HomeMy WebLinkAboutResolutions - 2003.09.18 - 27345MISCELLANEOUS RESOLUTION #03257 September 18, 2003
BY: General Government Committee, William R. Patterson, Chairperson
IN RE: DEPARTMENT OF HUMAN SERVICES/HEALTH DIVISION - 2003/2004 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 $7,044,863, which is a
3.8% ($278,356) decrease from the Fiscal Year 2002/2003 amended allocation of
$7,323,219; 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 2004 Budget when details are finalized; and
WHEREAS this agreement is for the period of October 1, 2003 through
September 30, 2004; and
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 2003/2004 Comprehensive Planning, Budgeting, and
Contracting (CPBC) agreement for funding in the amount of $7,044,863 for the
period of October 1, 2003 through September 30, 2004.
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 Vote:
Motion carried on a roll call vote with Hatchett absent.
N.:
CONTRACT REVIEW - Health Division
GRANT NAME: FY 03-04 Comprehensive Planning, Budgeting, and Contracting
Agreement
FUNDING AGENCY: Michigan Department of Community Health
DEPARTMENT CONTACT PERSON: Tom Fockler / 22151
STATUS: Application
DATE: September 10, 2003
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:
No comment,
Personnel Department:
No comment.
Risk Management and Safety:
Approval. - Gerald Mathews (9/5/2003)
Corporation Counsel:
I have reviewed this Agreement with the State of Michigan, and with the
modifications to Addendum A that Tom Fockler has made, approve it for
signature. - John Ross (9/9/2003)
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.
Greg Givens, Supervisor
Grants Administration Unit
Fiscal Services Division
COUNTY OF OAKLAND
DEPARTMENT OF HUMAN SERVICES
HEALTH DIVISION
FY 2003/2004 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 $7,044,863. The Agreement is for the period October 1, 2003 through September 30, 2004.
• 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 2003/04 Agreement include:
• Funding for the Emergency Preparedness Specialist position continues through Fiscal Year
2003/04.
• Other Bioterrorism-related funding includes $20,000 to defray the costs of housing the Regional
Epidemiologist and SNS Planner, and $19,000 to enhance communication capabilities.
• Funding in the amount of $155,992 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.
Contract #:
Agreement Between
Michigan Department of Community Health
hereinafter referred to as the "Department"
and
Oakland County Health Division
hereinafter referred to as the "Local Governing Entity"
1200 North Telegraph Road, Department 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 I
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,
2003 and continue through September 30, 2004. 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.
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 $7,044,863.
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 1n
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
- 1
Contractor that, during the course of the agreement period,
chose to reduce or transfer local funds from the Family
Planning program.
4. Agreement Attachments:
A. The following documents are attachments to this Agreement Part I
and Part II - General Provisions, which are 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, II and IV (Revised)
5. 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 II 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, CPBC Consultant, 517-241-2493
(Contract Consultant Name) Title Phone
V
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 Department 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 Date
For the LOCAL GOVERNING ENTITY/CONTRACTOR
Name and Title
Signature Date
Part II
General Provisions
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 of 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 st and 3rd 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.
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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.
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 records, files and documentation
related to this agreement, to the extent authorized by applicable state or
federal law, rule or regulation.
G. Single Audit
Comply with requirements of the Single Audit Act Amendments of 1996,31
USC 7501 et seq, and Section .320 of Office of Management and Budget
(OMB) Circular A-133, "Audits of States, Local Governments, and Non-Profit
Organizations", and provide the Department copies of any audits of the
Contractor on any program elements covered by this agreement. The
Contractor is required to file with the Department the Single Audit reporting
package and management letter within nine months after the end of the
contractor's fiscal year, even if there are no findings reported in the audit
pertaining to Department programs. A contractor that expends less than
$300,000 in federal awards and received less than $300,000 in total
Department funding is required to file the Audit Status Notification Letter
(attachment E).
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 OMB Circular A-133, and should
provide these to the Contractor).
The Contractor must assure that the Schedule of Expenditures of Federal
Awards includes expenditures for all federally-funded grants. A copy of the
Single Audit reporting package should be forwarded to:
Michigan Department of Community Health
Office of Audit
Quality Assurance and Review Section
P.O. Box 30479 (Capital Commons Center, 400 S. Pine Street)*
Lansing, Ml 48909-7979
MDCH/CMS
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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,
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
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 Program 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.
MDCH/CMS
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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 I, 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.
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.
MDC1-1/CMS
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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.
I. Technical Assistance
To make technical assistance available to the Contractor for the
implementation of this agreement.
J. Health Insurance Portability and Accountability Act
The Department assures that it will be in compliance with the Health
Insurance Portability and Accountability Act.
Ill. 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
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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 or to receive services. The
Contractor further agrees that every subcontract entered into for the
performance of any contract or purchase order resulting herefrom will
contain a provision requiring non-discrimination in employment,
service delivery and access, as herein specified binding upon each
subcontractor. This covenant is required pursuant to the Elliot Larsen
Civil Rights Act, 1976 PA 453, as amended, MCL 37.2201 et seq, and
the Persons with Disabilities Civil Rights Act, 1976 PA 220, as
amended, MCL 37.1101 et seq, and any breach thereof may be
regarded as a material breach of the contract or purchase order.
2. Additionally, assurance is given to the Department that efforts will be
made to identify and encourage the participation of minority owned
and women owned businesses, and businesses owned by
handicapped persons in contract solicitations. The Contractor shall
incorporate language in all contracts awarded: (1) prohibiting
discrimination against minority owned and women owned businesses
and businesses owned by handicapped person in subcontracting; and
(2) making discrimination a material breach of contract.
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 three-year period preceding this agreement been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with
MDCH/CNIS
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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 three-year period preceding this agreement had one
or more public transactions (federal, state or local) terminated for
cause or default.
E. Federal Requirement: Pro-Children Act
1. Assurance is hereby given to the Department that the 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.
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.
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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.
2. That any executed subcontract shall require the subcontractor to
comply with all applicable terms and conditions of this agreement. In
the event of a conflict between this agreement and the provisions of
the subcontract, the provisions of this agreement shall prevail. A
conflict between this agreement and a subcontract, however, shall not
be deemed to exist where the subcontract:
a. Contains additional non-conflicting provisions not set forth in
this agreement; or
b. Restates provisions of this agreement to afford the Contractor
the same or substantially the same rights and privileges as the
Department; or
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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 terms, 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).
8. That all subcontracts and subgrants in support of programs or
elements utilizing funds provided by the Department, the State of
Michigan or the federal government in excess of $2,000 for
construction or repair, awarded by the 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).
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).
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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.
J. Health Insurance Portability and Accountability Act
To the extent that this act is pertinent to the services that the Contractor
provides to the Department under this agreement, the Contractor assures
that it is in compliance with the Health Insurance Portability and
Accountability Act (HIPAA) requirements including the following:
1. The Contractor must not share any protected health data and
information provided by the Department that falls within HIPAA
requirements except to a subcontractor as appropriate under this
agreement.
2. The Contractor must require the subcontractor not to share any
protected health data and information from the Department that falls
under HIPAA requirements in the terms and conditions of the
subcontract.
3. The Contractor must only use the protected health data and
information for the purposes of this agreement.
4. The Contractor must have written policies and procedures addressing
the use of protected health data and information that falls under the
HIPAA requirements. The policies and procedures must meet all
applicable federal and state requirements including the HIPAA
regulations. These policies and procedures must include restricting
access to the protected health data and information by the
Contractor's employees. •
5. The Contractor must have a policy and procedure to report to the
Department unauthorized use or disclosure of protected health data
and information that falls under the HIPAA requirements of which the
Contractor becomes aware.
6. Failure to comply with any of these contractual requirements may
result in the termination of this agreement in accordance with Part II,
Section V. Termination.
MDCH/CMS
4/03 Page 14 of 22
7. In accordance with HIPAA requirements, the Contractor is liable for
any claim, loss or damage relating to unauthorized use or disclosure
of protected health data and information received by the Contractor
from the Department or any other source.
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:
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.
MDCH/CMS
4/03 Page 15 of 22
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 11301XX, 41301XX, and 7/301XX. 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 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.
MDCH/CMS
4/03 Page 16 of 22
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. Unobliqated 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 Reporting
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.
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
MDCH/CMS
4/03 Page 17 of 22
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 and as 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
Contractor's LPHO allocation
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.
MDCH/CMS
4/03 Page 18 of 22
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.
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.
MDCH/CMS
4/03 Page 19 of 22
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 June 2nd. The
Department will provide a written response within thirty (30) calendar
days.
All amendments must be submitted to the Department by June 2nd 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.
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 borne 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.
MDCH/CMS
4/03 Page 20 of 22
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 I, the Program Specific Assurances and Requirements -
Attachment ill, and as outlined in the Funding/Reimbursement Matrix -
Attachment IV.
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 1. All LPHO required services must be
maintained throughout the entire period of the agreement.
MDCH/CMS
4/03 Page 21 of 22
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
4/03 Page 22 of 22
ATTACHMENT III
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
FY 03/04 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, local budgets and
projected output measures reports, State/local agreements, and periodic department on-site program
management evaluation and audits, while minimizing local program plan detail beyond that needed for input
on the State budget process.
Many program specific assurances and other requirements are defined within the referenced documents
including Minimum Program Requirements established for the following program elements as of October 1,
2003:
a.
b.
C.
d.
e.
f.
9.
h.
AIDS/HIV Prevention
Breast and Cervical Cancer Control
Childhood Lead
Childhood Immunization Registry
Family Planning
Food Service Sanitation
General Communicable Disease Control
Hearing
Immunization — (Local Public Health
Operations & Categorical)
j. LHD/CSHCS Services
k. Maternal and Infant Support
I. Oral Health
m. Primary Dental Care
n. Sexually Transmitted Disease
o. Vaccine Handling
p. Vision
q. WIC
MDCH/CMS
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Page 1 of 57 ATTACHMENT III
For F/Y 03/04, special requirements are applicable for the remaining program elements and funding sources
listed in the attached pages and checked below:
0- AIDS/HIV CARE
0- AIDS/HOPWA (Housing Opportunities for Persons Living with HIV/AIDS)
0- AIDS/HIV Pediatric
EZ- AIDS/HIV Prevention
0- AIDS/HIV Provider Education
tz- Bioterrorism (Focus A) — Coordinators
Bioterrorism (Focus A) — SNS Planner Workspace
Bioterrorism (Focus B) — Regional Epidemiology Workspace
Z- Bioterrorism (Focus E) Information Technology
CSHCS
21- Childhood Immunization Registry
0- Childhood Lead
0- Diabetes Outreach Network
D- Family Planning/BCCCP Joint Project
0- Family Planning-Pregnancy Prevention
0- Fetal Alcohol Syndrome (FAS)
Z- Immunization Action Plan
0- Immunization - Field Service Representatives
IZ- Immunization VFC Provider Site Visit
[Z- Immunization - Nurse Training Reimbursement
EZ- Informed Consent
[Z- Laboratory Services
[Z- Lead Hazard Remediation Program
Z- Local MCH
[Z- Local Public Health Operations (LPHO)
Ej- Local Tobacco Reduction
0- Michigan Abstinence Program (MAP)
0- Michigan Childhood Immunization Registry (MCIR)
0- Michigan Teen Outreach Program (MTOP)
(Z- Minority Health
0- Nurse Family Partnership (NFP)
0- Primary Care Dental Special Project
0- Rape and Sexual Assault Prevention Education (RSAPE)
[Z- SIDS
[Z- TB Control (DOT)
Ej- WIC Services
0- WIC Special Increased Participation
0- WI SEWOMAN
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 administeiing the
program element.
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 ATTACHMENT III Page 2 of 57
6/03
AIDS/HIV CARE SPECIAL REQUIREMENTS (MARQUETTE COUNTY HEALTH DEPARTMENT, CITY OF
DETROIT HEALTH DEPARTMENT AND DISTRICT HEALTH DEPARTMENT #10)
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 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.
3. Assure Ryan White Title II and Michigan Health Initiative (MHI) resources are used as payor of last
resort.
4. Participate in quality assurance, program evaluation, and contract monitoring activities conducted
and/or facilitated by MDCH/DHAS-HAPIS.
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 subcontractors 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: 1-4,8-23, and
33-39.
8. 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.
9. Provide immediate notification to the Department, in writing, of any formal grievance procedures
initiated by a service recipient and subsequent resolution of that grievance.
10. 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 redipients or contractor or subcontractor employees.
11. 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.
12. Assess client satisfaction annually and use methods, instruments and analysis that minimize bias and
ensure confidentiality of responses.
13. Utilize results of client satisfaction assessments and other evaluation activities to inform program
development and implement program level changes.
14. Demonstrate appropriate expenditure of funds consistent with the contract, HRSA regulations and
MDCH/DHAS-HAPIS regulations and guidelines.
15. Attend all mandatory training sponsored by MDCH/DHAS-HAPIS.
16. Demonstrate that the agency provides opportunity and fiscally supports on-going staff development and
training.
17. 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 according to the
MDCH/CMS
6/03
Page 3 of 57 ATTACHMENT III
schedule below. Submit the CARE Act Report for the period of January 1 through December 31 by
January 15th of each year, along with annual client-level URS data for the same time range.
URS Data Report Range
October — December, 2003
January — December, 2003
Date Due
January 15, 2004
January 15, 2004 (CADR and Annual Client-Level Data)
January — March, 2004 April 15, 2004
April — June, 2004 July 15, 2004
July— September, 2004 October 15, 2004
18. URS data belongs to MDCH/DHAS-HAPIS. In the event that services are no longer delivered under this
agreement, arrangements must be made to return data to MDCH/DHAS-HAPIS.
19. 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.
20. 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.
21. Assure that STD and HIV secondary prevention practices for the purposes of reducing risk of transmittal
and re-infection are integrated into the delivery of HIV/AIDS care services.
22. Utilize sound accounting methods to distribute and monitor expenditures of funds for HIV Care services,
ensuring expenditure of funds is in accordance with approved workplan and budget(s).
23. Submit separate budgets and financial status reports by funding sources.
24. Submit original FSRs to MDCH-Budget and Finance Administration, as detailed in Part II General
Provisions, and submit one copy to MDCH/DHAS-HAPIS to the attention of Traci Goulding.
25. Submit the "Allocations and Expenditures by Service Category" Table to MDCH/DHAS-HAPIS on April
15, 2004 and October 15, 2004.
26. Submit program Progress Reports in accordance with the following dates and reporting format:
Period Covered Due to MDCH/DHAS-HAPIS
October 1 - December 31, 2003 January 15, 2004
January 1 - March 31, 2004 April 15, 2004
April 1 — June 30, 2004 July 15, 2004
July 1 — September 30, 2004 October 15, 2004
- Progress Report Format
Submit quarterly progress reports that include all of the following components in the order listed:
A. Fiscal Accountability and Contract Monitoring
1. Identify any cost saving efforts.
2. Summarize any subcontract monitoring and oversight activities conducted during the
report period. Attach relevant findings.
MDCH/CMS
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Page 4 of 57 ATTACHMENT III
3. Provide updates on any remediation activities and/or corrective action plans initiated with
subcontractors in this report period.
4. 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. Identify any new services provided during the report period, and/or new access points to
existing services.
4. Describe the progress made towards achieving goals, objectives, and service outcomes
as described in your workplan.
5. Discuss any issues at the agency level that impact ability to achieve stated goals and
objectives.
6. Describe staff development and training activities related to client-level service
provision.
7. Describe any technical assistance needs related to programmatic and fiscal
administration.
C. Submit Progress Reports electronically to SzweidaDmichigan.dov, cc:
GouldinciTa,michician.00v. Materials that cannot be emailed should be sent to:
Debra L. Szwejda, Manager
HIV/AIDS Prevention and Intervention Section
Division of HIV/AIDS-STD
2479 Woodlake Circle, Suite 300
Okemos, Michigan, 48864
27. Provide one copy of all fully-signed subcontracts to MDCH/DHAS-HAPIS by October 15,2003 or within
30 days of execution. 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 local funds for the same service.
F. Minority provider status.
28. By October 15, 2003 provide to MDCH/DHAS-HAP1S 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. 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.
29. Document by October 15, 2003, 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
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Ryan White CARE Act Title II funds. If requested, document compliance with HRSA's "Issue Paper:
Administrative Costs."
30. Implement goals and objectives as specified in a written workplan approved by MDCH/DHAS-HAPIS.
31. When issuing requests for proposals or bid solicitations, clearly state that the resources are open for
availability to faith-based organizations.
32. Work in concert with MDCH/DHAS-HAPIS staff to develop appropriate outcome measures and
tools.
33. Assist MDCH/DHAS-HAPIS in needs assessment activities, as appropriate.
34. Maintain a mechanism to obtain input about needed services from infected and affected persons.
35. Participate in MDCH/DHAS-HAPIS care-related conferences, as appropriate.
36. Document that clients receiving services are eligible beneficiaries of services (document HIV
status).
37. Establish written client grievance procedures, and assure that those procedures are consistent with
any guidance issued by HRSA or MDCH/DHAS-HAPIS, including following MDCH/DHAS-HAPIS'
mediation process.
38. Maintain, for a minimum of three (3) years, program and fiscal records and files including
documentation to support program activities and expenditures, under the terms of this agreement,
for clients residing in the State of Michigan.
39. Assure that any subcontractors maintain the organizational, administrative and fiscal capacity
necessary for provision of services supported under this agreement. At a minimum, the
subcontractor shall:
A. Establish and maintain appropriate organizational governance, guided by written by-laws.
B. Convene and maintain a Board of Directors. Board members must possess expertise and
experience appropriate and necessary to provide general oversight, develop organizational
policy and work in partnership with the Executive Director to ensure achievement of its mission.
C. Establish and main appropriate fiscal management of the agency consistent with generally
accepted accounting principles.
D. Establish and maintain written personnel policies and procedures.
E. Ensure that all staff, including executive directors and program coordinators:
I. Possess the knowledge, skills, abilities and credentials essential to assigned responsibilities;
ii. Are hired or discharged through fair and objective processes which are appropriately
documented.
AIDS/HOPWA SPECIAL REQUIREMENTS
(Housing Opportunities for Persons Living with HIV/AIDS)
1. Budget and Aqreement Requirements
, A. HOPWA Eligibility
An eligible person means a person with acquired immunodeficiency syndrome or related diseases
who is below 80% median income. A family member regardless of income is eligible to receive
" housing information services. Any person living in proximity to a community residence is eligible to
participate in that residence's community outreach and educational activities regarding AIDS or
related diseases.
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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 HOP WA 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 preliminary research and making expenditures necessary
to determine the feasibility of specific housing-related initiatives.
3. Permanent housing placement.
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.
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1.
2.
3.
This information was taken from the HOP WA regulations (24 CFR 574). Please check the regulations for
further information.
C. HOPWA 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
PLWH/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. 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 ofthe 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
PLWH/A's served. As supportive documentation, the provider must maintain the following for each
PLWH/A served:
Documentation of a supportive services plan (form included with allocation letter).
Documentation of consideration of other funding sources (form included with allocation letter).
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
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documentation of consideration of other funding sources for each person for whom a certificate is
being requested. Requests may be sent to:
Community Living Division
Michigan Department of Community Health
3423 North Martin Luther King, Jr. Boulevard, Room 303
Lansing, Michigan 48909
Attention: Sue Eby
2. Contractor Requirements
In 2003, each region must submit to the department their annual plan for providing HOPWA services. The
plan should cover the period October 1, 2003 through September 30, 2004 and include both the regular
HOPWA allocation and the HOPWA 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, 2003 and must be submitted to:
Community Living Division
Michigan Department of Community Health
3423 North Martin Luther King, Jr. Boulevard, Room 303
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).
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, are 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.
1. Plan Components
The plan consists of five components. Generally a brief description of current year activities
and the region's plan for FY 2003/2004 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, -
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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.
b. Coordination
Information about FY 2003 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 2003/2004 along with a brief
description of FY 2002/2003 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 "connect" or 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.
4. 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 FY 2002/2003.
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 HOPWA 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 2004 by the three funding
categories.
1. Direct Housing Assistance.
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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 2003/2004 as well. Finally, describe how the
use of these funds is "coordinated" or related to the use of HOPWA funds.
e. Budget Plan
On the form entitled "HOPWA FY 2003/2004 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
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.
D. 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.
It's important that the quarterly reports reflect the breakdown of costs according to the categories
listed above. Equally important is that a quarterly report reflect only the costs from the months that
make up the quarter. It's important to understand that the contract year and calendar year do not
coincide. The quarters that aggregate for the final contract reconciliation are not the same quarters
that aggregate for the Annual Progress Report. The Annual Progress Report for calendar year 2003
must be submitted by February 1, 2004, and will include data from the quarterly report for the period
10/1/2003-12/31/2003. Quarterly Reports are due as follows:
February 1 for the 10/1/2003 - 12/31/2003 quarter
May 1 for the 1/1/2004 - 3/31/2004 quarter
August 1 for the 4/1/2004 - 6/30/2004 quarter
November 1 for the 7/1/2004 - 9/30/2004 quarter
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All reports should be sent to:
Community Living Division
Michigan Department of Community Health
3423 North Martin Luther King, Jr. Boulevard, Room 303
Lansing, Michigan 48909
Attention: Sue Eby
Contractor Requirements
1. 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 2003 by February 1, 2004.
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 processes.
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.
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G. Ensure, then issue statements, press releases, RFP, bid solicitations and other documents
describing projects or programs funded in whole or in part with Federal funds, clearly state 1) the
percentage or total cost of the program or project which will be funded with Federal funds; 2) the
amount of Federal funds for the project or program; and 3) percentage and dollar amount of the total
costs of the project or program that will be financed by non-governmental resources. 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:
Community Living Division
Michigan Department of Community Health
3423 North Martin Luther King, Jr. Boulevard, Room 303
Lansing, Michigan 48909
Attention: Sue Eby
AIDS/HIV PEDIATRIC — DETROIT HEALTH DEPARTMENT
Contractor Requirements
1. Provide 1.0 full-time Health Educator to the program with Ryan White Title IV funds. This person will
provide health education services as outlined in the job description.
2. Provide 1.0 full-time Risk Reduction Counselor to the program with the division of Substance Abuse
Quality and Planning funds. This person will provide risk reduction counseling and health education
services at the Detroit Medical Center — Hutzel Hospital (obstetrics). Provide necessary training and
technical support to the person to assure services are provided in a family-centered manner.
3. Actively participate and maintain management level representation on the Executive Committee
established for project oversight, implementation, and evaluation of Title IV programming on the DMC
campus. Participate in other Title IV activities across the service area through attendance at partner
network meetings.
4. Obtain consumers' consent to collect and share person-based data with agencies receiving funding
from the MDCH Ryan White Title IV program.
5. Support the coordination and comprehensiveness of the Ryan White Title IV program by requiring Title
IV supported staff and others as appropriate to attend scheduled coordination meetings convened by
the Program Coordinator and other related meetings as necessary to serve women, children,
adolescents and families.
6. Submit quarterly narrative and statistical data reports as outlined in Attachment C,
Performance/Progress Report Requirements.
7. Encourage consumer involvement in Title IV program activities.
Department Requirements
1. Provide all administrative, professional, and technical staff for operation of the program at the grantees
office.
2. Provide administrative direction, program coordination, and data management for statewide reporting of
Title IV activities.
3. Support the development and support of a comprehensive infrastructure to provide coordinated, family-
centered care under the Maternal Child HIV/AIDS program (Ryan White Title IV) at the Children's
Hospital of Michigan Pediatrics and Adolescent Medicine, Hutzel Hospital HIV in Pregnancy Clinic, and
University Health Center and AIDS Consortium of Southeast Michigan.
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4. Convene monthly a Ryan White Title IV Executive Committee for the purposes of program oversight and
implementation. The board will consist of executive level staff from each of the Ryan White Title IV-
funded agencies, and a consumer.
5. Convene quarterly, a Partner Network meeting to include all Ryan White Title IV-funded agencies and
agencies who provide services to women, children, adolescents and families.
6. Use Ryan White Title IV dollars to fund 1.0 full-time Health Educator position. Provide funds from the
Substance Abuse Quality and Planning for 1.0 full-time Risk Reduction Counselor position.
Reporting Requirements
1. The Contractor shall submit reports on the following dates:
Type of Report and timeframe Due Date
1st Quarterly Data Report (for period Jan 1 — March 31) April 15
2nd Quarterly Data Report (for period April 1 — June 30) July 15
3rd Quarterly Data Report (for period July 1 — September 30) October 15
Annual Data Report (for period January 1 — December 31) January 15
The Annual Data Report is an aggregate calendar year report.
2. Any such other information as specified in Attachment A shall be developed and submitted by the
Contractor as required by the Contract Manager.
3. Reports and information shall be submitted to the Contract Manager at:
Michigan Department of Community Health
Division of Family and Community Health
Maternal Child HIV/AIDS Program
3056 W. Grand Blvd., Suite 3-350
Detroit, MI 48202
4. The Contract Manager shall evaluate the reports submitted as described in Attachment C, items A.
and B. for their completeness and adequacy.
5. The Contractor shall permit the Department or its designee to visit and to make an evaluation of the
projects as determined by the Contract Manager.
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 for HIV Prevention Interventions. Michigan Department of
Community Health, HIV/AIDS Prevention & Intervention Section, August 2002, May 2003, 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.
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F. Partner Notification Guidelines. Michigan Department of Community Health, HIV/AIDS
Prevention and Intervention Section. Revised, January 2000 or subsequent revisions.
G. Michigan Local Public Health Accreditation Program (Accreditation Standards), 2002.
H. Strategies to Improve Client Failure Rate to Return for HIV Test Results. Michigan Department
of Community Health, HIV/AIDS Prevention and Intervention Section, July 2002, or subsequent
revisions.
Michigan HIV Laws: How They Affect Physicians and Other Health Care Providers. Michigan
Department of Community Health, HIV/ADS Prevention and Intervention Section. September
2002 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
NIDCH/DHAS-HAPIS.
5. Participate/cooperate in program evaluation activities conducted and/or facilitated by MDCH/DHAS-
HAPIS.
6. 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, 2003), a description of the activities. This
description is to include:
1. A description of the target population(s).
2. Specific, time phased and measurable 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 15 days following the close of each month statistical data which detail progress
toward meeting process and outcome objectives. Agencies are to utilize the CTR and PCRS
modules of the HIV Event System.
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-HAP1S.
C. Participate in technical assistance consultations and/or skills-enhancement opportunities as
directed by MDCH/DHAS-HAPIS 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.
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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-
E] 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
A. Goal 1: Reduce HIV Risk Behaviors among residents of Kent County.
1. Outcome Objective 1: By September 20, 2004, 90% of training participants will report
that they are better prepared to conduct HIV risk assessment and risk reduction
education as a result of the program. Achievement of this objective will be measured by
administration of pre- and post-test questionnaires.
a. Process Objective A: By September 30, 2004, conduct two (2) HIV trainings
targeting 60 physicians in Kent County. Achievement of this objective will be
measured by attendance sheets and training agenda.
b. Process Objective B: By September 30, 2004, conduct four (4) HIV trainings
targeting 120 nurses in Kent County. Achievement of this objective will be
measured by attendance sheets and training agenda.
c. Process Objective C: By September 30, 2004, conduct one training targeting 50
undergraduate nursing students enrolled at Calvin College. Achievement of this
objective will be measured by attendance sheets and training agenda.
d. Process Objective D: By September 30, 2004, conduct five (5) HIVE trainings
targeting 300 undergraduate nursing students enrolled at GVSU. Achievement
of this objective will be measured by attendance sheets and training agenda.
e. Process Objective E: By September 30, 2004, conduct one HIV training
targeting 85 graduate nursing students enrolled at GVSU. Achievement of this
objective will be measured by attendance sheets and training agenda.
f. Process Objective F: By September 30, 2004, conduct one HIV training
targeting 60 physician assistant students enrolled at GVSU. Achievement of this
objective will be measured by attendance sheets and training agenda.
Process Objective G: By September 30, 2004, conduct one HIV training
targeting 60 medical students in Kent County. Achievement of this objective will
be measured by attendance sheets and training agenda.
h. Process Objective H: By September 30, 2004, conduct one HIV training
targeting 30 students fro.m a previously untargeted school. Achievement of this
objective will be measured by attendance sheets and training agenda.
g.
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2. Outcome Objective 2: By September 30, 2004, 90% of healthcare providers who have
completed an HIV training will indicate that they intend to encourage other providers in
their clinic to discuss HIV prevention with patients and to conduct risk assessment and
risk reduction activities. Achievement of this objective will be measured by
administration of pre- and post-test questionnaires.
a. Process Objectives: See process objectives A & B.
3. Outcome Objective 3: By September 30, 2004, 90% of providers who have completed
HIV provider trainings will report that they plan to increase the number of risk
assessments they perform on patients. Achievement of this objective will be measured
by administration of pre- and post-test questionnaires.
a. Process Objectives: See process objectives A & B.
4. Outcome Objective 4: By September 30, 2004, the number of training participants who
report that they feel comfortable conducting a sexual history and discussing sexuality
issues with patients will increase by 25% as a result of the training. Achievement of this
objective will be measured by administration of pre- and post-test questionnaires.
a. Process Objectives: See process objectives A through H.
5. Outcome Objective 5: By September 30, 2004, six-week follow-up with providers who
completed an HIV provider training will demonstrate a 25% increase in risk assessment
and risk reduction activities and a 25% increase in the number of sexual histories
performed. Achievement of this objective will be measured by a follow-up questionnaire.
a. Process objective H: By September 30, 2004, follow-up surveys will be collected
from 70% of physicians, nurses, nurse practitioners, midwives and physician
assistances who attended an HIV provider training. Achievement of this
objective will be measured by the number of surveys on file.
B. Goal 2: Reduce the number of HIV positive individuals in Kent County who are diagnosed late
in infection.
1. Outcome Objective 6: By September 30, 2004, 95% of training participants will report
that they are more knowledgeable about the need to discuss HIV testing with patients as
a result of the training. Achievement of this objective will be measured by administration
of pre- and post-test questionnaires.
a. Process Objectives: See process objectives A through H.
2. Outcome Objective 7: By September 30, 2004, 90% of training participants will report
that they intend to discuss the importance of conducting HIV testing and counseling with
other clinicians in their practices. Achievement of this objective will be measured by
administration of pre- and post-test questionnaires.
a. Process Objectives: See process objectives A & B.
3. Outcome Objective 8: By September 30, 2004, 95% of training participants will report
that they feel confidents in their ability to use their knowledge of a patient's risk factors
as a basis for recommending HIV testing and counseling. Achievement of this objective
will be measured by administration of pre- and post-test questionnaires.
a. Process Objectives: See process objectives A through H. -
4. Outcome Objective 9: By September 30, 2004, 95% of training participants will report
increased knowledge of HIV testing and counseling resources in the community.
Achievement of this objective will be measured by administration of pre- and post-test
questionnaires.
a. Process Objectives: See process objectives A through H.
5. Process Objective 10: By September 30, 2004, six-week follow-up will demonstrate that
90% of providers who have completed a HIV training have increased the number of tests
MDCH/CMS
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they perform by 25%. Achievement of this objective will be measured by a follow-up
questionnaire.
a. Process Objective I: By September 30, 2004, follow-up surveys will be collected
from 70% of physicians, nurses, nurse practitioners, midwives and physician
assistants who attended a HIV provider training. Achievement of this objective
will be measured by the number of surveys on file.
C. Goal 3: Increase the number of Kent County residents who are knowledgeable about HIV
transmission routes, the link between STI's and HIV infection, risk factors and effective
prevention activities.
1. Outcome Objective 11: By September 30, 2004, 95% of training participants will report
knowledge of HIV transmission routes, incidence and prevalence, risk factors and
prevention activities increased as a result of the training. Achievement of this objective
will be measured by administration of pre- and post-test questionnaires.
a. Process Objectives: See process objectives A through H.
2. Outcome Objective 12: By September 30, 2004, 90% of training participants will report
that they intend to discuss HIV transmission, prevention and risk factors with an
increased number of patients. Achievement of this objective will be measured by
administration of pre- and post-test questionnaires.
a. Process Objectives: See process objectives A through H.
3. Outcome Objective 13: By September 30, 2004, 90% of providers who have completed
a HIV training will report that they intend to encourage other clinicians in their practices
to discuss HIV transmission, prevention, and risk factors with patients. Achievement of
this objective will be measured by administration of pre- and post-test questionnaires.
a. Process Objectives: See process objectives A & B.
4. Outcome Objective 14: By September 20, 2004, six-week follow-up will demonstrate
that 90% of providers who attend an HIV Provider Education Training will have increased
by 25% the number of patients they counsel about HIV. Achievement of this objective
will be measured by a follow-up questionnaire.
a. Process Objectives: See process Objective I.
4. Progress Reports
Submit quarterly reports to MDCH/DHAS-HAPIS in accordance with the following dates and reporting
format:
Quarter Covered
October 1 - December 31, 2003
January 1 - March 31, 2004
April 1 - June 30, 2004
July 1 - September 30, 2004
Due to MDCH/DHAS-HAPIS
January 15, 2004
April 15, 2004
July 15, 2004
October 15, 2004
Guidelines for narrative reports will be provided by HAPIS/DHAS.
BIOTERRORISM — FOCUS AREA A
Local Health Departments (LHD) Emergency Preparedness Coordinators (EPC)
Contractor Requirements
The EPC will serve as a point of contact within the health department jurisdiction during public health
emergencies and develop protocols for the procedures to be followed in the event of a public health emergency,
outbreak of infectious disease and/or terrorism incident. To ensure that local health department staff is
appropriately trained and knowledgeable about local public health response to biological, chemical and/or
radiological agents whether occurring naturally, accidentally, or as a result of a terrorism to assure rapid and
effective public health response to such events.
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1. EPC will "develop a workplan and budget for the implementation of CDC Public Health Preparedness
funds received by the LHD and submit to MDCH for approval."
2. Coordinate local health department emergency response to public health emergencies.
3. Coordinate OPHP assessments as required by CDC funding.
4. Update LHD capacities on MDCH/MPHI Interactive Assessment web site monthly.
5. Develop local health department public health emergency response plan.
6. Integrate local public health emergency response plan with local emergency management plans for LHD
jurisdiction.
7. Maintain all pubic health emergency response plans to assure contact information, duties and
responsibilities are current.
8. Provide trainings to other disciplines on the role of local public health in public health emergency
response.
9. Provide training to LHD staff on the role of public health in a multi-disciplinary public health emergency
response.
10. Develop protocols for coordination of epidemiology and law enforcement activities during criminal
investigations affecting the health of the public and train LHD staff appropriately
11. Conduct a minimum of one internal tabletop exercise for Local Health Department staff.
12. Participate annually in a functional exercise in collaboration with local agencies and regional initiatives.
13. Actively participate in Strategic National Stockpile (SNS) planning and exercises.
14. Assist regional SNS planners in identifying sites for the receipt, storage, staging and dispensing of
pharmaceuticals during mass medical emergencies within local health department jurisdiction.
15. Assess and report the training needs of the LHD staff based upon internal assessment of competencies
and participate in the development and implementation of the MDCH Crisis Communication manual.
16. Actively participate and represent local public health interests in Regional Advisory Meetings.
17. Participate in at least 7 of the 9 teleconferences/monthly meetings with the OPHP BT Coordinator.
18. Attend 2 of the 3 conferences hosted by the OPHP BT Coordinator.
19. Attend at least 9 Regional Advisory Meetings.
20. Provide semi-annual progress reports to OPHP BT Coordinator.
SNS Planner Workspace
For those local health departments receiving additional funds to provide workspace for SNS Planners, the
contractor must provide adequate office space, supplies and materials, telephone connections, and high-speed
Internet access. The position must also have access to fax and photocopiers. Funding can be used to provide
additional clerical support.
BIOTERRORISM — FOCUS AREA B
Regional Epidemiology Workspace -
For those local health departments receiving additional funds to provide workspace for Regional
Epidemiologists, the contractor must provide adequate office space, telephone connections, and high-speed
Internet access. The position must also have access to fax and photocopiers.
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BIOTERRORISM — FOCUS AREA E
Michigan Health Alert Network - Communications & Information Technology
The new Michigan Health Alert Network (MIHAN) can be accessed and its alerting functionally utilized through a
slower Internet connection like that provided by the WAN or a phone line, dial-up ISP. However, the MIHAN will
include a number of features like document sharing that will function much more efficiently with a higher speed
connection to the Internet. Besides the MIHAN, MDCH will be implementing the Internet based Michigan
Disease Surveillance System (MOSS) in the fall of 2003.
Budget and Agreement Requirements:
1. LHDs that do not have high speed, broadband connections to the Internet must use their grants to
upgrade their Internet connections. If the cost of upgrading the Internet connections and firewalls is less
than the amount of the grant the remainder may be used for other IT and communications initiatives
consistent with the Focus E grant funding and any guidance developed by the Health Alert Network
Steering Committee.
2. LHDs already having high speed, broadband connections to the Internet can use funds for other IT and
communication initiatives consistent with the Focus E grant funding and any guidance developed by the
Health Alert Network Steering Committee.
Contractor Specific Requirements:
1. The optimum solution will be obtaining service through an Internet Service Provider (1SP) that is capable
of delivering a T1 circuit of 1.54Mbps or greater capacity. Examples of1SP providers that can meet this
standard include Merit, SBC, MCI, Sprint, and Verizon. (LHDs should consider whether the costs of a
Ti connection can be supported without Health Alert Network grant funding in future years.)
2. In multi-county LHDs, Internet connectivity solutions which provide more locations with high speed,
broadband connections than a single Ti at one location should be carefully considered. LHDs who find
1SP's that provide high speed broadband connections other than T1 lines which meet their needs and
can be funded in future years may use their grant monies for these connections.
3. A plan that describes the Internet connectivity solution and other IT and communication initiatives
including the cost must be submitted to and approved by Bill Colville, Health Alert Network Coordinator,
colvillebmichiqan.qov prior to expenditure of funds.
4. All LHDs should have a back-up connection to the Internet in case their primary connection fails in an
emergency situation. This back-up Internet connection can be a reliable dial-up ISP who provides
service in their health jurisdiction.
5. Purchase, install, configure and maintain an appropriate firewall based on the Internet connection at a
particular location. Firewall description and cost should be part of the information submitted to Bill
Colville.
6. Send an E-mail to E-helpdeskmichiqan.qov prior to beginning service with the ISP. The E-mail should
detail when the local health department will be getting a connection to the Internet so that DIT can
coordinate changing the health department's connection to the state network to the LGNET.
CSHCS SPECIAL REQUIREMENTS
I.
CSHCS OUTREACH AND ADVOCACY REQUIREMENTS
Contractor Requirements
A. Program Representation and Advocacy
I. Provide program representation which includes the provision of information regarding
Children's Special Health Care Services (CSHCS) policy on diagnostic referrals,
program eligibility, covered services, CSHCS Special Health Plan (SHPs), prior
authorization, and the appeals process to providers, the community, other agencies and
families.
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2. Inform families of their rights and responsibilities in the CSHCS program.
3. Describe special CSHCS programs to families which are outside the scope of covered
services but unique to the program, such as the Children with Special Needs (CSN)
Fund and the insurance premium payment program.
4. 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.
5. 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.
6. Participate in community health assessments and community systems reform initiatives.
Facilitate the direct participation of families in these processes.
7. Work collaboratively with the CSHCS SHPs to provide information to the local provider
community and solicit participation in the health plan provider networks.
B. Application and Renewal
1. Arrange for diagnostic evaluation referrals or obtain Release of Information form(s) for
the purpose of securing medical reports for determining medical eligibility in new and
renewal cases.
2. 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.
3. 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).
4. Assist in locating individuals or families who do not return a CSHCS Application after
being made medically eligible.
5. Assist in locating individuals or families who do not respond when requested to make a
health plan choice.
Support Services
1. Link families to the CSHCS Parent Participation Program, Family Phone Line or to the
Family Support Network.
2. Link families to Michigan Enrolls for assistance in CSHCS health plan selection.
3. Link families to Special Health Plan member services offices for health plan questions.
4. Provide consultation and work collaboratively with the CSHCS Special Health Plans to
identify and facilitate linkages and referrals to community-based agencies and
resources.
5. Provide care coordination services.
D. General Performance Requirements
1. All LHD/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.
2. LHD/CSHCS staff are expected to contact families when a referral is made or when the
Customer Support Section initiates a "Notice of Action" request to locate or assist a
family.
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2. Case Management
Families eligible for case management services typically have complex medical care and/or complex
psycho-social situations which require that intervention and direction be provided by an outside,
independent professional. Eligible beneficiaries include but are not limited to the Private Duty Nursing
(PDN) population. Case management requires the development of a comprehensive care/service plan
meeting the minimum elements as determined by MDCH/CSHCS. All services must relate to
objectives/goals documented in the comprehensive plan of care. For persons enrolled in a Special
Health Plan (SHP), local health department staff must be authorized by the SHP to provide the services.
Case management will be reimbursed through the CPBC/FSR system. Case management will be
based on the "fixed unit rate" method. The fee for case management is $201.58 per service which
requires that services be provided in the home setting (or other settings based on family preference),
and be provided face-to-face. Case management service reimbursement includes the costs of travel,
planning, documentation, completion of a Home Environment Needs Survey (see attached) and service
coordination. Case management cannot be billed for beneficiaries also receiving Level I/IHCP or Level II
Care Coordination services during the same billing period.
To be reimbursed, costs associated with the services rendered must be included on the CSHCS Case
Management and Care Coordination Supplemental Attachment to the CPBC FSR. Total costs for Case
Management should be included on line 24 of the FSR as "CSHCS Case Management" and should
reconcile with the costs detailed on the Supplemental Attachment for Case Management.
Clients are eligible for a maximum of six (6) services per eligibility year. PDN clients must receive a
minimum of four (4) services per eligibility year. Any services above six would require approval by
MDCH by sending a detailed request including documentation and the rationale for additional services
to:
Michigan Department of Community Health
Customer Support Services Section
P.O. Box 30734
Lansing, MI 48909
Documentation of the types of activities, the staff involved and the resolution must be maintained in the
client's case file. Local CSHCS offices must maintain documentation on a paper or computer log for all
case management services. This documentation must include at a minimum: beneficiary name,
CSHCS ID number, date(s) of service, date of the FSR and Supplemental Attachment on which the
services were billed, and SHP name and authorization date for SHP enrollees.
3. Care Coordination Services
Care coordination services are reimbursed as part of the CPBC contract as a "Fixed Unit Rate
Reimbursement." Care coordination will be provided by qualified LHD/CSHCS staff who are registered
nurses, social workers, or para-professionals, under the direction and 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.
There are two levels of coordination services
Level I Care Coordination
Level II Care Coordination
A. 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). IHCPs are developed or renewed on an annual basis. Care Coordination for
beneficiaries in a SHP are authorized by the SHP of enrollment.
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Level I Care Coordination activities are to be provided by qualified LHD/CSHCS staff 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. Fixed unit reimbursement rates are as follows:
Initial IHCP Long Form:
Initial 1HCP Short Form:
Renewal IHCP Long Form:
Renewal IHCP Short Form:
$200.00
$150.00
$100.00
$90.00
B. Level 11 Care Coordination consists of interaction with the beneficiary/family and others
involved with care of the beneficiary by telephone, in person or in writing that meet Level II Care
Coordination criteria. Level 11 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, facilitating transitional services to Medicaid
Health Plan process for CSHCS/Medicaid beneficiaries at age 21 and processing CSN Fund
applications. In addition, these services: 1) are non-routine; 2) involve multiple contacts; and 3)
are substantive. Each CSHCS Special Health Plan is the authorizing agent for their enrollees.
Level II Care Coordination is reimbursed at $30.00 per unit. A maximum of 10 units per
beneficiary per eligibility year will be reimbursed.
C. Authorization, Billing and Documentation Procedures for LevellandlICare 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. A supplemental attachment to the FSR, as provided by the program, is
required for reimbursement. Total costs for Care Coordination should be included on Line 24 of
the FSR and labeled "CSHCS Care Coordination." Level II Care Coordination is specific to care
coordination activities not involving the development of an Individualized Health Care Plan
(IHCP).
Local CSHCS offices must maintain documentation on a paper or computer log for all Care
Coordination. This documentation must include: beneficiary name, CSHCS ID number, date(s)
of service, date of the FSR and Supplemental Attachment on which the services were billed and
the SHP name and authorization date for SHP enrollees.
4. Reporting Requirements
A. CSHCS Outreach and Advocacy Plan Instructions
Using the following format, please prepare a plan that reflects the requested information
and submit by November 1, 2003 (address at end of document):
1. Describe as objectives the specific activities that will be carried out using the CSHCS
Outreach and Advocacy fund, including at a minimum the efforts that will be made to
involve other community-based organizations in identifying families with CSHCS-eligible
children.
2. Describe strategies and resources to be used:
a. to provide additional CSHCS Program information and information about
other community resources to families who have chosen the Basic Health
Plan (NOA 2-A) or families who live in a county without a health plan choice
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b. to communicate with families who have not returned the CSHCS enrollment
application (NOA 2-B)
c. to provide follow-up to families enrolled in CSHCS who have not a health plan
choice (NOA 2-C)
d. to communicate with families the need to submit necessary medical or
financial information for the purpose of renewing enrollment (NOA 2-D)
B. CSHCS Outreach and Advocacy Annual Report
An annual narrative report including information is due on October 30, 2004. (address at
end of document)
1. Describe the Program Representation and Advocacy activities conducted with children
eligible and/or enrolled in CSHCS as specified in the Contractor Requirement section of
this document. Include actions taken to work collaboratively with agencies and provider
networks. Describe successes, areas of need, and challenges experienced in carrying
out this expectation.
2. Describe the Application and Renewal activities conducted as specified in the Contractor
Requirement section of this document. Describe successes, areas of need, and
challenges experienced in carrying out this expectation.
3. Describe the Support Services activities conducted as specified in the Contractor
Requirement section of this document. Describe successes, areas of need, and
challenges experienced in carrying out this expectation.
4. Describe the activities conducted under the General Performance Requirements section
of this document. Describe successes, areas of need, and challenges experienced in
carrying out the expectations.
a. Include the percentage of contacts based on the number of referrals. The
reporting of contacts means the number of people with whom the local CSHCS
offices communicated. Please describe the methods of communication (phone
contact, electronic or postal mail, face to face, etc).
b. Describe the successful methods used to contact the families and any needs for
technical assistance in contacting the families referred.
Submit plan and report to:
Sylvia Shepherd
Michigan Department of Community Health
CSHCS Plan Division
400 S. Pine Street — 7th Floor
Lansing, MI 48933
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.
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CHILDHOOD LEAD SPECIAL REQUIREMENTS
Contractor Requirements
1. Each funded entity will provide regional case management for a group of 58-60 children with blood lead
levels of 20 mg/dL. Case management for each region will encompass a number of counties and health
jurisdictions.
2. Each of three funded entities will provide primary prevention in the assigned regions. Primary prevention
activities will include actions that will require certified Lead Inspector/Risk Assessor status.
3. All funded agencies/individuals in the program will be required to participate in program evaluation.
4. CDC reporting and state-based data exercises will be required of all funded entities.
DIABETES OUTREACH NETWORK — BRANCH-HILLSDALE-ST. JOSEPH
COMMUNITY HEALTH AGENCY
Contractor Requirements
1. Maintain an independently located regional office as a non-competing, coordinating health
care/education resource for the counties within the network region. The office shall be equipped with an
"800" access telephone number, FAX, E-mail capability and computer equipment specified by the
department and as needed to carry out network functions.
2. Support a competent, on-site, core staff meeting the qualifications specified by the department. The
core staff will consist of a project director who manages the network program and budget, hires and
trains staff, and supervises all employees and consultant staff. Remaining staff shall include at least an
office manager, data analyst/manager and a diabetes educator. Additional staff may be hired by the
director. All funded staff must be qualified to meet the established standards for the Diabetes Outreach
Network.
3. Limit maximum of funding which may be retained by the fiduciary to the lesser of $15,000 or 5% of the
contractual amount.
4. Maintain an interdisciplinary advisory council which represents the major diabetes interests in the network
service region including consumers, and which will advise the project on goals, planning, policy, technical
issues, evaluation and project implementation.
5. Coordinate participation in the network among local health departments, other department-funded
diabetes projects and other agencies in the network service region.
6. By November 1, 2003, prepare and submit to the department for review and approval, the annual year
program plan for FY 03-04 including measurable goals and objectives for program planning,
implementation, and evaluation which are consistent with the Department's Federal grant and National
Diabetes Objectives.
7. Utilizing model language provided by the Department, annually develop subcontracts or letters of
agreement with providers for the purpose of providing quality diabetes care; providing diabetes in-
services for all professional staff; collecting data on each diabetes client served and improving care
based on the analysis of the collected data.
8. Provide each subcontract agency with a quarterly analysis of their client data.
9. Have DON representation at each MDON and MDON/MDCP meeting and on each MOON and
MDON/MDCP conference call.
10. Educate consumers, communities, health care delivery agencies, health care providers and legislators on
the importance of individual diabetes self-management, implementation of quality diabetes care and
education into the practices of health care providers and of the need to have sufficient funding to sustain
these network activities.
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11. Participate in the MDON/MDCP Michigan Nurses Association Continuing Education Approval Program to
provide continuing education credits to Nurses and Dietitians. Conduct at least six MDON CEAP
Educational presentations (EDI ) yearly and promote the use of the Independent Study Modules (ED2).
12. Collaborate and partner as needed with: National Kidney Foundation of Michigan, American Heart
Association, American Diabetes Association, Michigan Association of Health Plans, Michigan
Organization of Diabetes Educators, American Heart Association and other key partners.
13. Participate in National and State Initiatives including the CDC Flu/Pneumococcal Vaccination Campaign
and the National Diabetes Education Program.
14. Develop collaborative partnerships with all the Community Health Centers (CHC) in the DON region by
establishing contact with CHCs, promoting the MDON DCIP, and supporting participation in the national
Health Disparities Collaborative if needed.
15. Participate in the Consumer Initiatives such as "Joining People with Diabetes" and/or lay health educator
initiatives.
16. Develop strategies to work with:
A. People (adults, children, adolescents) who are at risk for diabetes or have pre-diabetes
(Impaired Glucose Tolerance)
B. Children/adolescents who have type 2 diabetes
C. Oral health and diabetes initiatives
17. Provide timely DON input and feedback on all department-initiated requests for MDON and MDCP
materials (such as program guidelines, evaluation data, policies/procedures, etc.)
18. Follow MDON/DCP policies/procedures as provided in the MDON Orientation and Procedure manual,
Strengthening Diabetes Care in Michigan, and/or other DCP directives.
19. Complete the Program Report Summary each quarter and submit to MDCH with quarterly reports.
Provide examples as needed of consumer awareness activities, professional education, advocacy efforts
and other pertinent activities.
FAMILY PLANNING/BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCCP)
JOINT PROJECT SPECIAL REQUIREMENTS
Contractor Requirements
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 (MBCIS) 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
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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 - 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. •
FETAL ALCOHOL SYNDROME (FAS) COMMUNITY PROJECT
(Delta-Menominee District Health Department, Kent County Health Department)
Contractor Requirements (Delta-Menominee District Health Department Only)
1. In accordance with the general purposes and objectives of this agreement will:
A. Maintain a FAS Advisory Committee to plan and help implement appropriate community
services.
B. Conduct activities to promote awareness and prevention of FAS, including distribution of
materials and provision of educational activities and trainings.
C. Conduct or facilitate outreach, prescreening and screening.
Contractor Requirements (Kent County Only)
1. In accordance with the general purposes and objectives of this agreement will:
A. Community Project:
1. Conduct activities to promote awareness and prevention of Fetal Alcohol Syndrome
(FAS), including distributing materials to 75 individuals, providing educational
presentations and trainings to 30 groups and coordinating a speakers' bureau for
youth education.
2. Maintain the Kent County FAS advisory committee through monthly meetings and
correspondence. The committee will plan and help implement appropriate
community projects.
3. Information on the use of FAS pre-screening tool will be included in 20 of the 30
educational presentations with the Healthy Kent 2010 Infant Health Implementation
Team Prenatal Care Core Concepts Subcommittee to initiate support for substance
abuse screening among pregnant women.
4. Assist with conducting a support group for families affected by FAS through the
provision of monthly meetings with childcare, continuing education opportunities for
support group members and the coordination of "Parenting Differently" classes. "
B. Consultant:
1. Convene and provide staffing to the statewide FAS Workgroup to building community
capacity for FAS awareness and prevention initiatives.
2. Publish a quarterly newsletter for FAS Community Projects and Diagnostic Clinics.
3. Arrange and provide consultation for Community Projects and Diagnostic Clinics.
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4. Participate in the semi-annual National Taskforce on FAS/FAE meetings to maintain
awareness of national FAS activities and support connections with the field's national
leaders.
Reporting Requirements (for both health departments)
1. Submit the following reports as required by the Contract Manager
A. Financial Status Reports (FSRs) as required in the Contract.
B. Six month progress report.
C. Year-end report on the year's activities toward meeting the objectives.
D. Notification by June 15 of anticipated under spending of grant monies.
Financial Reports shall be submitted as directed by the contract. Other reports, including six
month progress report, community presentation reports and year end report shall be
submitted to:
Cheryl Lauber
Michigan Department of Community Health
Division of Family and Community Health
P.O. Box 30195
Lansing, Michigan 48909
2. Shall permit the Department or its designee to visit and to make an evaluation of the project.
IMMUNIZATION ACTION PLAN SPECIAL REQUIREMENTS
Contractor Requirements
1. Adhere to all federal and state appropriation laws pertaining to use of programmatic funds.
2. Adhere to requirements set forth in the Omnibus Budget Reconciliation Act of 1993 and other related
documents pertaining to the Vaccines For Children (VFC) Program.
A. The VFC "Basic" Program serves only eligible children who meet the following criteria: are
enrolled in Medicaid, have no health insurance, are American Indian or Alaskan Native, are
served at a Federally Qualified Health Center (FQHC), a Rural Health Center (RHC) or a public
health clinic affiliated with a FQHC and are also under-insured.
B. Ensure state-supplied vaccines (VFC Expanded coverage) provided to your jurisdiction are
administered only to eligible children. This program allows for the immunization of children who
are underinsured and not served at a FQHC, RHO, or a public health immunization clinic
affiliated with a FQHC.
C. Ensure that all providers receiving vaccine from the state screen children for VFC eligibility.
3. Adhere to all Federal and Michigan Laws pertaining to immunization administration and reporting
including reporting to the MCIR.
4. Ensure that federally procured vaccine is administered to eligible children only.
5. Monitor any provider receiving federally procured vaccine at least once every 3 years, and preferable at
least once every 2 years.
6. Ensure attendance at two (2) Immunization Action Plan (IAP) meetings each year.
7. Submit original FSR's to MDCH on a quarterly basis.
8. Develop, implement, and submit program IAP Reports to the MDCH Immunization Program in
accordance with the following dates:
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Period Covered
10/01/2003 — 03/31/2004
04/01/2004 — 09/30/2004
Date Due
April 15, 2004
October 15, 2004
9. By February 15 of each year provide one copy of the provider enrollment and profile for each provider
who receives vaccine from the state. One profile should also be submitted summarizing the entire
population of children 18 years of age and younger by eligibility status for the health jurisdiction
10. By August 15, 2004 provide to MDCH/Immunization Program a budget and narrative justification for
each component of the immunization program. This budget justification must contain the following
information: personnel, fringe benefits, travel, supplies, equipment, contractual, and other incidental
and/or indirect costs.
11. Michigan Childhood Immunization Registry (MCIR) responsibilities:
A. Ensure that all immunizations administered to children born after December 31, 1993 by the
state, or by any agency or provider participating in any of the vaccine distribution programs
on behalf of the Contractor, are reported to the MCIR.
B. Ensure that all providers within the Contractor's 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.
12. The contractor implements Perinatal Hepatitis B program activities to prevent the spread of Hepatitis
B Virus (HBV) from mother to newborn.
A. Ensure that protocols for the Hepatitis B Perinatal activities are in place and adhered to
through collaboration between communicable disease and immunization divisions.
B. Report all Hepatitis B surface antigen (HBsAg) positive pregnant women to the state health
department.
C. Ensure that all susceptible infants, household and sexual contacts associated with women
who are HBsAg + are given appropriate doses of Hepatitis B vaccine series in a timely
manner, and they receive pre or post serology testing as recommended.
D. Ensure that infants, household and sexual contacts associated to HBsAg+ women receive
testing, vaccination, and support services.
13. Surveillance of vaccine preventable disease (VPD) activities:
A. Ensure that all reportable diseases are reported to MDCH in the time specified in the public
health code and appropriate case investigation is completed.
B. Conduct active surveillance when indicated (i.e. during an outbreak) and contact hospitals,
laboratories, and/or other providers on a regular basis.
14. School and Day Care Requirements:
A. Ensure that 100% of the schools are reported to MDCH by December 15 th and March 15th
of each year.
B. Ensure that 100% of the licensed childcare centers are reported to MDCH by February 15 th
of each year.
15. Adherence to accreditation standards is expected through the waived period for 2003.
16. Service Delivery:
A. Collaborate with public and private sector organizations to promote adult immunization
activities in the county:
1. Inform providers that pneumoccocal and influenza vaccine and their accompanying
administrative costs are Medicare covered benefits.
2. Provide and implement strategies for addressing the immunization rates of special
adult populations (i.e., college students, educator, health care workers, and child
care employees).
B. Assign an appropriate individual to serve as an immunization liaison for WIC.
Department Requirements
1. The department will receive and review IAP reports.
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2. Provide program direction and definition of Immunization Action Plan coordinator responsibilities.
. 3. Provide technical assistance in establishing and operating immunization action plans.
4. Provide supportive services and resource identification when needed.
5. Provide financial support for LHD and Community/ Migrant Health Centers for immunization in pocket of
need (PON) areas.
IMMUNIZATION — FIELD SERVICE REPRESENTATIVES SPECIAL REQUIREMENTS
(District Health Department #10, Marquette County Health Department, Saginaw County Health
Department, St. Clair County Health Department, VanBuren/Cass District Health Department)
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 and supplies, including, but
not limited to: a telephone, general office supplies, a computer with Pentium III processor or better, a
printer, a modem, a cellular telephone and a use of vehicle or reimbursement mechanism for
transportation unless otherwise arranged.
3. Make the Immunization Field Representative available to all local health departments in the assigned
jurisdictions to provide Immunization Program activities equitable and at the direction of the Department.
Refer to field representative responsibilities as defined and distributed to the contractor.
4. Provide for reimbursement for reasonable telephone charges incurred in the conduct of business by the
Immunization Field Representative unless otherwise arranged.
5. Provide reasonable reimbursement for any travel and subsistence expenses incurred by the
Immunization Field Representative necessary to the conduct of the Immunization Program. Travel will
include the annual National Immunization Conference or other professional immunization related
conferences, attendance at the MDCH Immunization staff meetings and trainings, and accreditation
visits made in other areas of the state.
Department Requirements
1. As financially feasible, provide necessary adjunct clerical services to the Immunization Field
Representatives for the duplicating/printing of materials and the packaging and distribution of these
materials.
2. Provide program direction and definition of Immunization Field Service Representative responsibilities.
IMMUNIZATION VFC PROVIDER SITE VISIT SPECIAL REQUIREMENTS
Budget and Agreement Requirements
The rate of reimbursement is $150 per site visit, not to exceed the maximum set for each individual
Contractor.
Contractor Requirements
1. The goal is to visit each recipient of state-supplied and federally funded vaccine at least once every
three years. More frequent visits are preferred. The minimum number of site visits to be performed
each calendar year by each Contractor is: 20 for Contractors with more than 20 providers receiving
federally funded vaccine and at least 80% of the total provider sites within jurisdictions with 20 or fewer
providers receiving vaccine from the Contractor.
2. The format of the site visit will be based on the site visit questionnaire distributed at the most recent Fall
IAP meeting and the guidance provided by the department. Completed site visit questionnaires will be
submitted to the MDCH/Immunization Program on a continuous basis.
3. Data from the MDCH/Immunization Program regarding the number of site visits will be used to reconcile
the request for reimbursement. The minimum number of site visits must be completed by March 31 to
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qualify. For additional detail on the program requirements, refer to the Resource Book for VFC
Providers and other guidance provided by the MDCH/Immunization Program in correspondence to
Immunization Action Plan (IAP) and Immunization Coordinators.
Department Requirements
1. The Department will provide payment annually based upon the fixed unit rate reimbursement
mechanism upon completion and submission of the questionnaires.
IMMUNIZATION — NURSE TRAINING REIMBURSEMENT SPECIAL REQUIREMENTS
Budget and Agreement Requirements
The rate of reimbursement is $100 per training session per day to the Contractor, upon completion and
submission of Provider Contracts and Report Forms. Reimbursement can only be made for one training
session per physician clinic site per year.
Contractor Requirements
1. Ensure that all Immunization Nurse Educators are trained as required by the Department.
2. Ensure that the Provider Contract and Report Form is complete and submitted to
MDCH/Immunization Program within 5 days after the presentation.
Department Requirements
The Department will provide payment annually based upon the fixed unit rate reimbursement mechanism
upon completion and submission of the Provider Contracts and Report Forms.
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:
A pregnancy test with a determination of the probable gestational stage of a confirmed 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 objectives 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.
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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 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 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 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.
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4. amplification specimens for chlamydia/gonorrhea 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 foodborne
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(s) 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. 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.
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:
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A. Perform tests for diagnosis of gonorrhea and chlamydia infections using a commercial nucleic
acid amplification assay and perform testing for detection of foodborne 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.
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 fora
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 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 May 15, 20.04 if more than 11,428 nucleic acid
amplification specimens will be performed.
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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 foodborne
disease outbreaks. Specimens will be processed within one hour of receipt if not in preservative, or
within 24 hours if preserved.
7. Administer the Region 3 in the Michigan Region Laboratory System.
A. Provide a qualified (as defined by CL1A) Technical Consultant for their region.
B. Technical Consultants will:
1. Assist the Laboratory Director in the administration of the operational needs of their
region.
2. Meet with local personnel from health departments on a regular basis including onsite
visits to major sites at least annually.
3. Act as a resource person to facilitate effective laboratory testing according to
accepted procedures and quality assurance guidelines.
4. Supply the laboratory procedures to the local site and instruct personnel in their use.
5. Assist in planning and participate in training exercises related to Regional Laboratory
procedures.
6. Review quality assurance procedures, quality control logs, assure adherence to
adopted procedures and evaluate corrective actions.
7. Review and perform competency evaluations, as needed.
8. Review and collate internal proficiency testing results and report scores to submitting
sites in a timely manner.
C. Provide information on specimen submission to local health jurisdictions to assure that
specimens are submitted to Agency regional laboratory, or nearest laboratory as determined
by the Department.
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 CL1A 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(s) 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.
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A.
B.
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.
13. Michigan Department of Community Health (MDCH):
Designate and assign personnel who meets the qualifications required as a high complexity
laboratory director in CLIA '88.
Laboratory Directors will:
1. Sign the appropriate CMS paperwork for CLIA certification for their region as needed.
2. Visit Agency Laboratory at least twice a year and participate in annual site
coordinator's meeting.
3. Be available for consultation to the Agency laboratory by telephone, email, and other
communication methods.
4. Provide laboratory guidelines, testing procedures, quality control methods and quality
assurance in accordance with CLIA requirements.
5. Review Quality Assurance program with attention to effective quality control activity
and corrective action.
6. Review and perform, as needed competency evaluations.
7. Review external proficiency testing results in a timely manner
8. Review and sign procedure manual(s) annually, and any new procedure prior to its
• implementation.
C. Notify Agency of funding changes for state supported testing initiatives
D. Provide training for state-funded initiatives.
E. Provide information on specimen submission to local health jurisdictions to assure that
specimens are submitted to Agency laboratory, or nearest Regional laboratory as
determined by the Department.
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 foodborne disease outbreaks as specified in items 5 and 6, and
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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.
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.
3. Provide the Bureau of Laboratories, the Bureau of Epidemiology, and the Divisions 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)
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- 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 May 15, 2004, if more than 16,258 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 foodborne
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.
8. Administer the Region 4 in the Michigan Region Laboratory System.
A. Provide a qualified (as defined by CLIA) Technical Consultant for the region.
B. Technical Consultants will:
1. Assist the Laboratory Director in administration of the operational needs of their
region.
2. Meet with the local personnel from health departments on a regular basis including
onsite visits to major sites at least annually.
3. Act as a resource person to facilitate effective laboratory testing according to
accepted procedures and quality assurance guidelines.
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4. Supply the laboratory procedures to the local site and instruct personnel in their use.
5. Assist in planning and participate in training exercises related to Regional Laboratory
procedures.
6. Review quality assurance procedures, quality control logs, assure adherence to
adopted procedures and evaluate corrective actions.
7. Review and perform competency evaluations as needed.
8. Review and collate internal proficiency testing results and report scores to submitting
sites in a timely manner.
C. Provide information on specimen submission to local health jurisdictions to assure that
specimens are submitted to Agency regional laboratory, or nearest laboratory as determined
by the Department.
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 rate for each swab
specimen and for each urine specimen for diagnosis of gonorrhea and chiamydia infection using a
commercial nucleic acid assay. Reimburse Contractor for 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(s) 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.
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13. Michigan Department of Community Health (MDCH):
A. Designate and assign personnel who meet the qualifications required as a high complexity
laboratory director in CLIA '88.
B. Laboratory Directors will:
1. Sign the appropriate CMS paperwork for CLIA certification for their region as needed.
2. Visit Agency Laboratory at least twice a year and participate in annual site
coordinator's meeting.
3. Be available for consultation to the Agency laboratory by telephone, email, and other
communication methods.
4. Provide laboratory guidelines, testing procedures, quality control methods and quality
assurance in accordance with CLIA requirements.
5. Review Quality Assurance program with attention to effective quality control activity
and corrective action.
6. Review and perform, as needed competency evaluations.
7. Review external proficiency testing results in a timely manner.
8. Review and sign procedure manual(s) annually, and any new procedure prior to its
implementation.
C. Notify Agency of funding changes for state supported testing initiatives
D. Provide training for state-funded initiatives.
E. Provide information on specimen submission to local health jurisdictions to assure that
specimens are submitted to Agency laboratory, or nearest Regional laboratory as determined by
the Department.
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 chlamydia infections using a commercial nucleic
acid amplification assay and perform testing for detection of foodborne 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.
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.
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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.
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 May 15, 2004 if more 14,859 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 foodborne
disease outbreaks. Specimens will be processed within one hour of receipt if not in preservative or
within 24 hours if preserved.
7. Administer the Region 2 in the Michigan Laboratory System.
A. Provide a qualified (as defined by CLIA) Technical Consultant for the region.
B. Technical Consultant will:
1. Assist the Laboratory Director in the administration of the operational needs of their
region.
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2. Meet with local personnel from health departments on a regular basis including onsite
visits to major sites at least annually.
3. Act as a resource person to facilitate effective laboratory testing according to accepted
procedures and quality assurance guidelines.
4. Supply the laboratory procedures to the local site and instruct personnel in their use.
5. Assist in planning and participate in training exercises related to Regional Laboratory
procedures.
6. Review quality assurance procedures, quality control logs, assure adherence to adopted
procedures and evaluate corrective actions.
7. Review and perform competency evaluations, as needed.
8. Review and collate internal proficiency testing results and report scores to submitting
sites in a timely manner.
C. Provide information on specimen submission to local health jurisdictions to assure that
specimens are submitted to Agency regional laboratory, or nearest laboratory as determined by
the Department.
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 CL1A 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(s) 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
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event. The Department will provide proficiency testing materials on a semi-annual basis and
funding for equipment necessary to perform Level B protocols.
13. Michigan Department of Community Health (MDCH):
A. Designate and assign personnel who meet the qualifications required as a high complexity
laboratory director in CLIA '88.
B. Laboratory Directors will:
1. Sign the appropriate CMS paperwork for CLIA certification for their region as needed.
2. Visit Agency Laboratory at least twice a year and participate in annual site
coordinator's meeting.
3. Be available for consultation to the Agency laboratory by telephone, email, and other
communication methods.
4. Provide laboratory guidelines, testing procedures, quality control methods and quality
assurance in accordance with CLIA requirements.
5. Review Quality Assurance program with attention to effective quality control activity
and corrective action.
6. Review and perform, as needed competency evaluations.
7. Review external proficiency testing results in a timely manner.
8. Review and sign procedure manual(s) annually, and any new procedure prior to its
implementation.
C. Notify Agency of funding changes for state supported testing initiatives
D. Provide training for state-funded initiatives.
E. Provide information on specimen submission to local health jurisdictions to assure that
specimens are submitted to Agency laboratory, or nearest Regional laboratory as determined by
the Department.
LEAD HAZARD REMED1ATION 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
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 LHRP in identifying and accessing private sector funding mechanisms for lead hazard
control activities.
C. Obtain and provide information on Healthy Homes issues.
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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 time for on-site supervision of
lead abatement contractors that are new to the program in your county and 25% of time for
on-site supervision of lead abatement contractors that are established within your county
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.
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C. Develop a lead-based paint hazard control activities performance report and closeout
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 warranty issues.
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.
Budaet 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 35 homes for the period.
Additionally, all contractors are required to appoint a full-time equivalent individual to provide all program
requirements as stated in this contract. The contractor will 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
CMI 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 (CSHCS) 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 MCH. 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 16 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 to determine and identify its MCH
needs.
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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.
Contractor 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., CSHCS Outreach & Advocacy, Child Health, Family
Planning, Immunization, Maternal & Infant Support, Healthy Kids Outreach & Advocacy, Oral Health, Prenatal
Care Clinic Services 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 the
Division of Family and Community Health.
Local MCH 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.
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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.
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; Tuberculosis 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."
Agency Requirements
1. 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.
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MICHIGAN ABSTINENCE PROGRAM (MAP) SPECIAL REQUIREMENTS —DISTRICT HEALTH
DEPARTMENT #10
Contractor Requirements
1. Objectives
A. The primary objectives under this agreement are outlined in the grant application submitted
by the Contractor and on file at the Department with the MAP Community Health consultant
at the Michigan Public Health Institute.
2. Conditions
A. Will follow the criteria outlined in the current MDCH appropriation act governing abstinence
education funding, and will work within the framework of the Michigan Abstinence
Partnership (MAP) Program guidelines/requirements.
B. No contraceptives may be distributed to minors and no safer sex message/information may
be delivered within either state funding or the local matching dollars.
C. The community selected abstinence education and parent education curricula must be prior
approved by the MDCH/MAP to assure compliance with state and federal regulations.
D. Funding
1. Funds will be released pending receipt/agreement of all required workplan revisions.
E. Other Conditions
1. Project activities will comply with the abstinence education definition in Section 510 of
Title V of the Social Security Act.
2. MDCH's appropriation boilerplate will be followed.
3. Federal funds will not be expended for sectarian instruction, worship, prayer or
proselytization in project activities. If a grantee is a faith-based or religious
organization and offers such activities, these activities shall be voluntary for the
individuals receiving services and offered separately from MAP.
4. Any discussions of other forms of sexual conduct or provision of services will be
conducted in a setting different from where and when the abstinence-only education
is being conducted.
5. The Contractor will work with the MAP Evaluation consultant to develop effective
evaluation tools including a required set of standardized questions to be supplied by
MDCH/MAP.
3. Reimbursement Method
The Contractor will be reimbursed in accordance with the performance reimbursement mechanism
as follows:
Must meet projected performance output measures in order to receive full reimbursement of costs
(net of program income and other earmarked sources) as long as at least a 35% match (hard or
soft) is met, up to the contracted amount of state funds. If performance falls short of the
expectation, the state maximum allocation will be reduced equivalent to actual performance.
Outputs are projected on designated MDCH form.
4. Submit the following reports as required:
A. Prepared quarterly narrative Performance/Progress Reports. Unduplicated and duplicated
counts must be submitted not later than fifteen (15) days after the close of each quarter.
January 15, 2004, April 15, 2004, and July 15 2004. The year-end report, which includes
both the last quarter and an annual summary is due October 30, 2004. Include a copy of the
most recently submitted Financial Status Report (FSR).
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Submit to the Community Health Consultant at:
Michigan Public Health Institute
2438 Woodlake Circle, Suite 240
Okemos, Michigan 48864
B. Final actual outputs are due no later than 120 days following the end of the fiscal year.
Report on designated MDCH form. Submit to:
MAP Coordinator
Michigan Department of Community Health
P.O. Box 30195
Lansing, Michigan 48909
MICHIGAN CHILDHOOD IMMUNIZATION REGISTRY (MCIR) REGIONAL SPECIAL REQUIREMENTS
(Public Health Delta and Menominee Counties, District Health Department #10, Genesee County Health
Department, Kalamazoo County Health Department, Mid-Michigan District Health Department,
Muskegon County Health Department)
Budget and Agreement Requirements
None specified
Contractor Requirements (Muskegon County Only)
1. Support the statewide scanner, fax server, and any other related systems that 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 scan forms and Teleform
software.
3. Provide data quality and data entry support staff for scan center services.
4. Provide monthly reports to regions and MDCH on doses entered per user.
Contractor Requirements (All Others)
1. Conduct reminder/recall 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. Develop strategies to encourage all providers to fully participate with the MCIR.
4. Duplicate and distribute MCIR materials 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. Ensure that records submitted via paper forms are entered in a timely fashion and according to
Department approved procedures.
9. Conduct ad hoc reporting and querying on behalf of MCIR users.
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10. Monitor infant death announcements in the region that appropriately mark MCIR records. Develop a
mechanism to ensure the records of children who have died in the region are appropriately flagged
in the MCIR.
11. Conduct regular de-duplication activities to ensure that duplicate records are removed from the
MCIR as quickly as possible.
12. Process user petitions to change MCIR data according to Department approved procedures.
13. Hold advisory group meetings on at least a quarterly basis to set regional policy and set regional
implementation and maintenance priorities.
14. Monitor ongoing immunization data submission for all local health departments and private
providers.
15. Conduct training functions as needed to ensure that local health department staff can provide
assistance to providers on how to access and submit data into the MCIR.
16. Maintain a policy/procedure manual, approved by the regional advisory group and the department.
17. Process and file all "opt out" forms according to Department approved procedures.
18. Attend regular MCIR regional Contractor/coordination meetings.
19. Perform quality assurance checks on the MCIR data for the region as prescribed by the Department.
20. Assist local health departments and private providers with methodologies to "clean up" their data.
21. Conduct training functions as needed to ensure that staff in private provider offices receive
education and training on how to access and submit data into MCIR.
22. The Contractor shall submit quarterly status reports on the progress of this program, as well as a
quarterly report showing all in-kind expenditures for each of the counties within the region. 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, MI 48909
Phone: (517) 335-8159
23. The Contractor shall permit the Department or its designee to visit and to make an evaluation of the
project as may be indicated or requested.
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 (CBO) 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:
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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.
MICHIGAN TEEN OUTREACH PROGRAM (MTOP) — SHIAWASSEE COUNTY HEALTH DEPARTMENT
Contractor Requirements
1. The primary objectives are outlined in the grant application on file at the Department with the MTOP
Community Health and Evaluation Consultant.
2. No contraceptives may be distributed and no safer sex message/information maybe delivered. The
community-selected abstinence education and parent education curricula must be prior-approved by
MDCH/MTOP to assure compliance with state and federal regulations.
The annual plan must include a projected total performance output target (number of unduplicated
youth projected to be served by the program following MTOP guidelines). Projected performance
output must be met to receive full reimbursement of costs, up to the contracted amount of state funds.
3. An annual workplan must be submitted to MDCH and shall follow MDCH/MTOP
guidelines/requirements. Funds will be released pending receipt and approval of the workplan.
Workplan revisions must receive prior approval by MDCH and must be submitted within 30 days of the
effective date of change.
4. The Contractor must agree and abide by the following conditions:
A. Project activities will comply with the abstinence education definition in Section 510 of Title V of
the Social Security Act.
B. MDCH's appropriation boilerplate must be followed. -
C. Federal funds will not be expended for sectarian instruction, worship, prayer or proselytization in
project activities. If a grantee is a faith-based or religious organization and offers such activities,
these activities shall be voluntary for the individuals receiving services and offered separately
from the MTOP, which is funded under the SPRANS Community-Based Abstinence Education
project grant program.
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D. Any discussion of other forms of sexual conduct or provision of services will be conducted in a
setting different from where and when the abstinence-only education is being conducted.
E. The Contract will work with MTOP Community Health and Evaluation Consultant to develop
effective evaluation tools including a required set of standardized questions to be supplied by
MDCH/MTOP.
5. Performance/Progress reports: submitted quarterly
A. Quarterly reports submitted no later than January 15, April 15 and July 15. The year-end report
is due October 30.
B. Unduplicated and duplicated counts must be submitted no later than fifteen (15) days after the
close of each quarter. These counts must be included on designated forms for an unduplicated
and total encounters of clients serviced in MTOP. Year-End Performance Measure Tracking
form must be completed for the year and submitted with the October 30 year-end report.
C. Any other information as specified should be developed and submitted by the Contractor as
required by the Community Health and Evaluation Consultant or the Adolescent Health
Coordinator.
D. Performance/Progress Data Reports described in #1 above should be submitted to the
Adolescent Health Coordinator at the address below:
Michigan Teen Outreach Program
Michigan Department of Community Health
Division of Family and Community Health
P.O. Box 30195
Lansing, Michigan 48909
E. The Adolescent Health Coordinator and MTOP Community Health and Evaluation Consultant
shall evaluate the reports submitted as described in a and b above for completeness and
adequacy.
F. The Department or its designee shall conduct annual site reviews and make an evaluation of
the project as determined by the Program Coordinator.
G. Final actual outputs are due on January 31 st following the end of the fiscal year. The final output
reports shall be submitted to:
Adolescent Health Coordinator
Michigan Department of Community Health
Division of Family and Community Health
P.O. Box 30195
Lansing, Michigan 48909
NURSE FAMILY PARTNERSHIP (NFP) PROJECT — BERRIEN COUNTY HEALTH DEPARTMENT
Contractor Requirements
1. Adhere to the Nurse Family Partnership (NFP) National Office program standards.
2. NFP services are to be targeted to African Americans/Benton Harbor, Michigan.
3. Nursing staff needs to reflect the community served.
4. Submit all required reports in accordance with the Michigan Department of Community Health
reporting requirements.
Reporting Requirements
1. The Contractor shall adhere to the National Family Partnership (NFP) National Office program
reporting requirements and submit a copy to the Michigan Department of Community Health.
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2. Reports and information shall be submitted to:
Alethia Carr, Interim Director
Division of Family and Community Health
Michigan Department of Community Health
P.O. Box 30195
Lansing, Michigan 48909
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.
NOTE: agencies 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
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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.
RAPE AND SEXUAL ASSAULT PREVENTION EDUCATION SPECIAL REQUIREMENTS — KENT
COUNTY HEALTH DEPARTMENT
Contractor Requirements
1. Secure and forward subcontracts, if applicable (Oct-Jan.).
A. Submit subcontracts for two (2) Hispanic facilitators.
B. Submit subcontracts for nine (9) male facilitators.
C. Submit subcontracts for six (6) male co-facilitators.
2. Access primary target population (youth ages 12— 18 years).
A. Provide Project Respect at twelve (12) at-risk sites (Oct—June).
B. Provide Project Respect at nine (9) male-specific sites (Oct.-June).
C. Provide Project Respect at eight (8) Hispanic sites (Oct.-June).
D. Provide Project Respect at two (2) faith-based sites (Oct.-June).
3. Access secondary target populations (parents, school staff, community members, etc.)
A. Provide two (2) TOT workshops to FBO leaders, CB0 staff, community members, and
parents (Oct.-June).
B. Provide program updates to community trainers (Oct.-June).
C. Provide technical assistance to community trainers (Ongoing).
D. Provide four (4) presentations to parents and CB0 staff (Oct.-June).
E. Provide training assistance and educational resources for policy development (Ongoing).
4. Implement survey and evaluation tools/techniques.
5. Analyze primary target population data (ongoing). Data will demonstrate:
A. Statistically significant increase in sexual assault knowledge.
B. Statistically significant increase in positive attitudes.
C. 80% of participants will be satisfied with facilitators, content, and method of delivery.
6. Analyze secondary target population data (ongoing). Data will demonstrate:
A. Trainers: statistically significant increase in knowledge.
- B. Trainers: statistically significant increase in positive attitudes.
C. Trainers: improved facilitation skills.
D. Trainers: 80% will be satisfied with TOT facilitator(s), content and method of delivery.
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E. Presentation participants: statistically significant increase in knowledge.
F. Presentation participants: 80% will be satisfied with facilitator(s), content and method of
delivery.
G. Policy Development: at least 50 school/FBO/CBO contacts will be offered (Oct-June).
7, Conduct project review using evaluation data (Sept.)
8. Provide evaluation report to MDCH project officer, partners & other interested parties by October
15, 2004.
9. Participate in one (1) grantee meeting (dates/locations to be determined).
10. Investigate options to ensure project viability after September 30, 2005.
A. Disseminate project-related information and materials to FBOs and CBOs (Oct. —Dec.)
B. Develop partnerships resulting from TOT workshops (Ongoing).
Reporting Requirements
1. The Contractor shall submit the following reports on the following dates:
Financial Status Report (FSR)
Report 1 (Oct. 2003-Jan 2004)
Report 2 (Feb. 2004 — May 2004)
Comprehensive Final Report (Nov. 2003-Sept. 2004)
Evaluation Report
Monthly (Final FSR due -Nov. 30, 2004)
February 15, 2004
June 15, 2004
October 15, 2004
October 15, 2004
2. Any such other information as specified in the Contract Requirements shall be developed and
submitted by the Contractor as required by the Contract Manager.
3. Reports and information shall be submitted to the Contract Manager at: Grzywaczimichiqan.qov.
4. The Contract Manager shall evaluate the reports submitted for their completeness and adequacy.
5. The Contractor shall permit the Department or its designee to visit and to make an evaluation of the
project as determined by Contract Manager.
SIDS AND OTHER INFANT DEATH - SPECIAL REQUIREMENTS
Contractor Requirements
1. LHD personnel will maintain current expertise in infant death research, bereavement counseling and
surveillance techniques through educational in-service and/or personal professional development.
2. The LHD will update current curriculum and materials and child health programs to incorporate SIDS
and other infant death risk reduction information.
3. Facilitate bereavement support services to families and other caretakers of infants experiencing an
infant death.
4. Complete a referral to the Tomorrow's Child (formerly Michigan SIDS Alliance) for bereavement
literature and information on program activities.
5. Encourage all infant deaths to be reviewed in the local Child Death Review team process or Fetal-Infant
Mortality Review process (if available) to improve the consistency of death scene investigation, autopsy,
death certificate documentation and accurate SIDS diagnosis.
Department Requirements
1. Provide payment of $85 for each family support visit. A maximum of 6 visits is reimbursable per infant
death.
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2. Provide forms for referral to Tomorrow's Child (formerly Michigan SIDS Alliance) for documenting
family support visits and for ordering risk reduction literature.
3. Provide training for certification of family support providers.
4. Provide technical assistance for bereavement support through Tomorrow's Child (formerly Michigan
SIDS Alliance).
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.
Specific Requirements
1. Submit an enrollment form (DOT registration form) for each TB case (including cases transferred into the
county) enrolled in DOT to the MDCH 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 ll 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.
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.
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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.
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.
For specific WISEWOMAN Program requirements, refer to the WISEWOMAN Program Policies and
Procedures Manual issued November 2002. Updates to be issued September 2003.
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Oakland County Health Department FY 2003-2004 CPBC
AGREEMENT
MDCH Funding Allocations/Reimbursement Mechanisms Matrix
Attachment IV
Total (3) State (4) State Funded Minimum
MDCH Funding Reimbursement Performance Target Perform. Funded Target Performance Percent
Program Element/Funding Source (1) ' Source Amount Mechanism (2) Output Measurement Expect. Perform. Number(5)
Program for Local MCH to be determined based on plan After Program approval, applicable Local MCH funding will be incorporated under the program elements selected in the plan,
approval Local MCH $332,964 along with approved output performance measures, via amendment
AIDS/HIV Prevention Reg. Alloc. $457,220 Performance # Persons Post-Test * 90%
Counseled in Anonymous
or Confidential Public
Health Clinics
Bioterrorism Emergency Preparedness
Focus Area A
Preparedness Coordinator - Reg. Alloc. $100,000 Staffing (9) N/A N/A N/A N/A N/A
SNS Planner Work Space Reg. Alloc. $10,000 Staffing (9) N/A N/A N/A N/A N/A
Focus Area B
Regional Epid. Planner Work Space Reg. Alloc. $10,000 Staffing (9) N/A N/A N/A N/A N/A
Focus Area E
Information Technology Reg. Alloc. $19,000 Staffing (9) N/A N/A N/A N/A N/A
CSHCS Care Coordination Calc. Amt. Various Fixed Unit Rate N/A N/A N/A N/A N/A
(6),(10)
CSHCS Outreach & Advocacy Reg. Alloc. $151,600 Staffing (9) N/A N/A N/A N/A N/A
,
Immunizations
Immunization Action Plan Reg. Alloc. $516,439 Staffing (9) N/A N/A N/A N/A N/A
Imm. Nurse Training Calc. Amt. $100/each Fixed Unit Rate N/A N/A N/A N/A N/A
(10),(16)
VFC Provider Site Visits Calc. Amt. $150/each Fixed Unit Rate N/A N/A N/A N/A N/A
Vaccine Replacement/Handling Reg. Alloc. $100,381 Staffing (9) N/A N/A N/A N/A N/A
— Informed Consent Cab. Amt. $50/each Fixed Unit Rate N/A N/A N/A N/A N/A
(10),(16)
Laboratory Services
Focus Area C - Bioterrorism Lab Reg. Alloc. $155,992 Fixed Unit Rate N/A N/A N/A N/A N/A
(10),(16)
Lead Hazard Remediation Reg. Alloc. $80,000 Staffing (9) N/A N/A N/A N/A N/A
Local Public Health Operations
MDCH Reg. Alloc. $2,666,254 LPHO (7) N/A N/A N/A N/A N/A
MDA Reg. Alloc. $853,593 Performance % of Food Service N/A 75% N/A N/A
Licensees receiving
required inspections ,
Minority Health Reg. Alloc. $48,495 Staffing (9) N/A N/A N/A N/A N/A
------ Sexually Transmitted Disease (STD) Control Reg. Alloc. $109,696 Performance # Persons Examined or * 90%
investigated 1
TOTAL MDCH FUNDING $7,044,863
Oakland County Health Department FY 2003-2004 CPBC
AGREEMENT
MDCH Funding Allocations/Reimbursement Mechanisms Matrix
Attachment IV
Total (3) State (4) State Funded Minimum
MDCH Funding Reimbursement Performance Target Perform. Funded Target Performance Percent
Program Element/Funding Source (1) Source Amount Mechanism (2) Output Measurement Expect. Perform. Number(5)
SIDS Calc. Amt. $85 each Fixed Unit Rate N/A N/A N/A N/A N/A
(14),(16)
TB Control (DOT) Reg. Alloc. $53,016 Performance #of Active TB Cases * 90%
Completing Therapy — WIC
Resident Services Reg. Alloc. $1,380,213 Performance (11) #Average Monthly N/A * 97%
Participation
*SPECIFIC OUTPUT PERFORMANCE MEASURES WILL BE INCORPORATED VIA AMENDMENT
(3)
(4)
FOOTNOTES:
(1) Refer to Plan and Budget Framework for element definitions
(2) Refer to master comprehensive agreement and program and budget instructions package for further explanation of applicability of
these reimbursement mechanisms.
Negotiated starting from the average of the past two complete years actual number where available.
Calculated by multiplying the "Total Performance Expectation" column by the ratio of the elements total State funding (DCH 0410, Line
24) to "Total Expenditures" (DCH 0410, Line 17). Prior to calculation, adjustments will be made for unallowable cost, equipment
funded by local funds, and 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
1. Case Management
A. Maximum of six (6) services per year.
B. PUN Clients must receive a minimum of four (4) services per eligibility year
C. Reimbursement - $201.58 per service provided In the house setting and face-to-face,
2. LEVEL I CARE COORDINATION '
A. Initial 1HCP
1. Long Form $200 .
2. Short Form $150
B. Renewal 111CP
1. Long Form $100
2. Short Form $90
2. LEVEL It CARE COORDINATION
A. Level II Care Coordination is reimbursed at $30.00 per unit.
B. A maximum of 10 units per beneficiary per eligibility year will be reimbursed.
(7) Funding Source (not a single element).
(8) Subject to Statewide Maintenance of Effort requirement for Title X.
(9) Stale funding is first source (after fees and other earmarked sources).
(10) Fixed unit rate subject to actual costs.
(11) Performance reimbursement target will be the base target caseload established by MDCH.
(12) Subject to a match requirement (hard or in-kind) for $1 for each $4 of MDCH agreement funding.
(13) Fixed unit rate limited to contract amount.
(14) Up to six (6) visits per family
(15) Subject to match requirement (hard or in-kind) of 35% of MDCH agreement funding
(16) Reimbursement Chart for Fixed Rates
Immunization Nurse $100 per session, upon completion and submission of Provider Contracts and Report Forms. Reimbursement limited to
Training one training session per physician clinic site per year.
Immunization VFC
Provider Site Visits $150 per site visit, not to exceed the maximum set for each individual Contractor,
Informed Consent $50 per woman served, for each woman that expressly states that she is seeking a pregnancy test or confirmation of a
pregnancy for the purpose of obtaining an abortion and is provided the services.
$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.
Dental - Special Project Provide reimbursement for services provided to the target popiilation as stipulated in the Funding Announcement.
SIDS .$85 for each family support visit. A maximum of six (6) visits per infant death is reimbursable.
WIC Increased
Participation $8.50 per month for each planned additional participant in excess of the "Allocated Base Caseload."
NOTE: Some footnotes may not apply to this agency,
Laboratory Services -
STD & AIDS
Version:CPBC
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
FY 03/04 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.
III. Assurances
A. Compliance with Applicable Laws. This first sentence of this
paragraph will be stricken in its entirety and replace with the following
language:
The 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 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
Attachment I
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
FY 03/04 CPBC Agreement
INSTRUCTIONS
FOR THE
ANNUAL BUDGET
MDCH/CMS
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INSTRUCTIONS FOR THE
ANNUAL BUDGET
FOR LOCAL HEALTH SERVICES
TABLE OF CONTENTS
Page
I. INTRODUCTION 3
11. MINIMUM BUDGETING REQUIREMENTS 3
III. REIMBURSEMENT CRITERIA 4
IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION
PROCEDURES 8
V. FORM PREPARATION GENERAL 8
VI. FORM PREPARATION - EXPENDITURE CATEGORIES 9
VII. FORM PREPARATION - EXCLUSION ITEMS 10
VIII. FORM PREPARATION - NET ALLOWABLE EXPENDITURES FOR
LOCALISTATE LPHO FUNDING 12
IX. SPECIAL BUDGET INSTRUCTIONS
WIC 13
Family Planning 14
Breast and Cervical Cancer 15
CSHCS Outreach and Advocacy 17
Minority 17
Program Budget - Cost Detail Schedule (DCH-0387) Form Preparation - 17
r
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INSTRUCTIONS FOR THE
ANNUAL BUDGET
FOR LOCAL HEALTH SERVICES
I. INTRODUCTION
A new approach to comprehensive health services planning and budgeting was initiated by the Michigan
Department of Public Health, in 1986. The intent was to consolidate many of the Department's existing
categorical programs and state/local cost sharing (now LPHO funding) into a comprehensive agreement
for local health departments. The Department's Plan and Budget Framework serves as a principal
reference point for budget development.
The Annual Budget for Local Health Services is to be completed on a state fiscal year basis, and is used to
establish budgets for Local Public Health Operations (LPHO) and Categorical Grant Programs.
II. MINIMUM BUDGETING REQUIREMENTS
A. Cost Principles - Types or items of cost which will be considered for reimbursement are generally
consistent with definitions contained in Federal OMB Circular A-87.
B. Federal Block Grant Funds - Maternal & Child Health and Preventive Health Block Grant funds may
not be used to: provide inpatient services; make cash payments to intended recipients of health
services; purchase or improve land; purchase, contract or permanently improve (other than minor
remodeling defined as work required to change the interior arrangements or other physical
characteristics of any existing facility or installed equipment when the cost of the remodeling incident
does not exceed $2,000) any building or other facility; or purchase major medical equipment (any item
of medical equipment having a unit cost of over $10,000 and used in the diagnosis or treatment of
patients, excluding equipment typically used in a laboratory); satisfy any requirement for the
expenditure of non-federal funds as a condition for the receipt of Federal funds; or provide financial
assistance to any entity other than a public or nonprofit private entity.
C. Expenditure and Funding Source Breakdown - For purposes of development, analysis and
negotiation activities must be budgeted at the individual expenditure and funding source category
level on the Annual Budget for Local Health Services (DCH-0410).
D. Special Budget Requirements for Certain Categorical Program Elements - In addition to the
Annual Budget for Local Health Services (DCH-0410), a Program Budget-Cost Detail Schedule (DCH-
0387) must be submitted for all program elements (excluding Contractor Support).
E. Local MCH (previously M&IC and Local MCH Funds) - Local MCH funds can be used for general
Maternal Child Health (MCH) activity. These funds are to be budgeted as a funding source under any
of the appropriate program element(s) (i.e., CSHCS Outreach and Advocacy, Child Health, Family
Planning, Immunization, Maternal & Infant Support Services, SIDS, F1MR and Prenatal Smoking
Cessation). If an agency wants to utilize this funding for another purpose, approval must be obtained
from the Division of Family and Community Health. These funding sources cannot be used under the
WIC element except in extreme circumstances where a waiver is requested in advance of
expenditures, and evidence is provided that the expenditures satisfy all funding requirements. The
MCH activities should address the priorities identified in the community health assessment and
improvement process.
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III. REIMBURSEMENT CRITERIA
Funding under the Comprehensive Agreement can generally be grouped under four (4) different
mechanisms of reimbursement. These mechanisms are defined as follows:
A. Performance Reimbursement - A reimbursement mechanism by which local agencies are
reimbursed based upon the understanding that a certain level of performance (measured by outputs)
must be met in order to receive full reimbursement of costs (net of program income and other
earmarked sources) up to the contracted amount of state funds prior to any utilization of local funds.
Performance targets are negotiated starting from the last year's negotiated target and the most recent
year's actual numbers except for programs in which caseload targets are directly tied to funding
formulas/annual allocations. Other considerations in setting performance targets include changes in
state allocations from past years, local fiscal and programmatic factors requiring adjustment of
caseloads, etc. Once total performance targets are negotiated, a minimum state funded performance
target percentage is applied (typically 90% unless otherwise specified). If local Contractor actual
performance falls short of the expectation by a factor greater than the allowed minimum performance
percentage, the state maximum allocation for cost reimbursement will be reduced equivalent to actual
performance in relation to the minimum performance.
B. Fixed Unit Rate Reimbursement - A reimbursement mechanism by which local health departments
are reimbursed a specific amount for each output actually delivered and reported.
C. 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.
D. 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 and a source before any local funding requirements unless a
special local match condition exists.
The following chart notes elements/funding sources, applicable payment mechanisms, target levels and
output measures for each program/element having a performance reimbursement option:
MDCH/CMS
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REIMBURSEMENT CHART
Performance Performance
Program Element/ Reimbursement Level If Target Output
Funding Source) Mechanism(2) Applicable (3) Measure
AIDS/HIV Care
MHI Staffing(6) N/A
Ryan White Staffing(6) N/A
AIDS/HIV HOPWA Staffing (6) N/A
- AIDS/HIV Pediatric Staffing(6) N/A
AIDS/HIV Prevention Performance 90% # Persons Post-Test Counseled in
Anonymous or Confidential Public
Health Clinics
AIDS/HIV Provider Staffing N/A
Education
Bioterrorism (Focus areas
A, B, E, F, and G) Staffing (6) N/A
Breast & Cervical Cancer
Control
Coordination Performance) (9) 100% #Women Screened for Breast&
Cervical Cancer
CSHCS - Care Fixed Unit Rate) N/A
Coordination
CSHCS - Outreach &
Advocacy Staffing (6) N/A
Child Health Staffing(6) N/A
-
Childhood Lead - Service
Delivery Staffing(6) N/A
Diabetes Outreach Performance 90% #Unduplicated Persons Enrolled Network
Family Planning Services
General Services Performance) (8) 95% #Unduplicated Clinic Users Served
_
Family Planning/BCCCP
Joint Project
Coordination Performance (9x9) 100% # Women receiving cervical cancer
diagnostic services
Fetal Alcohol Syndrome
(FAS) Staffing (a) N/A
- Immunization
Field Service Reps Staffing(6) N/A
IAP Staffing (6) N/A
VFC Provider Site Fixed Unit Rate) N/A
Visits Nurse Training Fixed Unit Rate) N/A
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REIMBURSEMENT CHART
Performance Performance
Program Element/ Reimbursement Level If Target Output
Funding Source ) Mechanism(2) Applicable Measure
Informed Consent Fixed Unit Rate ) N/A
Laboratory Svcs./Bioterrorism Staffing (8) N/A
Lead Hazard Remediation Staffing
Local Tobacco Reduction Staffing (6) N/A
LPHO
MDCH LPHO(4) N/A
MDA Performance 75% Percentage of Food Service
Licensees receiving required
inspections
Maternal and Infant Support
Services (MSS/ISS) Staffing (6) N/A
Michigan Abstinence Program
(MAP) Performance(8) (12) N/A #Unduplicated users
Michigan Childhood
Immunization Registry (MCIR) Staffing(6) N/A
Michigan Teen Outreach
Program (MTOP) Performance(B) (12) N/A #Unduplicated users
Minority Health Staffing(6) N/A
Nurse Family Partnership Staffing(6) N/A
Oral Health Promotion Performance 90% #Children Provided Dental
Sealants
Primary Care
Medical Care Performance 90% #Unduplicated Persons Served
Dental Care Performance 90% #Unduplicated Persons Served
Special Projects Fixed Unit Rate)(1°)
Rape and Sexual Assault
) Prevention Education (RSAPE) Staffing(6 N/A
Sexually Transmitted Disease #Persons Examined or
(STD) Control Performance 90% investigated
SIDS Fixed Unit Rate (11) N/A
TB Control
Directly Observed Therapy Performance 90% Number of active TB cases (DOT) completing therapy
Vaccine Replacement/Handling Staffing (6) N/A .
W1SEWOMAN Project Performance (8) 90% #Women Screened for
Coordination Cardiovascular Disease Risk
Factors
MDCH/CMS
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(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
Footnotes:
Program element or funding source as applicable.
Refer to the master comprehensive agreement and the program and budget instructions package for further
explanation of applicability of these reimbursement mechanisms.
Performance percent for applicable programs.
Funding source (not a single element).
Subject to statewide maintenance of effort requirement for Title X.
State funding is first source (after fees and other earmarked sources).
Fixed unit rate subject to actual costs.
The performance reimbursement target will be the base target caseload established by MDCH.
Subject to a match requirement (hard or in-kind) of $1 for each $4 of MDCH agreement funding.
Fixed rate limited to contract amount.
$85 per visit, up to 6 visits per family.
Subject to match requirement (hard or in-kind) of 35% of MDCH agreement funding.
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IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION
PROCEDURES
As in past years, no additional accounting system detail is being required beyond local uniform accounting
procedures prescribed by the Michigan Department of Treasury, Local Financial - Management System
requirements, documentation requirements of categorical program funding sources and any local
requirements. Some agencies may already have separate cost centers in their accounting system to
directly identify costs and related funding of required services, but such breakdowns are not essential to
being able to meet minimum reporting requirements if proper allocation procedures are used and
adequate documentation is maintained. All allocations must have clearly measurable bases that directly
apply to the amounts being allocated, must be documented with work papers that will provide an
adequate audit trail and must result in a representative reporting of costs and funding for affected
programs. More specific guidance can be found in Federal OMB Circular A-87.
V. FORM PREPARATION - GENERAL
The Annual Budget for Comprehensive Local Health Services (DCH-0410) is utilized to provide a budget
summary for each program element administered by the local Contractor. The form is designed to
accommodate any number of local program elements including those unique to a particular local
Contractor. The form is designed to accommodate four (4) programs or elements per page. Use as
many pages as necessary to reflect all Contractor program elements and provide a grand total on the last
page of the budget.
The budget is to be prepared using the attached format. Agencies may produce their own computerized
version of the budget provided it is an accurate facsimile of the attached format. Otherwise, it will not be
accepted. Agencies producing facsimile budget formats should have no more than five columns per
page.
Each item of cost, revenue and exclusion is to be budgeted on an annual, state fiscal year basis. Form
heading instructions follow.
A. Page of - Enter the page number of this page and the total number of pages comprising the
Annual Budget for Local Health Services.
B. Local Contractor - Enter the name of the local Contractor.
C. Prepared By - Enter the name of the person preparing the form.
D. Date Prepared - Enter the date the form is prepared.
E. Agreement Period - Enter the budget period.
F. Approved By - The signature of the local health officer is to be entered in this space.
G. Date Approved - Enter the date of the local health officer's review and approval.
H. Program Element Columns - Enter the name of each program, project or service group using as
many columns as necessary.
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VI. FORM PREPARATION - EXPENDITURE CATEGORIES
Budgeted expenditures are to be entered for each program element, project or group of services by
applicable major category.
A. Salaries and Wages (Line 1) - This category includes the compensation budgeted for all permanent
and part-time employees on the payroll of the Contractor and assigned directly to the program. This
does not include contractual services, professional fees or personnel hired on a private contract basis.
Consulting services, professional fees or personnel hired on a private contracting basis should be
included in "Other Expenses." Contracts with secondary recipient organizations such as cooperating
service delivery institutions or delegate agencies should be included in Contractual (Sub-contract)
Expenses.
B. Fringe Benefits (Line 2) - This category is to include, for at least the specified elements, all
Contractor costs for social security, retirement, insurance and other similar benefits for all permanent
and part-time employees assigned to the specified elements.
C. Cap Exp for Equip & Fac (Line 3) - This category includes expenditures for budgeted stationary and
movable equipment used in carrying out the objectives of each program element, project or service
group. The cost of a single unit or piece of equipment includes necessary accessories, installation
costs, freight and other applicable expenses associated with the purchase of the equipment. Only
budgeted equipment items costing $5,000 or more may be reported under this category. Small
equipment items costing less than $5,000 are properly classified as Other Expenses (Supplies and
Materials). This category also includes capital outlay for purchase or renovation of facilities.
D. Contractual (Sub-contracts) (Line 4) - Use for expenditures applicable to written contracts or
agreements with secondary recipient organizations such as cooperating service delivery institutions or
delegate agencies. Payments to individuals for consulting or contractual services, are to be included
under Other Expenses. Specify subcontractor(s) address, amount by subcontractor and total of all
subcontractors.
E. Other Expenses (Line 5) - This category includes expenditures for other allowable costs incurred by
the Contractor for the benefit of each program element. The category includes costs described as
follows:
1. Supplies and Materials (Line 6) - Use for all consumable items and materials including
equipment-type items costing less than $5,000 each. This includes office, printing, janitorial,
postage and educational supplies; medical supplies; contraceptives and vaccines; tape and
gauze; prescriptions and other appropriate drugs and chemicals.
2. Travel (Line 7) - Travel costs of permanent and part-time employees assigned to each program
element. This includes costs of mileage, lodging and meals, and other approved travel costs
incurred by the employee. Travel of private, non-employee consultants should be reported under
Other Expenses.
3. Communication Costs (Line 8) - These are costs for telephone, internet, telegraph, data lines,
etc., when related directly to the operation of the program element.
4. County/City Central Services (Line 9) - These are costs associated with central support
activities of the local governing unit allocated to the local health department in accordance with
Federal OMB Circular A-87.
5. Space Costs (Line 10) - These are costs of building space necessary for the operation of the
program.
MDCH/CMS
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6. All Others (Line 11) - These are costs for all other items purchased exclusively for the operation
of the program element and not appropriately included in any of the other categories including
items such as repairs, janitorial services, consultant services, equipment rental, depreciation on
locally funded equipment, ADP systems, etc.
F. Total Direct Expenditures (Line 12) - Used to enter the total of the direct expenditures budgeted for
each program element, project or service grouping.
G. Admin. 0/H Cost, Rate (Lines 13 and 14) - Used to distribute costs of general administrative
operations that have not been directly charged to individual programs. The Indirect/ Administrative
Overhead Cost Rate is used for distribution of administrative costs to each program element, project
or service grouping. Two separate local rates may apply to the agreement period (i.e., one for each
local fiscal year). Line 13 should be used for the rate applicable to the first part of the agreement
period and line 14 for the latter part.
The amount of Admin. 0/H should be allocated to all appropriate program columns with the total
equivalent amount reflected as a credit or minus in the column(s) for Administration.
H. Total Direct & Admin. Expenditures (Line 15) - Enter the totals for each program column. This
would be the total of lines 12, 13 and 14.
I. Other Cost Distributions (Line 16) - This line provides for allocation of various contributing activity
costs to appropriate program areas based upon activity counts, time study supporting data or other
reasonable and equitable means. An example of cost distribution may be nursing supervision. The
distribution process permits costs reflected in a single program column to be subsequently distributed,
perhaps only in part, to other programs or projects as appropriate. If an allocation is made, the
charges must be reflected in the appropriate program columns and the offsetting credit reflected in the
program column being distributed. There must be a documented, well-defined rationale and audit trail
for any cost distribution or allocation based upon federal OMB Circular A-87 Cost principles.
Total Expenditures (Line 17) - Enter the total of each column (i.e., net of lines 15 and 16) after all
cost distributions have been made.
VII. FORM PREPARATION - EXCLUSION ITEMS
Budgeted exclusions are to be entered for each program element, project or group of services by
applicable major category as follows:
A. Fees & Collections - Fees 1 st & 2nd z Party (Line 18) - Enter (1 5t party) funds projected to be
received from private payers, including patients, source users and any member of the general
population receiving services. Also enter (2n d party) funds received from organizations, private or
public, who might reimburse services for a group or under a special plan.
B. Fees & Collections - 3rd Party (Line 19) - Third Party Fees - Funds projected to be received from
private insurance, Medicaid, Medicare or other applicable titles of the Social Security Act directly
related to the cost of providing patient care or other services (e.g., Includes EPSDT Screening, Family
Planning and Medicaid Cost-based Reimbursement).
J.
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C. Federal/State Funding (Non-MDCH) (Line 20) - Funds budgeted directly from the federal
government and from any state Contractor other than MDCH (such as DEQ). This line would also be
used to exclude state aid funds such as those provided through the Michigan Department of Treasury
under P.A. 264 of 1987 (cigarette tax). In addition, this line would include any federal Title XIX
participation (50%) of excess costs for eligible Medicaid administrative programs (such as CSHCS-
Outreach & Advocacy).
D. Local Non-LPHO (Line 21) - Local funds budgeted for the following expenditures:
1. Expenditures for services not designated as required and allowable for LPHO funding (e.g.,
medical examiner and inpatient maternity services); expenditures determined not to be
reasonable; and, expenditures in excess of the maximum state share of funds available.
2. Any losses arising from uncollectible accounts and other related claims. Under-recovery of
reimbursable expenditures from, or failure to bill, available funding sources that would otherwise
result in exclusions from LPHO funding if recovered.
However, no exclusion is required where the local jurisdiction has made and documented a
decision to have local funds underwrite:
a. the cost of uncollectible accounts or bad debts incurred in support of providing required or
allowable health services. An example of this condition would be for services provided to
indigents who are billed as a matter of procedure with little chance for receipt of payment.
b. potential recoveries or under-recoveries from other sources for the principal purpose of
providing required and allowable health services at free or reduced cost to the public served
by the Contractor. An example would be keeping fees for services at a reduced level for the
benefit of the people served by the Contractor while recognizing that to do so limits recovery
from third parties for the same types of services.
3. Contributions to a contingency reserve or any similar provisions for unforeseen events.
4. Charitable contributions and donations.
5. Salaries and other incidental expenditures of the chief executive of a political subdivision (i.e.,
county executive and mayor).
6. Legislative expenditures; such as, salaries and other incidental expenditures of local governing
bodies (i.e., county commissioners and city councils). Do not enter board of health expenses.
7. Expenditures for amusements, social activities and other incidental expenditures related thereto;
such as, meals, beverages, lodging, rentals, transportation and gratuities.
8. Fines, penalties and interest on borrowings.
9. Expenditure (Local) to Match State/Federal Funds - Local funds applied to meet match
requirements for state and federal funding (e.g., Substance Abuse, LHD
Infrastructure/Administrative Services, and Title XIX match for eligible Medicaid administrative
programs including Prenatal programs, EPSDT Outreach, CSHCS-LBS and Medicaid Cost-Based
Reimbursed clinical programs).
10. Capital Expenditures - Local capital outlay for purchase of facilities and equipment (assets) are
excluded from LPHO funding. Depreciation (expense) for such items, however, is allowable and
to be reported on line 11, Other Expenses.
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E. Other Non-LPHO (Line 22) - Funds budgeted from sources other than state, federal and local
appropriations to the extent that they are not eligible for LPHO (e.g., funding from local substance
abuse coordinating Contractor, local area Contractor on aging).
F. MDCH - NON-CPBC (Line 23) - Funds budgeted for services provided under separate MDCH
agreements. Examples include: funding provided directly by the Community Services for Substance
Abuse for community grants, etc.
G. MDCH - CPBC (Line 24) - This section includes all funding projected to be due under the
Comprehensive (CPBC) agreement. This funding is provided in multiple ways, some based upon a
fixed unit rate of reimbursement for services such as Vaccine Replacement/Handling and others on a
cost reimbursement basis.
Examples: Program Name - # svcs x - Enter for each applicable service covered by a fee or
rate for service, the program name, the number of services and the fixed unit rate per service with the
result of the calculation showing in the appropriate program element column.
Other CPBC - Enter other amounts due under the Comprehensive Agreement for each applicable
program element. Each separate source must be identified. Each page of the report may reflect a
different combination of funding sources on these lines, if needed. It is most important that each
different source of funding for each element be consistently and completely identified.
H. Total MDCH CPBC (Line 25) - Enter the total cumulative amount of the funding sources shown on
line 24 for each program element under the Comprehensive (CPBC) Agreement.
I. Total Exclusions (Line 261- Enter for each program element or column the total of lines 18 through
23 and line 25 to arrive at the total exclusions affecting LPHO funding.
VIII. FORM PREPARATION - NET ALLOWABLE EXPENDITURES FOR LOCAL/STATE LPHO FUNDING
A. Net Allowable Expenditures (Line 27) - Enter the difference between Total Expenditures (line 17)
and Total Exclusions (line 26) for each column.
B. State LPHO (Line 28) - Enter the total amount of state LPHO funds budgeted for each eligible
program element applied to Net Allowable Expenditures.
C. Local Funds-Other (Line 29) - Enter all local support in the appropriate element, project or service
group column. This may include local property tax, and other local revenues (does not include fees).
This amount is the difference between the State LPHO amount on line 28 and the Net Allowable
Expenditures on line 27. THE LPHO REQUIRED SERVICE PROGRAMS CANNOT HAVE A
NEGATIVE AMOUNT.
IX. SPECIAL BUDGET INSTRUCTIONS
Certain elements are supported by federal or other categorical program funds for which special budgeting
requirements are placed upon grantees and subgrantees. These include:
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Element Federal or Other Funding Contractor
WIC
Family Planning
Breast and Cervical Cancer
CSHCS Outreach & Advocacy
Minority Health
U.S. Department of Agriculture, Food & Nutrition Service
U.S. Department of Health & Human Services, Public Health
Service
U.S. Department of Health & Human Services,
Centers for Disease Control
Michigan Department of Community Health
Michigan Department of Community Health
In general, subgrantee budgets must provide sufficient budget detail to support grantee budget requests
and be in a format consistent with grantor Contractor requirements. Certain types of costs also must
receive approval of the federal grantor Contractor and/or the grantee prior to being incurred.
A. WIC Special Budget Requirements
1. Cost/Funding Categories - The following local budget breakdowns are required to fulfill WIC
grant application budget requirements each fiscal year:
Salaries & Fringe Benefits
Automated Management Systems
Space Utilization Costs
Equipment
Supplies
Communications & Travel
All Other Direct Costs
Indirect Costs
All Funding Sources By Type
The WIC cost/funding categories and supporting budget detail requirements are satisfied by
completion of a Cost Detail Schedule (DCH-0387) with the master budget. General
instructions for these forms are contained at the end of this section.
Funding for increased participation should be computed using the "Local Contractor
Participation Level Plan" worksheet.
2. Costs Allowable Only With Prior Approval - The following costs are allowable only with
prior review/approval of the Michigan Department of Community Health as specified by the
U.S. Department of Agriculture, Food and Nutrition Service (Ref.: 7 CFR Part 246, and
USDA-WIC Administrative Cost Handbook 3/86). Prior approval is accomplished by providing
appropriate detail in the budget request approved by MDCH or subsequently in a written
request approved in writing by MDCH.
A. Automated Information Systems - which are required by a local Contractor except for
those used in general management and payroll, including acquisition of automated data
processing hardware or software whether by outright purchase or rental-purchase
agreement or other method of acquisition.
B. Capital Expenditures of $2,500 or More - such as the cost of facilities, equipment,
including medical equipment, other capital assets and any repairs that materially
increase the value or useful life of capital assets.
C. Management Studies - performed by agencies or departments other than the local
Contractor or those performed by outside consultants under contract with the local
Contractor.
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D. Accounting and Auditing Services - performed by private sector firms under professional
service contracts for purposes of preparation or audit of program and financial
records/reports.
E. Other Professional Services - rendered by individuals or organizations, not a part of the
local Contractor, such as:
1. Contractual private physician providing certification data.
2. Contractual organization providing laboratory data.
3. Contractual translators and interpreters at the local Contractor level.
F. Training and Education - provided for employee development, which directly or indirectly
benefits the grant program, to the extent that such training is contracted for or involves
out-of-service training over extended periods of time.
G. Building Space and Related Facilities - the cost to buy, lease or rent space in privately or
publicly owned buildings for the benefit of the program.
H. Non-Fringe Insurance and Indemnification Costs
All charges to WIC must be necessary, reasonable, allowable and allocable for the
proper and efficient administration of the program. Further information and cost
standards are provided in federal instructions including OMB Circulars A-87, A-102
Common Rule, A-110 and 7 CFR Part 3015.
B. Family Planning Special Budget Requirements
1. Cost/Funding Categories - The following local budget breakdowns are required to fulfill
Family Planning grant application budget requirements each fiscal year:
Salaries & Wages
Fringe Benefits
Travel
Equipment
Supplies
Contractual
Construction
All Other Direct Costs
Indirect Costs
All Funding Sources By Type
The Family Planning cost/funding categories and supporting budget detail requirements are
satisfied by completion of a Cost Detail Schedule (DCH-0387) with the master budget.
General instructions for these forms are contained at the end of this section.
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2. Costs Allowable Only With Prior Approval - The following costs are allowable only with
prior review/approval of MDCH. Prior approval is accomplished by providing appropriate
detail in the budget request approved by MDCH or subsequently in a written request approved
in writing by MDCH.
A. Alterations and Renovations - to change the interior arrangements or other physical
characteristics of existing facilities or installed equipment, to the extent that such
changes cost more than $1,000 each.
B. Audiovisual Materials and Activities - acquired, produced, presented or disseminated to
the general public.
C. Consultant Contracts for General Support Services - including equipment and supplies,
that will cost in excess of $25,000 or 10% of the total direct cost budget (whichever is
greater).
D. Equipment - including general purpose and special equipment (e.g., air conditioning)
costing $5,000 or more per unit.
E. Insurance - contributions to a reserve for a self-insurance program.
F. Public Information Service Costs
G. Publication and Printing Costs - for the cost of publications.
H. Capital Expenditures - for land or buildings.
I. Indemnification Against Third Parties Costs - insurance against potential liabilities.
J. Mass Severance Pay - involving grant-supported personnel.
K. Organization/Reorganization Costs - allocable to the program.
L. Overtime Premium - involving grant-supported personnel.
M. Patient Care Costs - rebudgeting out of or reduction in patient care costs (considered a
change in scope).
N. Professional Services - in connection with Patent/Copyright Infringement Litigation.
0. Trailers or Modular Units
P. Transfers Between Construction and Nonconstruction - for approved construction funds.
Q. Transfers Between Indirect and Direct Costs - for amounts awarded for indirect costs to
absorb increases in direct costs.
R. Transfers for Substantive Programmatic Work - to a third party, by contracting or any
other means used for the actual performance of substantive programmatic work.
All charges to Family Planning must be necessary, reasonable, allowable and allocable for
the proper and efficient administration of the program. Further information and cost standards
are provided in federal instructions including OMB Circulars A-87, A-102 Common Rule and
A-110.
MDCH/CMS
4/03 Page 15 of 18
C. Breast and Cervical Cancer Control Program Special Budget Requirements
1. Breast and Cervical Cancer Control Program (BCCCP) budget is to be developed in the
following way:
One budget column, titled "BCCCP Coordination" should be used to budget costs associated
with coordination of the program. Only coordination expenses will be reimbursed through the
CPBC agreement.
All Direct Service claims including Case Management Reimbursement must be billed to the
Third Party Administrator (TPA) contracted with the state for Direct Service claim processing.
The Local Coordinating Agency (LCA) and/or direct service providers with contracts or letters
of agreement with the LCA will be responsible for billing Direct Service claims to the TPA. No
Direct Services or Case Management expenses will be reimbursed through the CPBC
Agreement.
The Coordination amount is $100 per woman based on a target caseload established by
MDCH. Performance reimbursement will be based upon the understanding that a certain
level of performance (measured by outputs) must be met. There is a 100% performance
requirement for this program. In addition, supplemental budget information must be provided
for required community match.
For specific TPA billing requirements refer to the Provider Billing Instruction Manual
issued in June 2002. For specific program requirements, including FY 200312004 Direct
Service Reimbursement Rate's and documentation related to Case Management
Reimbursement, refer to the FY 2003/2004 Special Budgeting and Other program
instructions for the BCCCP and Family Planning/BCCCP Joint Project issued in August
2003.
2. The Family Planning (FP)/BCCCP Joint Project budget is to be developed in the following
way:
One budget column, titled "FP/BCCCP Coordination" should be used to budget costs
associated with coordination of the program. Only coordination expenses will be reimbursed
through the CPBC agreement.
All Direct Service claims including Case Management Reimbursement must be billed to the
Third Party Administrator (TPA) contracted with the sate for Direct Service claim processing.
The Local Coordinating Agency (LCA) and/or direct service providers with contracts or letters
of agreement with the LCA will be responsible for billing Direct Service claims to the TPA. No
Direct Services or Case Management expenses will be reimbursed through the CPBC
agreement.
The Coordination amount is $50 per woman based on a target caseload established by
MDCH. Performance reimbursement will be based upon the understanding that a certain
level of performance (measured by outputs) must be met. There is a 100% performance
requirement for this project. In addition, supplement budget information must be provided for
required community match.
For specific TPA billing requirements refer to the Provider Billing Instruction Manual
issued in June 2002. For specific program requirements, including FY 2003/2004 Direct
MDCH/CMS
4/03 Page 16 of 18
Service Reimbursement Rates and documentation related to Case Management
Reimbursement, refer to the FY 2003/2004 Special Budget and Other Program
Instructions for the BCCCP and Family Planning/BCCCP Joint Project issued in August
2003.
3. The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN)
Project budget is to be developed in the following way:
One budget column, titled "WISEWOMAN Coordination" should be used to budget costs
associated with coordination of the program. Only coordination expenses will be reimbursed
through the CPBC agreement.
All Direct Service claims must be billed to the Third Party Administrator (TPA) contracted with
the state for Direct Service claim processing. The Local Coordinating Agency (LCA) and/or
direct service providers with contracts or letters of agreements with the LCA will be
responsible for billing Direct Service claims to the TPA. No Direct Services expenses will
be reimbursed through the CPBC agreement.
The Coordination amount is $105 per woman based on a target caseload established by
MDCH. Performance reimbursement will be based upon the understanding that a certain
level of performance (measured by outputs) must be met. There is a 90% performance
requirement for this project. There will be no match requirement for this project.
For specific TPA billing requirements refer to the Provider Billing Instruction Manual
issued in June 2002. For specific program requirements, including FY 2003/2004 Direct
Service Reimbursement Rates and documentation related to Case Management
Reimbursement, refer to the FY 2003/2004Special Budget and Other Program
Instructions for the WISEWOMAN Project issued in August 2003.
D. CSHCS Outreach and Advocacy - Funds related to CSHCS Outreach and Advocacy shall be
reflected as such under one column of the CPBC package.
E. Minority Health - Payments for Minority Health programs will require a hold back of 10% of grant
funds until receipt of final report in order to adjust for a one-twelfth prepayment. Funding will be
released upon the receipt and approval of the final report.
F. Program Budget - Cost Detail Schedule (DCH-0387) Form Preparation
Use the LHD - Program Budget - Cost Detail Schedule (DCH-0387) supplied by the Michigan
Department of Community Health. An example of this form is attached (see Attachment A) for
reference.
1. Program - Enter the title of the program.
2. Code - Enter a program code if applicable.
3. Budget Period - Enter the inclusive dates of the budget period.
4. Date Prepared - Enter the date prepared.
5. Page of - Enter the page number of this page and the total number of pages
comprising the complete budget package.
MDCH/CMS
4/03 Page 17 of 18
6. Local Contractor - Enter the name of the local Contractor.
7. Original or Amended - Check whether this is the original budget or an amended budget. If
an amended budget, enter the number of the amendment to which the budget is to be
attached.
8. Position Description - List all position titles or job descriptions required to staff the program.
9. Positions Required - Enter the number of positions required for the program corresponding
to the specific position title or description. This entry may be expressed as a decimal when
necessary. If other than a full-time position is budgeted, it is necessary to have a basis in
terms of time reports to support time charged to the program.
10. Total Salary - Enter the total salary for the positions required.
11. Comments - Enter any explanatory information that is necessary for the position description.
Include an explanation of the computation of Total Salary in those instances when the
computation is not straightforward.
12. Totals - Enter a total in the Positions Required column and the Total Salary column. The total
salary amount is transferred to the Program Budget Summary - Salaries & Wage category. If
more than one page is required, sub-totals should be entered on the last line of each page.
On the last page, enter the total amounts.
13. Fringe Benefits - Specify applicable ("X") for staff working in this program. Enter the
composite fringe benefit rate and total amount of fringe benefit.
14. Equipment - Enter a description of the equipment being purchased (including number of units
and the unit value), the total by type of equipment and total of all equipment.
15. Subcontracts - Specify subcontractor(s) working on this program, including the
subcontractor(s) address, amount by subcontractor and total of all subcontractor(s). Multiple
small subcontracts can be grouped (e.g., various worksite subcontracts).
16. Other Expenses - Enter amount by category and total for all categories. A specific
description is required for any item which exceeds 10% of total expenditures.
17. Other Cost Distributions - Enter a description of the cost, percent distributed to this program
and the amount being distributed.
18. Indirect Cost Calculation - Enter the base(s), rate(s) and amount(s).
19. Program Grand Total Exp. - Enter the total amount of all expenditures. Amount should
equal the amount entered on line 17 of the Annual Budget for Comprehensive Local Health
Services (DCH-0410).
MDCH/CMS
4/03 Page 18 of 18
FISCAL NOTE
BY: FINANCE COMMITTEE, CHUCK MOSS, CHAIRPERSON
IN RE: DEPARTMENT OF HUMAN SERVICES/HEALTH DIVISION - 2003/2004 COMPREHENSIVE
PLANNING, BUDGETING AND CONTRACTING (CPBC) AGREEMENT ACCEPTANCE
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS
Chairperson, Ladies and Gentlemen:
Pursuant to Rule XII-C of this Board, the Finance Committee has reviewed
the above-referenced resolution and finds:
1. The Michigan Department of Community Health (MDCH) has awarded
Oakland County Health Division funding in the amount of $7,044,863
for the period of October 1, 2003 through September 30, 2004. This
award reflects a 3.8% ($278,356) decrease from the FY2002/2003
amended funding allocation of $7,323,219.
2. Changes from the previous award have been made by the MDCH
including;
i) Funding for the continuation of an Emergency Preparedness
Specialist position in the amount of $100,000.
ii) Related Bio-terrorism funding to defray the costs of housing
the Regional Epidemiologist and SNS Planner, in the amount of
$20,000.
iii) An increase of $19,000 for Enhancement of communications
capabilities.
iv) Funding has been awarded to equip and staff the laboratory to
attain " Level B" status, which will allow the laboratory to
examine potential bio-terrorism related materials, an increase
of $13,234.
3. Acceptance of this grant does not obligate the County to any future
commitment.
4. The impact of this agreement was included in the FY 2004 Finance
Committee Budget. Therefore, no amendments are required.
FINANCE COMMITTEE
FINANCE COMMITTEE
Motion carried unanimously on a roll call vote with Moffitt and Gregory absent.
OAKLAND COUNTY HEALTH DIVISION
CPBC AGREEMENT FUNDING ANALYSIS (9/10/03)
• FY 2003/04
FY 02/03
Amended FY 03/04
FY 02/03 Fixed Unit Fixed Unit
Amended FY 03/04 Rate Rate Increase/
PROGRAM ELEMENT Allocation Allocation Allocation Allocation Decrease
Comprehensive Planning,
Budgeting & Contracting
Agreement (CPBC)
AIDS/HIV Prevention $373,743.00 •$457,220.00 $83,477.00
Bioterrorism Focus Area A
Bioterror Coordinator $129,104.00 $100,000.00 -$29,104.00
SNS Planner Workspace $0.00 $10,000.00 $10,000.00
Bioterrorism Focus Area B
Reg Epi Planner Workspace $0.00 $10,000.00 $10,000.00
Bioterrorism Focus Area C
Bioterror Lab $142,758.00 $155,992.00 $13,234.00
Bioterrorism Focus Area E
Info Tech $0.00 $19,000.00 $19,000.00
Childhood Lead $40,000.00 $0.00 -$40,000.00
Community Health Assessment $19,279.00 $0.00 -$19,279.00
Family Planning Model Project $54,444.00 $0.00 -$54,444.00
Hepatitis B $9/each $0.00
Immunization Action Plan $514,475.00 $516,439.00 $1,964.00
Immunization Nurse Train $100/each $100/each
Lead Hazard Remediation
Program $80,000.00 $80,000.00 $0.00
„
FY 02/03
• Amended FY 03/04
FY 02/03 Fixed Unit Fixed Unit
Amended FY 03/04 Rate Rate Increase/
PROGRAM ELEMENT Allocation Allocation Allocation Allocation Decrease
_ Maternal & Child Health Block
Grant (inc Maternal & Inf Supp
Srv & Child Health Conference) $332,964.00 $332,964.00 $0,00
CSHCS Outreach & Advocacy $151,600.00 $151,600.00 $0.00
•CSHCS Care Coordination various various $0.00
Maternal & Child Outreach &
Advocacy $58,656.00 $0.00 -$58,656.00
MINAS $151,338.00 $0.00 -$151,338.00
Minority Health $48,495.00 $48,495.00 $0.00
SIDS $70/each $85 each
STD Control $109,696.00 $109,696.00 $0.00
TB Control $65,591.00 $53,016.00 -$12,575.00
Vaccine Replacement/Handling $103,789.00 $100,381.00 -$3,408.00
VFC Provider Site Visits $150/each $150/each
Informed Consent $50/each $50/each
West Nile Virus $34,151.00 $0.00 -$34,151.00
WIC $1,380,213.00 $1,380,213.00 $0.00 ,
Subtotal CPBC $3,790,296.00 $3,525,016.00 -$265,280.00
Local Public Health Operations
(LPHO)
•MDCH $2,676,159.00 $2,666,254.00 , -$9,905.00•
MDA 1 $856,764.00 $853,593.00 -$3,171.00 _
Subtotal LPHO I $3,532,923.00 $3,519,847.00 _ -$13,076.00
I
TOTAL CPBC & LPHO t$7,323,219.00 $7,044,863.00 _ -$278,356.00
Percent Increase Increase (Decrease) i -3.80%
G. William Caddell, County Clerk
Resolution #03257 September 18, 2003
Moved by Patterson supported by Knollenberg the resolution be adopted.
AYES: Gregory, Hatchett, Jamian, Knollenberg, KowaII, Law, Long, McMillin, Middleton, Moffitt,
Moss, Palmer, Patterson, Potter, Rogers, Scott, Suarez, Webster, Wilson, Zack, Bullard, Coleman,
Coulter, Crawford, Douglas. (25)
NAYS: None. (0)
A sufficient majority having voted therefore, the resolution was adopted.
I IEREBY RESOLUTION
ORA /111111n-- 7/24/D)
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 18, 2003, with the original record thereof now remaining in my office.
In Testimony Whereof, I have hereunto set my hand and affixed the seal ofothe County of Oakland at
Pontiac, Michigan this 18th day of September, 2003.