to, health, mental health, assessment, drug and
alcohol abuse treatment and counseling, day care, personal assistance, nutritional services,
intensive care when required, and assistance in gaining access to local, State, and Federal
government benefits and services, except that health services may only be provided to
individuals with acquired immunodeficiency syndrome or related diseases and not to family
members of these individuals.
11. Administrative expenses (general management, staff training, oversight, coordination,
evaluation, and reporting on eligible activities). Such costs do not include costs directly related
to carrying out eligible activities, since those costs are eligible as part of the activity delivery
costs of such activities. Each project sponsor receiving amounts from grants made under this
program may use not more than 7% of the amounts received for administrative costs.
Fiduciaries who are not project sponsors may not use more than 3% for administrative costs.
This information was taken from the HOPWA regulations (24 CFR 574). Please check the regulations
for further information.
C. HOP WA Certificate Program
The Michigan Department of Community Health is offering a certificate program to support housing
subsidies for eligible persons for up to two years. The purpose of the program is to promote
housing permanency/stability through the development of a plan for moving the person from a
homeless or emergency situation to a stable housing situation, or through maintaining an eligible
person in their current housing. An eligible person is a person with Acquired Immunodeficiency
Syndrome (AIDS) or related diseases who is below 80% median income and is currently, or at
immediate risk of, homelessness. Funding for this program comes from unspent prior year federal
allocations and is expected to be available for three years.
The certificates are valued at up to $200 per month for up to 24 months per participant and are
intended for specific participants for whom a housing plan has been developed and linkage to
supportive services has been made. Additional funding will be made available for each region for
housing information, resource identification services and development of a housing stabilization
plan for participating individuals. Regions will be reimbursed $500 per plan developed, up to a total
of $5,000 per fiscal year. The certificates are intended to be used for interim housing support until
a PLVVH/A (person living with HIV/AIDS) qualifies for Section 8 housing assistance, is able to afford
their own housing through a return to work or other means, or requires more intensive services that
preclude living independently. Certificates may be used to fund mortgage (up to 21 weeks per
year) and utility payments to prevent the homelessness of the tenant or mortgagor of a dwelling,
for tenant-based rental assistance, and for operating costs. The monthly mortgage assistance may
be increased above $200 per month, but total payments per person may not exceed $2,400 in a
12-month period and $4,800 in a 24-month period. "Preventing homelessness" includes
maintaining mortgage or rent payments while a person is experiencing episodic hospitalization.
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Certificates may not be used to fund supportive or administrative services (other than for
reimbursement for plan development as outlined above), and certificate payments must be made
directly to the vendor.
Routine follow-up with each individual served by the program is required. The follow-up should be
at least once a month and address the adequacy of the housing arrangement, ongoing participation
in their supportive services plan, and a check with the landlord, if applicable, to determine any
problems.
Each region will be awarded at least 10 certificates annually as long as funding remains available
and will be eligible to apply for additional certificates based upon available funding, demonstrated
need and use of the current certificates. The value of unused certificates will lapse at the end of
the contract year. Certificates will be awarded by allocation letter and reimbursement to the region
will be made based on the submission of a Financial Status Report (FSR) including the number of
PLVVH/A's served. As supportive documentation, the provider must maintain the following for each
PLWH/A served:
1. Documentation of a supportive services plan (form included with allocation letter).
2. Documentation of consideration of other funding sources (form included with allocation letter).
3. A housing plan (form included with allocation letter).
To protect recipient confidentiality, the region/service provider must provide a unique confidential
client identification number for each participant when transmitting this information to MDCH.
In addition to the FSR submission for reimbursement purposes, regions must also submit quarterly
the data requirements specified in the contract.
To apply for additional certificates, send a letter of request identifying the number of certificates
requested and a completed housing plan, documentation of a supportive services plan and
documentation of consideration of other funding sources for each person for whom a certificate is
being requested. Requests may be sent to:
Program Administration and Consumer Resources Division
Community Living, Children and Families Administration
Michigan Department of Community Health
3423 North Martin Luther King, Jr. Boulevard
Lansing, Michigan 48909
Attention: Sue Eby
2. Contractor Requirements
In 2002, each region must submit to the department their annual plan for providing HOPWA services.
The plan should cover the period October 1, 2002 through September 30, 2003 and include both the
regular HOPWA allocation and the HOP WA Certificate Program. This plan, along with quarterly reports
and the region's FSR, will provide MDCH with information to satisfy most federal reporting requirements,
carry out monitoring activities, and assure that departmental goals for this program can be met. •This
plan is due September 21, 2002 and must be submitted to:
Program Administration and Consumer Resources Division
Community Living, Children and Families Administration
Michigan Department of Community Health
3423 North Martin Luther King, Jr. Boulevard
Lansing, Michigan 48909
Attention: Sue Eby
The plan, as implemented and subject to the availability of funds and need, must assure that all persons
living with HIV/AIDS (PLWH/A) have access to:
A. Direct housing assistance (including rent, mortgage payments, and utilities).
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B. Housing advocacy staff assistance for:
1. Helping a person find and maintain housing, including permanent housing placement.
2. Creating links in the community for long range housing solutions, such as participation in
planning activities with continuum of care, public housing authorities, and housing coalitions.
3. Connecting persons with HIV/AIDS to generic sources of housing (such as Section 8
certificates), financial support-(such as SSI), and service dollars (such as Medicaid).
C. Supportive services, with HOPWA dollars limited to only those essential services which are not the
responsibility of other funding sources or service providers.
Funding priorities are in the order listed above. For those regions not yet at 75% for specific
housing-related activities (priorities 1 and 2), the plan must reflect movement toward using 75% of
the HOPWA allocation for direct housing assistance and housing advocacy. The utilization of
resources within the 75% goal and the three activities identified above are at the discretion of the
region and are expected to reflect local needs and priorities.
I. Plan Components
The plan consists of five components. Generally a brief description of current year activities
and the region's plan for FY 2002/2003 is required.
a. Needs
. Describe the demographic characteristics of the population with HIV/AIDS in the
region in comparison to the population served by the HOPWA program. Describe
the service needs of the PLWH/A's in your region within the following three funding
categories:
1. Direct housing assistance,
2. Housing advocacy, and
3. Supportive services in relation to the population's ability to achieve and
maintain a stable housing arrangement.
This is a narrative component and should reflect the outcome of regional needs
assessment activities and analysis of demographic information. Specifically
describe any needs assessment activities carried out in FY2001/2002.
b. Coordination
Information about FY 2002 achievements and the current status of coordination
between HOPWA-funded staff and other service providers within the regional
HIV/AIDS network, Ryan White-funded HIV/AIDS related services including
outreach to mothers and infants who are HIV positive, with the "generic" housing
community, and with support service providers is requested as part of the plan.
Describe the anticipated relationship between the HOPWA program and other
agencies providing housing assistance and health care and supportive services in
your catchment area. Describe your activities for coordinating HOPWA services
with other programs and planned activities for improving coordination in FY
200212003 along with a brief description of FY 2001/2002 activities. Provide this
information in the five categories identified below.
1. HOPWA-funded staff and their role in the regional service delivery system.
Specifically address children, families and mothers/infants who are HIV
positive and at risk of homelessness.
2. How eligible persons "connecror obtain HOPWA-funded services, i.e., are
persons referred from other regional providers, do service providers routinely
assess housing needs, etc.
3. The working relationships between HOPWA-funded staff and case managers.
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Within the generic housing community, describe the working relationship and
the liaison roles of the HOPWA-funded staff; describe participation in the local
continuum of care planning activities, etc.
5. Describe how the housing needs of persons living with HIV/AIDS are
assessed and how linkages with support services will be made.
c. Certificate Program
Provide a concise description of the use of the certificate program in FY001/2002.
Include the number of persons/families receiving assistance, nature of the
assistance provided (i.e. mortgage, utilities, rent, etc.) and whether participants
were renters or home owners.
To assist the Department in assessing the program, also provide:
1. The protocol, procedure or "working policy" the region implemented in order
to determine when a certificate would be issued (include criteria for
determining when to use certificate versus HOP WA formula funds).
2. Specification of the barriers and successes in accessing other community
housing resources such as section 8 vouchers, FIA emergency assistance, or
other local housing-related funds.
d. Services
Indicate what services are planned to be provided in FY 2003 by the three funding
categories.
I. Direct Housing Assistance.
2. Housing Advocacy and Staff Assistance.
3. Supportive Services.
With respect to housing advocacy such as linkages with the housing community,
describe planned efforts. Indicate the number of individuals with HIV/AIDS to be
assisted and their demographic characteristics. The plan must show that the
PLWH/A's in all parts of the region have access to the direct housing assistance
and housing advocacy staff assistance.
Some regional networks are also the direct service providers. However, most
contract for HOPWA-funded services. Provide a list of HOPWA-funded service
providers, the type of services they provide (direct housing assistance, housing
advocacy, and supportive services), and the geographic area that each provider
serves in a chart.
In addition describe all other regional funds planned to be used for direct housing
assistance and housing advocacy (using the HOPWA definitions for this purpose).
Provide estimated expenditures for FY 2002/2003 as well. Finally, describe how the
use of these funds is "coordinated"/or related to the use of HOPVVA funds.
e. Budget Plan
On the form entitled "HOPWA FY 200212003 Plan" provided with your allocation
letter, indicate how the funds allocated to the region will be allocated to each
provider (including the region if services are provided directly) by the following
categories:
A. Administration
A-1 Central
A-2 Provider
B. Direct Housing Assistance
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C: HoUsing Advocacy Assistance
D. Supportive Services
E. Certificate Program
Also provide the planned number of persons to be served. Provide a brief narrative
explanation as necessary.
B. Reporting
In addition to submitting monthly Financial Status Reports for reimbursement, reports of program
activities must be submitted quarterly to the address below. The form entitled "HOPWA Quarterly
Reporting Requirements" provided with your allocation letter must be used to submit this
information. The Annual Progress Report for calendar year 2002 must be submitted by February
1, 2003. Quarterly Reports are due as follows:
February 1 for the 10/1/2002 - 12/31/2002 quarter
May 1 for the 1/1/2003 - 3/31/2003 quarter
August 1 for the 4/1/2003 - 6/30/2003 quarter
November 1 for the 7/1/2003 - 9/30/2003 quarter
All reports should be sent to: -
Program Administration and Consumer Resources Division
Community Living, Children and Families Administration
Michigan Department of Community Health
3423 North Martin Luther King, Jr. Boulevard
Lansing, Michigan 48909
Attention: Sue Eby
Contractor Requirements
I .
All fiduciaries and project sponsors using grant funds to provide housing must adhere to the following
standards:
A. Ensure that qualified service providers in the area make available appropriate supportive services
to the individuals assisted with housing under HOPWA. For any individual with acquired
immunodeficiency syndrome or a related disease who requires more intensive care than can be
provided in housing assisted under HOPWA, the project sponsor shall provide assistance in
locating a care provider who can appropriately care for the individual and for referring the individual
to the care provider.
B. Ensure that grant funds will not be used to make payments for health services for any item or
service to the extent that payment has been made, or can reasonably be expected to be made,
with respect to that item or service: under any State compensation program; under an insurance
• policy; under any Federal or State health benefits program; or by an entity that provides health
services.
C. Operate the program in accordance with the provision of 24 CFR 574 and other applicable HUD
regulations. Document the eligibility of each person receiving HOPWA benefits.
D. Keep records and reports which are consistent with the information required by the Annual
Progress Report (APR) for HOPWA (copy attached) by calendar year. Implement the Uniform
Reporting System which includes data regarding HOPWA eligible persons and information needed
for quarterly reports and the APR. Submit the annual progress report for calendar year 2002 by
February 1, 2003.
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E. Participate with MDCH in facilitating and conducting site visits with the HOPWA project sponsors.
F. Provide services in accordance with an approved plan and comply with reporting. Requirements
as spelled out in Plan Guidance (provided with the allocation letter).
2. Provide Oversight
A. Oversee process and performance for subcontracts for the provision of HIV related HOPWA
services. Ensure a contractual requirement to adhere to all applicable state and federal laws and
regulations for all subcontractors.
B. Assure that contractors and subcontractors have developed and make available to service
recipients both grievance and appeals process.
C. Determine/document the unit cost per service for each funded service. Retain data supporting the
per unit cost and how it was determined.
D. Assess client satisfaction of services provided. Assure the confidentiality of the name of any
individual assisted and any other information regarding individuals receiving assistance.
E. Assure that no fee, except tenant portion of rent, shall be charged to an eligible person for housing
or services.
F. Assure that contractors and subcontractors have the capacity to effectively carry out the activity
and that they agree to maintain and make available to HUD for inspection financial records
sufficient to ensure proper accounting and disbursing of amounts received.
G. Ensure, then issues statements, press releases, RFP, bid solicitations and other documents
describing projects or programs funded in whole or in part with Federal funds, clearly state 1) the
percentage or total cost of the program or project which will be funded with Federal funds; 2) the
amount of Federal funds for the project or program; and 3) percentage and dollar amount of the
total costs of the project or program that will be financed by non-governmental resources. Provide
to MDCH copies of statements and press releases issued by the Contractor, Retain copies of same
on file for two (2) years.
H. Ensure all services are available in the entire region.
I. Ensure that all activities funded under the program will meet urgent needs that are not being met
by available public and private sources.
J. Send copy of all HOPWA required documents to:
Program Administration and Consumer Resources Division
Community Living, Children and Families Administration
Michigan Department of Community Health
3423 North Martin Luther King, Jr. Boulevard
Lansing, Michigan 48909
Attention: Sue Eby
AIDS/HIV PREVENTION COMMUNITY PLANNING SPECIAL REQUIREMENTS
1. Provide administrative and technical support for the regional HIV prevention community planning group
(RCPG) in compliance with guidance issued by the Centers for Disease Control and Prevention and/or
the Department.
2. Manage HIV prevention community planning resources, in consultation with the regional community
planning group.
3. Foster support for HIV prevention community planning among key community leaders.
4. Submit, according to guidance disseminated by MDCH/DHAS-HAPIS, an annual work plan and budget
for HIV prevention community planning activities.
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• AIDS/HIV PREVENTION SPECIAL REQUIREMENTS
• Contractor Requirements
1. Promote reporting and follow-up of HIV infection and AIDS cases within jurisdiction.
2. Conduct prevention program activities in a manner consistent with applicable state and federal laws,
program and quality assurance guidelines and standards issued by the Centers for Disease Control and
Prevention and/or the Michigan Department of Community Health. Current laws, guidelines and
standards include:
A. Revised Guidelines for HIV Counseling, Testing and Referral, Centers for Disease Control and
Prevention, U.S. Department of Health and Human Services, November, 2001.
B. Revised Recommendations for HIV Screening of Pregnant Women, U.S. Department of Health
and Human Services, November, 2001.
C. Quality Assurance Standards and Guidelines for HIV Counseling, Testing and Referral. Michigan
Department of Community Health, HIV/AIDS Prevention & Intervention Section. September 1996,
or subsequent revisions.
D. Protocol for HIV Counseling and Testing Using Oral Mucosal Transudate Technology. Michigan
Department of Community Health, HIV/AIDS Prevention & Intervention Section. March 1997.
E. HIV Partner Counseling and Referral Services Guidance, Centers for Disease Control and
Prevention, National Center for HIV, STD & TB Prevention, December 1998.
F. Partner Notification Guidelines. Michigan Department of Community Health, HIV/AIDS Prevention
and Intervention Section. Revised, 1997 or subsequent revisions.
G. "Quality Assurance of HIV Prevention Interventions", Michigan Department of Community
Health, HIV/AIDS Prevention and Intervention Section, April, 2002. (Central Michigan District
Health Department, Dickinson-Iron District Health Department, City of Detroit Health
Department, District Health Department #10, and Saginaw County Health Department only).
H. Michigan Local Public Health Accreditation Program (Accreditation Standards), 2002.
I. Strategies to Improve Client Failure to Return for HIV Test Results. Michigan Department of
Community Health, HIV/AIDS Prevention and Intervention Section, November, 1998, or
subsequent revisions.
J. Michigan HIV Laws: How They Affect Physicians and Other Health Care Providers. Michigan
Department of Community Health, HIV/AIDS Prevention and Intervention Section. November 1995
or subsequent revisions.
It is understood that the laws, guidelines and standards described above may be revised, supplemented
or replaced at any time and that the Contractor will conduct prevention program activities in a manner
consistent with the most current laws, guidelines and standards.
3. Participate in quality assurance activities conducted by and/or facilitated by MDCH/DHAS-HAPIS.
4. Participate in technical assistance consultations and/or skills-enhancement opportunities as directed
by MDCH/DHAS-HAP1S and/or as recommended by RCPGS.
5. Participate/cooperate in program evaluation activities conducted and/or facilitated by MDCH/DHAS-
HAPIS.
6. Participate in community-based HIV prevention planning•:as resources allow. Local Health Agencies
are encouraged to participate in prevention planning group activities on a regular basis.
7. If health education and risk reduction activities are supported with formula funds the Contractor is to:
A. Submit to HAPIS, within 90 days (by December 31, 2002), a description of the activities. This
description. is to include:
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1. A description of the target population(s).
2. Specific, time phased and measurable outcome and process objectives.
3. The process and/or mechanisms used for obtaining the input of target populations in the
design, implementation and evaluation of interventions.
B. Submit within 30 days following the close of each quarter, narrative and statistical reports which
detail progress toward meeting process and outcome objectives. The format, content and due
dates of these reports are to conform to the guidelines issued by MDCH/DHAS-HAP1S.
AIDS/HIV PROVIDER EDUCATION PROJECT SPECIAL REQUIREMENTS
- KENT COUNTY HEALTH DEPARTMENT
Contractor Requirements
1. Purpose
In carrying out the terms of this agreement, the Contractor shall:
A. Work in concert with MDCH/DHAS-HAPIS staff to develop appropriate program outcome
measures and tools.
B. Participate in contract monitoring and quality assurance activities conducted by and/or facilitated
by MDCH/DHAS-HAPIS.
. C. Participate in technical assistance consultations and/or skills-enhancement opportunities as
directed by MDCH/DHAS-HAP1S and/or as recommended by regional community planning groups
(RCPGs) or consortia.
D. Participate in program evaluation activities conducted and/or facilitated by MDCH/DHAS-HAPIS.
E. Submit all educational materials, manuals and training curricula (e.g. brochures ) posters,
pamphlets and videos) used in conjunction with HIV provider education activities to the MDCH
Program Review Panel for review and approval prior to their use. Pursuant to federal law, all
educational materials must contain current and scientifically accurate information.
F. All subcontracts issued under this funding agreement are to include the above requirements
[A-El and are subject to prior approval by MDCH/DHAS-HAPIS.
G. Submit a copy of the Financial Status Report (FSR, FIN-130) to MDCH/DHAS-HAPIS
simultaneous to submission to Budget and Finance Administration. Copies of FSRs are to be
addressed to the designated contract monitor.
2. Methodology and Program Content
The following services are supported under this agreement: HIV/AIDS Provider Education. Program
development, implementation and evaluation will be delivered according to the methods, time line,
work plan and staffing plan approved by MDCH/DHAS-HAPIS.
3. Objectives
The Contractor will adhere to goals and objectives negotiated in consultation with MDCH/DHAS-
HAPIS.
4. Progress Reports
Submit quarterly reports to MDCH/DHAS-HAP1S in accordance with the following dates and reporting
• format:
Quarter Covered Due to MDCH/DHAS-HAPIS
October 1-December 31, 2002
January 1-March 31, 2003
April 1 - June 30, 2003
July 1 - September 30, 2003
January 15, 2003
April 15, 2003
July 15, 2003
October 15, 2003
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Narrative Report
Provide the following organizational and program information:
A) Organization/program name, address, telephone and fax number;
B) Name and title of contact person;
C) Any program level changes, including changes in staff, services, catchment area, etc.;
D) Narrative description of progress toward meeting established goals and objectives.
Specifically, list each goal separately, followed by corresponding objectives for that goal and
a description of progress towards each objective;
E) Narrative description of data collection process which ensures clear delineation between
activities funded by MDCH/DHAS-HAP(S, and other funding sources;
F) Narrative description of accomplishments not directly related to the established goals and
objectives;
G) Narrative discussion of any issues at the agency level that impact ability to achieve stated
goals and objectives;
H) Staff development and training activities and needs;
1) Technical assistance needs related to programmatic and fiscal administration; and
J) Summary of evaluation findings.
6. STATISTICAL REPORT
The method and format for submission of the following electronic data will be determined by
MDCH/DHAS-HAPIS. Grantees must provide electronic statistical reports which describe:
A) Target audience;
B) Number of participants;
C) Method of information delivery;
D) Program venue;
E) Intervention elements;
F) Topics addressed; and
G) Other variables as determined by MDCH/DHAS-HAP1S
AIDS/HIV SPECIAL PREVENTION SPECIAL REQUIREMENTS
-CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT
Contractor Requirements
1. Purpose
To reduce the incidence of HIV infection by providing support for HIV prevention services targeting
men who have sex with men (MSM) and high risk heterosexuals (HRH) in HIV prevention planning
region 7.
2. Objectives
A. Process Objective 1.1: By September 30, 2003, Central Michigan District Health Department
(CMDHD) will provide 5 group counseling sessions to 15 MSM at PRISM (a gay/lesbian
association at CMU).
B. Process Objective 2.1: By September 30, 2003, CMDHD will provide a minimum of 5 AIDS
101 presentations to 150 HRH between the ages of 13-24 at community venues such as
alternative and adult education programs in six counties (Arenac, Clare, Gladwin, Isabella,
Osceola, and Roscommon).
C. Process Objective 3.1: By September 30, 2003, CMDHD will provide AIDS education
information and materials to 550 HRH between the ages of 13-24 at community-wide events
including health fairs in six counties (Arenac, Clare, Gladwin, Isabella, Osceola, and
Roscommon).
Page 19 of 54
October - December 2002
January - March 2003
April - June 2003
July - September 2003
January 31, 2003
April 30, 2003
July 31, 2003
October 31, 2003
MOCH/CiVIS
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Methodology and Program Content
The following prevention strategies are supported under this agreement: group level intervention,
health communication/public information, and outreach. Al! program activities will be conducted in a
manner consistent with applicable state and federal laws, and the program and standards described
in the "Quality Assurance of HIV Prevention Interventions" (April, 2002). " Program development,
implementation and evaluation will be delivered according to the methods, timeline, workplan and
staffing plan described in the Agency's program proposal and/or negotiated amendments and
revisions.
4. Performance/Progress Report Requirements
A. The Contractor shall submit the following reports on the following dates:
1. A narrative report detailing progress toward meeting process and outcome objectives.
The format and content of these reports are to conform to the guidelines issued by
MDCH/DHAS-HAPIS Narrative reports are due 30 days after the close of each quarter:
Reporting Period Narrative Report Due
2. Applicable statistical reports. The format and content of these reports is to conform to
guidelines issued by MDCH/DHAS-HAPIS. Current required statistical reports include:
(a) HIV Counseling and Testing Report Form (USGPO #1933-2430-S)
HIV Counseling and Testing Report Forms are due on the 10th working day of each
month.
(b) Summary Activity Tables, produced through utilization of the HIV Event System.
Summary Activity Tables, if applicable, are to accompany narrative reports. Tables are
to be accompanied by an electronic copy of associated data. Due dates are listed in
A.1
It is understood that the reports described above may be revised, supplemented or
replaced at any time and that the agency will provide information and/or data
responsive to modified reporting requirements.
NOTE: Agencies receiving support for HIV counseling and testing activities only are not
required to submit Summary Activity Tables.
B. Any such other information as specified in The Objectives shall be developed and submitted
by the Contractor as required by the Contract Manager.
C. The original and one copy of the quarterly narrative and statistical reports (if applicable) are
to be submitted by the Contractor to the designated contract monitor.
D. The Contractor shall submit copies of quarterly narrative reports and summary activity tables
(if applicable) to regional community planning group(s) (RCPGs) simultaneous to submission
to MDCH/DHAS-HAPIS.
E. The Contract Manager shall evaluate the reports submitted as described in a and b above for
their completeness and adequacy.
F. The Contract Manager shall permit the Department and/or its designee to visit and to make an
evaluation of the project as determined by Contract Manager.
Page 20 of 54
Reporting Period
October - December 2002
January - March 2003
April - June 2003
July - September 2003
Narrative Report Due
January 31, 2003
April 30, 2003
July 31, 2003
October 31, 2003
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ATTACHMENT III
AIDS/HIV SPECIAL PREVENTION SPECIAL REQUIREMENTS
- CITY OF DETROIT HEALTH DEPARTMENT
Contractor Requirements
1. Purpose
To reduce the incidence of HIV infection by providing support for HIV prevention services targeting
HRH, African American 'MSM, and MSM/IDUs.
2. Objectives
A. Process Objective 1.1: By September 30, 2003, the Detroit Health Department will provide
200 street/field outreach sessions to 1200 AA MSM in the zip code areas of 48201, 48202, and
48203 in the city of Detroit.
B. Process Objective 2.1: By September 30, 2003, the Detroit Health Department will provide
100 street/field outreach sessions to 500 AA MSM and AA MSM/IDU in Palmer Park, zip code
areas of 48202 and 48203, Mack and Bewick and Dexter and Lawrence. Of these 500, 250
will be unduplicated and 10% (50) will be M MSM/IDU.
C. Process Objective 3.1: By September 30, 2003, the Detroit Health Department will facilitate
250 individual counseling sessions with 125 MSM or MSM/IDU using the Project Respect HIV
Prevention Counseling Model in support groups and bars.
3. Methodology and Program Content
The following prevention strategies are supported under this agreement: Counseling, Testing and
Referral, Outreach, and Individual Prevention Counseling. All program activities will be conducted in
a manner consistent with applicable state and federal laws, and with the program standards described
in the "Quality Assurance of HIV Prevention Interventions" (April 2002). Program development,
implementation and evaluation will be delivered according to the methods, time line, work plan and
staffing plan described in the Agency's program proposal and/or negotiated amendments and
revisions.
2. Performance/Prowess Report Requirements
A. The Contractor shall submit the following reports on the following dates:
1. A narrative report detailing progress toward meeting process and outcome objectives.
The format and content of these reports are to conform to the guidelines issued by
MDCH/HAPIS-DHAS. Narrative reports are due 30 days after the close of each
quarter.
2. Applicable statistical reports. The format and content of these reports is to conform to
guidelines issued by MDCH/DHAS-HAPIS. Current required statistical reports include:
(a) HIV Counseling and Testing Report Form (USGPO #1933-2430-S)
HIV Counseling and Testing Report Forms are due on the 10th working day of
each month.
• (b) Summary Activity Tables, produced through utilization of the HIV Event
System.
Summary Activity Tables, if applicable, are to accompany narrative reports.
Tables are to be accompanied by an electronic copy of associated data. Due
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- dates are listed in A.1. '
It is understood that the reports described above may be revised, supplemented or
replaced at any time and that the agency will provide information and/or data
responsive to modified reporting requirements.
NOTE: Agencies receiving support for HIV counseling and testing activities only are not
required to submit Summary Activity Tables.
- B. Any such other information as specified in The Objectives shall be developed and submitted
by the Contractor as required by the Contract Manager.
C. The original and one copy of the quarterly narrative and statistical reports (if applicable) are
to be submitted by the Contractor to the designated MDCH/DHAS-HAPIS contract monitor.
D. The Contractor shall submit copies of quarterly narrative reports and summary activity tables
(if applicable) to regional community planning group(s) (RCPGs) simultaneous to submission
to MDCH/DHAS-HAPIS.
E. The Contract Manager shall evaluate the reports submitted as described in a and b above for
their completeness and adequacy.
F. The Contract Manager shall permit the Department and/or its designee to visit and to make an
evaluation of the project as determined by Contract Manager.
AIDS/HIV SPECIAL PREVENTION SPECIAL REQUIREMENTS
- DICKINSON-IRON DISTRICT HEALTH DEPARTMENT
Contractor Requirements
1. Purpose:
The purpose of this program is to reduce the incidence of HIV infection by providing support for HIV
prevention services targeting Men who have Sex with Men (MSM) and High-Risk Heterosexuals (HRH)
in Region 8.
2. Objectives:
A. Process Objective 1.1: By September 30, 2003, Dickinson-Iron District Health Department
(DEADHEAD) will provide individual counseling to 30 MSM in someone's home.
B. Process Objective 1.2: By September 30, 2003, DEADHEAD will provide individual
counseling to 15 HRH in someone's home.
C. Process Objective 2.1: By September 30, 2003, DEADHEAD will provide 10 home parties
to 35 MSM providing skills-building and risk reduction education.
D. Process Objective 2.2: By September 30, 2003, DEADHEAD will conduct one Men's Health
. Retreat for 15 MSM Peer Opinion Leaders to provide updates on HIV related issues and
outreach skills.
E. Process Objective 3.1: By September 30, 2003, DEADHEAD will provide 10 outreach
sessions to 50 MSM in venues that include gay bars, street outreach and community events.
F. Process Objective 3.2: By September 30, 2003 DEADHEAD will provide 5 outreach sessions
to 40 HRH in.venues that include home parties, street outreach and community events.
3. Methodoloav and Program Content
The following prevention strategies are supported under this agreement: Individual level, group level,
outreach, and peer Opinion Leader. All program activities will be conducted in a manner consistent
with applicable State and federal laws, and with the program standards described in the "Quality
Assurance of HIV Prevention Interventions" (April 2002). Program development, implementation and
evaluation will be delivered according to the methods, time line, work plan and staffing plan described
in the Agency's program proposal and/or negotiated amendments and revisions.
Page 22 of 54
October - December 2002
January - March 2003
April - June 2003
July - September 2003
January 31, 2003
April 30, 2003
July 31, 2003
October 31, 2003
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ATTACHMENT III
4. , Performance/Progress Report Requirements
' A. The Contractor shall submit the following reports on the following dates:
1. A narrative report detailing progress toward meeting process and outcome objectives.
The format and content of these reports are to conform to the guidelines issued by
MDCH/DHAS-HAPIS. Narrative reports are due 30 days after the close of each
quarter:
Reporting Period Narrative Report Due
2. Applicable statistical reports. The format and content of these reports is to conform to
guidelines issued by MDCH/DHAS-HAPIS. Current required statistical reports include:
(a) HIV Counseling and Testing Report Form (USPO #1933-2430-S)
HIV Counseling and Testing Report Forms are due on the 10 th working day of each
month.
(b) Summary Activity Tables, produced through utilization of the HIV Event System.
Summary Activity Tables, if applicable, are to accompany narrative reports. Tables are
to be accompanied by an electronic copy of associated data. Due dates are listed in
A.1.
It is understood that the reports described above may be revised, supplemented or replaced
at any time and that the agency will provide information and/or data responsive to modified
reporting requirements.
NOTE: Agencies receiving support for HIV counseling and testing activities only are not
required to submit Summary Activity Tables.
B. Any such other information as specified in The Objectives shall be developed and submitted
by the Contractor as required by the Contract Manager.
C. The original and one copy of the quarterly narrative and statistical reports (if applicable) are
to be submitted by the Contractor to the designated MDCH/DHAS-HAP1S contract monitor.
D. The Contractor shall submit copies of quarterly narrative reports and summary activity tables
(if applicable) to regional community planning group(s) (RCPGs) simultaneous to submission
to MDCH/DHAS-HAPIS.
E. The Contract Manager shall evaluate the reports submitted as described in a and b above for
their completeness and adequacy.
F. The Contract Manager shall permit the Department and/or its designee to visit and to make an
evaluation of the project as determined by Contract Manager.
AIDS/HIV SPECIAL PREVENTION SPECIAL REQUIREMENTS
- DISTRICT HEALTH DEPARTMENT #10
Contractor Requirements
1. Purpose -
To reduce the incidence of HIV infection by providing support for HIV prevention services targeting
men who have sex with men (MSM) and high risk heterosexuals (HRH) in HIV prevention planning
regions 5 and 7.
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,
2.: 0 bi ectives
A. Process Objective 1.1. By September 30, 2003, DHD #10 will provide skills-building
workshops to 200 incarcerated adolescents at detention camps.
B. Process Objective 1.2. By September 30, 2003, DHD #10 will provide skills-building
workshops to 250 HRH youth aged 13 - 18 enrolled in alternative education or through other
at risk youth venues.
C. Process Objective 1.3. By September 30, 2003, District Health Department #10 will provide
12 skills-building workshops for 200 HRH, ages 17 - 25, at colleges and universities in
Mecosta County.
D. Process Objective 1.4. By September 30, 2003, DHD #10 will provide 4 skills-building
workshops to 30 African American HRH women in Lake County.
E. Process Objective 2.1. By September 30,2003, DHD #10 will provide outreach to 200 MSM
at rural rest areas, parks, annual Gay Pride picnic and other venues frequented by the rural
MSM population within DHD #10's 10 county service area.
F. Process Objective 2.2. By September 30,2003, DHD #10 will provide outreach to 400 HRH
at bars and other community venues in all 10 counties of service area.
G. Process Objective 3.1. By September 30, 2003, DHD #10 will provide Peer Opinion Leader
training to 10 MSM in Mason, Manistee, and Oceana Counties.
3. Methodology and Program Content
The following prevention strategies are supported under this agreement: group level intervention,
outreach and peer education training. All program activities will be conducted in a manner consistent
with applicable state and federal laws, and the program standards as described in the "Quality
Assurance of HIV Prevention Interventions (April 2002). Program development, implementation and
evaluation will be delivered according to the methods, timeline, workplan and staffing plan described
in the Agency's program proposal and/or negotiated amendments and revisions.
4. Performance/Progress Report Requirements
A. The Contractor shall submit the following reports on the following dates:
1. A narrative report detailing progress toward meeting process and outcome objectives.
The format and content of these reports are to conform to the guidelines issued by
MDCH/DHAS-HAP1S. Narrative reports are due 30 days after the close of each
quarter.
Reporting Period Narrative Report Due
October - December 2002 January 31, 2003
January - March 2003 April 30, 2003
April - June 2003 July 31, 2003
July - September 2003 October 31, 2003
2. Applicable statistical reports. The format and content of these reports is to conform to
guidelines issued by MDCH/DHAS-HAPIS. Current required statistical reports include:
(a) HIV Counseling and Testing Report Form (USGPO #1933-2430-S)
HIV Counseling and Testing Report Forms are due on the 10th working day of each
month.
(b) Summary Activity Tables, produced through utilization of the HIV Event System.
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Summary Activity Tables, ifapplicible, are to accompany narrative reports. Tables are
to be accompanied by an electronic copy of associated data. Due dates are listed in
Al.
It is understood that the reports described above may be revised, supplemented or replaced
at any time and that the agency will provide information and/or data responsive to modified
reporting requirements. _
NOTE: Agencies receiving support for HIV counseling and testing activities only are not
required to submit Summary Activity Tables.
B. Any such other information as specified in The Objectives shall be developed and submitted
by the Contractor as required by the Contract Manager.
C. The original and one copy of the quarterly narrative and statistical reports (if applicable) are to
be submitted by the Contractor to the designated MDCH/DHAS-HAP1S contract monitor.
D. The Contractor shall submit copies of quarterly narrative reports and summary activity tables
(if applicable) to regional community planning group(s) (RCPGs) simultaneous to submission
to MDCH/DHAS-HAPIS.
E. The Contract Manager shall evaluate the reports submitted as described in a and b above for
their completeness and adequacy.
F. The Contract Manager shall permit the Department and/or its designee to visit and to make an
evaluation of the project as determined by Contract Manager.
AIDS/HIV SPECIAL PREVENTION SPECIAL REQUIREMENTS
- SAGINAW COUNTY DEPARTMENT OF PUBLIC HEALTH
Contractor Requirements
1. Purpose
The purpose of this program is to reduce the incidence of HIV infection by providing support for HIV
prevention services targeting MSM and HRH (ages 10-24) in Region 6.
2. Objectives
A. Process Objective 1.1. By September 30, 2003, Saginaw County Department of Public Health
(SCDPH) will provide a two-session skills-building workshop entitled "Making the Right
Choices" to 100 adolescent and youth (ages 10-24) males ,25 who are MSM and 75 who are
HRH at community agencies that provide services to high-risk adolescents and youth including
alternative/vocational schools, juvenile detention facilities, halfway houses and other
collaborating agencies.
B. Process Objective 1.2. By September 30, 2003, SCDPH will provide a two-session skills-
building workshop entitled "Making the Right Choices" to 50 HRH adolescent and youth (ages
10-24) females at community agencies that provide services to high-risk adolescents and youth
including alternative/vocational schools, juvenile detention facilities, halfway houses and other
collaborating agencies.
3. Methodology and Program Content
The following prevention strategies are supported under this agreement: Group Level Intervention
using the "Making the Right Choices" model. All program activities will be conducted in a manner
consistent with applicable state and federal laws, and the program standards as described in the
"Quality Assurance of HIV Prevention interventions" (April 2002). Program development,
implementation and evaluation will be delivered according to the methods, timeline, workplan and
staffing plan described in the Agency's program proposal and/or negotiated amendments and
revisions.
Paoe 25 of 54
Reporting Period
October - December 2002
January - March 2003
April - June 2003
July - September 2003
Narrative Report Due
January 31, 2003
April 30, 2003
July 31, 2003
October 31, 2003
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4:: Performance/Progress Report Requirements
The Contractor shall submit the following reports on the following dates:
1. A narrative report detailing progress toward meeting process and outcome objectives.
The format and content of these reports are to conform to the guidelines issued by
' MDCH/DHAS-HAPIS. Narrative reports are due 30 days after the close of each
quarter
A.
I.
Applicable statistical reports. The format and content of these reports is to conform to
guidelines issued by MDCH/DHAS-HAPIS. Current required statistical reports include:
(a) HIV Counseling and Testing Report Form (USGPO #1933-2430-S)
HIV Counseling and Testing Report Forms are due on the 10th working day of each
month.
(b) Summary Activity Tables, produced through utilization of the HIV Event System.
Summary Activity Tables, if applicable, are to accompany narrative reports. Tables are to be
accompanied by an electronic copy of associated data. Due dates are listed in A.1.
It is understood that the reports described above may be revised, supplemented or replaced
at any time and that the agency will provide information and/or data responsive to modified
reporting requirements.
NOTE: Agencies receiving support for HIV counseling and testing activities only are not
required to submit Summary Activity Tables.
B. Any such other information as specified in The Objectives shall be developed and submitted
by the Contractor as required by the Contract Manager.
C. The original and one copy of the quarterly narrative and statistical reports (if applicable) are
to be submitted by the Contractor to the designated MDCH/DHAS-HAPIS contract monitor.
D. The Contractor shall submit copies of quarterly narrative reports and summary activity tables
(if applicable) to regional community planning group(s) (RCPGs) simultaneous to submission
to MDCH/DHAS-HAPIS.
E. The Contract Manager shall evaluate the reports submitted as described in a and b above for
their completeness and adequacy.
F. The Contract Manager shall permit the Department and/or its designee to visit and to make an
evaluation of the project as determined by Contract Manager.
CSHCS SPECIAL REQUIREMENTS
CSHCS OUTREACH AND ADVOCACY REQUIREMENTS
Contractor Requirements -
1. Program Representation and Advocacy
A. Provide program representation which includes the provision of information regarding
Childrens Special Health Care Services (CSHCS) policy on diagnostic referrals,
program eligibility, covered services, prior authorization, and the ,5appeals process to
providers, the community, other agencies and families.
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B. Inform famifles of their rights-and responsibilities in the CSHCS program.
C. Describe special CSHCS programs to families which are outside the scope of covered
services but unique to the program, such as the CSHCS Trust Fund and the insurance
premium payment program.
D. Provide information and referral or assist persons in making applications for other
programs in the community for which the child and/or family may be eligible, for such
as Early On, WIC, MI-Child, Healthy Kids and Medicaid.
E. Provide answers to any questions or concerns families might have and help families
, advocate on their own behalf if they are unable to perform this task.
F. Participate in community health assessments and community systems reform initiatives
and facilitate the direct participation of families in these processes.
G. Work collaboratively with the CSHCS Special Health Plans to provide information to the
local provider community and solicit participation in the health plan provider networks.
2. Application and Renewal
A. Arrange for diagnostic evaluation referrals or obtain Release of Information form (s) for
the purpose of securing medical reports for determining medical eligibility.
B. Assist any family who is referred by the CSHCS program or who comes to the local
health department for assistance in applying to join the CSHCS program with
completion of the CSHCS application form, including the financial assessment and third
party liability forms.
C. Contact and provide information about the CSHCS program and assess family needs
for those persons referred by the CSHCS program that enroll in the Basic Health Plan
(BHP - previously known as Fee-For-Service).
D. Assist families in obtaining medical reports to establish medical eligibility for the
CSHCS program in new and renewing cases.
E. Obtain Release of Information forms for securing medical reports or to allow release
of medical and case information to the CSHCS Special Health Plans.
F. Assist in locating individuals or families who do not return a CSHCS Application after
being made medically eligible.
G. Assist in locating individuals or families who do not respond when requested to make
a health plan choice.
H. Provide additional information about CSHCS to families who choose the Basic Health
Plan in counties where a Special Health Plan is available.
3. Support Services
A. Link families to the CSHCS Parent Participation Program, Family Phone Line or to the
Family Support Network.
B. Advise families about and provide linkage to Michigan Enrolls for assistance in CSHCS
health plan selection.
C. Link families to Special Health Plan member services offices for health plan questions.
D. Provide consultation and work collaboratively with the CSHCS Special Health Plans to
identify and facilitate linkages and referrals to community-based agencies and
resources.
E. Provide care coordination services.
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F. Make available to CSHCS Special Health Plans and the C$HCS Plan Division a
community resource directory for the counties covered by the health department. This
directory shall include the names, addresses and phone numbers of the full
complement of community-based services and resources available in each county.
4. General Performance Requirements
All Local CSHCS staff should be conversant about the benefits of the CSHCS Special Health
Plans versus the Basic Health Plan and should be able to explain these advantages to families.
Local Health departments are asked, as they come in contact with eligible persons and/or their
families, to encourage enrollment into a CSHCS Special Health Plan. In addition, Local
CSHCS staff should be able to describe the MIChild interface with the CSHCS Special Health
Plans and identify children who might be eligible and facilitate enrollment in the CSHCS Special
Health Plan as well as establish MIChild eligibility.
The Department's goal for 2003, for those persons eligible to enroll in the CSHCS Special
Health Plan, is that 90% of newly eligible CSHCS beneficiaries voluntarily enroll into a CSHCS
Special Health Plan. Further there is a minimum goal of 60% of previously eligible CSHCS
beneficiaries who renew their eligibility to enroll in a CSHCS Special Health Plan. To the extent
possible, local health departments will be expected to assist the Department in reaching these
goals to assure continued funding of local CSHCS services.
Local CSHCS staff are also expected to attempt to contact families when a referral is made or
when asked to locate families via "Notice of Action" forms by the CSHCS Customer Support
Section.
Four additional performance requirements are identified in the annual Local MCH Block Grant.
Local CSHCS staff are notified of the need to take action regarding these performance
requirements by way of a "Notice of Action" from the CSHCS program. These objectives
require the local CSHCS staff to attempt to contact 100% of the beneficiaries/families referred
and successfully contact a percentage of these beneficiaries/families for the purposes of giving
assistance or information or obtaining information for the purposes of health plan enrollment,
CSHCS eligibility renewal, or completion of the CSHCS application process. The targeted
percentages for successful contacts are:
1. Offer additional information or referral for other services 60%
2. Obtain medical renewal and/or financial assessment information
to renew CSHCS eligibility 60%
3. Make health plan choice 45%
4. Complete CSHCS application 45%
In addition, in counties where there is currently a CSHCS Special Health Plan(s) and in other
counties as they become approved network services areas, health departments will be
expected to sign a contractual agreement to provide services, including care coordination with
CSHCS Special Health Plans as they become available in their counties. Local health
departments that fail to sign a contractual agreement with CSHCS Special Health Plans
already approved in their jurisdiction or as they become approved will risk losing local CSHCS
funding.
Care Coordination Services
Care coordination services are authorized by the CSHCS Program and reimbursed as part of the
CPBC contract as a "Fixed Unit Rate Reimbursement". Reimbursement for authorized care
coordination services are paid for separately through the CPBC contract until available funds are
depleted each fiscal year. If/when CPBC funds become depleted in advance of the end of the fiscal
year, care coordination services are expected to be provided without additional remuneration under
the CPBC Contract.
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Care coordination will be provided by qualified Local CSHCS staff Who are registered nurses, social
workers, or pars-professionals, under the supervision of registered nurses who are trained in the
service needs of the CSHCS population and who demonstrate skill and sensitivity in communicating
with children with special health care needs and their families.
A. There are two levels of coordination services
1. Level I Care Coordination
2. Level ll Care Coordination
B. Level I Care Coordination consists of identification and documentation of a beneficiary's medical,
social, educational, functional status and requirements to treat and support those needs through
the development of a comprehensive plan of care or Individualized Health Care Plan (IHCP).
1HCPs are developed or renewed on an annual basis. Authorization for Level I Care Coordination
is communicated to the Local CSHCS office by either the CSHCS Program or by a CSHCS Special
Health Plan (SHP). Care Coordination for beneficiaries in the Basic Health Plan (BHP - previously
known as Fee-for-Service) is authorized by the CSHCS Program. Care Coordinator for
beneficiaries in a SHP are authorized by the SHP of enrollment.
Initial IHCP development may require completion of a long form, or short form. Renewal of the
IHCP is required annually. IHCP renewals also require completion of a long form, or short form.
Updates to an IHCP also may be requested, .and authorized as needed by the appropriate
authorizing agency.
Level I reimbursement is based on a fixed unit rate. The rate depends upon whether the initial or
renewal IHCP is completed, and whether a long or short form is required. A bonus is paid for both
the long and short form if the 1HCP is completed within 45 calendar days from the date of referral.
Whichever authorizing agency (CSHCS Plan Division or SHP) authorizes the development of an
1HCP must be notified immediately when the IHCP has been completed. The rates and procedures
for Level I Care Coordination reimbursement are described below in 2.E. "Authorization, Billing and
Documentation Procedures for Level I and II Care Coordination".
Level I Care Coordination activities are to be provided by an authorized LHD/CSHCS staff member
when delivered through the LHD. The LHD/CSHCS local care coordinator (LCC), in collaboration
with the beneficiary/family, health care and support service providers, develops and distributes the
plan. The LCC provides the beneficiary/family with information and clarification regarding services
and care coordination. The LCC assists with the arrangement and/or follow-up of IHCP identified
services as appropriate, and to document and communicate to affected parties if circumstances
have changed. The LCC also provides appropriate referrals and advocacy for other services as
needed.
Specialized Community-Based Care Coordination (SCBCC) is not covered under this agreement.
Beneficiaries receiving the CSHCS Hourly Nursing Benefit (HNB) are not eligible for Level) Care
Coordination as they receive the Hourly Nursing Services IHCP/Assessment and Home Survey.
SCBCC differs from Level I Care Coordination in that an Hourly Nursing Services
IHCP/Assessment and Home and Family Survey are only a few of the activities that are separately
reimbursed apart from the CPBC-FSR. Reimbursement is a fixed rate per beneficiary based upon
Specialized Community-Based Care Coordination (SCBCC)/HNB requirements and criteria. A
description of the SCBCC authorization procedures, service requirements and criteria, as well as
reimbursement rates are described in a separate MSA Bulletin. Local Health Departments/Local
CSHCS offices may participate as a SCBCC provider but are not required, to do so.
C. Level II Care Coordination consists of interaction with the beneficiary/family and others involved
with care of the beneficiary by telephone or in person that meet Level II Care Coordination criteria.
Level II Care Coordination activities include, but are not limited to, arranging for service delivery
from CSHCS qualified providers, client advocacy, assisting with needed social, education, or other
support services, and processing CSHCS Trust Fund applications. In addition, these services: 1)
are non-routine; 2) involve multiple contacts; 3) are substantive, and 4) take more than 30 minutes.
The CSHCS Plan Division is the authorizing care coordination agent for beneficiaries in the BHP.
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Each CSHCS Special Health Plan is the authorizing agent for their ,enrollees. Pre-authorization
• requirements regarding Level 11 Care Coordination are listed below.
D. LHD/CSHCS staff involved in CSHCS Care Coordination activities are responsible to attend
related training conducted by the CSHCS Plan Division or their agents, and remain current and
informed of CSHCS program policies and procedures.
E. Authorization, Billing and Documentation Procedures for Level I and II Care Coordination
The CSHCS Plan Division provides reimbursement through the CPBC-FSR process for both Level
I and Level II Care Coordination when provided by LHD/CSHCS office staff for both BHP and SHP
beneficiaries for as long as the funding remains available. If CSHCS Care Coordination funding
becomes depleted, reimbursement for SHP Care Coordination activities reverts to the contractual
payment process between the SHP and local care coordination provider/agency.
Level I Care Coordination activities must be authorized by the CSHCS Plan Division for
beneficiaries in the BHP, or by the SHP of enrollment for beneficiaries in a SHP. After the Level I
Care Coordination has been authorized and completed, a CSHCS Care Coordination Authorization
For Payment Form is sent to the CSHCS Plan Division (by the SHP) who forwards a copy to the
LHD/CSHCS office. The CSHCS Plan Division completes this form for BHP beneficiaries and sends
a copy to the LHD/CSHCS office staff. This authorization will specify the rate to be paid, for an
Initial IHCP, a Renewal IHCP, or an update to the- IHCP. It will also specify if the bonus payment
applies for completion of the 1HCP within 45 calendar days from the date of referral. The
LHD/CSHCS office completes a monthly CSHCS Fi:;ed Unit Rate Reimbursement Form and
submits it as a Supplemental Attachment to the quarterly CPBC-FSR for payment. The CSHCS
Fixed Unit Rate Reimbursement Form will be compared to the authorization form to assure proper
payment for Level I Care Coordination Services
Level II Care Coordination is specific to care coordination activities not involving the development
of an Individualized Health Care Plan (IHCP). Level II consists of Code A and Code B services for
BHP members and Code B services only for SHP members. A maximum of ten units per
beneficiary, through any combination of Code A and/or Code B, are allowed for a single beneficiary
during a fiscal year.
Code A is one unit of care coordination as previously described in Section 2.0 above and refers
to BHP members only. Referral/authorization for Code A Care Coordination is not required. LHD
staff must notify the CSHCS Plan Division, on a form provided by the department, when code A
Care Coordination has occurred for tracking purposes.
Code B Care Coordination requires prior authorization. Code B consists of more than one Unit of
Care Coordination required to complete the service. Authorization is required for BHP beneficiaries
by the CSHCS Plan Division, and for SHP beneficiaries by the SHP of enrollment. A copy of a
CSHCS Care Coordination Authorization for Payment Form is sent to the LHD/CSHCS office after
the LHD/CSHCS office has notified the authorizing agent that the Code B service has been
completed.
The CSHCS Fixed Unit Rate Reimbursement Form for CSHCS Level II Code A is submitted by the
LHD/CSHCS office with the Supplemental Attachment to the CPBC-FSR. The CSHCS Fixed Unit
Rate Reimbursement Form for CSHCS Level II Care Coordination, Code B, will be compared to
the Authorization Form to assure proper payment for Level II Care Coordination Services.
When completing the CSHCS Fixed Unit Rate Reimbursement Form for a Level II service, check
the Code A box and indicate the service date. When completing the form for a Code B service,
check the box for Code B and indicate the authorization date. If both Code A and Code B services
were provided to the same beneficiary in the same billing time frame, complete both Code A and
Code B information.
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Local CSHCS offices must maintain documentmtion on a paper or -Computer log for all Code A and
Code B Care Coordination. This documentation must include: beneficiary name, ID number,
date(s) of service, level of care coordination, types of activity performed, whether in person or by
phone, staff involved, resolution, and duration on contacts.
CHILDHOOD IMMUNIZATION REGISTRY SPECIAL REQUIREMENTS
Contractor Requirements
The contractor assures that:
1. All immunizations administered by the Contractor, or by any agency or provider participating in any of
the vaccine distribution programs on behalf of the Contractor, are reported to the MCIR for all children
born after December 31, 1993.
2. All providers within their jurisdiction are registered through the MCIR and that all of their activities are
coordinated with the regional contractor of the Department and operated within their guidelines.
3. Existing immunization records shall be submitted to the MCIR in accordance with the instructions from
the Department's regional contractor.
CHILDHOOD LEAD SPECIAL REQUIREMENTS
Contractor Requirements
1. Submit a Lead Poisoning Prevention Plan for use of allocated Childhood Lead funds as follows:
A. Briefly describe each of the program components listed below: Description of the Problem-
1. Describe the problem in the local jurisdiction in terms of numbers of children affected,
housing stock and other sources of exposure. Identify areas within the jurisdiction where
children are at high risk.
2. Jurisdiction-wide Plan for Blood Lead Screening - Develop a plan to address the
screening/testing needs in the jurisdiction, describe how and where children can be
screened, specific outreach activities, types of testing provided and how the local coalition
is utilized to develop the plan.
3. Jurisdiction-wide Surveillance System - Describe how data is kept in the agency and the
method for ensuring that data is incorporated into the state STELLAR system. Describe the
standard process for follow-up by nursing and environmental health staff and the case
management activities.
4. Ensuring Screening/Testing and Follow-up - Describe how the jurisdiction will assure that
children identified with elevated blood lead levels receive the appropriate medical follow-up
and the nursing and environmental health visits to assess the child's health status and
identify lead hazards and their clearance.
5. Public and Professional Health Education and Communication - Describe the public,
professional and community education components of the program including the providers
of educational services.
6. Primary Prevention - Describe any primary prevention activities the jurisdiction provides, or
any coordination activities with other community agencies providing primary prevention
activities.
7. Method of Evaluation - Describe how the project will be evaluated, including outcome
objectives for children and families affected by lead poisoning and community collaboration
for the prevention of lead poisoning. Describe any current barriers to the successful
completion of all program objectives.
8. Reporting - CDC Reporting and data exercises will be required of all local health
• departments participating in the Lead Screening Program.
9. A Plan and Budget for the next grant year must be submitted in March of each year.
COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT SPECIAL REQUIREMENTS
Contractor Requirements
1. Facilitate a community health assessment and improvement process in a defined geographic region
consistent with written Guidelines and Plan Requirements provided by the Department.
2. Submit products in accordance with target dates established in written Guidelines provided by the
Department.
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FAMILY PLANNING/BREAST AND CERVICAL CANCER CONTROL, PROGRAM (BCCCP)
JOINT PROJECT SPECIAL REQUIREMENTS
dontractor Requirement
The FP/BCCCP Demonstration Project is a joint program designed to provide diagnostic services to Title X
(Family Planning) clients who have Pap tests indicating possible cervical cancer.
Extensive data is required by the Center for Disease Control and Prevention (CDC) for each woman served
by federal funds. Dates of service and results of testing are required prior to authorizing reimbursement to
providers. Therefore, data about the abnormal Pap smear will have to be transmitted from the Family
Planning program to the designated BCCCP agency prior to arranging diagnostic services.
1. Women eligible for this program will be Title X clients, under age 40, be uninsured or underinsured, and
with income under 250% of poverty. A Family Planning client meeting these eligibility criteria will sign
a release form to allow her data to be provided to the BCCCP. Forms will be provided to the Family
Planning agencies for recording data required for referral to a BCCCP agency. All data required for
enrollment in the BCCCP will be collected by the BCCCP agency.
2. Once the BCCCP agency accepts the Family Planning client in this project, she becomes the sole
responsibility of the BCCCP agency, and the BCCCP agency must make every effort to ensure the
woman receives proper services.
3. Dates and results of all diagnostic procedures must be recorded in the Michigan Breast and Cervical
Cancer Information System (MBC1S) by the BCCCP agency before reimbursement can be approved.
4. The data must indicate the outcome of testing with a final diagnosis of cancer/not cancer and, if cancer,
the stage and date of treatment initiation. It is expected that there will be extensive communication
between the referring Title X agency and the BCCCP agency managing the diagnostic process, so that
the woman will proceed seamlessly through the medical system(s).
5. The BCCCP agency must provide results of diagnostic evaluation to the referring Family Planning
agency upon request, and upon completion of the diagnostic process.
6. If cancer is diagnosed the woman will have access to the BCCCP treatment network, and the BCCCP
agency must make every effort to ensure the woman receives proper treatment.
FAMILY PLANNING - LONG-TERM CONTRACEPTIVE DISTRIBUTION SPECIAL REQUIREMENTS
1. Agencies participating in the Long-Term Contraceptive Distribution Project must follow protocols as
outlined by the Department.
FAMILY PLANNING - PREGNANCY PREVENTION SPECIAL REQUIREMENTS
Contractor Requirements
1. The funds appropriated in the current State Public Health Appropriations Act for pregnancy prevention
programs shall not be used to provide abortion counseling, referrals or services.
2. All delegate agencies must serve a minimum of 95% of proposed users to access total amount of
allocated funds.
FAMILY PLANNING - SPECIAL PROJECT SPECIAL REQUIREMENTS
Contractor Requirements
1. Submit quarterly and annual reports on a timely basis as directed by the Department.
2. Provide ongoing monitoring to delegate agencies as they incorporate substance abuse risk assessment
into existing services.
3. Attend MDCH sponsored project coordinators meetings -and participate in project evaluation.
4. Participate in activities required to assist delegate agencies in providing services to women and
adolescents at risk for substance abuse and/or using substances.
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- H'EPATMS B SPECIAL KEQUIREMENTS
Budget and Agreement Requirements.
Approved allocations can be budgeted in CPBC underthe Family Planning, STD or Adolescent Health element
(as a funding source) where the staff providing the services are being budgeted.
Reimbursement must be noted as a funding source, on the Comprehensive FSR in the budgeted element.
Rates are: administration of first, second or third dose of vaccine with submission of intake form or Vaccine
Follow-up Form to MPHI $9.00 per dose. For specific program requirements and additional detail refer
to the Guidance Document For Hepatitis B - Supplemental Attachment To The CPBC FSR.
Contractor Requirements
1. Assure that all staff are trained as required by the Department.
2. Assure that Intake Forms and Vaccination Follow-up Forms are complete and submitted to MPHI on
a continuous basis.
Department Requirements
The Department will provide payment based on the fixed unit rate reimbursement mechanism upon completion
of the intake forms and submission of the Comprehensive FSR (DCH-0412)
IMMUNIZATION - FIELD SERVICE REPRESENTATIVES SPECIAL REQUIREMENTS -
Contractor Requirements
1. Employ and supervise 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.
2. Provide the Immunization Field Representative with permanent office space, including a telephone.
3. Make the Immunization Field Representative available to all local health departments in the assigned
jurisdictions to provide Immunization program activities equitably and at the direction of the Department.
Refer to field representation responsibilities as defined and distributed to the contractor.
4. Provide for reimbursement for telephone charges incurred in the conduct of business by the
Immunization Field Representative.
5. Provide any supplies to the Immunization Field Representative necessary to the conduct of the
Immunization Program, including a computer with a Pentium processor or better, a printer, as well as
a modem and a car phone.
6. Provide reimbursement for any travel and subsistence expenses incurred by the Immunization Field
Representative necessary to the conduct of the Immunization Program. Travel will include the annual
National Immunization Conference and attendance at the MDCH Immunization staff meetings and
trainings.
Department Requirements
1. Provide necessary adjunct clerical services to the Immunization Field Representative for the
duplicating/printing of materials and the packaging and distribution of these materials.
2. Provide program direction and definition of Immunization Field Service Representative
responsibilities.
IMMUNIZATION VFC AND MI-VFC SPECIAL REQUIREMENTS
Contractor Requirements
The goal is to visit each VFC and 11/11-VFC provider is to be visited at least once every two years, with the
minimum number of site visits being 20 for larger local health departments with 20 or more providers and at
least 80 percent of the provider sites in jurisdictions with fewer than 20 providers.
ryf 94
MDCH/CMS
6/02
ATTACHMENT III
The format of the site visit be based on the site visit questionnaire distributed at the most recent Fall IAP
• meeting. Completed site visit questionnaires will be submitted to the Division of Communicable Disease and
Ithmunization on a continuous basis.
Budgeting and Agreement Requirements
Approved allocations can be budgeted in the CPBC under the Immunization element (as a funding source)
where staff providing the services are being budgeted.
Data from the Immunization Division regarding the number of site visits will be used to reconcile the request
for reimbursement on the Comprehensive FSR (DCH-0412). The corresponding reimbursement must be
noted as a funding source in the budgeted element. The minimum number of site visits must be completed
by March 31 to qualify for the incentive of $150 per site visit. Local health departments (LHDs) with 20 or
fewer sites are expected to conduct site visits with at least 80% of the sites. LHDs with more than 20 sites
are expected to conduct visits at 20 or more sites. LHDs with 49 or fewer sites may conduct as many as 40
visits, each of which would qualify for the $150 incentive. LHDs with between 50 to 94 sites may conduct up
to 50 visits and LHDs with more than 95 sites may conduct up to 60 visits. For additional detail on the
program requirements, refer to the Resource Book For VFC and MI-VFC Providers and other guidance
provided by the Department in correspondence to Immunization Action Plan (lAP) and Immunization
Coordinators.
Department Requirements
The Department will provide payment based on the fixed unit rate reimbursement mechanism upon completion
and submission of the Comprehensive FSR (DCH-0412).
IMMUNIZATION - NURSE TRAINING REIMBURSEMENT SPECIAL REQUIREMENTS
Budget and Aareement Requirements
The rate of reimbursement is $100.00 per training session per day to the Local Health Department„ upon
completion and submission of the Comprehensive FSR (DCH-0412). Reimbursement can only be made
for one training session per physician clinic site per year.
Contractor Requirements
1. Assure that all staff Immunization Nurse Educators are trained as required by the Department.
2. Assure that the Provider Contract and Report Form is complete and submitted to the Division of
Communicable Disease and Immunization within 5 days after the presentation.
Department Requirements
The Department will provide payment based upon the fixed unit rate reimbursement mechanism upon
completion and submission of the Comprehensive FSR. Data from the Division of Communicable Disease
and Immunization regarding the number of Provider Contract and Report Forms submitted will be used to
reconcile the request for reimbursement.
INDIAN HEALTH SPECIAL REQUIREMENTS
Contractor Requirements
1. Use the funds provided by the Department to support and provide Community Health Representative
(CHR) services to and for designated Indian population groups.
INFORMED CONSENT
Contractor Requirements
The following requirements apply to all local health departments, whether the health department 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
Contractor will provide:
Page 34 of 54
MDCH/CM3
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ATTACHMENT III
r A pregnancy test with, a determination of the probable gestational stage of a tonfirmed pregnancy.
Note: The contractor must destroy the individual "informed consent" files containing identifying
information (Name, Address, etc.) after 30 days.
2. When a woman seeks a pregnancy test and does not explicitly state that she is doing so for the purpose
of obtaining an abortion, she should be directed to a family planning clinic or to her primary care provider
for a pregnancy test. Services to comply with PA 345 of 2000 should not be provided to a woman in
a Title X funded family planning clinic.
Department Requirements
The Department will provide funding, at the fixed rate of $50 per woman served, for each woman that
expressly states that she is seeking a pregnancy test or confirmation of a pregnancy for the purpose of
obtaining an abortion and is provided the services noted in item 1 above. The number of services, rate per
service and total amount due must be noted as a funding source, under the element where the staff providing
the services are funded, on the Comprehensive FSR.
LABORATORY SERVICES SPECIAL REQUIREMENTS - DETROIT CITY
Contractor Specific Requirements
1. Meet established standards of performance and objegtives in the following areas:
A. Perform testing for detection of foodbome disease outbreaks as specified in items 5 and 6.
Perform HIV diagnostic testing using a test designated by the Department. Perform test for
diagnosis of gonorrhea and chlamydia using commercial nucleic Acid Amplification Test for family
planning clinic clients and other special populations designed by the Department.
B. Utilize standardized testing procedures, standards of quality assurance and quality control approved
by the Department laboratory director. Assist the Department in Quality Assurance Assessment
semi-annually or as determined by the Department (including test and report turn-around times,
indeterminate rate).
C. Maintain Clinical Laboratory Improvement Amendments of 1988 certification for high complexity
testing.
D. Test gonorrhea and chlamydia specimens from approved agencies within 1 working day of receipt
of specimen. Perform HIV-1/2 screening tests for diagnostic specimens within one work day of
receipt of specimen. Perform HIV-1 confirmatory tests for diagnostic specimens within three days
of screening assay positive. Submit specimens for HIV-2 testing to Department within one day of
HIV-1 testing completion. Establish Quality Assurance Monitor to investigate and correct situations
when HIV testing is not complete within 10 working days.
E. Send laboratory test reports to submitters within 1 day of completing testing via a system of delivery
at least as expedient as the US Postal Service. Establish and maintain confidential fax for HIV-2
reports and other laboratory reports from Department laboratory.
F. Establish testing personnel training program and maintain documentation of training of all testing
personnel.
G. Establish submission procedures for designated agencies/physicians for the timely transport of
appropriate specimens to the laboratory.
H. Maintain an adequate inventory of test kits and reagents purchased by the Department
Communicate shipment needs to manufacturers representative if shipments supplementary to the
routine shipments are needed.
I. Make one FIE available to participate in training and-exercises associated with Bioterrorism (BT);
Train additional staff to perform Level A & B procedures. Maintain competency and proficiency for
testing procedures described in LRN protocols. Temporarily reassign one FTE to MDCH or another
Level B laboratory as surge capacity for emergency situations, if needed. Develop a plan to provide
laboratory services 24 hours a day, seven days a week for a BT event. Provide secure facilities to
Page 35 of 54
MDCH/CMS
6/02
ATTACHMENT III
store reagents, quality cOntrol organisms, and patient isolates.
2.. Purchase and maintain adequate inventories of any supplies needed for testing and reporting, not
specifically supplied by the Department in this agreement.
3. Provide the Bureau of Epidemiology, HIV/AIDS-STD Division and Bureau of Laboratories records and
reports as required. For all testing services performed under contract by the Contractor for MDCH (e.g.,
HIV, foodborne disease, chlamydia, gonorrhea, BT, etc), all specimen submission data and reporting
data will be entered and reported using EPIC software. The Contractor will designate one staff member
as a liaison to the Bureau of Laboratories. Each Contractor must designate appropriate staff to take part
in EPIC training activities. Training and purchase of modules for EPIC other than those modules
provided by MDCH will be the responsibility of the Contractor.
The Contractor is responsible for modules not directly related to testing performed under this agreement
with the Bureau of Laboratories -
- Initial Purchase Price (paid to MDCH)
- Monthly maintenance fees (paid to MDCH)
- Use of modules purchased by an Contractor will be restricted to the Contractor purchasing the
module
- Use of modules purchased by one Contractor can be negotiated (formulas for payment will be
based upon the percentage of total specimens entered into the module).
Modules purchased by any Contractor will become available to any participating Contractor at no cost
after five years. However, each Contractor using the module will share in the maintenance fees.
4. Inform the Infectious Diseases Division by June 30, 2003 if more than 9,459 commercial nucleic acid
amplification specimens for chlamydia/gonorrhea will be performed.
5. Provide laboratory support (examination of food specimens) to investigate up to 12 foodbome disease
outbreaks. Laboratory support includes providing test reports and food samples to the Bureau of
Laboratories. Specimens will be processed within 36 hours of collection, except fish which will be
processed within 6 hours of collection.
6. Provide laboratory support for examination of up to 100 stool specimens associated with foodbome
disease outbreaks. Specimens will be processed within one hour of receipt if not in preservative or 24
hours if preserved.
Department Requirements
1. Reimburse the Contractor for the examination of specimens related to foodborne disease outbreaks to
the extent outlined in Items 5 & 6 above. Reimburse the Contractor at the fixed unit rate for each swab
specimen and for each urine specimen for diagnosis of gonorrhea and chlamydia using a nucleic acid
amplification assay. Reimburse the Contractor for performing HIV Diagnostic Testing.
2. Notification and explicit instruction for stop and start days to Contractor laboratory regarding this
contractual arrangement prior to its implementation.
3. The Department will provide access to EPIC, support for EPIC hardware (UNIX server) and software,
support and maintenance for one computer and one laser printer (excluding consumable supplies), user
training for EPIC modules utilized for testing performed under contract, advanced training for EPIC
liaisons for test master and Contractor specific data base support, and support for network
communications between the Contractor and the EPIC server.
The Department will maintain the sole contract with EPIC. Payment for additional modules and
maintenance fees for those modules will be paid for by the Contractor(ies) through MDCH.
Tape backups and maintenance of all modules will be performed by MDCH staff.
4. Purchase and arrange for shipment of test kits and reagents from manufacturer.
5. Purchase specimen collection kits. Ship collection kits to designated agencies/physician submitters.
Monitor specimen collection kit utilization.
Page 36 of 54
MDCH/CMS
6/02 ATTACHMENT lit
. Analyze data from reports submitted from Contractor. Supply timely feedback of statistical analysis and
other data related to on-going program activities.
7. Assist in technical training of testing personnel and computer software utilization.
8. Provide technical consultation and assistance with program activities. Perform Quality Assurance
Assessment for HIV testing semi-annually.
9. Supply Contractor with a copy of the contracts associated with this program.
10. Monitor monthly utilization reports.
11. Provide reagents and culture media for food and stool specimen examination related to foodbome
disease outbreaks.
12. The Department will provide funding for one FTE and provide training at MDCH for up to two individuals
in Level A and Level B procedures. The Department will provide access to LRN protocols on a secure
website and funding for supplies used to train for or to handle a potential BT event. The Department
will provide proficiency testing materials on a semi-annual basis and funding for equipment necessary
to perform Level B protocols.
LABORATORY SERVICES SPECIAL REQUIREMENTS - KALAMAZOO COUNTY
•
Contractor Specific Requirements
1. Meet established standards of performance and objectives in the following areas:
A. Perform tests for diagnosis of gonorrhea and chlamydia infections using a commercial nucleic acid
amplification assay and perform testing for detection of foodbome disease outbreaks as specified
in items 5 and 6.
B. Utilize standardized testing procedures approved by the laboratory director and standards of quality
assurance and quality control. Assist Department in quality assurance assessment of testing
annually or as determined by Department.
C. Maintain Clinical Laboratory Improvement Amendments of 1988 certification for high complexity
testing.
D. Test gonorrhea and chlamydia specimens from approved agencies/physicians within 1 working day
of receipt of specimen.
E. Send laboratory test reports to submitters within 1 day of completing testing via a system of delivery
at least as expedient as the US Postal Service.
F. Establish testing personnel training program and maintain documentation of training of all testing
personnel.
G. Establish submission procedures for designated agencies/physicians for the timely transport of
appropriate specimens to the laboratory.
H. Maintain an adequate inventory of test kits and reagents purchased by the Department.
Communicate shipment needs to manufacturer's representative if shipments supplementary to the
routine shipments are needed.
I. Make one FIE available to participate in training and exercises associated with Bioterrorism (BT).
Train additional staff to perform Level A & B procedures. Maintain competency and proficiency for
testing, procedures described in the LRN protocols. Temporarily reassign one FTE to MDCH or
another Level B laboratory as surge capacity for emergency situations, if needed. Develop a plan
to provide laboratory services 24 hours a day, seven days a week for a BT event. Provide secure
facilities to store reagents, quality control organisms, and patient isolates.
2. Purchase and maintain adequate inventories of any supplies needed for testing and reporting, not
specifically supplied by the Department in this agreement.
Page 37 of 54
MDCH/CMS
6/02
ATTACHMENT III
3.- ' Provide the Bureau of Epidemiology, HIV/AIDS-STD Division and Bureau of Laboratories records and
reports as required. For all testing services performed under contract by the Contractor for MDCH (e.g.,
HIV, foodbome disease, chlamydia, gonorrhea,BT etc), all specimen submission data and reporting
data will be entered and reported using EPIC software. The Contractor will designate one staff member
as a liaison to the Bureau of Laboratories. Each Contractor must designate appropriate staff to take part
in EPIC training activities. Training and purchase of modules for EPIC other than those modules
provided by MDCH will be the responsibility of the Contractor.
The Contractor is responsible for modules not directly related to testing performed under this agreement
with the Bureau of Laboratories -
- Initial Purchase Price (paid to MDCH)
- Monthly maintenance fees (paid to MDCH)
- Use of modules purchased by an Contractor will be restricted to the Contractor purchasing the
module
- Use of modules purchased by one Contractor can be negotiated (formulas for payment will be
based upon the percentage of total specimens entered into the module).
Modules purchased by any Contractor will become available to any participating Contractor at no cost
after five years. However, each Contractor using the module will share in the maintenance fees.
4. Inform the Infectious Diseases Division by June 30, 2003 if more than 23,000 nucleic acid amplification
specimens will be performed.
5. Provide laboratory support (examination of food specimens) to investigate up to 12 foodbome disease
outbreaks. Laboratory support includes providing test reports and food samples to the Bureau of
Laboratories. Specimens will be processed within 36 hours of collection, except fish which will be
processed within 6 hours of collection.
6. Provide laboratory support for examination of up to 100 stool specimens associated with foodbome
disease outbreaks. Specimens will be processed within one hour of receipt if not in preservative, or
within 24 hours if preserved.
Department Requirements
1. Reimburse the Contractor for the examination of specimens related to foodborne disease outbreaks to
the extent outlined in Items 5 & 6 above. Reimburse the Contractor at the fixed unit rate for each swab
specimen and for each urine specimen for diagnosis of gonorrhea and chlamydia infections using a
nucleic acid amplification assay. Reimburse the Contractor for administrative costs associated with
operation of the CLIA umbrella certificate.
2. Notification and explicit instruction for stop and start days to Contractor laboratory regarding this
contractual arrangement prior to its implementation.
3. The Department will provide access to EPIC, support for EPIC hardware (UNIX server) and software,
support and maintenance for one computer and one laser printer (excluding consumable supplies), user
training for EPIC modules utilized for testing performed under contract, advanced training for EPIC
liaisons for test master and Contractor specific data base support, and support for network
communications between the Contractor and the EPIC server.
The Department will maintain the sole contract with EPIC. Payment for additional modules and
maintenance fees for those modules will be paid for by the Contractor(ies) through MDCH.
Tape backups and maintenance of all modules will be performed by MDCH staff.
4. Purchase and arrange for shipment of test kits and reagents from manufacturer.
5. Purchase specimen collection kits. Ship collection kits to designated agencies/physician submitters.
Monitor specimen collection kit utilization.
6. Analyze data from reports submitted from Contractor. Supply timely feedback of statistical analysis and
other data related to on-going program activities.
Page 38 of 54
7: Assist in technical training of testing personnel and computer software utilization.
8. Provide technical consultation and assistance with program activities.
9. Supply Contractor with a copy of the contracts associated with this program.
10. Monitor monthly utilization reports.
11. Provide reagents and culture media for food and stool specimen examination related to foodbome
disease outbreaks.
12. The Department will provide funding for one FTE and provide training at MDCH for up to two individuals
in Level A and Level B procedures. The Department will provide access to LRN protocols on a secure
website and funding for supplies used to train for or to handle a potential BT event. The Department
will provide proficiency testing materials on a semi-annual basis and funding for equipment necessary
to perform Level B protocols.
LABORATORY SERVICES SPECIAL REQUIREMENTS - KENT COUNTY
Contractor Specific Requirements
1. Meet established standards of performance and objectives in the following areas:
A. Perform tests for diagnosis of gonorrhea and chlamydia infections using a commercial assay,
perform testing for detection of foodbome disease outbreaks as specified in items 5 and 6, and
perform tests for diagnosis of HIV infection using a test designated by the Bureau of Laboratories,
and perform tests for epidemiological assessment of HIV incidence as specified in item 7.
B. Utilize standardized testing procedures, standards of quality assurance and quality control approved
. by the laboratory director. Assist Department in quality assurance assessment of testing semi-
annually or as determined by the Department (including test and report turn-around times,
indeterminate rate).
C. Maintain Clinical Laboratory Improvement Amendments of 1988 certification for high complexity
testing.
D. Test gonorrhea and chlamydia specimens from approved agencies/physicians within one working
day of receipt of specimen. Perform HIV-1/2 screening tests within one work day of receipt of
specimen. Perform HIV confirmatory test within three days of screening assay positive results.
Submit specimens for HIV-1 testing to Department within one day of HIV-1 testing completion.
Establish Quality Assurance Monitor to investigate correct situations when HIV testing is not
completed within 10 working days.
E. Send laboratory test reports to submitters within one day of completing testing via a system of
delivery at least as expedient as the US Postal Service. Establish and maintain confidential fax for
HIV-2 and other laboratory reports from Department.
F. Establish testing personnel training program and maintain documentation of training of all testing
personnel. Arrange on-site training of personnel with test kit manufacturer's representative.
G. Establish submission procedures for designated agencies/physicians for the timely transport of
appropriate specimens to the laboratory.
H. Maintain an adequate inventory of test kits and reagents purchased by the Department.
Communicate shipment needs to manufacturer's representative if shipments supplementary to the
routine, shipments are needed.
I. Make one FTE available to participate in training and exercises associated with Bioterrorism (BT).
Train additional staff to perform Level A & B procedures. Maintain competency and proficiency for
testing procedures described in the LRN protocols. Temporarily reassign one FTE to MDCH to
another Level B laboratory as surge capacity for emergency situations, if needed. Develop a plan
to provide laboratory services 24 hours a day, seven days a week for a BT event. Provide secure
facilities to store reagents, quality control organisms, and patient isolates.
2. Purchase and maintain adequate inventories of any supplies needed for testing and reporting, not
specifically supplied by the Department in this agreement.
MDCH/CMS ATTACHMENT III
6/02
Page 39 of 54
MDCH/CMS
6/02
ATTACHMENT III
3. : Provide the Bureau of Laboratories, the Bureau. of Epidemiology, and the Divtsions of HIV-AIDS/STD
records and reports as required. For all testing services performed under contract by the Contractor for
MDCH (e.g., HIV, foodborne disease, chlamydia, gonorrhea, BT, etc), all specimen submission data and
reporting data will be entered and reported using EPIC software. The Contractor will designate one staff
member as a liaison to the Bureau of Laboratories. Each Contractor must designate appropriate staff
to take part in EPIC training activities. Training and purchase of modules for EPIC other than those
modules provided by MDCH will be the responsibility of the Contractor.
- The Contractor is responsible for modules not directly related to testing performed under this agreement
with the Bureau of Laboratories -
- Initial Purchase Price (paid to MDCH)
- Monthly maintenance fees (paid to MDCH)
- Use of modules purchased by an Contractor will be restricted to the Contractor purchasing the
module
- Use of modules purchased by one Contractor can be negotiated (formulas for payment will be
based upon the percentage of total specimens entered into the module).
Modules purchased by any Contractor will become available to any participating Contractor at no
cost after five years. However, each Contractor using the module will share in the maintenance
fees.
4. Inform the Infectious Diseases Division by June 30, 2003, if more than 46,000 Nucleic Acid Amplification
specimens will be performed.
5. Provide laboratory support (examination of food specimens) to investigate up to 12 foodborne disease
outbreaks. Laboratory support includes providing test reports and food samples to the Bureau of
Laboratories. Specimens will be processed within 36 hours of collection, except fish which will be
processed within 6 hours of collection.
6. Provide laboratory support for examination of up to 100 stool specimens associated with foodbome
disease outbreaks. Specimens will be processed within one hour of receipt if not in preservative or
within 24 hours if preserved.
7. Perform tests for epidemiological assessment of HIV incidence rates using a test designated by the
Bureau of Laboratories.
A. Utilize testing procedures, standards of quality assurance and quality control approved by the
Centers for Disease Control and Prevention and the laboratory director.
B. Test monthly up to 1,400 serum specimens previously tested by standard HIV diagnostic methods.
• Specimens to be tested will be determined by Bureau of Epidemiology or out-of-state public health
agencies.
C. Submit testing results and demographic information as designated by the Bureau of Epidemiology
(weekly/monthly) electronically in a format compatible with Bureau of Epidemiology database.
D. Hire and train two medical technologists/microbiologists and one laboratory technician to perform
testing, quality control and quality assurance, enter demographic data and prepare electronic result
transmission. Participate in training or meetings to be determined by the Bureau of Laboratories.
E. Arrange for equipment shipment, installation and training as described in the approved methods.
F. Coordinate and pay for shipment of specimens from laboratory of initial diagnosis.
G. Purchase and maintain adequate inventory of test kits, supplies, and materials needed for testing
and reporting.
Page 40 of 54
MDCH/CNIS
6/02
ATTACHMENT III
• Dvpartment Requirements '
1., Reimburse the Contractor for the examination of specimens related to foodbome disease outbreaks to
the extent outlined in items 5 & 6 above. Reimburse the Contractor at the fixed rate for each swab
specimen and for each urine specimen for diagnosis of gonorrhea and chlamydia infection using a
commercial nucleic acid assay. Reimburse Contractorfor administrative costs associated with operation
of the CLIA umbrella certification.
2. Notification and explicit instruction for-stop and start days to Contractor laboratory regarding this
contractual arrangement prior to its implementation.
3. The Department will provide access to EPIC, support for EPIC hardware (UNIX server) and software,
support and maintenance for one computer and one laser printer (excluding consumable supplies), user
training for EPIC modules utilized for testing performed under contract, advanced training for EPIC
liaisons for test master and Contractor specific data base support, and support for network
communications between the Contractor and the EPIC server.
The Department will maintain the sole contract with EPIC. Payment for additional modules and
maintenance fees for those modules will be paid for by the Contractor(ies) through MDCH.
Tape backups and maintenance of all modules will be performed by MDCH staff.
4. Purchase and arrange for shipment of test kits and reagents from manufacturer as outlined in items 1,
5 and 6.
5. Purchase specimen collection kits for diagnostic testing. Ship collection kits to designated
agencies/physician -submitters. Monitor specimen collection kit utilization.
6. Analyze data from reports submitted from Contractor. Supply timely feedback of statistical analysis and
other data related to on-going program activities.
7. Assist in technical training of testing personnel and computer software utilization.
8. Provide technical consultation and assistance with program activities. Perform Quality Assurance
Assessment for HIV testing semi-annually.
9. Supply Contractor with a copy of the contracts associated with this program.
10. Monitor monthly utilization reports.
11. Provide reagents and culture media for food and stool specimen examination related to foodborne
disease outbreaks.
12. The Department will provide funding for one FTE and provide training at MDCH for up to two individuals
in Level A and Level B procedures. The Department will provide access to LRN protocols on a secure
website and funding for supplies used to train for or to handle a potential BT event. The Department
will provide proficiency testing materials on a semi-annual basis and funding for equipment necessary
to perform Level B protocols.
LABORATORY SERVICES SPECIAL REQUIREMENTS - SAGINAW COUNTY
Contractor Specific Requirements
1. Meet established standards of performance and objectives in the following areas:
A. Perform tests for diagnosis of gonorrhea and chiamydia infections using a commercial nucleic acid
amplification assay and perform testing for detection of foodbome disease outbreaks as specified
in items 5 and 6. •
B. Utilize standardized testing procedures approved by the laboratory director and standards of quality
assurance and quality control. Assist Department in quality assurance assessments of testing
annually or as determined by Department.
C. Maintain Clinical Laboratory Improvement Amendments of 1988 certification for high complexity
testing.
P.,,ge 41 of 54
MDCH/C1VIS
6/02
ATTACHMENT In
D. Test gonorrhea and chlamydia specimens from approved agencies/physicians within 1 working day
of receipt of specimen.
E. Send laboratory test reports to submitters within 1 day of completing testing via a system of delivery
at least as expedient as the US Postal Service.
F. Establish testing personnel training program and maintain documentation of training of all testing
personnel.
G. Establish submission procedures for designated agencies/physicians for the timely transport of
appropriate specimens to the laboratory.
H. Maintain an adequate inventory of test kits and reagents purchased by the Department.
Communicate shipment needs to manufacturer's representative if shipments supplementary to the
routine shipments are needed.
I. Make one FTE available to participate in training and exercises associated with Bioterrorism (BT).
Train additional staff to perform Level A & B procedures. Maintain competency and proficiency for
testing procedures described in the LRN protocols. Temporarily reassign one FTE to MDCH or
another Level B laboratory as surge capacity for emergency situations, if needed. Develop a plan
to provide laboratory services 24 hours a day, seven days a week for a BT event. Provide secure
facilities to store reagents, quality control organisms, and patient isolates.
2. Purchase and maintain adequate inventories of any -supplies needed for testing and reporting, not
specifically supplied by the Department in this agreement.
3. Provide the Bureau of Epidemiology, HIV/AIDS-STD Division and Bureau of Laboratories records and
reports as required. For all testing services performed under contract by the Contractor for MDCH (e.g.,
HIV, foodborne disease, chlamydia, gonorrhea, BT, etc), all specimen submission data and reporting
data will be entered and reported using EPIC software. The Contractor will designate one staff member
as a liaison to the Bureau of Laboratories. Each Contractor must designate appropriate staff to take part
in EPIC training activities. Training and purchase of modules for EPIC other than those modules
provided by MDCH will be the responsibility of the Contractor.
The Contractor is responsible for modules not directly related to testing performed under this agreement
with the Bureau of Laboratories
Initial Purchase Price (paid to MDCH)
- Monthly maintenance fees (paid to MDCH)
- Use of modules purchased by a Contractor will be restricted to the Contractor purchasing the
module
- Use of modules purchased by one Contractor can be negotiated (formulas for payment will be
based upon the percentage of total specimens entered into the module).
Modules purchased by any Contractor will become available to any participating Contractor at no cost
after five years. However, each Contractor using the module will share in the maintenance fees.
4. Inform the Infectious Diseases Division by June 30, 2003 if more 23,041 nucleic acid amplification
specimens will be performed.
5. Provide laboratory support (examination of food specimens) to investigate up to 12 foodbome disease
outbreaks. Laboratory support includes providing test reports and food samples to the Bureau of
Laboratories. Specimens will be processed within 36 hours of collection, except fish which will be
processed within 6 hours of collection.
6. Provide laboratory support for examination of up to 100 stool specimens associated with foodbome
disease outbreaks. Specimens will be processed within one hour of receipt if not in preservative or
within 24 hours if preserved.
Page 42 of 54
• Department Requirements
MDCH/CMS
6/02
ATTACHMENT III
1., Reimburse the Contractor for the examination of specimens related to foodborne disease outbreaks to
the extent outlined in Items 5 & 6 above. Reimburse the Contractor at the fixed unit rate for each swab
specimen and for each urine specimen for diagnosis of gonorrhea and chlamydia infections using a
nucleic acid amplification assay. Reimburse the Contractor for administrative costs associated with
operation of the CLIA umbrella certificate.
2. Notification and explicit instruction for -stop and start days to Contractor laboratory regarding this
contractual arrangement prior to its implementation.
3. The Department will provide access to EPIC, support for EPIC hardware (UNIX server) and software,
support and maintenance for one computer and one laser printer (excluding consumable supplies), user
training for EPIC modules utilized for testing performed under contract, advanced training for EPIC
liaisons for test master and Contractor specific data base support, and support for network
communications between the Contractor and the EPIC server.
The Department will maintain the sole contract with EPIC. Payment for additional modules and
maintenance fees for those modules will be paid for by the Contractor(ies) through MDCH.
Tape backups and maintenance of all modules will be performed by MDCH staff.
4. Purchase and arrange for shipment of test kits and reagents from manufacturer.
5. Purchase specimen collection kits. Ship collection kits to designated agencies/physician submitters.
Monitor specimen collection kit utilization.
6. Analyze data from reports submitted from Contractor. Supply timely feedback of statistical analysis and
other data related to on-going program activities.
7. Assist in technical training of testing personnel and computer software utilization.
8. Provide technical consultation and assistance with program activities.
9. Supply Contractor with a copy of the contracts associated with this program.
10. Monitor monthly utilization reports.
11. Provide reagents and culture media for food and stool specimen examination related to foodborne
disease outbreaks.
12. The Department will provide funding for one FTE and provide training at MDCH for up to two individuals
in Level A and Level B procedures. The Department will provide access to LRN protocols on a secure
website and funding for supplies used to train for or to handle a potential BT event. The Department
will provide proficiency testing materials on a semi-annual basis and funding for equipment necessary
to perform Level B protocols.
LEAD HAZARD REMEDIATION PROGRAM SPECIAL REQUIREMENTS
Contractor Requirements
Provide lead-based paint hazard control activities for eligible families residing in high risk homes containing
lead-based paint. Lead Hazard Remediation Program (LHRP) requirements are divided into the following
categories: 1) Education and Outreach; 2) Identification of Candidate Housing Units; 3) Lead Hazard Control
Activities; 4) Follow-up Activities; and 5) Post Remediation Client Surveys and Data Collection. These
procedures are to be adhered to and should not be interpreted to be inclusive of all present and future program
requirements. -
1. Education and Outreach (HUD funded projects only)
It is expected that each county will provide a minimum of 2 local presentations on lead poisoning paint
issues per year.
A. Develop new partnerships with other affiliated housing and non-profit agencies in the jurisdiction.
B. Assist LHIRP in identifying and accessing private sector funding mechanisms for lead hazard control
activities.
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, C. Obtain and provide information on Healthy Homes issues
• D. Conduct local education and outreach activities targeting remodelers, renovators, maintenance
personnel, painters, rental property owners, and other segments of the population.
E. Plan and implement local activities for Michigan's Lead Poisoning Prevention Week education
campaign.
F. Act as a local lead information liaison with Michigan State Housing Development Authority, local
housing authorities, housing rehabilitation organizations, and rental property owners; especially
regarding HUD 24 CFR part 35 requirements.
G. Attend regularly scheduled Subgrantee meetings.
2. Identification of Candidate Housing Units
A. Per the Lead Abatement Act, perform combination Lead Inspection/Risk Assessment to identify all
present and potential lead-based paint hazards and document accordingly. Use this information
to develop abatement specifications.
B. Follow HUD Policy and Procedures Field Guide.
C. Assist in lead hazard control activities. This includes field investigations, working with families
(serve as household liaison for lead hazard control activities), and verifying program requirements.
Submit to LHRP accurate and complete documentation on each unit. Field investigation reports
must include digital photos of lead hazards found within the interior and exterior of the unit.
D. Obtain and verify blood levels of children residing in units.
E. Collaborate with local housing rehabilitation organizations, if necessary.
F. Address historic preservation issues, if necessary.
3. Lead Hazard Control Activities
A. Draft specifications in conjunction with the homeowner. The specification report should include all
lead hazard control activities which are required to make the residence a lead-safe home using the
most cost-effective measures. The specification report will also document the lead hazard control
activities that are to be performed.
B.. Perform pre-bid walk-through on units.
C. Process bid documents and addendums and provide to LHRP office.
D. Ensure home and families are prepared for lead-hazard control activities.
E. If necessary, assist the residents of the home in arranging for temporary lodging while lead hazard
control work is being completed.
F. Participates in project oversight. Spend a minimum of 50% of on-site supervision during lead
hazard control work for each project to ensure that work is being done according to project
specifications and in compliance with LHRP work standards. Documentation of oversight hours is
required by LHRP.
4. Follow-up Activities .
A. Conduct a visual inspection and obtain clearance dust wipe samples of all work areas according
to LHRP protocol and submit for analysis to MDCH Lead Laboratory.
B. Upon achieving appropriate clearance sample levels, document the unit is ready to be re-occupied,
and contact the residents and abatement contractor.
C. Develop a lead-based paint hazard control activities performance report and close-out
documentation for submission to LHRP within 30 days of completion of work.
D. Conduct a 6-month follow-up which includes a visual and dust wipes of all work areas. Address any
contractor warranty issues.
E. Conduct a 14-month visual certification to address contractor warrant/ issues.
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• F. Perform proper maintenance on the XRF unit.
5.. Post-Remediation Client Surveys and Data Collection
A. Assist LHRP in monitoring the quality and cost effectiveness of lead hazard control projects.
B. Assist LHRP in implementation of the Client Satisfaction Survey.
C. Conduct ongoing data collection and quarterly reporting to LHRP.
- Budget and Agreement Requirements
As an established contractor (a contractor who has been awarded a Lead-Based Paint Hazard Control Grant
before) agree to coordinate lead-based paint hazard control activities in approximately 19 homes funded
through the HUD Grant and 25 homes funded with the Clean Michigan Initiative Bond funds. Additionally, all
contractors are required to appoint a full-time equivalent individual to provide all program requirements as
stated in this contract. The contractorwill provide a quarterly report in accordance with format and instructions
from LHRP. The report must be submitted by the fifteenth of the month following the end of each quarter.
In addition, monthly reports must be electronically submitted to LHRP prior to sub-grantee meetings.
Reference Documents
The following reference documents are essential to performing the stated requirements in this contract:
LHRP quarterly report guidance - HUD policy and procedure field guide
CM! policy and procedure field guide
HUD 2000 Grant Proposal
Lead Abatement Act and corresponding rules
XRF Performance Characteristics Sheets
Lead Hazard Remediation Project Procession and accompanying MDCH form
LOCAL CHILDREN'S SPECIAL HEALTH CARE SERVICES (CSHCS1 AND MATERNAL AND CHILD
HEALTH (MCH) PROGRAM SPECIAL REQUIREMENTS
General Performance Requirements
For fiscal year 2003, there are two separate components for the Local CSHCS and MCH Programs, those
being: 1) Local CSHCS Outreach and Advocacy and 2) Local MCI-I. A separate allocation for each of these
components is made to each local health department in Michigan.
It is still necessary that the specific funds designated for each component be used to address the general
purposes for which they are appropriated.
1. CSHCS OUTREACH AND ADVOCACY REQUIREMENTS
For detailed instructions, general and performance requirements see "CSHCS Outreach and Advocacy"
beginning on page 27 of this document.
2. LOCAL MATERNAL AND CHILD HEALTH
Local MCH funds are intended to be flexible and available to local health departments to address locally
identified needs related to the health of women and children in their jurisdictions. It is expected that
each local health department will use a defined needs assessment process (in most cases the
Community Health Assessment and Improvement Process) to determine and identify its MCH needs.
In addition, local health departments are asked to examine, (to the extent data is available) their status
on each of 27 MCH related indicators. Eighteen of these indicators have been established by the MCH
Bureau (MCHB) of the federal Department of Health and Human Services as mandated reporting
requirements for all states. An additional 9 indicators have been selected as optional State indicators
by MDCH for annual monitoring and reporting. It is important that local jurisdictions review these
performance measures and assure that efforts are being made where there is significant negative
variation from stated HP 2000 (or 2010 goals) or from State averages. It is left to local health
departments to determine how Local MCH funds are to be used to address MCH needs.
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Coptractor Requirements
1., Submit a Local Maternal and Child Health Community Plan for use of the funds allocated for Local MCH
Programs.
CSHCS Outreach and Advocacy
Funds related to CSHCS outreach and advocacy shall be labeled as such under a column of the CPBC
budget. These funds are restricted for use by the CSHCS local office at the local health department.
Local MCH - Local MCH (previously M&IC and Local MCH funds) - funds are to be budgeted as a funding
source under any appropriate program element(s) (i.e. Adolescent health, CSHCS Outreach & Advocacy,
Child Health, Family Planning, Immunization, Maternal & Infant Health Advocacy Services, Maternal & Infant
Support, Healthy Kids Outreach & Advocacy, Oral Health, Prenatal Care Clinic Services, Prenatal Care
Outreach & Advocacy and Primary Care). This funding source cannot be used under the WIC element except
in extreme circumstances where a waiver is requested in advance of the expenditures and evidence is
provided that the expenditures satisfy all funding requirements. Local MCH funds used to provide health care
services (except Family Planning) to non-pregnant women should be budgeted under Primary Care. If funds
are to be used for a program other than those outlined above, local health departments are asked to consult
with their Division of Family and Community Health assigned agency consultant first.
Local NCH funds may not be used to supplant available/billable program income such as Medicaid fees or
additional funding under the Medicaid Cost-Based Reimbursement process.
Local effort for program elements supported by Local MCH funds must not be reduced in instances in which
added Medicaid has been generated through enhanced collection of Medicaid fees and/or funding under the
Medicaid Cost-Based Reimbursement process.
LOCAL PUBLIC HEALTH OPERATIONS (LPHO) SPECIAL REQUIREMENTS
Budget and Agreement Requirements
1. State funding for LPHO shall support and the agency 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.
Drinking Water Supply* Immunization
Food Service Sanitation On-Site Sewage Treatment Management*
General Communicable Disease Control Sexually Transmitted Disease
Hearing Vision
State funding for LPHO can support administrative cost for the eight required services including
allowable indirect cost, or an agency's cost allocation plan. (*Services funded under a separate
agreement with the Michigan Department of Environmental Quality.)
2. LPHO 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 could 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 LPHO funding is subject to local maintenance of effort compliance, in that full distribution of state
LPHO funds shall only be made to agencies with total local general fund public health services spending
in FY 99/00 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 99/00 the FY 92/93 Local Maintenance of Effort Level must be met.
6. A final statewide cost settlement will be performed to assure that all available LPHO funds are fully
distributed and applied for required services.
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Contractor Requirements
1., Assure the availability and accessibility of services for the following basic health services: Prenatal
Care; Immunizations; Communicable Disease Control; Venereal Disease Control; Tuberculous Control;
Health/Medical Annex of Emergency Preparedness Plan.
2. Fully comply with the Minimum Program Requirements for each of the required services.
3. Contractor will be held to accreditation_standards and follow the accreditation process and schedule
established by the Department for the required services to achieve full accreditation status. Agencies
designated as "not accredited" may have their Department allocations reduced for Departmental costs
incurred in the assurance of service delivery. The accreditation process is based upon the Minimum
Program Standards and scheduled on a three year cycle. The Minimum Program Standards include the
majority of the required Department reviews. Some additional reviews, as mandated by the funding
agency, may not be included in the Program Standards and may need to be scheduled at other times.
Department Requirements
1. Whenever the Department delivers direct services within the Contractor's area, it shall give prior
notification and provide summary reports of those activities upon the request of the local health officer.
LOCAL TOBACCO REDUCTION 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. Under this law, "lobbying, means communicating directly with
an official in the executive branch of state government or an official in the legislative branch of state
government for the purpose of influencing legislative or administrative action."
Aciency Requirements
I.
Maintain a local tobacco reduction coalition to help mobilize community awareness and interest in
addressing the problems of tobacco use.
2. Emphasize multi-cultural inclusiveness and outreach to diverse groups as appropriate within the
community.
3. Undertake activities focusing on protecting non-smokers from secondhand smoke.
4. Prepare and implement an annual agency tobacco reduction work plan.
5. Submit triannual reports and other required program documentation to Tobacco Program Consultant
on a timely basis.
6. Attend Department regional and statewide coalition coordinator training.
MICHIGAN CHILDHOOD IMMUNIZATION REGISTRY (MCIR) REGIONAL SPECIAL REQUIREMENTS
( Public Health Delta and Menominee Counties, District Health Department#1 0, Genesee County Health
Department, Kalamazoo County Health Department, Mid-Michigan District Health Department and
Muskegon County Health Department)
Contractor Requirements (Muskeg_on County Only)
1. Support the statewide scanner, fax server, and any other related systems which contain childhood
immunization records. Collaborate with the scan form software support company, Teleform, on an as
needed basis.
2. Provide ongoing development and technical assistance for statewide can forms and Teleform software.
3. Provide data quality and data entry support for scan center services.
Contractor Requirements (All Others)
The Contractor shall perform the following activities on behalf o the Department to support the Michigan
Childhood Immunization Registry.
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1: , Conduct reminder/reca for all children in the Contractor's region that are not being recalled directly by
a provider. The Contractor should work with the local health departments and providers in the
Contractor's region to develop a reminder/recall schedule and generate notices per that schedule.
2. Support regional MCIR users by operating the regional help desk in accordance with Department
approved procedures.
3. Monitor and develop strategies to increase private provider enrollment and participation in the MCIR.
Develop strategies to encourage all providers to fully participate with the MCIR.
4. Duplicate and distribute software, manuals, and related material to new MCIR users.
5. Process all user/usage agreements, according to Department approved procedures, to create user
accounts.
6. Continue to implement and update marketing plans in support of increased provider and parent
acceptance and use of the MCIR.
7. Keep regional users updated on MCIR status and system changes.
8. Assure that records submitted via paper forms are entered in a timely fashion and according to
Department approved procedure.
9. Conduct ad hoc reporting and querying on behalf of MCIR users.
10. Monitor infant death announcements in the region that appropriately mark MCIR records.. Develop a
mechanism to assure the records of children who have died in the region are appropriately flagged in
the MCIR.
11. Maintain a listing of private and public immunization providers according to the format prescribed by the
Department. The listing should be as comprehensive as possible and should include all providers in the
region.
12. Conduct regular de-duplication activities to assure that duplicate records are removed from the MCIR
as quickly as possible.
13. Process user petitions to change MCIR data according to Department approved procedures.
14. Hold advisory group meetings on at least a quarterly basis to set regional policy and set regional
implementation and maintenance priorities.
15. Monitor ongoing immunization data submission for all local health departments and private providers.
16. Conduct training functions as needed to assure that local health department staff can provide assistance
to providers on how to access and submit data into the MCIR.
17. Maintain a policy/procedure manual, approved by the regional advisory group and the Department.
18. Process and file all "opt out" forms according to Department approved procedures.
19. Attend regular MCIR regional Contractor/coordination meetings.
20. Perform quality assurance checks on the MCIR data for the region as prescribed by the Department.
21. Assist local health departments and private providers with methodologies to "clean up" their data.
22. Conduct training functions as needed to assure that staff in private provider offices receive education
and training on how to access and submit data into MCIR.
23. The Contractor shall submit quarterly status reports on the progress of this program. Reports are due
within 30 days of the end of each quarter. This report shall be submitted to:
Robert Swanson, MPH
Michigan Department of Community Health -
Division of Communicable Disease and Immunization
P.O. Box 30195
Lansing, Michigan 48909
Phone: (517) 335-8159
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24; The Contractor shall permit the Department 'or its designee to visit and to make an evaluation of the
project as determined by the Contract Consultant.
MINORITY HEALTH SPECIAL REQUIREMENTS
Contractor Requirements
1. Develop an evaluation tool which identifies the process and outcome indicators of the project.
2. Submit quarterly progress reports and a final report within 30 days of the completion of the project to
the Office of Minority Health.
3. Submit completed Community Based Organization (CB0) Funded Projects Report within 30 days of the
completion of the project to the Office of Minority Health.
4. Ensure delivery of services to all populations as applicable including African American, Arab/Chaldean,
Asian and Pacific Islander, Hispanic, Native American, Eastern European and other multicultural refugee
and rural populations.
5. Ensure that programs targeting multicultural populations are culturally competent. Cultural competency
is defined as:
A set of academic and interpersonal skills that allow individuals to increase their understanding and
appreciation of cultural differences and similarities within, among, and between groups. This
requires a willingness and ability to draw on community-based values, traditions, and customs and
to work with knowledgeable persons of and from the community in developing focused
interventions, communications, and other supports.
6. Services provided are linguistically appropriate to meet the needs of the respective client population.
7. Data collected on clients served will reflect the multicultural racial and ethnic clients served consistent
with the law and Department recommendations stated in Public Acts 88 and 89.
8. Health care providers should reflect the racial and ethnic groups served to the extent that such providers
can be reasonably recruited and utilized.
9. The request for proposal (RFP) and the Contractor's technical proposal, as amended, is made a part
of this agreement by reference.
10. The data collection form updated in 1997 and approved by the joint Local Health and MDCH Forms
Committee can be collected quarterly for Contractor tracking purposes, but the year long data must be
submitted with the final report to the Office of Minority Health.
NOTE: Ten percent (10%) of the agreement amount will be deferred for payment pending the Department's
receipt of the final report from the LHD which includes completed CBO Funded Projects Report and the
required evaluation.
Department Requirements
1. Provide technical assistance in the development of RFP's, if applicable.
OUTREACH FOR MEDICAID AND MI-CHILD-SPECIAL REQUIREMENTS
Contractor Requirements
1. Target geographic areas within the community where low income families reside.
2. Collaborate with other community organizations within that geographic area for the purpose of making
contacts with low income families who may be eligible for Medicaid or MIChild.
3. Provide information to low income families within local community based sites such as churches,
schools, day care facilities, community centers, hospital emergency rooms, physicians offices, etc., on
the Medicaid and MIChild programs and the application assistance services that are available within the
local health department.
4. Assist families in the completion of a Medicaid and/or MIChild application.
5. Obtain verifications, including necessary copies of proof of specified in Medicaid program policy. .
6. Obtain a signature that permits the transmitting of the application for processing.
7. Prepare, assemble and submit information, verification of Medicaid applications for pregnant women
(with no other children) and families directed to the local Family Independence Agency office. Submit
the MIChild/Health Kids/Notification form to DCH for processing simultaneously.
8. Prepare and assemble and submit the information, verification and the Medicaid and/or MIChild
application for submission to Maximus along with Notification Form.
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Department Requirements
1., Provide initial and ongoing training to the contractor.
2. Provide current information on health and dental plans to contractor.
3. Notify the contractor of policy, program and process changes affecting the scope of work. •
4. Process Medicaid/MIChild Outreach Notification forms to generate a quarterly payment to contractor.
Contractor will be reimbursed by Direct Voucher, based on the accurate completion of these forms, at
a rate of $25 per person enrolled (no standard CPBC FSR reimbursement).
5. Provide contractor with Department requirements for forms and publications.
6. Make Medicaid and MIChild applications available to the contractor.
7. Collaborate with the Local Health Department to improve application assistance services.
8. Monitor compliance with program requirements.
9. Conduct site visits for performance auditing purposes.
PRIMARY CARE DENTAL SPECIAL PROJECT
Contractor Requirements
1. Carry out the intent of the Funding Announcement in accordance with the CPBC Minimum Program
Requirements for the Primary Care Dental element.
2. Provide preventive and remedial dental services to persons not eligible for any other programs and with
incomes under the 200% of the Federal Poverty Level.
3. Provide the services without supplanting existing funding or patients.
4. Submit the following reports as indicated:
A. Monthly Billing Worksheet and FSR
The Monthly billing Worksheet (to be provided by the Department) must be completed each month
to report the numbers of each service provided. This will determine the reimbursement amount that
is then submitted on the FSR for payment. A running total of unduplicated persons served will also
be requested each month.
B. Michigan Oral Data (MOD)
Each funded agency must participate in the Michigan Oral Data (MOD) Project for all of the patients
served in their clinic. Special forms will be provided by the Department to record the funding source
for each patient so comparisons can be made between the disease patterns of the various
population groups. The monthly forms will be submitted with the Billing Worksheet and FSR. The
data will be compiled and analyzed by the Department.
C. Final Report
At -the end of the grant period, each funded agency will be required to submit the following data:
1. Unduplicated number of patients served by age.
2. Average cost of providing dental care by age.
3. Impact of program - this could include studies with before and after pictures or may be
anecdotal stories, e.g. patient was able to get a job or a better job after the dental work was
complete, a child's grades improved because they weren't missing school because of dental
pain. The intent of this requirement is to document what impact the program had and to
evaluate the value of continuation.
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%\ 1 NOTE: agenciez:, serving multiple counties shall indicate numbers from each county.
Reports and information shall be submitted to:
Denise Reinhart
Michigan Department of Community Health
P.O. Box 30195
3423 N. Martin Luther King, Jr., Blvd.
Lansing, Michigan 48909
Telephone: (517) 335-8928
Fax: (517) 335-8294
reinhartd@michigan.gov
The Contractor shall permit the Department or its designee to visit and to make an evaluation of
the project as determined by Contract Manager.
Department Requirements
1. Provide administrative direction and technical assistance.
2. Reimbursement for services provided to target population as stipulated in the Funding Announcement.
3. Provide master copies of the billing and MOD forms.
4. Evaluate the reports submitted as described above for their completeness and accuracy.
SIDS SPECIAL REQUIREMENTS
Contractor Requirements
1. Assure local dissemination of risk reduction information including Back-to-Sleep and Safe Infant Sleep
Guidelines.
2. Provide family support services to families and other caretakers of infants who have died suddenly and
unexpectedly. Family support includes bereavement support, assessment of other needs, referral for
services, anticipatory guidance regarding future pregnancies. Infants eligible for service include any
between 1 month and 1 year of age. Infant deaths which are excluded are those attributed to an
intentional cause such as homicide or abuse/neglect.
3. Assure potential family support providers are certified in SIDS and Infant Death family support. Assure
providers have inservice and updates on relevant maternal child health issues.
4. Complete a referral to the Michigan SIDS Alliance for bereavement literature and information on
program activities.
Department Requirements
1. Provide payment of $70 for each family support visit. A maximum of 6 visits is reimbursable per infant
death.
2. Provide forms for referral to the SIDS Alliance, documenting family support visits and for ordering risk
reduction literature.
3. Provide training for certification of family support providers.
4. Provide referral of new infant deaths from central surveillance database.
TB CONTROL (DOT) SPECIAL REQUIREMENTS
General Requirements
Directly Observed Therapy (DOT) is defined by the Core Curriculum on Tuberculosis 2000 as: "a health care
worker on another designated person watching the patient swallow each dose of TB medication". It is the most
effective strategy to ensure patient adherence to treatment. DOT should be used with all intermittent
regimens. Multi-drug resistant TB (MDR TB) should always be treated with a daily regimen and under direct
observation.
Requirements for eligibility in this program include providing DOT at least 5 days/weeks (excluding holidays)
for daily regimens, and 2 or 3 days/week for intermittent regimens.
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Wecific Requirements
Submit an enrollment form (DOT registration form) for each TB case (including cases transferred into
the county) enrolled in DOT to the iVIDCH TB Program.
2. Submit evidence (i.e., DOT logs), for each patient enrolled in DOT, monthly to the MDCH TB Program
indicating that DOT was accomplished.
3. Submit RVCT II forms (Completion of Therapy), for each patient enrolled in DOT, to the MDCH DT
Program upon completion or termination of therapy.
4. Achieve a minimum of 60% of TB cases enrolled annually in DOT (October 1 to September 30).
5. Achieve an 80% adherence rate for each DOT case enrolled. Patients will take at least 80% of their
prescribed doses of medication.
6. Achieve>95% completion rate for treatment of all TB cases.
TEEN PREGNANCY PREVENTION SPECIAL REQUIREMENTS (BERRIEN AND JACKSON COUNTY
HEALTH DEPARTMENTS
Contractor Requirements
1. Objectives
Comply with the primary objectives under this agreement which are outlined in the plan submitted by
the Contractor and on file at the Department. This plan is incorporated by reference upon signature of
this agreement.
2. Conditions
A. Assure cooperation with the Teen Pregnancy, Prevention Project (TPPP) stakeholder (identified
in the plan referenced above) with the state-selected, independent evaluator.
B. Permit the Department or any of its identified agents access to the facilities being utilized at any
reasonable time to observe the operation of the program. The Contractor shall retain all books,
records or other documents relevant to this Agreement for six (6) years after final payment at the
cost of the Contractor, and Federal auditors, and any persons duly authorized by the Department
shall have full access to and the right to examine and audit any of said material during said period.
If an audit is initiated prior to the expiration of the six-year period and extends past that period, all
documents shall be maintained until the audit is completed. The Department shall provide findings
and recommendations of audits to the Contractor and adjust future payments or final payment if
the findings of an audit indicate over or under payment to the Contractor in the period prior to the
audit. If no payments are due and owing the Contractor, the Contractor shall immediately refund
all amounts which may be due the Department. The Contractor shall assure, as a condition of any
sale or transfer of ownership of the Contractor agency, that the new purchases or owner maintains
the above-described books, records or other documents for any unexpired portion of the six-year
period after final payment under this Agreement or the Contractor shall otherwise maintain said
records as the Department may direct. The Contractor shall, if business operations cease, maintain
the records as the Department may direct.
The Contractor shall, as a provision of the Agreement between the Contractor and the auditor,
assure that the Department may make reasonable inquiries of the auditor relating to audit work
papers and furthermore, the Department may review the auditor's work papers in support of the
audit .
3. Indirect Costs
Department funding provided for indirect costs, if applicable, cannot exceed 12% of the total budget.
4. Reporting
A. The Contractor shall submit a quarterly progress report within 15 days from the end of each
calendar quarter (January 15 th, April 15, July 15th, and October 15th)• Reports must contain: 1)
narrative description of accomplishments/milestones during the quarter; 2) significant changes in
the projects including objectives, approaches, stakeholders and/or time delays; 3) the duplicated
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and unduplicated number of teens served during the quarter inciuding a duplicate count broken
down by program; 4) challenges and barriers encountered during the quarter and 5) planned
activities for the next quarter.
B. Quarterly Progress Reports and Information shall be submitted to the attention of:
Teen Pregnancy Prevention Project
Division of Family and Community Health
Michigan Department of Community Health
P.O. Box 30195
Lansing, MI 48909
C. The Teen Pregnancy Prevention Project Coordinator and/or the assigned Community Technical
Assistant shall evaluate the reports submitted as described in a above, for completeness and
adequacy and will request additional information if the reports do not provide the necessary
information outlined above.
D. The department or its designee shall visit and make an evaluation of the project as a mutually
agreeable time by the Department and the Contractor.
WIC SPECIAL REQUIREMENTS
Contractor Requirements
1. Provide for security of coupon stock stored in the local Contractor prior to issuance. The Contractor
must notify the WIC Division in writing of any lost, stolen, inappropriately issued or otherwise
unaccounted for coupons, immediately upon recognition of such condition.
2. Comply with the requirements of the WIC program as prescribed in the Code of Federal Regulations
(7CFR, Part 246) including the following special provisions:
A. If a local Contractor 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 Contractor employee authorized for or requesting access to the automated WIC system
complete and sign a security agreement (Form MIS-176) which will then be returned to MDCH.
WIC INCREASED PARTICIPATION SPECIAL REQUIREMENTS
Budget and Agreement Requirements
The funding described below for WIC Increased Participation is to be shown separately from WIC regular
allocated funding under the WIC element and is to be designated as Increased Participation Funds".
The "Increased Participation Funds" are budgeted on a cumulative basis at a rate of $8.50 per month for each
planned additional participant in excess of the "Allocated Base Caseload".
This additional funding is contingent on the Contractor meeting the following conditions:
1. To earn and retain the entire additional "Increased Participation Funds", the Contractor must serve the
entire "Net Over Base" caseload by September 30,
• And
2. The Contractor's actual, final WIC expenditures through September 30, must not be less than the
amount of the regular WIC allocation plus the additional Increased Participation Funds and Computer
• Maintenance Funds.
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Any reduced level of participation and/or reduced level of actual expenditures would reduce final WIC
increased Participation Funds" reimbursements accordingly.
Contractor Requirements
Include the amounts in and attach a "Local Contractor Participation Level Plan" to the Annual Comprehensive
Budget.
Department Requirements
1. Upon WIC Division approval, reimburse the Contractor based on the number of cumulative actual
participants served in excess of the "Allocated Base Caseload" on a fixed unit rate basis, as reported
by the Contractor on the Comprehensive Financial Status Report.
2. Perform year-end cost settlement to assure that the cumulative actual number of increased participants
reported on the Comprehensive Financial Status Report is in agreement with the Department's Priority
Status Participation by WIC Code Closeout Report (P16111).
WELL-INTEGRATED SCREENING AND EVALUATION FOR WOMEN ACROSS THE NATION
(WISEWOMAN) PROJECT SPECIAL REQUIREMENTS
Contractor Requirements -
WISEWOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation) is a program
designed to screen women for cardiovascular disease risk factors, counsel them about lifestyle changes to
reduce risk factors, and refer them for medical treatment of hypertension and/or hyperlipidemia. This program
will be based within Michigan's Breast and Cervical Cancer Control Program.
Extensive data is required by the Centers for Disease Control and Prevention (CDC) for each women served
by federal funds. Dates of service and results of testing are required prior to authorizing reimbursement to
providers. Therefore, for care provided off-site, data about screening tests and abnormal lab work will need
to be transmitted to the BCCCP agency.
1. Women eligible for this program will be BCCCP clients: ages 40-64 (target: 75% 50-64), uninsured or
underinsured, and with income under 250% of poverty.
2. Participation in this program will be optional, not mandatory, for participants in the BCCCP.
3. Dates and results of all diagnostic procedures must be recorded in the Michigan Breast and Cervical
Cancer Control Information System (MBCIS) by the BCCCP agency.
4. Women with abnormal screening results ("urgent," "emergent," "high") will be referred for medical
management as indicated.
5. The LCA will notify the MDCH staff about clients with abnormal screening results requiring case
management.
6. Women with abnormal screening results will have their follow-up care coordinated (or "case managed")
by identified LCA staff.
7. Women will be appointed to a "lifestyles counselor" who will refer them to risk factor appropriate
education in their community or at the local agency.
8. Follow-up visits will be scheduled to check blood pressure, weight and cholesterol as indicated.
Page 64 of 54
Program Element/
Funding Source (1)
Program for Local MCH
to be determined based
on plan approval.
MDCH Funding
. Source Amount
Local MCH $332,964 •
Reg. Alloc.
Rag. -Alloc.
Calc. Amt.
Reg. Alice.
Reg. Alloc.
Reg. Moe.
Reg. Mac.
Reg. Moe.
Reg. Mac.
Cale. Amt.
Calc. Amt.
Calc. Amt.
Reg. Alloc.
$514,475 .
$100/Each
$150/Each
550/Each
$80,000 •
Staffing (9)
Fixed Unit Rate (10)
Fixed Unit Rate (10)
Fixed Unit Rate (10)
Staffing (9)
NIA
N/A
N/A
N/A
N/A
NIA
N/A
NIA
N/A
N/A
N/A
N/A
N/A
Percentage of Food Service
licensees receiving required
inspections.
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
NIA 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
90%
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
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
75% N/A NIA
# Persons Post-Test
Counseled in Anonymous or
Confidential Public Health Clinics
5373,743 • Performance
$100,000 • Staffing (9)
Various Fixed Unit Rate (6) (10)
$151,600 • Staffing (9)
$40,000 • Staffing (9)
$66,479 • Staffing (9)
$217,775 • Staffing (9)
$9/Each Fixed Unit Rate (10) (15)
52.695,911 • LPHO (7)
$863,087 • Performance
$260,925 • Staffing (9)
MATERNAL & INFANT
HEALTH/ADVOCACY
(MIHAS)
# Unduplicated Women and
Infants Discharged
Reg. Alloc. $215,794 • Performance 90%
N/A
N/A
P0°A•
N/A N/A
N/A N/A
N/A N/A
97%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Oaidz..d County Health Department ATTACHMENT IV
FlY 2002.2003 CPBC
AGREEMENT
MOCH Funding AllocatIons/Relmbursement Mechanisms Matrix
Performance Total (3)
Reimbursement Target Output Perform.
Mechanism (2) _. Measure Expect.
After Pro-gram approval, applicable Local MCH funding will be incorporated un
selected in the plan, along with approved output performance measures, via
State (4) State Funded
Funded Minimum
Target Performance
Perform. Percent Number (5)
der the program elements
amendment.
AIDS/HIV PREVENTION
BIOTERRORISM EMERGENCY
PREPAREDNESS COORDINATOR
CHSCS Care Coordination
CSHCS OUTREACH
& ADVOCACY
CHILDHOOD LEAD
Service Delivery
COMMUNITY HEALTH
ASSESSMENT &
IMPROVEMENT
FAMILY PLANNING -
Special Projects
HEPATITIS 8
IMMUNIZATIONS
Immunization Action
Plan (IAP)
Imm. Nurse Training
VFC Provider Site Visits
INFORMED CONSENT- PA 133
LEAD HAZARD REMEDIATION
LOCAL PUBLIC HEALTH OPERATIONS
MDCH Reg. Moo.
MDA Reg. Alloc.
MATERNAL & CHILD
OUTREACH ENROLLMENT &
COORDINATION
Reg. Mac.
SEXUALLY TRANSMITTED DISEASE
(STD) CONTROL Reg. Akio.
SIDS Cale. Amt.
TB CONTROL
Directly Observed
Therapy (DOT)
VACCINE REPLACEMENT/ Cato. Amt.
HANDUNG
WIC
Resident Services Reg. Moo.
5109,696 • Performance # Persons Examined
570/Each Fixed Unit Rate (14) N/A
$65,591 • Staffing (9)
$103,789 • Fixed Unit Rate
51.168,177 • Performance (11) # Avg.Mo.Participation
Reg. Moo.
TOTAL MDCH FUNDING 57 350 006 • .
*SPECIFIC OUTPUT PERFORMANCE MEASURES WILL BE INCORPORATED VIA AMENDMENT.
(1) Refer to Plan and Budget Framework for element definitions.
(2) Hofer to master comprehensive agreement and program and budget instructions package for further explanation of applicability of
these reimbursement mechanisms.
(3) Negotiated starting from the average of the past two complete years' actual numbers where available.
(4) 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 MDCH reimbursement not performance based (i.e. fixed unit rate, staffing).
(5) Calculated by multiplying the "State Funded Element Target Performance" column by the "Percent" column.
(6) CSHCS Care Coordination 4
1. LEVEL I CARE COORDINATION
A. Initial IHCP
1. Long Form $150, plus $50 Bonus for timely completion ."
2. Short Form $125, plus $25 Bonus for timely completion 7*
3. Update to IHCP $30
B. Renewal IHCP
1. Long Form $75, plus $25 Bonus for timely completion ."
2. Short Form $65, plus $25 Bonus for timely completion ."
3. Update to IHCP $30
2, LEVEL II CARE COORDINATION
A. Code A or B unit $30/Unit (10 unit limit per beneficiary per year)
Timely completion is defined as 45 days from the date of referral.
(7) Funding Source (not a single element).
(6) Subject to statewide maintenance of effort requirement for Title X.
(9) State funding is first source (after fees and other earmarked sources).
;10) Fixed unit rate subject to actual costs.
01) Performance reimbursement target will be the base target caseload established by MDCH.
(12) Subject to a match requirement (hard or in-kind) of $1 for each $4 of MDCH agreement funding.
;13) Fixed unit rate limited to contract amount
;14) Up to 6 visits per family.
(15) Local health departments will receive the following amounts for services rendered to patients seen in
family planning, STD, and adolescent clinics:
Administration of first, second or third dose of vaccine with submission of intake or vaccination follow up form to MPH: $9.00
:16) $2.45 for each swab specimen and $3.96 for each urine specimen for diagnosis of gonorrhea and chlamydia infections using
a nucleic acid amplification assay.
:17) Teen Pregnancy Prevention (TP3) Allocation
The allocation amount is an estimate. To be eligible for the full 3500,000 allocation the Contractor must: 1) score at least 40 points on the TP3 performance
criteria review in June 2002 to be eligible for a maximum of $350,000 and 2) reduce the teen birth rate by 30% (comparison of July - December 1999 with
July-December 2002), determined in April 2003, to be eligible for an additional maximum of $150,000.
The Contractor will be notified in writing by July 30, 2002 the actual allocation amount based on the performance criteria reviews conducted in June, 2002. If the
Contractor is not eligible for the full $350,000 amount the CPBC allocation will be reduced, In the first CPBC amendment, to reflect the lower amount
The Contractor will be notified in writing by April 15, 2003 the actual allocation amount based on the review conducted by April 2003. If the Contractor is not eligible
for the full additional $150,000 amount the CPBC allocation will be reduced, in a subsequent amendment, to the lower amount
40TE: Some footnotes may not apply to this agency.
FISCAL NOTE (MISC. 102235) September 19, 2002
BY: FINANCE COMMITTEE, SUE ANN DOUGLAS, CHAIRPERSON
IN RE: DEPARTMENT OF HUMAN SERVICES/HEALTH DIVISION - 2002/2003 COMPREHENSIVE
PLANNING, BUDGETING AND CONTRACTING (CPBC) ACCEPTANCE
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS
Chairperson, Ladies and Gentlemen:
Pursuant to Rule XII-C of this Board, the Finance Committee has reviewed
the above-referenced resolution and finds:
1. The Michigan Department of Community Health (MDCH) has awarded
Oakland County Comprehensive Planning, Budgeting and Contracting
(CPBC) funding in the amount of $7,489,764 for the period of October
1, 2002 through September 30, 2003. This award reflects a 7.51%
($608,267) decrease from the FY2001/2002 amended funding allocation
of $8,098,031.
2. Changes from the previous award have been made by the MDCH
including:
a. Funding from Aids/HIV Prevention has been decreased by
$15,058.
b. Funding for the bio-terror Coordinator has increased by
$70,000.
c. The following decrease was for one-time Funding in FY2001/02
for:
1. Bio-terror Planning $270,349
2. Bio-terror EPC $10,000
3. Bio-terror CO IT $3,000
d. Funding in the amount of $47,725 for the Cardiovascular
Disease Prevention Program has been discontinued.
e. Family Planning Funding has been eliminated from this year's
agreement, which is a decrease of $222,949.
f. The Immunization Action Plan has been decreased by $943.
g. Funding for Minority Health has been discontinued in the
amount of $48,495.
h. Funding for TB Control has been reduced by $4,229.
i. Funding in the amount of $139,758 has been amended to include
equip and staff the laboratory to attain " Level B" status.
This will allow the laboratory to examine potential bio-
terrorism-related materials including the request of one
Medical Technologist position to assist the Laboratory. This
position is 100% grant funded.
j. Funding for Vaccine Replacement/Handling has been increased by
$10,091.
k. Funding for Women Infants, and Children (WIC) has been
decreased by $205,431.
3. The acceptance of this grant does not obligate the County to any future
commitment.
4. The budget detail for the various programs is a matter of negotiation
between the Health Division and the Michigan Department of Community
Health (MDCH). Amendments will be recommended to the FY2003 budget
when details are finalized.
FINANCE COMMITTEE
FINANCE COMMITTEE
Motion carried unanimously on a roll call vote with Causey-Mitchell and Palmer
absent.
G. William Caddell, County Clerk
Resolution #02235 September 19, 2002
Moved by Patterson supported by McPherson the resolution be adopted.
Moved by Patterson supported by McPherson the Personnel Committee Report be accepted.
A sufficient majority having voted therefore, the report was accepted.
Vote on resolution:
AYES: McPherson, Melton, Middleton, Moffitt, Moss, Obrecht, Palmer, Patterson, Sever, Suarez,
Taub, Amos, Appel, Causey-Mitchell, Coleman, Crawford, Dingeldey, Douglas, Galloway, Garfield,
Gregory, Law. (22)
NAYS: None. (0)
A sufficient majority having voted therefore, the resolution was adopted.
\f jjP F F()PPr)rs'", RE SOLUTION
•
/2 '/2
on County Executive Date
Brooke Pa
STATE OF MICHIGAN)
COUNTY OF OAKLAND)
I, G. William Caddell, 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
19, 2002, with the original record thereof now remaining in my office.
In Testimony Whereof, I have hereunto set my hand and affixed the seal ofle County of Oakland at Pontiac,
Michigan this 19th day of September, 2002.