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Resolutions - 2005.09.22 - 28037
41,44 GENERAL GOVERNMENT COMMITTEE MISCELLANEOUS RESOLUTION #05 207 September 22, 2005 BY: General Government Committee, William R. Patterson, Chairperson IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION - 2005/2006 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 $7,854,416, which is a 3.14% ($254,759) decrease from the Fiscal Year 2004/2005 amended allocation of $8,109,175; 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 2005 Budget when details are finalized; and WHEREAS this agreement is for the period of October 1, 2005 through September 30, 2006; and WHEREAS the CPBC Agreement has been submitted through the County Executive Review Process and is recommended for approval. NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners hereby accepts the 2005/2006 Comprehensive Planning, Budgeting, and Contracting (CPBC) agreement for funding in the amount of $7,854,416 for the period of October 1, 2005 through September 30, 2006. 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 Vote: Motion carried unanimously on a roll call vote. Pam Worthington From: Sent: Cc: Subject: Greg Givens [givensg©co.oakland.mi.us ] Friday, September 02, 2005 2:31 PM Frederick, Candace; Smith, Laverne; Mitchell, Sheryl; Pardee, Mary; Hanger, Helen; Wenzel, Nancy; Johnston, Brenthy; Worthington, Pam; Doyle, Larry; Fockler, Tom; Pearson, Linda GRANT REVIEW— Health Division GRANT REVIEW - Health Division GRANT NAME: FY 2005-2006 Comprehension Planning, Budgeting and Contraction (CPBC) Agreement FUNDING AGENCY: Michigan Department of Community Health DEPARTMENT CONTACT PERSON: Tom Fockler / 2-2151 STATUS: Acceptance DATE: September 2, 2005 Pursuant to Misc. Resolution #01320, please be advised the captioned grant materials have completed internal grant review. Below are the comments returned by review departments. Please note the comments from Management and Budget. These issues should be considered before submission to the Board for acceptance 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. Department of Management and Budget: Approved with the following clarifying information, There has been a reduction of approximately $390,000 in local public health operations reimbursement. I have discussed this funding reduction issue with Tom Gordon. As I understand it, the reduction is still being debated in the legislature, and the Michigan Association for Local Public Health is actively working to restore the funding. If the reduction is not restored, Tom Gordon has committed to identify offsetting expenditure reductions within the Health Division's budget in order to maintain a balanced budget. As a result of the uncertainty of the reduction (pending potential legislative action), it is recommended that formal approval and execution of this agreement by the Board of Commissioners be delayed until the September 22 Board meeting. If there are no changes to the current agreement offered by the State Department of Community Health, it still needs to be executed prior to October 1 in order to preserve the remainder of the funding in this agreement (this is a comprehensive agreement which provides funding for all contracted programs between Health and the MDCH).- Laurie Van Pelt (8/23/2005) Department of Human Resources: Approved. - Nancy Scarlet (8/26/2005) 1 Risk Management and Safety: Approved. - Gerald Mathews (9/1/2005) Corporation Counsel: After reviewing the CPBC Contract and discussing it with you and George Miller, I approve the Contract for signature. - John F. Ross (9/2/2005) Contract #: Agreement Between Michigan Department of Community Health hereinafter referred to as the "Department" and County of Oakland hereinafter referred to as the "Local Governing Entity" 1200 North Telegraph Road, Department 432 Pontiac, Michigan 48341-0432 38-6004876 hereinafter referred to as the "Contractor" for The Delivery of Public Health Services under araar.e.heraive_Elanniumaudgetinc Part I nd Contract (CPBC) Agreement 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, 2005 and continue through September 30, 2006. This agreement is full force and effect for the period specified. The Department has the option to assume no responsibility for costs incurred by the contractor prior to the signing of this agreement. MDCH/CMS 06/05 Page 1 of 24 3. Program Budget and Agreement Amount A. Agreement Amount: In accordance with Attachment IV - Funding/Reimbursement Matrix, the total State budget and amount committed for this period for the program elements covered by this agreement is $ 7,854,416. 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 C.1, including any related adjustment to the total state amount of the budget, must be made in writing through a formal amendment executed by all parties to this agreement in accordance with Section VIII. A. of Part II. 3. The C.1 and C.2 provisions authorizing transfers or changes in local funds apply also to the Family Planning program, provided statewide local maintenance of effort is not diminished in total. Any statewide diminishing of total local effort for family planning and/or any related funding penalty experienced by the Department shall be recovered proportionately from each local Contractor that, during the course of the agreement period, chose to reduce or transfer local funds from the Family Planning program. MDCH/CMS 06/05 Page 2 of 24 4. Agreement Attachments: A. The following documents are attachments to this Agreement Part I and Part II - General Provisions, which are part of this agreement through reference: 1. Attachment 1 - Annual Budget 2. Attachment II - Output Measures 3. Attachment III - Program Specific Assurances and Requirements 4. Attachment IV - Funding/Reimbursement Matrix B. The attachments are added into this Agreement as follows: 1. Original Agreement (Part I and Part II) - Attachment III, IV 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 part of this agreement through reference. 6. Method of Payments and Financial Reports: The payment procedures shall be followed as described in Part II and Attachment I - Annual Budget and Attachment IV - Funding/Reimbursement Matrix, which are part of this agreement through reference. 7. Performance/Progress Report Requirements: The progress reporting methods, as applicable, shall be followed as described in Attachments II - Output Measures and IV - Funding/Reimbursement Matrix, which are part of this agreement through reference. 8. General Provisions: The Contractor agrees to comply with the General Provisions outlined in Part II, which are 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) is: Rirhrr McCubbin CPBC Consultant. 517-241-2493 McCubbinRmichidan.dov (Contract Consultant Name) Title Phone E-mail Address MDCH/CMS 06/05 Page 3 of 24 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 COUNTY OF OAKLAND Name and Title Signature Date For the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH Nick Lyon, Deputy Director, Date Operations Administration MDCH/CMS 06/05 Page 4 of 24 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 3"d party fees, where applicable, and report these as outlined by the Department's fiscal procedures. Any underrecoveries of otherwise available fees resulting from failure to bill for eligible services will be excluded from reimbursable expenditures. C. Program Operation Provide the necessary administrative, professional, and technical staff for operation of the program. D. Reporting Utilize all report forms and reporting formats required by the Department at the effective date of this agreement, and provide the Department with timely review and commentary on any new report forms and reporting formats proposed for issuance thereafter. E. Record Maintenance/Retention Maintain adequate program and fiscal records and files, including source documentation to support program activities and all expenditures made under the terms of this agreement, as required. MDCH/CMS 06/05 Page 5 of 24 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. Audits 1. Single Audit Provide, consistent with the regulations set forth in the Single Audit Act Amendments of 1996, P.L. 104-156, and Section .320 of the Office of Management and Budget (OMB) Circular A-133, "Audits of States, Local Governments, and Non-Profit Organizations," a copy of the Contractor's annual Single Audit reporting package, including the Corrective Action Plan, and management letter (if one is issued) to the Department. The Contractor must assure that the Schedule of Expenditures of Federal Awards includes expenditures for all federally-funded grants. 2. Other Audits The Department or federal agencies, may also conduct or arrange for "agreed upon procedures" or additional audits to meet their needs. 3. Due Date The Single Audit reporting package, management letter, if one is issued, and Corrective Action Plan shall be submitted to the Department within nine months after the end of the Contractor's fiscal year. The Single Audit reporting package, management letter, and Corrective Action Plan shall be filed with the Department even if there are no findings or disclosures reported in the audit pertaining to Department programs. 4. Penalty Failure to submit the required Single Audit reporting package and management letter by the due date will result in the deferral of Department payments until the required Single Audit reporting package is received. MDCH/CMS 06/05 Page 6 of 24 5. Where to Send A copy of the Single Audit reporting package, management letter, if one is issued, and Corrective Action Plan must be forwarded to: Michigan Department of Community Health Office of Audit Quality Assurance and Review Section P.O. Box 30479* Lansing, Michigan 48909-7979 or *Capital Commons Center 400 S. Pine Street Lansing, Michigan 48933 As an alternative to paper filing, the audit report and related documentation may be submitted to the above address on a CD-ROM in a Portable Document Format (PDF) compatible with Adobe Acrobat (read only). The audit report and related documentation should be assembled as one document in the following order: a. Financial Statement Audit Report/Single Audit Report, b. Corrective Action Plan or other information as applicable to MDCH grants, and c. Management Letter (Comments and Recommendations). Another alternative is to send notification to the above address that the required audit materials may be accessed, in Adobe PDF, from the local agency website. 6. Management Decision The Department shall issue a management decision on findings and questioned costs contained in the Contractor's Single Audit within six months after the receipt of a complete and final audit report. The management decision shall include whether or not the audit finding is sustained; the reasons for the decision; and the expected Contractor action to repay disallowed costs, make financial adjustments, or take other action. Prior to issuing the management decision, the Department may request additional information or documentation from the Contractor, including a request for auditor verification related to the documentation, as a way of mitigating disallowed costs. MDCH/CMS 06/05 Page 7 of 24 H. SubrecipientNendor Monitoring The Contractor must ensure that each of its subrecipients comply with the Single Audit Act requirements. The Contractor must issue management decisions on audit findings of their subrecipients as required by OMB Circular A-133. The Contractor must also develop a subrecipient monitoring plan that addresses "during the award monitoring" of subrecipients to provide reasonable assurance that the subrecipient administers Federal awards in compliance with laws, regulations, and the provisions of contracts, and that performance goals are achieved. The subrecipient monitoring plan should include a risk-based assessment to determine the level of oversight, and monitoring activities such as reviewing financial and performance reports, performing site visits, and maintaining regular contact with subrecipients. The Contractor must monitor vendors for performance of contract requirements. 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. J. Software Compliance The Contractor must ensure that software compliance and compatibility with the Department's data systems for services provided under this agreement including but not limited to: stored data, databases, and interfaces for the production of work products and reports. All required data under this agreement shall be provided in an accurate and timely manner without interruption, failure or errors due to the inaccuracy of the Contractor's business operations for processing date/time data. K. 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 Institutional Review Board (IRB) for approval prior to the initiation of the research. L. Terms To abide by the terms of this agreement including all attachments. MDCH/CMS 06105 Page 8 of 24 M. 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. N. 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. 0. Maintenance of Effort All agencies shall comply with maintenance of effort requirements for LPHO, as defined in the current Department appropriation act, and Family Planning in accordance with federal requirements, except as noted in Section 3.C.3 of Part I. P. Accreditation 1. All 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. 2. Consent Agreement/Administrative Order/Administrative Hearings for "Not Accredited" Local Health Departments: a. If after 365 days from the conclusion of the On-Site Accreditation Review, the Corrective Action Plan is not complete and implemented and the Accreditation Commission has designated the Local Health Department to have a "Not Accredited" status, the Department will forward a Consent Agreement Package to the Local Health Department. b. If after 395 days from the conclusion of the On-Site Accreditation Review, the Local Health Department has not signed the Consent Agreement, a meeting between the Department and Local Health Department officials will occur. Local Health Department officials include the governing board and health officer. MIDCH/CMS 06/05 Page 9 of 24 c. If the Local Health Department complies with the Consent Agreement, the Local Health Department's Accreditation status will remain "Not Accredited" until the completion of the next Accreditation cycle for the Local Health Department. d. If after 440 days from the conclusion of the On-Site Accreditation Review the Local Health Department has not signed the Consent Agreement or if the Local Health Department does not comply with the signed Consent Agreement, an Administrative Order will be issued by the Department. e. After the Department has issued an Administrative Order, the Local Health Department may request an Administrative Hearing. f. The Department implements an Administrative Order or the Administrative Order resulting from the Administrative Hearing. g. The Administrative Order is filed in Circuit Court by the Department. Q. Medicaid Outreach Activities Reimbursement The Contractor agrees to report allowable costs and request reimbursement for the Medicaid Outreach activities it provides in accordance with OMB Circular A-87 and the requirements in Medicaid Bulletin number: MSA 05-29. The Contractor agrees to submit a Cost Allocation Plan Certification to the Department to bill for the Medicaid Outreach Activities. The Cost Allocation Plan Certification is valid until a change is made to the cost allocation plan or the Department determines it is invalid. The Contractor will submit quarterly FSRs for the Medicaid Outreach activities and an annual FSR for the Children with Special Health Care Services Medicaid Outreach activities in accordance with the instructions contained in Attachment I. II. Responsibilities - Department The Department in accordance with the general purposes and objectives of this agreement will: A. Payment Provide payment in accordance with the terms and conditions of this • agreement based upon appropriate reports, records, and documentation maintained by the Contractor. B. Report Forms Provide any report forms and reporting formats required by the Department at the effective date of this agreement, and to provide the Contractor with any new report forms and reporting formats proposed for issuance thereafter at least ninety (90) days prior to required usage to afford the Contractor an opportunity for review and commentary. MDCH/CMS 06/05 Page 10 of 24 C. Terms Abide by the terms of this agreement including all attachments. D. Notification of Modifications To notify the Contractor in writing of modifications to Federal or State laws, rules and regulations affecting this agreement. E. Identification of Laws To identify for the Contractor relevant laws, rules, regulations, policies, procedures, guidelines and State and Federal manuals, and provide the Contractor with copies of these documents to the extent they are not otherwise available to the Contractor. F. Modification of Funding To notify the Contractor in writing within thirty (30) calendar days of becoming aware of the need for any modifications in agreement funding commitments made necessary by action of the Federal Government, the Governor, the Legislature or the Department of Management and Budget on behalf of the Governor or the Legislature. Implementation of the modifications will be determined jointly by the Contractor and the Department. G. Monitor Compliance To monitor compliance with all applicable provisions contained in federal grant awards and their attendant rules, regulations and requirements pertaining to program elements covered by this agreement. H. Reimbursement To reimburse local agencies for costs based upon timely, accurately completed Financial Status Reports in accordance with Section IV. Technical Assistance To make technical assistance available to the Contractor for the implementation of this agreement. J. Health Insurance Portability and Accountability Act The Department assures that it will be in compliance with the Health Insurance Portability and Accountability Act. K. Accreditation 1. Adhere to the Accreditation processes including the processes for "Not Accredited" Local Health Departments. Processes will include developing and monitoring consent agreements, issuing and implementing administrative orders, participating in administrative hearings if requested by the Local Health Department and filing administrative orders in Circuit Court. MDCH/CMS 06/05 Page 11 of 24 2. Adhere to all Accreditation time lines and post Accreditation commission action time lines, especially the time line for approving corrective action plans within 30 days. L. Medicaid Outreach Activities Reimbursement The Department agrees to reimburse the Contractor for all allowable Medicaid Outreach activities that meet the standards of the Medicaid Bulletin: MSA 05-29 including the cost allocation plan certification and that are billed in accordance with the requirements in Attachment I. 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 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 MDCH/CMS 06/05 Page 12 of 24 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 persons with disabilities 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 persons with disabilities 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 obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in section 2, and; 4. Have not within a three-year period preceding this agreement had one or more public transactions (federal, state or local) terminated for cause or default. E. Federal Requirement: Pro-Children At 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 MDCH/CMS 06/05 Page 13 of 24 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. 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. MDCH/CMS 06/05 Page 14 of 24 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 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. 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. MDCH/CMS 06/05 Page 15 of 24 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). 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 amended, 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: MDCH/CMS 06/05 Page 16 of 24 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. 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. MDCH/CMS 06/05 Page 17 of 24 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. 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 1/30/XX, 4/30/XX, and 7/30/XX. All FSR's must be submitted to: Michigan Department of Community Health, Bureau of Finance, Accounting Division, P.O. Box 30720, Lansing, Michigan 48909-8220 FSR's must report total actual program expenditures regardless of the source of funds. The Department will reimburse the Contractor for expenditures in accordance with the terms and conditions of this agreement. Failure to comply with the reporting due dates will result in the deferral of the Contractor's monthly prepayment. MDCH/CMS 06/05 Page 18 of 24 E. Reimbursement Method The Contractor will be reimbursed in accordance with the reimbursement methods for applicable program elements described as follows: 1. Performance Reimbursement - A reimbursement method 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 method by which local health departments are reimbursed based upon the understanding that State dollars will be paid up to total costs in relation to the State's share of the total costs and up to the total State allocation as agreed to in the approved budget. This reimbursement approach is not directly dependent upon whether a specified level of performance is met by the local health department. Department funding under this reimbursement method is allocable as a source before any local funding requirement unless a specific local match condition exists. 3. Fixed Unit Rate Reimbursement - A reimbursement method by which local health departments are reimbursed a specific amount for each output actually delivered and reported. 4. LPHO - A reimbursement method by which local health departments are reimbursed a share of reasonable and allowable costs incurred for required services, as noted in the current Appropriations Act. F. Unobligated Funds Any unobligated balance of funds held by the Contractor at the end of the agreement period will be returned to the Department or treated in accordance with instructions provided by the Department. G. Fiscal Year-End 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 MDCH/CMS 06/05 Page 19 of 24 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 agreement 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: IPP final total contractor FSR and Outut Measures report (H-977) is due Jan!Ian/ 11 after the aareement period end date. WIC financial data reportinaand final FSR must be received by January 15.Upon receipt of the final FSR and output measures report including final actual service outputs, the Department will determine by program, if funds are owed to the Contractor or if the Contractor owes funds to the Department. If funds are owed to the Contractor, payment will be processed. However, if the Contractor underestimated their year-end obligations in the preliminary close out report as compared to the final FSR and the total reimbursement requested does not exceed the agreement amount that is due to the Contractor, the Department will make every effort to process full reimbursement to the Contractor per the Final FSR. Final payment may be delayed pending final disposition of the Department's year-end obligations. If funds are owed to the Department, it will generally not be necessary for Contractor to send in a payment. Instead the Department will make the necessary entries to offset other payments and as a result the Contractor will receive a net monthly prepayment. When this does occur, clarifying documentation will be provided to the 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 MDCH/CMS 06/05 Page 20 of 24 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: 1. 1% - 1 day to 30 days late; 2. 2% - 31 days to 60 days late; 3. 3% - over 60 days late with a maximum of 3% reduction in the 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. 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. MDCH/CMS 06/05 Page 21 of 24 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. 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 MDCH/CMS 06/05 Page 22 of 24 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. Al) 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 shalt 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. 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. XI. 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. MDCH/CMS 06/05 Page 23 of 24 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 III, 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. 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 06/05 Page 24 of 24 MICHIGAN DEPARTMENT OF COMMUNITY HEALTH FY 05/06 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; and adds the following changes to CPBC Agreement for 10/1/05 Through 9/30/06: Part I 11. Agreement Exceptions and Limitations Notwithstanding any other term or condition in this Agreement including, but not limited to, any provisions related to any services as described in the Annual Action Plan, any Contractor (Oakland County) services provided pursuant to this Agreement, or any limitations upon any Department funding obligations herein, the Parties specifically intend and agree that the Contractor may discontinue, without any penalty or liability whatsoever, any Contractor services or performance obligations under this Agreement when and if it becomes apparent that State or Department funds for any such services will be no longer available. Notwithstanding any other term or condition in this Agreement, the Parties specifically understand and agree that no provision in this Agreement shall operate as a waiver, bar or limitation of any kind, on any legal claim or right the Contractor may have at any time under any Michigan constitutional provision or other legal basis (e.g., any Headlee Amendment limitations) to challenge any State or Department program funding obligations; and, the parties further agree that no term or condition in this Agreement is intended and no such provision shall be argued to state or imply that the Contractor voluntarily assumed or undertook to provide any services as described in the Annual Action Plan, and thereby, waived any rights the Contractor may have had under any legal theory, in law or equity, without regard to whether or not the Contractor continued to perform any services herein after any State or Department funding ends. 2. This addendum modifies the following sections of Part II, General Provisions: Part II I. Responsibilities-Contractor J. Software Compliance. 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 identify and overcome potential data incompatibility problems. HI. 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. J. Health Insurance Portability and Accountability Act. The provisions in this section shall be deleted In their entirety and replaced with the following language: Contractor agrees that it will comply with the Health Insurance Portability and Accountability Act of 1996, and the lawfully enacted and applicable Regulations promulgated thereunder. IX. 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. 3. This Addendum modifies the following sections of Attachment III-C, Special Program Requirements for Infant Mortality Coalition Support : Item # 2 shall be amended to read, "At a minimum, the coalition must meet Infant Mortality Coalition (Revised March 28 and July 15, 2005) requirements 1) purpose, 11) function, Ill) objectives, IV) membership, V) responsibilities, and VI) work plan components. A copy of the revised Infant Mortality Coalition requirements for the Oakland County Health Division is attached to this Agreement as Exhibit III-C (a)." 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 Department or the Contractor. Signature Section: For the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH Date For the CONTRACTOR Bill Bullard, Jr., Chairman, Oakland County Board of Commissioners Name and Title Signature Date Exhibit III-C (a) MICHIGAN'S INFANT MORTALITY INITIATIVE Infant Mortality Coalitions Revised July 15, 2005 I. Coalition Purpose: to keep African American mothers and babies alive and well, before, during, and after birth. II. Coalition Function: to be the single arena in which key community leaders and stakeholders develop, implement, monitor, and evaluate a community-wide plan for keeping African American mothers and babies alive and well. It is a decision making group relative to achieving the defined purpose on behalf of the covered community. Its individual members are authorized by their respective agencies to act and to commit agency resources to this community process. III. Coalition Scope: Cities of Pontiac and Southfield A. Engage all relevant community parties in a shared involvement to a proactive set of community-based changes and activities designed to support healthy African American mothers and infants. B. Identify those access and service system barriers that make live births and well babies more difficult for African American women and infants (incorporating a PPOR conceptual framework when data is available, as well as utilizing FIMR data.) C. Identify the necessary and desirable community, prevention, primary care and support activities and services that contribute to healthy African American mothers and infants (incorporating a PPOR conceptual framework when data is available, as well as utilizing FIMR data,) D. Implement effective management and monitoring of all work plan activities assigned to the coalitions. E. Assure outreach to women and infants eligible for Medicaid relative to enrollment and access to services. F. Evaluate continuously the effectiveness and efficiency of actions and changes implemented; revise work plans and actions on an ongoing basis using data based decision-making processes and inclusion of existing and emerging evidence-based best practices, IV. Suggested Coalition Membership: A. The following members are strongly recommended to be invited to the table to discuss infant mortality related issues in the community. Documentation should be maintained demonstrating this invitation (where these agencies are present in the covered community, it is also recommended that no individual members represent more than two of the following:) i. Local Public Health Medicaid Health Plans — representation from each that has members within the covered community iii. Community Mental Health also Office of Substance Abuse and Tobacco Coalition iv. Local Human Services Department (formerly Family Independence Agency) v. County Commissioner and/or County Administrator (or his/he representative) vi. Community Collaborative (formerly the Multi-Purpose Collaborative Body) vii. Local institutions of higher education viii. United Way ix. Local foundations x. Faith-based organizations xi. Birthing hospitals — representation from each in the covered community xii. WIC program/s xiii. MSS/ISS program/s xiv. Nurse Family Partnership program xv. Family Planning and abstinence programs xvi. Early On xvii. Representatives of local obstetricians, pediatricians, neonatalogists, other locally relevant professions xviii. Local FIMR program xix. African American women of child-bearing age, including young mothers (at least three) xx. Local Healthy Start project xxi. Local REACH project xxii. Any other local projects and/or grants directed toward infant mortality B. Other members are determined by these required members in order to achieve inclusiveness of all relevant stakeholders. V. Coalition Responsibilities: A. Gain commitment from participating organizations, including identification of the authorized representative for coalition membership B. Evaluate progress and report to MDCH and to local stakeholders VI. Coalition Work Plan Components: (work plans must address in some way, each of the following) A. Completing the six identified objectives B. Incorporation of local FIMR data analysis C. Integration and/or coordination with Healthy Start, REACH, and other grant funded projects D. Safe Sleep strategies E. Nutrition and breast feeding strategies F. Access to prenatal and infant care and support services, including outreach to Medicaid-eligible women and infants G. Care coordination H. Hospital discharge planning and follow-up VII. MDCH Responsibilities: A. Provide each coalition with a data-specific profile for their community B. Provide seed funding to support coalition formation and/or activities C. Assure communication between and among the coalitions to promote transfer of ideas, shared problem-solving, research and evidence based practice sharing and other activities determined to be helpful by the coalitions D. Engage other stakeholders and partners who will contribute to the support and success of the community coalitions and to achieving healthy African American mothers and infants. This would include parties such as: i. University of Michigan's researchers currently addressing AA pregnancy and birth outcomes Wayne State University and Hutzel Hospital staff currently addressing stillbirths iii. Michigan Hospital Association iv. University of Michigan's Prevention Research Center, including use of their Advisory Council v. Michigan State Medical Society vi. Other medical and professional organizations vii. Other related associations and organizations viii. Other state and national support matter experts and researchers E. Provide expert consultation for completing a community systems analysis F. Provide the staffing support and format for local focus groups G. Technical assistance H. Contract monitoring and management I. Evaluation of the statewide Infant Mortality Initiative effectiveness and efficiency Immunization — (Local Public Health Operations & Categorical) LHD/CSHCS Services Maternal and Infant Support Primary Dental Care Sexually Transmitted Disease WIC I. J. k. m. n. ATTACHMENT III MICHIGAN DEPARTMENT OF COMMUNITY HEALTH FY 05/06 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 1,2005: a. AIDS/HIV Prevention b. Breast and Cervical Cancer Control C. Childhood Lead d. Childhood Immunization Registry e. Clinical Laboratory f. Family Planning g- Food Service Sanitation h. General Communicable Disease Control MDCH/CMS 6/05 Page 1 ATTACHMENT III OAKLAND COUNTY HEALTH DEPARTMENT For FY 05/06, special requirements are applicable for the remaining program elements and funding sources listed in the attached pages and checked below: - AIDS/HIV CARE AIDS/HOPWA (Housing Opportunities for Persons Living with HIV/AIDS) - AIDS/HIV Pediatric X - AIDS/HIV Prevention - AIDS/HIV Provider Education - AIDS/H1V Rapid Testing - Asthma Coalition X - Bioterrorism X - Bioterrorism - Cities of Readiness X - Bioterrorism Regional Epidemiology Support - Booster Seat - Cardiovascular Disease X - CSHCS - Chief Medical Executive X - Childhood Immunization Registry X - Childhood Lead Poisoning Prevention - Diabetes Outreach Network X - Early Warning Infectious Disease Surveillance (EWIDS) Travel - Family Planning/BCCCP Joint Project - Family Planning-Pregnancy Prevention - Health Disparities Reduction - HIV/STD Partner Counseling and Referral Services X - Immunization Action Plan X - Immunization Assessment Feedback Incentive Exchange (AFIX) Provider Site Visit - Immunization - Field Service Representatives X - Immunization Vaccine For Children (VFC) Provider Site Visit X - Immunization - Nurse Education Reimbursement X - Infant Mortality Coalition Support X - Informed Consent X - Laboratory Services - Laboratory Services - STARHS & VARHS - Lead Hazard Remediation Program X - Local Public Health Operations (LPHO) - Local Tobacco Reduction X - Maternal and Child Health (MCH) - Michigan Abstinence Program (MAP) - Michigan Childhood Immunization Registry (MCIR) X - Nurse Family Partnership (NFP) - Primary Care Dental Special Project - Rape and Sexual Assault Prevention Education (RSAPE) X -SIDS - Smoke-Free Workplace Project X - TB Control (DOT) X - WIC Services - WIC EBT - WIC - USDA Infrastructure Grant WISEWOMAN FORMAT (PROGRAM/ELEMENT) SPECIAL REQUIREMENTS I. Budget and Agreement Requirements - Lists those special funding and agreement requirements applicable to the program/element as a whole. II. Contractor Requirements - Lists those special requirements applicable to all agencies administering the program element. III. Department Requirements - Lists those special requirements applicable to the Department. IV. Contractor Specific Requirements - Lists those unique requirements applicable only to the single Contractor covered by this agreement. MDCH/CMS 6/05 Page 3 ATTACHMENT III AIDS/HIV CARE SPECIAL REQUIREMENTS (MARQUETTE COUNTY HEALTH DEPARTMENT, DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION AND DISTRICT HEALTH DEPARTMENT #10) Contractor Specific Requirements 1. Adhere to all Ryan White CARE Act Title II and MDCH/DHWDC-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/DHWDC-HAP1S 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. Develop written procedures to document and ensure that clients have been screened for eligibility for Medicaid, Medicare, veteran's health benefits, private health insurance or other programs to ensure that CARE Act funds are the payor of last resort. 4. Document that clients receiving services are eligible for services (documented HIV status). 5. Conduct quality assurance activities and participate in contract monitoring conducted and/or facilitated by MDCH/DHWDC-HAPIS. 6. Annually monitor 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/DHWDC-HAPI S. 7. Participate in oversight of all remediation efforts for subcontractors found in non-compliance with established MDCH/DHWDC-HAPIS program and practice standards, policy directives and program guidance. 8. The following requirements must be included in all subcontracts with service providers: 1-5, 9-23, and 31-35. 9. 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 Client Level Data 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. 10. Provide immediate notification to the Department, in writing, of any formal grievance procedures initiated by a service recipient and subsequent resolution of that grievance. 11. Provide immediate notification to the Department, in writing, of any event occurring, or notice received by the contractor or subcontractor, that reasonably suggests that the contractor or subcontractor may be the subject of, or a defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or contractor or subcontractor employees. 12. Establish a workplan that includes client-level outcome objectives for each service funded with Ryan White Title II and MHI resources and conduct outcome evaluation based on those objectives. 13. Assess client or participant satisfaction annually and use methods, instruments and analysis that minimize bias and ensure confidentiality of responses. 14. Utilize results of client or participant satisfaction assessments and other evaluation activities to make appropriate program level changes and monitor the effects of these changes. 15. Demonstrate appropriate expenditure of funds consistent with the contract, HRSA regulations and MDCH/DHWDC-HAPIS regulations and guidelines. Page 4 MDCH/CMS 6/05 ATTACHMENT Jr1 16. Document that the agency provides opportunity and fiscally supports on-going staff development and training. 17. The health department and all HIV care service sub-contractors funded by the health department must collect and maintain client-level Uniform Reporting System CURS) data to track HIV care services delivered and the clients receiving the services. Electronic client-level URS data files must be submitted to MDCH according to the following schedule and must comply with the standards outlined in a) and b) below. The CARE Act Data Report (CADR) for the calendar year must also be submitted by January 30th from each entity that receives Title II resources. Date Range of Services Provided Date Due to MDCH Description FY Quarter 1 CY Annual & CADR FY Quarter 2 FY Quarter 3 FY Quarter 4 FY Annual October 1-December 31, 2005 January 1-December 31, 2005 January 1-March 31, 2006 April 1-June 30, 2006 July 1-September 30, 2006 October 1, 2005-September 30, 2006 January 15, 2006 January 30, 2006 April 15, 2006 July 15, 2006 October 15, 2006 October 30, 2006 a. The submitted URS data files must conform to the export format defined by HRSA in documents found at the HRSA web site (http://hab.hrsa.00v/careware/) including "Instructions for Export Format", "Header Export Format"2 , and "Client Record Export Format" 3 , or be exported directly from RW CARE-Ware 3.x or 4.x. b. Submitted URS electronic data files must include all clients who received any CARE Act eligible service (regardless of the source of funding for the services) and must include all CARE Act eligible services delivered to HIV-infected or affected clients during the specified time range. 18. URS data is the property of MDCH/DHWDC-HAPIS. In the event that services are no longer delivered under this agreement, electronic data files must be returned to MDCH/DHWDCHAP1S. 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, as well as HIV medication adherence practices, 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 PartliGeneral Provisions, and submit one copy to MDCH/DHWDC-HAPIS to the attention of Traci Goulding. I flp://ftP.hrsa.qovihab/undup instruct.pdf 2 ftp://ftp.hrsa.gov/hab/CW%2031%20Header%20Expore/020Format.pdf 3 ftp://ftD.hrsa.gov/habiCWV02031%20Client °/020Record°/020Export.pdf MDCH/CMS 6/05 Page 5 ATTACHMENT III Report administrative expenditures, for each preceding quarter, consistent with budgeted costs. Attach a separate page, identifying this quarterly expenditure, to your HIV/AIDS care FSRs, according to the following schedule: Quarter FSR October-December, 2005 December FSR January-March, 2006 March FSR April-June, 2006 June FSR July-September, 2006 September FSR 25. Submit reports of allocations and expenditures by service category to MDCH/DHWDC-HAPIS as requested. 26. Submit program Progress Reports in accordance with the following dates and reporting format: Period Covered Due to MDCH/DHWDC-HAPIS October 1 - December 31, 2005 January 15, 2006 January 1 - March 31, 2006 April 15, 2006 April 1 — June 30, 2006 July 15, 2006 July 1 — September 30, 2006 October 15, 2006 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, including areas where cost savings were achieved and how this was accomplished. 2. Summarize any subcontract monitoring and oversight activities conducted during the report period. Attach relevant findings. 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, or written agreements with "key points of access" executed during this report period. B. Program 1, Provide the following information for each funded service provider: agency name, address, telephone and fax number, name, title, telephone number and e-mail address of contact person. 2. Identify any program level changes, including changes in staff, services, catchment area, etc. 3. Identify any new services added during the report period, and/or new access points to existing services, 4. Identify and describe your relationships with "key points of access," as required in #19. , e.g., linkage of care and prevention services through staff assignments, joint staff meetings that include emergency room representatives, counseling and testing staff and case managers, etc. 5. Describe the progress made towards achieving goals, objectives, and service outcomes as described in your workplan. 6. Discuss any issues at the agency level that impact ability to achieve stated goals and objectives. Page 6 MDCH/CMS 6/05 ATTACHMENT III 7. Describe major program and service accomplishments not directly related to the established goals and objectives. 8. Describe how services during this reporting period demonstrate the integration of STD and HIV secondary prevention, and HIV medication adherence practices into HIV/AIDS care services. 9. Describe staff development and training activities related to client-level service provision. 10. Describe any technical assistance needs related to programmatic and fiscal administration. C. Submit Progress Reports electronically to SzweidaDmichician.gov , cc: GouldinoTmichician.00v. Materials that cannot be emailed should be sent to: Debra L. Szwejda, Manager HIV/AIDS Prevention and Intervention Section Division of Health, Wellness and Disease Control 2479 Woodlake Circle, Suite 300 Okemos, Michigan, 48864 27. Provide one copy of all fully signed subcontracts to MDCH/DHWDC-HAPIS by October 15,2005 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 subcontract. E. Amount and source of other federal, state and local funds for the same service. F. Minority provider status. 28. By October 15, 2005 provide to MDCH/DHWDC-HAPIS a programmatic, categorical budget and narrative justification (by funding source) for each 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. 29. Document by October 15, 2005, in a format provided by MDCH/DHWDC-HAPIS, that administrative expenditures will not exceed the 10% cap authorized by HRSA for "first-line entities" receiving Ryan White CARE Act Title U funds. If requested, document compliance with HRSA's "Issue Paper: Administrative Costs." 30. When issuing requests for proposals or bid solicitations, clearly state that the resources are open for availability to faith-based organizations. 31. Assist MDCH/DHWDC-HAPIS in appropriate needs assessment activities, and maintain a mechanism to obtain input about needed services from infected and affected persons. 32. Participate in MDCH/DHWDC-HAPIS care-related trainings and conferences, as appropriate. 33. Establish written client grievance procedures, and assure that those procedures are consistent with any guidance issued by HRSA or MDCH/DHWDC-HAPIS, including following MDCH/DHWDC-HAPIS' mediation process. 34. 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. Page 7 MDCH/CMS 6/05 ATTACHMENT III 35. 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. Establish and maintain 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: Possess the knowledge, skills, abilities and credentials essential to assigned responsibilities; Are hired or discharged through fair and objective processes which are appropriately documented. 36. Use the Counselor-Assisted Referral Form (CARF), DCH-1225 to refer consenting HIV-positive individuals, identified through counseling and testing activities, to appropriate case management providers. 37. Assure that the agency and its employees, volunteers and subcontractors (if applicable), maintain confidentiality of all records. No information obtained in connection with individuals served by the contractor will be released without the expressed written consent of the individual client. AIDS/HOPWA SPECIAL REQUIREMENTS (Housing Opportunities for Persons Living with HIV/AIDS) 1. Budget and Agreement Requirements A. HOP WA Eligibility An eligible person means a person with acquired immunodeficiency syndrome or related diseases who is below 80% median income. A family member regardless of income is eligible to receive housing information services. Any person living in proximity to a community residence is eligible to participate in that residence's community outreach and educational activities regarding AIDS or related diseases. Within the population eligible for this program, nondiscrimination and equal opportunity regulations must be followed, including fair housing and affirmative outreach. A project sponsor and all contractors and subcontractors must adopt procedures to ensure that all persons who qualify for the assistance, regardless of their race, color, religion, sex, age, national origin, familial status, or handicap, know of the availability of the HOPWA program, including facilities and services accessible to persons with a handicap, and maintain evidence of implementation of the procedures. B. Allowable Use of Funds Funds may be used to assist all forms of housing designed to prevent homelessness. This includes emergency housing, shared housing arrangements, apartments, single room occupancy (SRO) dwellings, and community residences. It includes assistance to remain in current homes, whether owned or rented, and assistance in relocating to another home, whether owned or rented. The following activities may be carried out with HOPWA funds: Page 8 MDCH/CMS 6/05 ATTACHMENT 10 1. Housing assistance through tenant based rental assistance, short-term rental assistance, mortgage and utility payments. 2. Case management, housing advocacy and permanent housing placement, client advocacy, and assistance with access to benefits. This can include 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. 3. Supportive services including, but not limited to, outreach, life management, education, 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. 4. Administrative expenses (general management, 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. Fiduciaries who are not also Project Sponsors may use 3% of the total Expenditures for administrative costs. Project Sponsors, and Fiduciaries who are also Project Sponsors, may use 7% of their total Expenditures for administration. Fiduciaries who are also Project Sponsors may not collect the 3% plus the 7%. For more information, please check the HOP WA regulations (24 CFR 574) 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 BO% 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 agency for housing information, resource identification services and development of a housing stabilization plan for participating individuals. Agencies 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. Page 9 MDCH/CMS 6/05 ATTACHMENT 10 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 agency will be awarded at least 10 certificates annually as long as funding remains available and will be eligible to apply for additional certificates based upon available funding, demonstrated need and use of the current certificates. The value of unused certificates will lapse at the end of the contract year. Certificates will be awarded by allocation letter and reimbursement to the region will be made based on the submission of a Financial Status Report (FSR) Supplemental Form including the number of PLWH/A's served. As supportive documentation, the provider must maintain the following for each PLWH/A served: 1. Documentation of a supportive services plan (form included with allocation letter). 2. Documentation of consideration of other funding sources (form included with allocation letter). 3. A housing plan (form included with allocation letter). To protect recipient confidentiality, the agency/service provider must provide a unique confidential client identification number for each participant when transmitting this information to MDCH. In addition to the FSR Supplemental Form submission for reimbursement purposes, agencies must also submit quarterly the data requirements specified in the contract. 2. Contractor Requirements In 2005, each agency must submit to the department their annual plan for providing HOPWA services. The plan should cover the period October 1, 2005 through September 30, 2006 and include both the regular HOPWA allocation and the HOPWA Certificate Program. This plan, along with quarterly reports and the agency FSR Supplemental Form, 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, 2005 and must be submitted to: Community Living Division Michigan Department of Community Health 320 S. Walnut, Lewis Cass 5th Floor N Lansing, Michigan 48913 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. Case management, housing advocacy, client advocacy 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). MDCH/CMS 6/05 Page 10 ATTACHMENT III 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. The total expenditures for items A & B above should exceed 75% of all expenditures. The utilization of resources within the 75% goal and the three activities identified above are at the discretion of the agency 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 agency's plan for FY 05/06 is required. a. Needs Describe the demographic characteristics of the population with HIV/AIDS in the agency's service area in comparison to the population served by the HOPWA program. Describe the service needs of the PLWH/A's in your agency's service area within the following three funding categories: 1. Direct housing assistance, 2. Case management, client advocacy, access to benefits, permanent housing placement, 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 05/06 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 05/06 along with a brief description of FY 04/05 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 HOP WA-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. Page 11 MDCH/CMS 6/05 ATTACHMENT III 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 04/05. 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 homeowners. To assist the Department in assessing the program, also provide: I. The protocol, procedure or "working policy" the agency implemented in order to determine when a certificate would be issued (include criteria for determining when to use certificate versus HOP WA formula funds). 2. Specification of the barriers and successes in accessing other community housing resources such as Section 8 vouchers, FIA emergency assistance, or other local housing-related funds. d. Services Indicate what services are planned to be provided in FY 05/06 by the three funding categories. I. Direct Housing Assistance. 2. Case management, client advocacy, access to benefits, permanent housing placement. 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 service area 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 05/06 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 "HOP WA FY 05/06 Plan" provided with your allocation letter, indicate how the funds allocated to the agency will be allocated to each provider (including the agency if services are provided directly) by the following categories: A. Administration A-1 Fiduciary (3% Limit) A-2 Project Sponsor (each) and/or Fiduciary-Project Sponsor (7% Limit each) Page 12 ATTACHMENT III B. Direct Housing Assistance - Certificate Program B-1 Long Term: Tenant-based rental assistance Certificates B-2 Short Term: Short-term rent, mortgage & utility payments to prevent homelessness C. Case Management, Advocacy Services D. Supportive Services Also provide the planned number of persons to be served. Provide a brief narrative explanation as necessary. D. Reporting In addition to submitting the FSR Supplemental Form which breaks down the HOPWA expenditures according to the four main categories listed above, quarterly demographic and financial data must be submitted by email to the addresses provided below. The forms entitled "DCH HOPWA Quarterly Report" and "Data for the HOP WA Annual Report" are provided with your allocation letter. Excel versions have been provided to all agencies and must be used to submit this information. It is important that the breakdown of costs according to the categories listed above submitted with the quarterly reports match the FSR Supplemental Form figures. It is important to understand that the contract year and calendar year to 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 2005 must be submitted by February 15, 2006, and will include data from the quarterly report for the period 10/1/2005-12/3112005. Quarterly Reports (including a copy of the FSR Supplemental Form Attachment) are due as follows: February 15 for the 10/1/2005- 12/31/2005 quarter May 15 for the 1/1/2006 - 3/31/2006 quarter August 15 for the 4/1/2006- 6/30/2006 quarter November 15 for the 7/1/2006- 9/30/2006 quarter. Note: The data for the annual report and the narrative portion of the annual report are due on February 15, 2007, for the 2006 calendar year. This is the same due date as the 10/01/2006-12/31/2006 quarterly report, and this data is included in the annual report totals. All reports should be sent to: Ebvsamichioan.00v IversonB ©Michigan.gov If necessary, hard copies can be sent to: Division of Community Living Michigan Department of Community Health Lewis Cass Bldg., 5th Floor North 320 S. Walnut Lansing, Michigan 48913 Attention: Sue Eby or Brian Iverson 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 Page 13 MDCH/CMS 6/05 ATTACHMENT III 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 HOP WA benefits. D. Keep records and reports, which are consistent with the information required by the Annual Progress Report (APR) for HOPWA, 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 2005 by February 1, 2006. 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. Ensure, then issue statements, press releases, REP, 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. G. Ensure all services are available in the entire agency service area. H. Ensure that all activities funded under the program will meet urgent needs that are not being met by available public and private sources. Page 14 MDCH/CMS 6/05 ATTACHMENT III Send copy of all HOP WA required documents to: Division of Community Living Michigan Department of Community Health Lewis Cass Building, 5th Floor North, 320 S. Walnut Lansing, Michigan 48913 Attention: Sue Eby AIDS/HIV PEDIATRIC (DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION) 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 and in the Title IV Work Plan. Provide necessary training and technical support to the person to assure services are provided in a family-centered manner. 2. Provide 1.0 full-time Risk Reduction Counselor to the program with resources from the Office of Drug Control Policy. 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. 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 the reporting requirement section. 7. Encourage consumer involvement in Title IV program activities. 8. 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)(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. 9. 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 of 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. Department Requirements 1. Provide administrative, professional, and technical consultation to the program. 2. Provide administrative direction, program coordination, and data management for statewide reporting of Title IV activities. Page 15 MDCH/CMS 6/05 ATTACHMENT HI 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 Title IV subcontracted agencies. 4. Convene quarterly, 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 Office of Drug Control Policy 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 1St Quarterly Data Report (for period Jan 1 — March 31) 2nd Quarterly Data Report (for period April 1 — June 30) 3rd Quarterly Data Report (for period July 1 — September 30) Annual Data Report (for period January 1 — December 31) The Annual Data Report is an aggregate calendar year report. Due Date April 15 July 15 October 15 January 15 A. The submitted URS data files must conform to the export format defined by HRSA in documents found at the HRSA web site (http://hab.hrsa.clovicareware/) including "Instructions for Export Format"1 , "Header Export Formar 2, and Client Record Export Formar3, or be exported directly from RW CARE-Ware 3.x. B. Submitted URS electronic data files must include all clients who received any CARE act eligible service (regardless of the source of funding for the services) and must include all CARE Act eligible services delivered to HIV-infected or affected clients during the specified time range. 2. URS data is the property of MDCH/DHWDC-HAPIS. In the event that services are no longer delivered under this agreement, electronic data files must be returned to MDCH/DHWDC-HAPIS. 3. Any such other information as specified in the Contractor requirements shall be developed and submitted by the Contractor as required by the Contract Manager. Reports and information shall be submitted to the Contract Manager at: Michigan Department of Community Health Division of Health, Wellness and Disease Control Maternal Child HIV/AIDS Program 3056W. Grand Blvd., Suite 3-150 Detroit, MI 48202 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 projects as determined by the Contract Manager. AIDS/HIV PREVENTION SPECIAL REQUIREMENTS Contractor Requirements (both Categorical) 1. Submit all educational materials (e.g. brochures, posters, pamphlets and videos) used in conjunction with program activities to the Department's Program Review Panel for review and approval prior to their use. MDCH/CMS 6/05 Page 16 ATTACHMENT III 2. Submit process and outcome monitoring data to the Division of Health, Wellness and Disease Control via the HIV Event System. The time line and procedures for submitting these data are to conform to guidelines issued by the Division of Health, Wellness and Disease Control. 3. Maintain the technological capacity necessary to comply with monitoring, reporting and evaluation requirements associated with this agreement and to ensure timely and efficient communication with the Department. 4. By August 30, 2005, submit to the Division of Health, Wellness and Disease Control for review and approval, a detailed proposed budget, associated narrative justification of the proposed budget and staffing plan associated with activities supported under this agreement. Special Requirements HIV Prevention — Non-Categorical Local Health Department that do not receive categorical AIDS/HIV prevention funds may request reimbursement for performing HIV tests. Agencies will be reimbursed at a rate of $8.50 per test, not to exceed $2,000 for fiscal year 2005/2006. Reimbursement requests must be submitted quarterly on the financial status reports. Requests for reimbursement will be verified based on data submitted to the Department via the HIV Event System (H ES). AIDS/HIV PROVIDER EDUCATION (KENT COUNTY HEALTH DEPARTMENT) Contractor Requirements 1. Participate in quality assurance activities conducted by and/or facilitated by the Division of Health, Wellness and Disease Control. 2. Participate in technical assistance, training and/or skills-enhancement opportunities as recommended or required by the Division of Health, Wellness and Disease Control. . 3. Participate in program evaluation activities conducted by or required by the Division of Health, Wellness and Disease Control 4. Submit all educational materials (e.g. brochures, posters, pamphlets and videos) used in conjunction with program activities to the Department's Program Review Panel for review and approval prior to their use. Submit process and outcome monitoring data to the Division of Health, Wellness and Disease Control via the HIV Event System. The time line and procedures for submitting these data are to conform to guidelines issued by the Division of Health, Wellness and Disease Control. 6. Maintain the technological capacity necessary to comply with monitoring, reporting and evaluation requirements associated with the agreement and to ensure timely and efficient communication with the Department. 7. Establish, maintain and document linkages with community and professional resources necessary and appropriate to addressing the needs of targeted audience(s) and that are essential to the success and effectiveness of services supported under this agreement. 8. Adhere to time lines, work plans, budgets and staffing plans submitted to and approved by the Division of Health, Wellness and Disease Control. Deviations from approved time lines, work plans, budgets, and staffing plans must receive advanced authorization from the Division of Health, Wellness and Disease Control. 9. Submit preliminary agendas to the Division of Health, Wellness and Disease Control for review and approval, for conferences, trainings, workshops and similar activities supported wholly or in part under this agreement. Page 17 MDCH/CMS 6/05 ATTACHMENT III 10. Submit program manuals, intervention curricula, training curricula and similar documents to the Division of Health, Wellness and Disease Control for review and approval prior to publication and use if development and implementation is supported wholly or in part under this agreement or if such documents are to be used in conjunction with activities supported under this agreement. 11. Submit a copy of the financial status report (FSR, FIN-130) to the Division of Health, Wellness and Disease Control simultaneous to submission to Budget and Finance Administration. FSRs pursuant to established protocol and procedures. Contractor Specific Requirements Goal 1: To improve the knowledge, attitudes and skills of medical providers to provide on-going risk assessment and risk reduction with persons at risk of acquiring or transmitting HIV. Process Objectives: Process Obj 1: By September 30, 2006 conduct at least three HIV, STI and sexual health discussion trainings targeting healthcare providers in Southeast Michigan. Process Obj 2: By September 30, 2006, conduct at least two Prevention and risk reduction trainings for healthcare providers in Southeast Michigan. Process Obj 3: By September 30, 2006, conduct at least one HIV, STI and sexual health discussion trainings targeting healthcare providers in West Michigan. Process Obj 4: By September 30, 2006, conduct at least one prevention and risk reduction training for healthcare providers in West Michigan. Process Obj 5: By September 30, 2006, conduct at least five student trainings in Southeast Michigan. Process Obj 6: By September 30, 2006, conduct at least three student trainings in West Michigan. Outcome Objectives: Outcome Obi 1: By September 30, 2006, 80% of participants in the Prevention and risk reduction trainings for healthcare providers will report that they are better prepared to conduct HIV risk assessment and risk reduction education as a result of the training. Outcome Obj 2: By September 30, 2006, 85% of participants in HIV, STI and sexual health discussion trainings will report that they are more knowledgeable about the need to discuss HIV and STI testing with patients as a result of the training. Outcome Obj 3:By September 30, 2006, 85% of participants will report that they feel better prepared to initiate sexual health discussion with patients as a result of the training. Outcome Obj 4: By September 30, 2006, 85% of participants will report that they are more knowledgeable about the need to conduct comprehensive sexual histories with patients. Reporting Requirements The Contractor shall submit: 1. Narrative Progress Reports. A narrative report detailing progress toward meeting process and outcome objectives. The format and content of these reports are to conform to the guidelines issued by the Division of Health, Wellness and Disease Control. Narrative reports are due 30 days after the close of each quarter: MDCH/CMS 6/05 Page 18 ATTACHMENT III Reporting Period Narrative Report Due October — December 2005 January 31 1 2006 January March 2006 April 30, 2006 April — June 2006 July 31, 2006 July — September 2006 October 31, 2006 2. Process and Outcome Monitoring Data. Applicable process and outcome monitoring data are to be submitted via the HIV Event System. The time line and protocol for submitting these data are to conform to guidelines issued by the Division of Health, Wellness and Disease Control. It is understood that the reports described above may be revised, supplemented or replaced at any time and that the agency will provide information and/or data responsive to modified reporting requirements. 3. Any such other information as specified in the Contractor's Requirements shall be developed and submitted by the Contractor as required by the Contract Manager. 4. The Contract Manager shall evaluate the reports submitted as described above for their completeness and adequacy. 5. The Contractor shall permit the Department and/or its designee to visit and to make an evaluation of the project as determined by the Contract Manager. AIDS/HIV RAPID HIV TESTING SPECIAL REQUIREMENTS (KENT COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY HEALTH DEPARTMENT AND DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION) Contractor Requirements: Conduct HIV counseling, testing and referral, using rapid test technologies, according to guidelines and standards issued by the Michigan Department of Community Health and/or the US Centers for Disease Control and Prevention. Local health agencies must: 1. Conduct quality assurance activities, guided by written protocol and procedures. Quality assurance activities are to be responsive to: Quality Assurance for Rapid HIV Testing. Michigan Department of Community Health (March 2003, or subsequent revisions). 2. Enroll in the Model Performance Evaluation Program (MPEP), CDC's external proficiency testing program. 3. Submit a photocopy of the local health department's CLIA certificate to Division of Health, Wellness and Disease Control. 4. Report anomalous test results to the Division of Health, Wellness and Disease Control, pursuant to established protocol. 5. Submit quality control and daily patient logs on a monthly basis. 6. Ensure that staff performing counseling and testing with rapid test technologies have completed, successfully, rapid test counselor certification courses, test device training, and proficiency testing. Staff who serve as "site supervisors" must complete, successfully, laboratory quality assurance training, blood borne pathogens training and test device training. ASTHMA COALITION SPECIAL REQUIREMENTS (KALAMAZOO COUNTY HEALTH AND HUMAN SERVICES) Contractor Requirements 1. Maintain a local Asthma coalition to help mobilize community awareness and interest in Asthma related community needs. MDCH/CMS 6/05 Page 19 ATTACHMENT III 2. Choose and complete asthma modules as determined by contractor and contract manager. 3. Participate in scheduled Summit of Asthma Coalition activities. 4. Submit trimester progress reports and a year-end summary of activities report. Department Requirements 1. Provide administrative professional and technical consultation to the program. 2. Convene bi-annual Summit of Asthma Coalitions meetings and quarterly Consortium of Asthma Coalitions Steering Team meetings. Reporting Requirements 1. The Contractor shall submit reports on the following dates: Type of Report and Timeframe Due Date 1 st Tr-Annual Report (for period Oct 1 — Jan 31) February 15 2nd Tr-Annual Report (for period Feb 1 — May 31) June 15 3rd Tr-Annual Report (for period June 1 — September 30) October 15 Summary of Activities Report (Oct 1 — September 30) October 15 2. Any such other information as specified in the Contractor 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: Michigan Department of Community Health Division of Chronic Disease and Injury Control Diabetes, Kidney, and Other Chronic Diseases 3423 N. MLK Jr. Blvd., 1 5t Floor Lansing, MI 48909 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 projects as determined by the Contract Manager. BIOTERRORISM Contractor Requirements Funded activities under these Focus Areas must be consistent with MDCH/OPHP approved work plans and budgets. Contractor Requirements Each local health department, as a sub-recipient of funding through the CDC Public Health Preparedness and Response on Bioterrorism Cooperative Agreement shall conduct activities to build preparedness and response capacity as defined by the Cooperative Agreement 05/06 and consistent with their approved FY 05/06 work plan and budget on file with the MDCH, Office of Public Health Preparedness (OPHP). In addition to these broad requirements, the LHD will: 1. Designate an Emergency Preparedness Coordinator (1 FTE), to the OPHP, as a Point of Contact and individual through whom, in addition to the LHD Health Officer, collaborative capacity building activities of the Public Health Emergency Preparedness and Response Program/Cooperative Agreement are communicated, coordinated and implemented. Page 20 MDCH/CMS 6/05 ATTACHMENT III BIOTERRORISM - CITIES OF READINESS INITIATIVE (CRI) (DETROIT DEPARTMENT OF WELLNESS AND HEALTH PROMOTION, LAPEER COUNTY HEALTH DEPARTMENT, LIVINIGSTON COUNTY HEALTH DEPARTMENT, MACOMB COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY HEALTH DEPARTMENT, ST. CLAIR COUNTY HEALTH DEPARTMENT, WAYNE COUNTY HEALTH DEPARTMENT) Budget and Agreement Requirements Funds are restricted pending work plan and budget approval by MDCH/Office of Public Health Preparedness (OPHP). These monies may not be re-directed. Funds under this program may not be used to purchase vehicles; or, supplant any current local expenditure. Supplantation means using Federal funds to replace local expenditures. Each awardee must use these funds to coordinate activities with relevant efforts currently underway within the jurisdiction. You must also coordinate activities within the jurisdiction between local agencies, among local agencies, with hospitals and major health care entities, private sector partners, with any Metropolitan Medical Response Systems in the jurisdictions as well as appropriate federal agencies, and as appropriate, with adjacent states and countries. Targeted funds may be allocated by the awardees within their own jurisdiction and, as appropriate, within adjacent jurisdictions that make up the metropolitan statistical area for staff, fringe benefits, travel, training, supplies, call down equipment, contracts [including distribution (if needed), training, public information, and dispensing exercising], and Point of Distribution equipment (computers, printers, signage, communications, etc.). Based on approved budgets all funds must be expended by 8/30/06 confirmed by submission of appropriate Financial Status Reports (FSRs) as required by the Michigan Department of Community Health under the terms of this contract. The activities conducted and funds expended under the Cities Readiness Initiative must follow all the guidance contained in Attachment K of the CDC Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism of 2005 and additional CRI guidance provided by CDC Cooperative Agreement 2006. BIOTERRORISM REGIONAL EPIDEMIOLOGY SUPPORT Regional Epidemiology Support: 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. BOOSTER SEAT PROGRAM (BRANCH-HILLSDALE-ST. JOSEPH COMMUNITY HEALTH AGENCY) Contractor Requirements The contractor will continue work on a community booster seat intervention project as part of the Michigan Department of Community Health program, "Community-Based Interventions to Reduce Motor Vehicle- Related Injuries." Goal 1: Increase public awareness about booster seat safety among the Hispanic population of St. Joseph County. Objective: Continue development and implementation of the community-wide public service campaign to increase knowledge of the importance of booster seat use with an emphasis on the Hispanic population in the city of Sturgis in St. Joseph County. Task 1. Develop a media campaign message appropriate for the Hispanic population. MDCH/CMS 6/05 Page 21 ATTACHMENT III Task 2. Deliver the booster seat message through various media outlets deemed appropriate for the population that may include: radio, press releases, newspaper ads, community fliers, etc. Goal 2: Increase the rate of booster seat use among the Hispanic population of -St. Joseph County. Objective: Continue development and implementation of educational strategies that increase knowledge of the importance of booster seat use among parents/guardians of Hispanic children ages 4-8 in St. Joseph County. Task 1. Work with local Hispanic agency to develop and disseminate educational materials. Task 2. Disseminate educational materials at other cultural events. Task 3. Implement educational strategies in conjunction with local Hispanic center, churches, or other venues. Goal 3. Increase access to booster seats and child restraint installation services. Objective: Maintain operation of the permanent fitting station in Sturgis, St. Joseph County. Task 1. Purchase seats for free distribution at fitting station. Task 2. Market the fitting station to Hispanic community. Task 3. Staff the fitting station to be operational at least one time per week by appointment. Task 4. Keep detailed records of fitting station as required by UMTRI researchers. Goal 4. Determine effectiveness of the booster seat intervention in conjunction with researchers from the University of Michigan Transportation Research Institute (UMTRI). Objective: Evaluate the booster seat project in conjunction with UMTRI researchers. Task 1. Keep detailed process records on data collection forms provided by UMTRI. Task 2. Provide forms to UMTRI on a quarterly basis. Task 3. Assist UMTRI staff as needed for pre- and post-observation work. Reporting Requirements 1. The Contractor shall submit the following reports: Due Date Product 1/30/06 A report for the period of October 1 - December 30, 2005 which contains: A. A status report on work toward accomplishment of stated program objectives and activities; B. Reasons for deviations from planned activities and corrective action taken; C. Other information including staffing changes or new program partners or resources; D. A summary of expenditures to date 4/30/06 A report for the period of January 1 — March 31, 2006 which contains: A. A status report on work toward accomplishment of stated program objectives and activities; B. Reasons for deviations from planned activities and corrective action taken; MDCH/CMS 6/05 Page 22 ATTACHMENT III C. Other information including staffing changes or new program partners or resources; D. A summary of expenditures to date. 7/30/06 A report for the period of April 1 - June 30, 2006 which contains: A. A status report on work toward accomplishment of stated program objectives and activities; B. Reasons for deviations from planned activities and corrective action taken; C. Other information including staffing changes or new program partners or resources; D. A summary of expenditures to date. 10/30/06 An eight-ten page final report for the entire project, which comprehensively explains the results achieved. Please attach copies of materials developed as a result of the program, as well as any media coverage. 2. Reports and information (EXCEPT original Financial Status Reports which are submitted to MDCH Accounting) shall be submitted to: Heather Hockanson Michigan Department of Community Health Injury Prevention Section P.O. Box 30195 Lansing, MI 48909 Ph: 517-335-9519 Fax: 517-335-8893 E-mail: hockansonhmichigan.gov 3. The Contract Manager shall evaluate the reports submitted as described above for their completeness and accuracy. 4. The Contractor shall permit the Department or its designee to make at least one site visit and to make an evaluation of the project as determined by the Contract Manager. CARDIOVASCULAR HEALTH Contractor Requirements: 1. The contractor's program plan will be submitted and on file with the Department. 2. Submit a quarterly progress report on January 15, April 15, July 15 and a final progress report on October 15 to the Cardiovascular Health, Nutrition and Physical Activity Section. 3. Attend Required Training. 4. Develop an evaluation process for the project in collaboration with MDCH staff. CHIEF MEDICAL EXECUTIVE COVERAGE FOR THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH (INGHAM COUNTY HEALTH DEPARTMENT) Contractor Requirements: 1. Provide one (1) day per week on-site Chief Medical Executive functions to the Michigan Department of Community Health. 2. Attend weekly Communicable Disease status meetings. Page 23 MDCH/CMS 6/05 ATTACHMENT III 3. Assume Second Call responsibilities for weekends and after hours. 4. Be available for telephone consultation on an as needed basis. Remuneration: Contractor shall be paid at a rate of Five Thousand Dollars ($5,000) per month and reimbursed for attributable travel and lodging expenses. 1. Statutory Governmental Immunity: Dr. Dean Sienko, acting or reasonably believing he is acting within the scope of his authority in accordance with the Statement of Work as Interim Chief Medical Executive is deemed to be an officer of the Department for the purposes of MCL § 691.1401 et. seq. 2. The position of Chief Medical Executive is required by MCL § 333.2202. 3. The Department will follow all regular procedures as it pertains to permissive decisions by the department under MCL § 691.1408. CSHCS SPECIAL REQUIREMENTS 1. CSHCS OUTREACH AND ADVOCACY REQUIREMENTS Contractor Requirements A. Program Representation and Advocacy 1. 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, prior authorization, and the appeals process to providers, the community, other agencies and families. 2. Inform families of their rights and responsibilities in the CSHCS program. 3. Describe special CSHCS programs to families, such as the Children with Special Needs (CSN) Fund the insurance premium payment program, skilled nursing respite, hospice and out-of-state travel assistance as applicable. 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, such as Early On, WIC, MI-Child, Healthy Kids and Medicaid. 5. Provide answers to any questions and/or listening to concerns families might have to help families advocate on their own behalf. 6. Assure that the strengths and priorities of families are integrated into the CSHCS system of care by facilitating the direct participation of families in program development, implementation, evaluation and policy formation. 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 contacts the local AhenanluthaldlyepcaortnmtaectntcfosrHacsssisetannrocellewditfhacmoimliepslebtiyoneiothf ethremCaSilHoCrSpahpopnleicatotiopnrofovridme, including the financial assessment and third party liability forms. 3. information about the CSHCS program, assess family needs and update client information. If this annual contact meets the criteria for care coordination (substantive and multiple contacts) care coordination can be billed forthis service. Page 24 MDCH/CMS 6/05 ATTACHMENT III 4. Assist in locating individuals or families who do not return a CSHCS Application after being made medically eligible. C. Support Services 1. Link families to the CSHCS Parent Participation Program, Family Phone Line or to the Family Support Network. 2. Facilitate transition through the Medicaid Health Plan (MHP) process and into the MHP environment for CSHCS/Medicaid clients prior to aging out of CSHCS (at age 21.) This service can be billed through care coordination and can be offered up to six months after the client ages off the CSHCS program at age 21. 3. Authorize in-state travel assistance for families eligible for the benefit per CSHCS policy. D. General Performance Requirements 1. 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. 2. Case Management and Care Coordination Requirements Local health departments are not required to provide CSHCS Case Management and Care Coordination services, however, are strongly encouraged to do so to improve the system of care for all CSHCS families. If these fee-for-service billable services are provided by local health departments, the most current Case Management and Care Coordination policies and procedures as established by CSHCS must be followed. 3. Reporting Requirements are added as follows: A. A brief annual narrative report is due by November 15 following the end of the fiscal year, describing CSHCS Outreach and Advocacy successes, challenges and any technical assistance needs the LHD is requesting the State to address. B. Report the number of diagnostic referrals completed, the number of families directly assisted in the CSHCS enrollment process, and the number of families directly assisted in the CSHCS renewal process through Attachment II (H-977) of the CPBC. CHILDHOOD IMMUNIZATION REGISTRY SPECIAL REQUIREMENTS Contractor Requirements 1. Michigan Childhood Immunization Registry (MCIR) responsibilities: A. Ensure that all immunizations administered to children born after December 31, 1993 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. B. Ensure that all immunization 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. MDCH/CMS 6/05 Page 25 ATTACHMENT III CHILDHOOD LEAD POISONING PREVENTION - SPECIAL REQUIREMENTS Contractor Requirements 1. Each funded entity will provide regional case management oversight for a group of approximately 50 children with blood lead levels of 20 ug/dL. Case management for each region will encompass a number of counties and health jurisdictions. 2. Each funded entity will provide primary prevention in the assigned regions. Primary prevention activities will be selected by the regional coordinator and the local jurisdiction. 3. All funded agencies/individuals in the program will be required to participate in program evaluation. 4. CDC reporting and state-based activity reporting will be required of all funded entities. Contractor Special Requirements Case Management A. Objective: Assure and facilitate case management of all children with a confirmed blood lead level equal to or greater than 20 ug/dL. B. Activities (REQUIRED): 1. Identify community resources and distribute resource list to lead contacts at local public health agencies within your region. 2. Communicate with lead contacts at local public health agencies (via phone or e- mail) upon receipt of regional file(s) for any newly poisoned child or a child with an increasing blood lead level to assure appropriate nursing and environmental follow- up and linkage to available community resources and programs. Document communication with local public health agency. 3. If case management barriers are identified, assist local public health agency to identify potential partners including other regional coordinators, private sector, and Michigan Department of Community Health. C. Performance Measures: 1. Number of contacts with local public health agency in respective region. 2. Number of new cases equal to or greater than 20 ug/dl_ having comprehensive nursing and environmental follow-up completed for each case (by agency). 3. Type of referrals and community linkages made by local public health agency. 4. Barriers encountered. 2. Secondary Prevention A. Objective: Increase regional blood lead testing in children 6 years of age and younger. First Priority: Increase testing numbers and rates in respective regions, especially those in the targeted communities. B. Activities: 1. Monitor and compare quarterly statistics provided by Michigan Department of Community Health to determine county testing trends especially among one and two year olds. Closely monitor testing rates in targeted communities. 2. Determine/report Chelations and number of hospital admissions each quarter. Determine how many initial and repeat Chelations. 3. Discuss (with local public health agency) outreach activities specific to physicians, health plans, and parents. Page 26 MDCH/CMS 6/05 ATTACHMENT HI 4. Determine local health department capacity and willingness to conduct testing through various county programs/services. If testing is occurring encourage local public health agency to continue efforts. If testing is not provided through local public health agency facilitate capillary testing training through Michigan Department of Community Health. C. Performance Measures: 1. Number of counties in the region with increased testing rates compared to same quarter last year. Report/comment on testing trends in targeted communities. 2. Number and type of outreach activities and trainings in the region. 3. Number of public health departments providing lead testing services. 3. Primary Prevention A. Objective, assure the following: 1. Increase public and professional awareness through intensive community outreach and education activities. 2. Prevent initial lead poisoning through early identification and remediation or interim control of hazards in at-risk housing. B. Activities (EXAMPLES): 1. Determine high-risk communities, blocks, and streets within the region utilizing GIS maps provided by Michigan Department of Community Health and focus outreach efforts in those areas. 2. Prepare and present education and outreach activities in the region for public and professional audiences. 3. Plan door-to-door canvassing in the highest risk areas leaving printed lead and resource information and offering available primary prevention services. 4. Explore capacity of local public health agency and regional coordinators to provide lead inspection/risk assessment in homes where children are not lead poisoned. (These homes: a) may include those located in the targeted high-risk communities; or b) homes where children have blood lead levels between 5 ug/dL and 9 ug/dL. 5. Identify homes through visual inspection, dust wipes, paint, or soil sampling. Once again, focus efforts in high-risk communities. 6. Educate local public health agency staff to incorporate lead awareness and anticipatory guidance when providing non-lead services in client homes. These include visits made for MSS/lSS, Early On, Children's Special Health Care Services, newborn screening follow-up, and maternal and infant care. Encourage local public health to train all nursing staff working with children about lead poisoning and its effects. In essence, promote the concept of "no missed opportunities". 7. Educate local public health about low interest loans for remediation [such as MSHDA's Property Improvement Program (PIP)]. Educate local public health agency staff about monies available in specific geographic areas through the Lead Hazard Remediation Program (LHRP) and specific lead funding available through Community Develop Block Grants (CDBG), LEAP, LIHEAP, Weatherization, etc. 8. Plan door-to-door canvassing in the high-risk areas leaving printed information on home cleaning, repair, and painting. Provide families with cleaning supplies such as buckets, sponges, soap, gloves, etc. MDCH/CMS 6/05 Page 27 ATTACHMENT III C. Performance Measures 1. Number and type of professional and public education activities occurring in the region. (Please feel free to share any resources, literature, or PowerPoint presentations that you prepared for your presentation and outreach activities). 2. Number of homes visited, number of calls received for information as a result of the canvassing effort, and number of primary prevention service appointments scheduled, if applicable. 3. Number of certified lead inspectors/risk assessors within each county in the region. Number of primary prevention visits made to at risk homes or homes where children reside with blood lead levels between 5 and 9 ug/dL. 4. Number of homes identified as at risk through inspection or sampling. 5. Number of lead trainings provided to in-home service providers and clinic staff. 6. Number of referrals to PIP and LHRP. 7. Number of homes visited and number of follow-up calls received as a result of canvassing effort. 4. Reporting Requirements Regional coordinators will submit a monthly report regarding caseload and activities for children in the respective region with blood lead levels equal to or greater than 20; quarterly data report regarding testing in their region; and quarterly narrative report addressing the outcomes, activities, and performance measures listed above. The quarterly narrative report will also include a written action plan for the next quarter. COLORECTAL CANCER EARLY DETECTION PILOT SPECIAL REQUIREMENTS Contractor Requirements 1. Create an approved statement of work that contains the following elements: A. Identify Geographic Area and Target Population B. Development of Collaborative Partnerships C. Provision of Early Detection Services D. Provider Care Network E. Options for Uncompensated Care F. Data Collection and Quality Control G. Billing and Reimbursement H. Project Coordination and Management Budget 2. Approval by MDCH of necessary elements must also be addressed in the statement of work including; A. All products and deliverables; B. Human subjects committee (IRB), as applicable; C. All publications, articles, brochures, flyers, presentations, and press releases generated by the project, as applicable; D. All health behavior messages regarding colorectal cancer early detection, as applicable. Page 28 MDCH/CMS 6/05 ATTACHMENT III 3. Submit quarterly progress reports, including budget amendments and outstanding invoices. 4. Participate with MDCH, Michigan Public Health Institute (MPHI), expert consultants, and other contractors in discussions, information sharing and problem solving. This will include at least three meetings/conference calls. 5. Submit a final project report and invoice for Phase II: Implementation. The final report, which is due 11/01/06, will include evidence that the agency: A. BCCCP local coordinating agencies that did not offer early detection services to men during the pilot must include a plan for provision of these services to men; B. Maintained relationships with providers needed in order to provide screening, diagnostic and treatment services; C. Conducted a pilot program for colorectal cancer early detection using the Michigan Cancer Consortium's Guidelines to provide services to 150 uninsured people , who are at or below 250% poverty, within a high mortality county; D. Maintained a record of screenings, with diagnostic, treatment, and genetic counseling and testing as appropriate, that was used by the funded agency and shared with MDCH/MPHI staff for quality control purposes; E. Maintained a record of clinical expenses for each client by CPT code, that was used by funded agencies and shared with MDCH/MPHI staff for evaluation purposes; F. Participated in evaluation of the overall pilot program and each funded site. G. Provided aggregated patient and clinical expense data to evaluate the project, using the specified format and frequency. H. Supplied evaluation data to MDCH/MPHI via other reporting mechanisms (i.e., quarterly reports). DIABETES OUTREACH NETWORK (BRANCH-HILLSDALE-ST. JOSEPH COMMUNITY HEALTH AGENCY) Contractor Requirements Diabetes Outreach Network Structure and Function 1. Maintain an independently located regional office as a non-competing, coordinating health care/education resource for the counties within the network region. Coordinate participation in the network among local health departments, other department-funded diabetes projects, as well as other health care and community-based agencies in the network service region. 2. Develop collaborative partnerships with the Community Health Centers (CHC) in the DON region by establishing contact with CHCs, promoting the DON Diabetes Care Improvement Project (DCIP), and supporting the center's participation in the national Health Disparities Collaborative, as appropriate. 3. Collaborate and partner as needed with: National Kidney Foundation of Michigan (NKFM), American Heart Association (AHA), American Diabetes Association (ADA), Michigan Association of Health Plans (MAHP), Michigan Organization of Diabetes Educators (MODE), and other key partners. 4. Educate consumers, communities, health care delivery agencies, health care providers, and legislators on the importance of pre-diabetes, diabetes self-management, implementation of quality diabetes care and education, and of the need to have sufficient funding to sustain these network activities. 5. Annually sign letters of agreement or memorandums of understanding with Diabetes Care Improvement Project (DCIP) agencies prior to entering client data from the agency into the Page 29 MDCH/CMS 6/05 ATTACHMENT III DCIP electronic database. These participating agencies must provide medical care to people with diabetes. For purposes of evaluation of the DON/DCIP continuous quality improvement objectives and targets, agency data collected and analyzed will not include data from the certified diabetes self-management training programs (DSMTPs). 6. The DON may continue to assist the DSMT programs in using the DCIP forms to compile and report the DSMTP intake and outcome data. The DONs are encouraged to continue other partnership activities with the DSMTPs. 7. Visit each participating agency at least once a year to discuss their DCIP data and strategize on ways to improve the quality of care. Provide each participating agency with a quarterly report and analysis of their client data; reports may be submitted less frequently upon the request of the participating agency. 8. Support and actively participate in consumer-driven or consumer-focused initiatives, such as Joining People with Diabetes, Stanford Chronic Disease Self-Management Program, lay health educator or other related initiatives. 9. Participate in the Michigan Nurses Association Continuing Education Approval Program to provide continuing education contact hours to Nurses and Dietitians. 10. Participate in National and State Initiatives including the CDC Flu/Pneumococcal Vaccination Campaign, National Diabetes Education Program (NDEP), and Diabetes Detection Initiative (DDI), as directed by the MDPCP. 11. Support a competent, core staff meeting the qualifications specified by the department. The core staff will consist of a project director, an office manager, and a diabetes educator. The director will manage the network program and budget; hire, train, and supervise all employees: and direct consultant staff. All funded staff must be qualified to meet the established standards for the Diabetes Outreach Network. Advisory Council Maintain an interdisciplinary advisory council that represents the major diabetes interests in the network region to advise the project on goals, planning, policy, technical issues, evaluation, strategic plan, and other project implementation. The advisory council must include people with diabetes and at least one representative from the Lion's Club. The DON will conduct no fewer than three (3) advisory meetings annually. Funding Limit maximum of funding that may be retained by the fiduciary to the lesser of $15,000 or 5% of the contractual amount. No more than one-third of DON resources/funding will be used to partner with or participate in regional primary prevention activities to address obesity, physical activity, smoking, school health, or related activities. Michigan Diabetes Prevention and Control Program Interface 1. Follow DON/DPCP policies/procedures as provided in the DON Orientation and Procedure manual, Strengthening Diabetes Care in Michigan, CEAP Procedure Manual and/or other MDPCP directives. 2. Have DON representation at each MDON and MDON/MDPCP meeting and on each MDON and MDON/MDPCP conference call. 3. Provide DON input and feedback by due dates on all department-initiated requests for MDON & MDPCP materials (such as program guidelines, evaluation data, policies/procedures, etc.) 4. Notify and submit to the MDPCP copies of all abstracts prior to submitting to conference or meeting planners for approval of participation at conferences or other types of presentations. Page 30 MDCH/CMS 6/05 ATTACHMENT III 5. Assure all primary prevention messages, campaigns, and initiatives are consistent with those implemented by the MDCH Cardiovascular Health, Nutrition and Physical Activity Section, the Michigan Surgeon General's Healthy Lifestyle campaign, and the Michigan Department of Education. Plan and Report Requirements 1. By 11/30/05 submit to the department for review and approval, the annual program plan for FY 05/06. This plan will include measurable goals, objectives, and target numbers. These shall be consistent with the objectives specified in this contract, the Department's CDC Federal Grant and National Diabetes Objectives, the Michigan Diabetes Strategic Plan, and the Regional DON Strategic Plan. 2. Complete quarterly reports, annual reports, annual plan & strategic plan reports, using MDCH- developed forms and instructions. information on progress toward meeting the DON region strategic planiuuummendaliuns will be integrated into the quarterly and annual report. Report due dates are: 1/21/06, 4/22/06, and 7/22/06: Quarterly Reports 10/21/06: 4th quarter and annual report (may be combined) 3. Complete the Program Numerical Report Summary each quarter according to the MDPCP procedure and submit to MDCH with quarterly reports. Provide examples as needed of consumer awareness activities, professional education, advocacy efforts and other pertinent activities. Contractor Specific Requirements 1. By September 30, 2006, provide diabetes continuous quality improvement (COI) consultation to 20 health care provider agencies in an effort to facilitate health system changes that result in measurable, improved quality of care. At least one of these agencies will be a federally qualified health center that is not currently participating in the Diabetes Collaborative. At least one of these agencies will primarily serve racial/ethnic minority or low-income populations. 2. By September 30, 2006, disseminate and promote use of all NDEP campaigns and materials to its regional partners and through local media channels. These campaigns are: A. Small Steps. Big Rewards. Prevent type 2 Diabetes. Includes promotion of at least one of the campaigns reaching racial and ethnic minority populations. B. Be Smart About Your Heart. Control the ABCs of Diabetes. C. Control Your Diabetes. For Life. 3. By September 30, 2006, utilize Taking on Diabetes program materials at one or more events for consumers or health professionals. 4. By September 30, 2006, partner with at least two managed care plans to facilitate their implementing a member-oriented or professional education initiative. (NOTE- UPDON contract will reflect one managed care plan). 5. By September 30, 2006, co-sponsor at least one consumer-driven initiative, such as Joining People with Diabetes Support Group Leader Training, Stanford Chronic Disease Self-Management Program, lay health educator initiative, or other related initiative. 4 These agencies will be those who are currently falling well below the DON regional target for at least three of the five diabetes care quality indicators. MDCH/CMS 6/05 Page 31 ATTACHMENT Ill 6. By September 1, 2006, update the website support group directory to reflect additions or changes in the support groups in their region. 7. UPDON will track the number of website hits to the support group directory and include the number of hits in each FY 06 MDPCP quarterly report. 8. By September 30, 2006, provide MNA pre-approved group presentations to 400 health care professionals, with a special emphasis on presentations aimed at improving diabetes clinical indicators. 9. By September 30, 2006, 100 health care professionals from the DON region will have successfully completed self-study module pre-approved for contact hours through the Michigan Nurses Association, the Commission for Dietetic Registration, or the Michigan Academy for General Dentistry. 10. By September 30, 2006, work collaboratively with the MDPCP, MNA, and CDR to revise or create the following self-study modules for pre-approved continuing education contact hours: A. Diabetes and Hypertension (5/05) B. Foot Care (9/05) C. Basic Nutrition (9/05) D. Type 1 (3/06) 11. By September 30, 2006, facilitate at least one project, in partnership with the American Diabetes Association, the American Heart Association, the American Cancer Society, or other voluntary health association, to increase awareness of the association of diabetes to other chronic health conditions (e.g. cardiovascular disease, cancer, depression, etc.) 12. By September 30, 2006, 25 health professionals from the DON region will have successfully completed the diabetes and hypertension self-study module. 13. By August 31, 2006, work in partnership with the MDPCP to disseminate federal or state campaign materials and promote annual flu and pneumococcal immunization for people with diabetes and their families. 14. By September 30, 2006, exhibit and provide educational material at one of the state's regional Immunization Conferences in an effort to promote the need to target immunization messages and services to reach people with diabetes. (Not in ECDON contract). 15. By September 30, 2006, partner with the National Kidney Foundation of Michigan (NKFM) to facilitate the NKFM implementation of the Healthy Hair Starts with a Healthy Body program in the DON region. (SEMDON, TENDON, and ECDON contracts only) 16. By September 30, 2006, actively participate in the DON region's access to care coalition or projects. 17. By September 30,2006, implement, in partnership with minority- and community-based agencies, four consumer-focused or professional education initiatives with specific strategies designed to reduce health disparities for diabetes, its complications, and its risk factors among Michigan's racial and ethnic minority or other underserved populations. 18. By September 30, 2006, actively partner with other state- and federally-funded diabetes initiatives reaching high-risk populations, as applicable (e.g., AIM-HI, REACH, Diabetes Detection Initiative, and Intertribal Council's STEPs project). 19. By September 30, 2006, establish or maintain a level three or higher' partnership with each of the Diabetes Collaborative projects in their region. (NOTE - not in UPDON contract, as they do not have a collaborative in their region). 4 The Bureau of Primary Health Care Health Disparities projects have developed a partnership classification identifying criteria to be met at specific partnership levels; this will be used to define the level of partnership. Page 32 MDCH/CMS 6105 ATTACHMENT III 20. By September 30, 2006, feature the message and media materials for the Michigan Surgeon General's Healthy Lifestyle campaign (Michigan Steps Up. Eat better. Move More. Stop Smoking. It's Just That Simple.) in at least one regional, major media or public relations campaign or community awareness event. EARLY WARNING INFECTIOUS DISEASE SURVEILLANCE (EWIDS) TRAVEL (CHIPPEWA COUNTY HEALTH DEPARTMENT, DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION, MACOMB COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY HEALTH DIVISION, ST. CLAIR COUNTY HEALTH DEPARTMENT AND WAYNE COUNTY HEALTH DEPARTMENT) Contractor Requirements The local health department must utilize these funds for travel expenses related to international cross- border infectious disease surveillance work. Such travel might include meetings with cross-border communicable disease public health partners, or attending Great Lakes Border Health meetings or conferences. Each health department must provide a report within 30 days of the end of the agreement citing how the funds were used for travel related to EWIDS. 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, 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 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. Women diagnosed with cervical cancer or pre-cancer (CIN 2) in the FP/BCCCP Joint Project are eligible to apply for Medicaid to pay for treatment. Page 33 MDCH/CMS 6105 ATTACHMENT ill 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, unless contradicts Title X Federal Law (Title X of the Public Health Service Act). 2. All delegate agencies must serve a minimum of 95% of proposed users to access total amount of allocated funds. HEALTH DISPARITIES REDUCTION PROGRAM - SPECIAL REQUIREMENTS (CALHOUN COUNTY HEALTH DEPARTMENT AND GENESEE COUNTY HEALTH DEPARTMENT) Contractor Requirements 1. START UP Agencies awarded funding under this RFP will be expected to have programs staffed and operational within forty-five (45) days of receipt of award. Direct client services are required to begin no later than ninety (90) days after receipt of award. Delays may result in revocation or reduction of award. If required, program development activities should be described in detail, justified in the description of the proposed program and detailed in the work plan and timeline. Failure to make reasonable progress in program development may result in revocation or reduction of award. 2. REPORTING Agencies awarded funding under this RFP will be required to submit quarterly narrative reports, according to a format and guidelines established by HDRP for minimum reporting requirements. 3. REIMBURSEMENT Grantee agencies are reimbursed on a monthly basis for expenditures incurred. Grantees will be required to prepare and submit monthly financial status reports. 4. HIPAA • Agencies awarded funding under this REP will be required to implement services in accordance with established program standards, as well as state and federal policy and statutes including HIPAA. Contractor Special Requirements: 1. Programs are required to be staffed and operational within 45 days of receipt of award, and direct client services are required to begin no later than ninety 90 days after receipt of award. 2. Failure to make reasonable progress in program development may result in revocation or reduction of award. 3. Quarterly reports shall adhere to the format arid guidelines established by HDRP for minimum reporting requirements. 4. Services must be implemented in accordance with established program standards, as well as state and federal policy and statutes including HIPAA. 5. Develop an evaluation tool, which identifies the process and outcome indicators of the project. Ensure that programs targeting multicultural populations are culturally competent. Cultural competency is defined as: A set of academic and interpersonal skills that allow individuals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups. This MDCH/CMS 6/05 Page 34 ATTACHMENT VI 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 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 department rules and statues as stated in Public Acts 88 and 89. 8. Service Providers should reflect the racial and ethnic groups served to extent that such providers could be reasonably recruited and utilized. The proposal criteria and the contractor's technical proposal on file in the Health Disparities Reduction Program Office, MDCH, as amended, are made a part of this agreement by reference. HIV/STD PARTNER COUNSELING AND REFERRAL SERVICES PROGRAM SPECIAL REQUIREMENTS (FOR HIV POSITIVE TEST NOTIFICATION, PARTNER COUNSELING AND REFERRAL SERVICES AND SYPHILIS INVESTIGATION (CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT) Contractor Requirements 1. Pursuant to a protocol established by MDCH, provide positive test notification, HIV partner counseling and referral services, victim notification and recalcitrant and syphilis investigation for the following local health departments: Central Michigan District Health Department, Barry Eaton District Health Department, Ottawa Health Department, Ionia County Health Department, Livingston County Health Department, Mid Michigan District Health Department, Shiawasee County Health Department, Lapeer County Health Department, St. Clair County Health Department, Sanilac County Health Department, Huron County Health Department, Tuscola County Health Department, Bay County Health Department, Midland County Health Department, District Health Department # 2, District Health Department #4, District Health Department #10, Leelanau-Benzie District Health Department, Grand Traverse County Health Department, Northwest Michigan District Health Department, Chippewa County Health Department, Luce- Mackinac-Alger-Schoolcraft District Health Department, Delta-Menominee District Health Department, Marquette County Health Department, Dickinson-Iron District Health Department, and Western Upper Peninsula District Health Department. 2. Provide these services fifty-two weeks a year. 3. Conduct program activities in accordance with state law. Relevant statutes are summarized in the document: Michigan HIV Laws: How They Affect Physicians and Other Health Care Providers. Michigan Department of Community Health. September 2002. 4. Establish, maintain and document linkages with community resources that are necessary and appropriate to addressing the needs of clients and that are essential to the success and effectiveness of services supported under this agreement. 5. Provide services supported under this agreement in accordance with guidelines and standards issued by the Michigan Department of Community Health and/or the US Centers for Disease Control and Prevention. Current guidelines and standards include: A. Revised Recommendations for HIV Screening of Pregnant Women. US Department of Health and Human Services. November 2001. B. Quality Assurance Standards for HIV Prevention Interventions. Michigan Department of Community Health. May 2003. C. Protocol for HIV Counseling and Testing Using Oral Mucosal Transudate Technology. Michigan Department of Community Health. March 1997, Page 35 MDCH/CMS 6/05 ATTACHMENT III D. Strategies to Improve Client Failure to Return for HIV Test Results. Michigan Department of Community Health. July 2002. E. Partner Notification Guidelines. Michigan Department of Community Health. January 2002. F. HIV Partner Counseling and Referral Service Guidelines, US Centers for Disease Control and Prevention. December 1998. G. Michigan Local Public Health Accreditation Standards. H. CDC STD Program Operation Guidelines. 2001 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 program activities in a manner consistent with the most current laws, guidelines and standards. 6. Conduct quality assurance of activities supported under this agreement. Quality assurance activities are to be guided by written policies and procedures. Policies and procedures associated with evaluation of staff providing services supported under this agreement are to include mechanisms for direct observation of provision of services. 7. Participate in quality assurance activities conducted by and/or facilitated by the Division of Health, Wellness and Disease Control, 8. Participate in technical assistance, training and/or skills-enhancement opportunities as recommended or required by the Division of Health Wellness and Disease Control, It is understood that the Division will provide travel support associated with participation in training and skills- enhancement opportunities. 9. Participate in program evaluation activities conducted by or required by the Division of Health, Wellness and Disease Control. 10. Submit all educational materials (e.g. brochures, posters, pamphlets and videos) used in conjunction with program activities to the Department's Program Review Panel for review and approval prior to their use. 11. Submit HIV test and HIV partner counseling and referral services data to the Division of Health, Wellness and Disease Control via the HIV Event System. The time line and procedures for submitting these data are to conform to guidelines issued by the Division of Health, Wellness and Disease Control. 12. Maintain the technological capacity necessary to comply with monitoring, reporting and evaluation requirements associated with this agreement and to ensure timely and efficient communication with the Department, IMMUNIZATION ACTION PLAN SPECIAL REQUIREMENTS Contractor Requirements 1. Service Delivery: Offer immunization services to the public. A. Collaborate with public and private sector organizations to promote adult immunization activities in the county: B. Inform providers that Hepatitis B, pneumococcal, and influenza vaccine and their accompanying administrative costs are Medicare covered benefits. C. Provide and implement strategies for addressing the immunization rates of special adult populations (i.e., college students, educators, health care workers, detention centers, homeless populations, and child care employees). D. Develop mechanisms to improve immunization rates. E. Ensure convenient accessible clinic hours MDCH/CMS 6/05 Page 36 ATTACHMENT III C. D. 10/01/2005 — 03/31/2006 04/01/2006 — 09/30/2006 April 15, 2006 October 15, 2006 F. Coordinate immunization services G. Develop methods to target local pocket of need areas. 2. Adhere to all federal and state appropriation laws pertaining to use of programmatic funds. 3. Adhere to requirements set forth in the Omnibus Budget Reconciliation Act of 1993, section 1928 Part IV — Immunizations and the 2003 Vaccines for Children Operations Manual and documents that are updated throughout the year pertaining to the Vaccines For Children (VFC) Program. 4. Ensure that federally procured vaccine is administered to eligible children only and properly documented per VFC guidelines. A. The VFC 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 provided in the jurisdiction are administered only to eligible clients. This program allows for the immunization of special populations who are underinsured and not served at a FQHC, RHC, or a public health immunization clinic affiliated with a FQHC. Ensure that all providers receiving vaccine from the state screen children for VFC eligibility. Abuse of federally procured vaccine should be monitored and reported. 5. Adhere to all Federal and Michigan Laws pertaining to immunization administration and reporting including reporting to the MCIR. 6. Monitor any provider receiving federally procured vaccine at least once every 3 years, and preferable at least once every 2 years, as a VFC site visit 7. Ensure attendance at two (2) Immunization Action Plan (IAP) meetings each year. 8. Submit original FSR's to MDCH on a quarterly basis. 9. Develop, implement, and submit program IAP Reports to immunization field representative or other designated point of contact in accordance with the following dates: Period Covered Date Due 10. Develop an IAP Plan for 2006 using a template provided by the Department, due to the Immunization Field Representative or other designated point of contact on December 15, 2005. 11. 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. These documents must be postmarked no later than February 15. Facsimile copies will not be accepted. 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. Page 37 MDCH/CMS 6/05 ATTACHMENT III 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. E. Collaborate with local birthing hospitals to ensure birth dose of Hepatitis B is given. 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. Department Requirements 1. The department will receive and review IAP reports and the annual IAP plan, and share this information with the local health departments. 2. Provide program direction and definition of IAP coordinator responsibilities. 2. Provide technical assistance in establishing and operating immunization action plans. 3. Provide technical assistance in MCIR activities through regional coordinators. 4. Provide supportive services and resource identification when needed. 5. Provide financial support for LHD and Community / Migrant Health Centers for immunization in pocket of need (POW) areas. 6. Each LHD will have an annual VFC site visit by the Department. 7. Develop pre-formatted tools including training for new initiatives and IAP reports / plan. IMMUNIZATION ASSESSMENT FEEDBACK INCENTIVE EXCHANGE (AFIX) PROVIDER SITE VISIT SPECIAL REQUIREMENTS Budget and Agreement Requirements The rate of reimbursement is $50 per site visit, not to exceed the maximum set for each individual Contractor. Contractor Requirements 1. Conduct an Assessment Feedback Incentive Exchange (AFIX) with 75% of the maximum number of VFC site visits for each Contractor. There will be a 25% minimum number of AFIX site visits set for each Contractor. 2. Combined VFC/AFIX site visits will be conducted using registry based assessment and tools developed by the Department. 3. Data from the Department regarding the number of AFIX site visits will be used to reconcile the request from the Comprehensive FSR (DCH-0412). The corresponding reimbursement must be noted as a funding source in requirements, refer to the guidance provided by the Department in correspondence to the Immunization Action Plan (IAP) and Immunization Coordinator. Department Requirements 1. The Department will provide payment based on the fixed unit rate reimbursement mechanism upon completion and submission of the Comprehensive FSR (DCH-0412). MDCH/CMS 6/05 Page 38 ATTACHMENT III 2. The Department will develop pre-formatted tools. 3. The Department will provide support to the Contractors. 4. The Department will provide training at IAP meetings and through field representatives. IMMUNIZATION — FIELD SERVICE REPRESENTATIVES SPECIAL REQUIREMENTS (DISTRICT HEALTH DEPARTMENT #10, KALAMAZOO COUNTY HEALTH DEPARTMENT, MARQUETTE COUNTY HEALTH DEPARTMENT, SAGINAW COUNTY HEALTH DEPARTMENT, AND ST. CLAIR COUNTY HEALTH DEPARTMENT) Contractor Requirements (Except Kalamazoo) 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, understanding that their full time is to be devoted for immunization related activities. 2. Provide the Immunization Field Representative with permanent office space and supplies, including, but not limited to: a telephone, general office supplies, a computer with high speed intemet capabilities, a printer, a cellular telephone and a use of vehicle or reimbursement mechanism for transportation unless otherwise arranged. 3. Ensure the Immunization Field Representative will be available to all local health departments in the assigned jurisdictions to provide Immunization Program activities equitable and at the direction of the Department. Refer to field representative responsibilities as defined by the Department and distributed to the 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 and other professional immunization related conferences, attendance at the MDCH Immunization staff meetings and trainings, and accreditation visits made in other areas of the state. Contractor Requirements — Kalamazoo Only Provide adequate office space, telephone connections, and high-speed internet access. Also provide access to fax and photocopiers. 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 responsibilities and definition of Immunization Field Service Representative responsibilities. 3. Support or solicit the Immunization Field Service Representative input into policy making decisions. IMMUNIZATION VACCINE FOR CHILDREN (VFC) PROVIDER SITE VISIT SPECIAL REQUIREMENTS Budget and Agreement Requirements The rate of reimbursement is $200 per site visit, not to exceed the maximum set for each individual Contractor. 1. The federal requirement is to visit each recipient of state-supplied and federally funded vaccine at least once every three years. More frequent visits may be necessitated for corrective actions vaccine deliveries, fraud investioatica, or_other §gecial events as they arise. The minimum Page 39 MDCH/CMS ATTACHMENT III 6/05 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. For the Detroit Health and Wellness Department,1 00% of all VFC providers will be visited annually through the Provider Service Representative (PSRLcontract, with no reimbursement due to the special circumstances of this contract. 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 and the CDC. 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 submitted by April 30 to qualify. For additional detail on the program requirements, refer to the Resource Book for Vaccine For Children Providers and other guidance provided by the MDCH/Immunization Program in correspondence to Immunization Action Plan (lAP) , Immunization Coordinators, or through health officers. 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 EDUCATION REIMBURSEMENT SPECIAL REQUIREMENTS Budget and Agreement Requirements The rate of reimbursement is $125 per educational session per day to the Contractor, upon completion and submission of INE Provider Contact and Report Forms. Reimbursement will be based on a first come-first served basis. Contractor Requirements 1. Ensure that all Immunization Nurse Educators are trained as required by the Department. 2. Ensure that the INE Provider Contact and Report Form is complete and submitted to MDCH/Immunization Program within 5 days after the presentation. Department Requirements 1. The Department will provide payment annually based upon the fixed unit rate reimbursement mechanism upon completion and submission of the INE Provider Contact and Report Forms. 2. The Department will provide two (2) sessions per calendar year for Contractor Immunization Nurse Educators. INFANT MORTALITY SUPPORT COALITION (BERRIEN COUNTY HEALTH DEPARTMENT, DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION, GENESEE COUNTY HEALTH DEPARTMENT, INGHAM COUNTY HEALTH DEPARTMENT, KALAMAZOO COUNTY HEALTH DEPARTMENT, KENT COUNTY HEALTH DEPARTMENT, MACOMB COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY HEALTH DIVISION, SAGINAW COUNTY HEALTH DEPARTMENT, WASHTENAW COUNTY HEALTH DEPARTMENT, WAYNE COUNTY HEALTH DEPARTMENT) Contractor Requirements 1. Adapt or organize a local community coalition to address African American infant mortality disparity according to Michigan's Infant Mortality Initiative — Infant Mortality Coalitions (Revised March 28, 2005). Page 40 MDCH/CMS 6/05 ATTACHMENT III 2. At a minimum, the coalition must meet Infant Mortality Coalition (Revised March 28, 2005) requirements: I) purpose, II) function, Ill) objectives, IV) membership, V) responsibilities, and VI) work plan components. 3. Provide MDCH consultant or authorized contractor access to coalition records of decisions, actions, plans; membership list; minutes, and any reviews and evaluations of actions and outcomes. 4. Build upon and maintain target population community collaboration and support. 5. Submit all required reports in accordance with the MDCH reporting requirements. Reporting Requirements 1. The contractor shall adhere to the Michigan's Infant Mortality Initiative Coalitions program reporting requirements in Infant Mortality Coalitions (Revised March 28, 2005). 2. Submit membership list and community representation of each member with the first coalition minutes and make any membership changes available for review by providing access to MDCH consultant or authorized contractor. 3. Submit to MDCH the community coalition minutes and attendance records 45 days after the meeting. Attendance records should include attendees' names and reflect their community representation. 4. Reports and information shall be submitted to: Infant Mortality Initiative Coalition Division of Family and Community Health Michigan Department of Community Health P.O. Box 30195 Lansing, Michigan 48909 Or via e-mail to: dfchmichiqan.00v Please put "[your county's name] Infant Mortality Coalition Reports/Minutes" in the subject line. 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. Page 41 MDCH/CMS 6/05 ATTACHMENT III A. B. C. (DETROIT Contractor LABORATORY SERVICES SPECIAL REQUIREMENTS DEPARTMENT OF HEALTH AND WELLNESS PROMOTION, KALAMAZOO COUNTY, KENT COUNTY, AND SAGINAW COUNTY HEALTH DEPARTMENTS) Requirements 1. Contractor Specific Requirements - All Contractors Meet established standards of performance and objectives in the following areas: 1. Bioterrorism: a. Make one FTE available to participate in training and exercises associated with Bioterrorism (BT). b. Train additional staff to perform Level A and B procedures. c. Secure and maintain Select Agent Registration. d. Maintain competency and proficiency for testing procedures described in the LRN protocols. e. Temporarily assign one FTE to MDCH or another Level B laboratory as surge capacity for emergency situations if needed. f. Develop a plan to provide laboratory services 24 hours a day, 7 days a week for a BT event. Provide secure facilities to store reagents, quality control organisms and patient isolates. 2. Maintain Clinical Laboratory Improvement Amendments of 1988 certification for high complexity testing and maintain select agent registration. 3. Establish submission procedures for designated agencies/physicians for the timely transport of appropriate specimens to the laboratory. 4. 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. Purchase and maintain adequate inventories of any supplies needed for testing and reporting, not specifically supplied by the Department in this agreement. Provide the Bureau of Epidemiology, and Bureau of Laboratories records and reports as required. For all testing services performed under contract by the Contractor for MDCH 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). g. MDCH/CMS 6/05 Page 42 ATTACHMENT III 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. D. 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. E. Provide laboratory support for examination of up to 100 stool specimens associated with foodbome disease outbreaks. Specimens will be processed within one hour of receipt if not in preservative or 24 hours if preserved. 2. Contractor Requirements — Detroit Department of Health and Wellness Promotion Only A. Meet established standards of performance and objectives in the following areas: 1. Perform testing for detection of foodbome disease outbreaks as specified in items 1.D and I.E. 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. 2. 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). 3. Test gonorrhea and chlamydia specimens from approved agencies within one working day of receipt of specimen. Perform HIV-1/2 screening tests for diagnostic specimens within one workday 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. 4. 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 reports and other laboratory reports from Department laboratory. 5. Establish testing personnel training program and maintain documentation of training of all testing personnel. B. Maintain an adequate inventory of tests kits and reagents purchased by the Department. Communicate shipment needs to manufacturer's representative if shipments supplementary to the routine shipments are needed. C. Inform the Infectious Disease Division by May 15, 2006 if more than 9,332 commercial nucleic acid amplification specimens for chlamydia/gonorrhea will be performed. 3. Contractor Requirements - Kalamazoo, Kent and Saginaw County Health Departments Only A. Administration of the Michigan Regional Laboratory System. 1. Administer the regional laboratories as specified: a. Kalamazoo County Health Department will administer Region 3 in the Michigan Regional Laboratory System. b. Kent County Health Department will administer Region 4 in the Michigan Regional Laboratory System. MDCH/CMS 6/05 Page 43 ATTACHMENT III c. Saginaw County Health Department will administer Region 2 in the Michigan Regional Laboratory System. 2. Provide a qualified (as defined by CLIA) Technical Consultant for their region. 3. Technical Consultants will: a. Assist the Laboratory Director in the administration of the operational needs of their region. b. Meet with local personnel from health departments on a regular basis including onsite visits to major sites at least annually. c. Act as a resource person to facilitate effective laboratory testing according to accepted procedures and quality assurance guidelines. Supply the laboratory procedures to the local site and instruct personnel in their use. e. Assist in planning and participate in training exercises related to Regional Laboratory procedures. f. Review quality assurance procedures, quality control logs, assure adherence to adopted procedures and evaluate corrective actions. g. Review and perform competency evaluations, as needed. h. Review and collate internal proficiency testing results and report scores to submitting sites in a timely manner. 4. 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. 4. Contractor Requirements - Kalamazoo County Health Department and Saginaw County Health Department ()nil/ A. Meet established standards of performance and objectives in the following areas: 1. Perform tests for diagnosis of gonorrhea and chlamydia infections using commercial nucleic acid amplification assay and perform testing for detection of foodbome disease outbreaks as specified in items 1.D and 1.E. 2. 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. 3. Test gonorrhea and chlamydia specimens from approved agencies/physicians within one working day of receipt of specimen. 4. 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. 5. Establish testing personnel training program and maintain documentation of training of all testing personnel. B. Inform the Infectious Diseases Division by May 15, 2006 if the health department performs more nucleic acid amplification specimens than specified: C. Kalamazoo County Health Department performs more than 12,000 nucleic acid amplifications prior to May 15, 2006. D. Saginaw County Health Department performs more than 12,850 nucleic acid amplifications prior to May 15, 2006. Page 44 MDCH/CMS 6/05 ATTACHMENT III 5. Contractor Requirements - Kent County Health Department Only A. Meet established standards of performance and objectives in the following areas: 1. Perform tests for diagnosis of gonorrhea and chlamydia infections using a commercial assay, perform testing for detection of foodbome disease outbreaks as specified in items 1.D and 1.E, and perform tests for diagnosis of HIV infection using a test designated by the Bureau of Laboratories, and perform tests for epidemiological assessment of HIV incidence as specified in item 5.C. 2. 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). 3. 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 workday of receipt of specimen. Perform HIV confirmatory test within three days of screening assay positive results. Submit specimens for HIV-2 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. 4. 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. 5. 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. B. Inform the Infectious Diseases Division by May 15, 2006, if more than 19,250 Nucleic Acid Amplification specimens will be performed. Department Requirements 1. Department Requirements (for All Contractors): A. Reimburse the Contractor for the examination of specimens related to foodbome disease outbreaks to the extent outlined in items 1.D & 1.E 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. B. Notification and explicit instruction for stop and start days to Contractor laboratory regarding this contractual arrangement prior to its implementation. C. The Department will provide access to EPIC, support for EPIC hardware (UNIX server) and software, provide one computer, 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. D. Analyze data from reports submitted from Contractor. Supply timely feedback of statistical analysis and other data related to on going program activities. E. Assist in technical training of testing personnel and computer software utilization. Page 45 MDCH/CIVIS 6/05 ATTACHMENT III F. Supply Contractor with a copy of the contracts associated with this program. G. Monitor monthly utilization reports. H. Provide reagents and culture media for food and stool specimen examination related to foodbome disease outbreaks. 2. Department Requirements — Detroit Department of Health and Wellness Promotion Only A. Reimburse the Contractor for performing HIV Diagnostic Testing. B. Purchase and arrange for shipment of test kits and reagents from manufacturer. C. Purchase specimen collection kits. Ship collection kits to designated agencies/physician submitters. Monitor specimen collection kit utilization. D. Perform Quality Assurance Assessment for HIV testing semi-annually. E. 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. 3. Department Requirements (for Kalamazoo County, Kent County and Saginaw County Health Departments) A. 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. B. Michigan Department of Community Health (MDCH): 1. Reimburse the Contractor for administrative costs associated with operation of the CLIA umbrella certification. 2. Designate and assign personnel who meet the qualifications required as a high complexity laboratory director in CLIA '88. 3. Laboratory Directors will: a. Sign the appropriate CMS paperwork for CLIA certification for their region as needed. b. Visit Agency Laboratory at least twice a year and participate in annual site coordinator's meeting. c. Be available for consultation to the Agency laboratory by telephone, email, and other communication methods. d. Provide laboratory guidelines, testing procedures, quality control methods and quality assurance in accordance with CLIA requirements. e. Review Quality Assurance program with attention to effective quality control activity and corrective action. f. Review and perform, as needed competency evaluations. g. Review external proficiency testing results in a timely manner. h. Review and sign procedure manual(s) annually, and any new procedure prior to its implementation. 4. Notify Agency of funding changes for state supported testing initiatives. 5. Provide training for state-funded initiatives. Page 46 MDCH/CMS 6/05 ATTACHMENT III 6. 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. 4. Department Requirements - Kalamazoo County and Saginaw County Health Departments only A. Purchase and arrange for shipment of test kits and reagents from manufacturer. B. Purchase specimen collection kits. Ship collection kits to designated agencies/physician submitters. Monitor specimen collection kit utilization. 5. Department Requirements - Kent County Health Department only A. Purchase and arrange for shipment of test kits and reagents from manufacturer as outlined in items 1.A, 1.D. and 1.E. B. Purchase specimen collection kits for diagnostic testing. Ship collection kits to designated agencies/physician submitters. Monitor specimen collection kit utilization. C. Perform Quality Assurance Assessment for HIV testing semi-annually. LABORATORY SERVICES SPECIAL REQUIREMENTS (OAKLAND COUNTY HEALTH DIVISION AND NORTHWEST MICHIGAN COMMUNITY HEALTH AGENCY) Contractor Specific Requirements - Oakland and Northwest Michigan 1. Meet established standards of performance and objectives in the following areas: A. Make one FTE available to participate in training and exercises associated with Bioterrorism (BT). B. Train additional staff to perform Level A and B procedures. C. Secure and maintain Select Agent Registration. Maintain Clinical Laboratory Improvement Amendments of 1988 certification for high complexity testing and maintain select agent registration. D. Maintain competency and proficiency for testing procedures described in the LRN protocols. E. Temporarily assign one FTE to MDCH or another Level B laboratory as surge capacity for emergency situations, if needed. F. Develop a plan to provide laboratory services 24 hours a day, 7 days a week for a BT event. G. 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 and Bureau of Laboratories records and reports as required. For all testing services performed under contract by the Contractor for MDCH (e.g. BT), 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) Page 47 MDCH/CMS 6/05 ATTACHMENT III - Monthly maintenance fees (paid to MDCH) - Use of modules purchased by a Contractor can be negotiated (formulas for payment will be based upon the percentage of total specimens entered into the module). Models 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. Department Requirements — for both Oakland and Northwest Michigan 1. Notification and explicit instruction for stop and start days to Contractor laboratory regarding this contractual arrangement prior to its implementation. 2. The Department will provide access to EPIC, support for EPIC hardware (UNIX server) and software, support and maintenance for one computer, user training for EPIC modules utilized for testing performed under the 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. 3. Assist in technical training of testing personnel and computer software utilization. 4. Provide technical consultation and assistance with program activities. 5. Supply Contractor with a copy of the contracts associated with this program. Department Requirements - Northwest Michigan Health Agency only 6. Provide CLIA director and QA program, training, monitoring and oversight. Department Requirements — for both Oakland and Northwest Michigan 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 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 SERIVCES — STARHS and VARHS (KENT COUNTY HEALTH DEPARTMENT AND DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION) Contractor Requirements Provide specimen tracking, packaging and shipping of Serologic Testing Algorithm for Determining Recent HIV Seroconversion (STARHS) and Variant and Atypical Resistant HIV Surveillance (VARHS) specimens as indicated in the study design. Department Requirements Support specimen tracking, packaging and shipping of VARHS and STARHS through funds for personnel and supplies. Provide instructions, training and study design. Perform VARHS testing in the Department's Lansing Laboratory. LEAD HAZARD REMEDIATION PROGRAM SPECIAL REQUIREMENTS Contractor Requirements Provide lead-based paint hazard control activities for eligible families residing in high-risk homes containing lead-based paint. Lead Hazard Remediation Program (LHRP) requirements are divided into the following categories: 1) Education and Outreach; 2) Identification of Candidate Housing Units; 3) Lead Hazard Control Activities; 4) Follow-up Activities; and 5) Post Remediation Client Surveys and Data MDCH/CMS 6/05 Page 48 ATTACHMENT III )CH/CMS ATTACHMENT HI 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 10 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. 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. H. Each county is expected to promote and distribute the application for the Michigan State Housing Development Authority's (MSHDA) Property Improvement Loan Program (PIP) to public and private entities, including but not limited to homeowners, rental property owners, non-profit organizations and rehabilitation/remodeling sections of local government groups. County will forward loan applications for interested applicants to MDCH LHRP. County should strive to submit between 5 and 10 applications to MDCH LHRP. 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. Page 49 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. Process contractor payment invoice and authorization to LHRP after visual inspection of project has been completed. 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. Completed form must be submitted to LHRP within 30 days of completion. E. Conduct a 14-month visual certification to address contractor warranty issues. Completed form must be submitted to LHRP within 30 days of completion. 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. Distribute to each participant the Client Satisfaction Survey at the completion of each unit, C. Conduct ongoing data collection and quarterly reporting to LHRP. Budget and Agreement Requirements As an established contractor (a contractor who has been awarded a Lead-Based Paint Hazard Control Grant before) agree to coordinate lead-based paint hazard control activities in approximately 30 homes for the period. At least 18 of these 30 homes should be completed no later than March 31, 2006. 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 by the 10 th of the following month. The contractor will provide to LHRP during the semi-annual site visits a summary of all expenditures related to this agreement in excess of $500 in a format specified by the department, including contracted services. Expenditures for salaries and fringe benefits of staff as provided in monthly FSRs are excluded from this requirement, as well as equipment expenditures in excess of $5,000 as provided in Part I, Section 3, Equipment Purchases and Title of the contract Reference Documents he following reference documents are essential to performing the stated requirements in this contract: LHRP quarterly report guidance Page 50 IDCH/CMS ATTACHMENT III '05 HUD 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 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* Infectious/Communicable Disease Control Sexually Transmitted Disease State funding for LPHO can support administrative cost for the six required services including allowable indirect cost, or an agency's cost allocation plan. (*Services funded under a separate agreement with the Michigan Department of Environmental Quality.) 2. LPHO funding can also be used to fund other core health functions including; Community Health Assessment & Improvement, Public Policy Development, Health Services Administration, Quality Assurance, Creating & Maintaining a Competent Work Force and Local Public Health Accreditation. These services could be budgeted separately as part of the Administrative Budget element. 3. Net allowable expenditures are the authorized actual/allowable expenditures (total costs less specified exclusions). Available funding is also limited by state appropriations. 4. First and second party fees earned in each required service program may be used only in that required service program. 5. State LPHO funding is subject to local maintenance of effort compliance, in that full distribution of state LPHO funds shall only be made to agencies with total local general fund public health services spending in FY 05/06 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 05/06 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; STD 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. Page 51 1DCH/CMS /05 ATTACHMENT III 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. Contractor Specific Requirements — Food Service Sanitation Budget and Agreement Requirements MDA Agrees to: Food Service Establishment Licensing 1. Furnish pre-printed food service establishment license applications and pre-printed licenses to the local health department for each licensing year (May 1 through April 30) using previous year active license data. 2. Provide a count of all licenses sent to the local health department titled "Record of Licenses Received." 3. Reprint any licenses requiring correction and send corrected copies to the local health department. 4. Bill the local health department for state fees upon notification by the local health department that the license has been approved and issued. Temporary Food Service Establishment Licensing 1. Furnish blank temporary food service license application forms (forms Fl-231, FI-231A) and blank Combined License/Inspection forms (FI-229) upon request from the local health department. 2. Furnish a "Record of Licenses Received" with each order of Combined Licenses/Inspection forms. 3. Periodically reconcile temporary food service establishment licenses sent to the local health department with the licenses that have been issued (copy returned to MDA). Request payment of state fees for any temporary food service establishment license that cannot be accounted for. 4. Bill the local health department for state fees upon notification by the local health department that the license has been approved and issued. Contractor Requirements The local health department agrees to: Food Service Establishment Licensing 1. Accept responsibility for all licenses specified in the "Record of Licenses Received," 2. Issue licenses in accordance with the Michigan Food Law 2000, as amended. 3. Provide updates to MDA on the 1 st and 15th of each month, as necessary to: A. Provide a list of food service establishments approved for licensure/license issued. B. Provide a list of food service establishment licenses that have not been approved for licensure and are considered voided or deleted. C. Return the actual licenses to MDA that are to be voided or deleted. D. Return renewal license applications and licenses that require correction. Mark the corrections on the renewal application. Page 52 MDCH/CMS 6/05 ATTACHMENT III Temporaly Food Establishment Licensing 1. Upon receipt, sign and return the "Record of Licenses Received" to MDA. 2. Issue licenses in accordance with the Michigan Food Law 2000, as amended. 3. Make every effort to issue temporary food establishment licenses in numerical order. 4. Provide updates to MDA on the 1 5t and 15th of each month, as necessary, to provide: A. A copy of each temporary food establishment license issued. B. A list of lost or voided licenses by license number. 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 tri-annual reports and other required program documentation to Tobacco Program Consultant on a timely basis. 6. Attend Department regional and statewide coalition coordinator training. MATERNAL AND CHILD HEALTH (MCH) PROGRAM SPECIAL REQUIREMENTS General Performance Requirements 1. 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. 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 Submit a Local Maternal and Child Health Community Plan for use of the funds allocated for Local MCH Programs. MDCH/CMS 6/05 Page 53 ATTACHMENT III 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, CSHCS Case Management and/or Care Coordination, 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. 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 and with the MAP Community Health Consultant at Michigan Public Health Institute. This grant application is incorporated by reference upon signature of this agreement. 2. Conditions A. By signing this agreement, the Contractor assures that the grant application and subsequent activities 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 Program (MAP) guidelines/requirements as outlined in the Request For Community Action Plans (RFCAP). By agreeing to this, the Contractor also understands that no contraceptives may be distributed to minors and no safer sex message/information may be delivered with either state funding or the local matching dollars. The community-selected abstinence education and parent education curricula must be prior-approved by MDCH/MAP to assure compliance with state and federal regulations. B. Funds will be released pending receipt/agreement of all required work plan revisions. Beginning October 1, 2005, funding is only authorized up to $48,241 for FY 06 MAP programming, until further written notice. C. The Contractor must agree and abide by the following 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. Page 54 MDCH/CMS 6/05 ATTACHMENT HI 4. 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. 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. Projected Outputs A. Record projected outputs on the Performance Output Measures report and return with the signed agreements and budget. 4. Reporting Requirements A. The Contractor shall prepare quarterly narrative Performance/Progress Reports following the format provided by MDCH/MAP. These quarterly narrative reports must be submitted no later than January 13, 2006, April 14, 2006 and July 14, 2006. The year-end report, which includes both the last quarter and an annual summary, is due November 15, 2006. 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 the Unduplicated form and the Total Encounters form as provided by MDCH. A copy of the Contractor's most recently submitted Financial Status Report (FSR) must accompany these data report forms. B. Any other information as specified should be developed and submitted by the Contractor as required by the Community Health Consultant or the MAP Coordinator. C. Performance/Progress Data Reports and a copy of the FSR described in #1 above should be submitted to the Community Health Consultant at the address below: Michigan Public Health Institute 2438 Woodlake Circle, Suite 240 Okemos, MI 48864 D. The Community Health Consultant shall evaluate the reports submitted as described in #1 and #2 above, for completeness and adequacy. E. The Department or its designee shall conduct site reviews and make an evaluation of the project as determined by the Program Coordinator. F. Final actual outputs as defined are due no later than 120 days following the end of the fiscal year. The final output reports shall be submitted to: MAP Coordinator Michigan Department of Community Health Division of Family & Community Health PO Box 30195 Lansing, MI 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) 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. MDCH/CMS 6/05 Page 55 ATTACHMENT III 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 Other Departments The regional contractor shall perform the following activities on behalf of the Michigan Department of Community Health to support the Michigan Childhood Immunization Registry: 1. Promote and train providers on all features of the MCIR Web application. 2. Support regional MCIR users by operating the regional help desk in accordance with Department approved procedures. 3. Monitor and develop strategies to increase private provider enrollment and participation in the MCIR. Develop strategies to encourage all providers to fully participate with the MC1R, (such as sites of excellence awards). 4. Process all user/usage agreements, according to MDCH approved procedures, to create user accounts. 5. Implement and update marketing plans in support of increased provider and parent acceptance and use of the MCIR. 6. Keep regional users updated on MGR status and system changes. 7. Assure that records submitted via paper forms are entered in a timely fashion and according to MDCH approved procedure. 8. Conduct ad hoc reporting and querying on behalf of MCIR users. Monitor infant death announcements in the region that appropriately mark MCIR records. 9. Develop a mechanism to assure children who have died within the region are appropriately flagged in the MCIR. 10. Maintain a listing of private and public immunization providers. This listing should be as comprehensive as possible and should include all providers in the region. 11. Conduct regular de-duplication activities to assure that duplicate records are removed from the MCIR as quickly as possible. 12. Process user petitions to change MC1R data according to MDCH 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 assure that local health department staff can train and educate providers on how to access and submit data into MCIR. 16. Maintain a policy/procedure manual, approved by the regional advisory group and MDCH. 17. Process and file all "opt out" forms according to the Department approved procedures. 18. Attend regular MCIR regional contractor/coordinator meetings. 19. Perform quality assurance checks on the MC1R 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. Provide assistance to the Department on User Acceptance Testing (UAT) enhancements. MDCH/CMS 6105 Page 56 ATTACHMENT III Contractor Performance/Progress Report Requirements 1. Submit quarterly status reports on work plan progress. Reports are due within 30 days of the end of each quarter. (January 31 1 April 30, July 31, October 31) 2. Final quarterly report shall be an annual report. The annual report will be distributed to Regional Advisory members and MDCH. The report shall include: A. summary of provider enrollment (breakdown by role); B. the amount of data submitted to the region during the fiscal year; C. summary of staff resources; D. regional advisory meeting review; E. sites of excellence award recipients. 3. Any other information as specified in the special requirements shall be developed and submitted by the contractor as required by the contract manager. Reports and information should be submitted to: Bob Swanson, MPH Michigan Department of Community Health Immunization Division P.O. Box 30195 Lansing, MI 48909 Phone; (517)335-8159 The contract manager shall evaluate the reports submitted as described above for their completeness and adequacy. The Contractor shall permit the Department or its designee to visit and to make an evaluation of the project as determined by the contract manager. Department Requirements 1. Provide support and technical assistance to Regional staff. 2. Provide initial training and support to regional coordinator. NURSE FAMILY PARTNERSHIP (NFP) PROJECT (DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION, BERRIEN AND KENT COUNTY HEALTH DEPARTMENTS AND OAKLAND COUNTY HEALTH DIVISION) 1. Adhere to the Nurse Family Partnership, Inc., (NFP) National Office program standards and operate the program with fidelity to the requirements. 2. NFP program recipients must be a resident of one of the specified areas: A. For Berrien County Health Department, NFP program recipients must be a resident of Benton Harbor or Benton Township, Michigan at the initiation of services. B. For the Detroit Department of Health and Wellness Promotion, NFP program recipients must be a resident of the City of Detroit at the initiation of services. C. For Kent County Health Department, NFP program recipients must be a resident Grand Rapids, Michigan or CENSUS TRACTS 126,127 and 128 of the Community of Kentwood, Michigan at the initiation of services. D. For Oakland County Health Division, NFP program recipients must be a resident of Pontiac, Michigan at the initiation of services. 3. The primary target population is low-income, first time African American pregnant women living in the specified area: Page 57 MDCH/CMS 6/05 ATTACHMENT III A. Benton Harbor and Benton Township, Michigan for Berrien County Health Department. B. Detroit, Michigan for Detroit Department of Health and Wellness Promotion. C. Grand Rapids and CENSUS TRACTS 126, 127, and 128 of the Community of Kentwood, Michigan for Kent County Health Department. D. Pontiac, Michigan for Oakland County Health Division. 4. NFP home visiting nursing staff will reflect the community served. Submit a staff roster for the fiscal year and within 30 days of a change. 5. Authorize the Michigan Department of Community Health (MDCH) access to the community's NFP Clinical Information System (CIS) and provide all necessary information for client identification, such as clients' demographic information and NFP or local identification numbers used in the CIS database. 6. Subject to match requirement (hard or in-kind) of two dollars and fifty cents for each ten dollars for MDCH agreement funding. 7. Provide MDCH consultant or authorized contractor program access. 8. Build upon and maintain diverse community and target population collaboration and support. 9. Develop and maintain a broad-based NFP community advisory committee. The committee shall consist of at least 50% consumers/community leaders from the target population and the remainder from referring/partnering/supporting agencies. Additional members would include appropriate health department staff. Meetings will be held once per quarter in coordination with the Michigan NFP Consultant or an MDCH designee, who will serve as an ad hoc member. Submit all required reports in accordance with the MDCH reporting requirements. Reporting Requirements 1. The contractor shall adhere to the NFP, Inc., National Office program reporting requirements. 2. Submit to MDCH the broad-based community advisory committee minutes and attendance records 45 days after the end of the quarter. Attendance records should include attendees' names and reflect their advisory committee representation as a consumer/community leader, referring/partnering/supporting agency staff or implementing agency staff. 3. Reports and information shall be submitted to: Nurse Family Partnership Division of Family and Community Health Michigan Department of Community Health P.O. Box 30195 Lansing, Michigan 48909 Or via e-mail to: Paulette Dobynes Dunbar at dunbaroamichioan.00v. (Please put "Nurse Family Partnership Reports FY 06" in the subject line.) 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. Page 58 MDCH/CMS 8/05 A'TTACHMENT UI 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. Develop or show collaboration of strong prevention focus for a primary dental care school- based/school-linked program. Reporting Requirements 1. 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. Report on prevention focus for school-linked, school-based programs that includes participating schools and services provided in schools; and if such a program is undeveloped, efforts made to initiate a school-linked, school-based oral health program. Reports due: February 15, 2006 (Periods Oct. 2005 — Jan 2006) and June 30, 2006. 2. Submit reports to: Brenda Fink 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 finkb@michigan.gov The Contractor shall permit the Department or its designee to visit and to make an evaluation of the project as determined by Contract Manager. Northwest Community Health Agency and Western UP. District Health Department have a staffing reimbursement method. 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. Page 59 MDCH/CMS 6/05 ATTACHMENT III RAPE AND SEXUAL ASSAULT PREVENTION EDUCATION SPECIAL REQUIREMENTS (KENT COUNTY HEALTH DEPARTMENT) Contractor Requirements 1. Submit performance/progress reports as listed below: A. The Contractor shall submit the following reports on the following dates: Financial Status Report (FSR) Monthly Report 1 (Oct. 2005-Jan. 2006) February 15, 2006 Report 2 (Feb. 2006— May 2006) June 15, 2006 Final Report (Oct. 2005-Sept. 2006) October 31, 2006 Evaluation Report (10/02/02-09/30/06) October 31, 2006 Any such other information as specified in the Contract Requirements shall be developed and submitted by the Contractor as required by the Contract Manager. C. Reports and information shall be submitted to the Contract Manager at: GrzywaczAmichioan,00v. D. • The Contract Manager shall evaluate the reports submitted for their completeness and adequacy. E. The Contractor shall permit the Department or its designee to visit and to make an evaluation of the project as determined by Contract Manager. Contractor Specific Requirements 1. Secure & forward subcontracts, if applicable (Oct-Jan) with first Project Report. A. Submit subcontracts for 2 Hispanic facilitators. B. Submit subcontracts for 6 facilitators. 2. Access primary target population (youth ages 12-18). A. Provide 16 Project Respect programs at at-risk sites (Oct-June). B. Provide 6 Project Respect programs at gender-specific sites (Oct-June). C. Provide 7 Project Repect programs at Hispanic sites (Oct-June). D. Provide 8 one-time presentations at F/CBOs & schools. (Oct-Aug). 3. Access secondary target populations (parents, school staff, community members, etc). A. Provide 2 TOT workshops to F/CBO representatives, community members, & parents (Oct- June). B. Provide program updates & technical assistance to community trainers (Ongoing). C. Provide 4 presentations to parents, F/CBO representatives, & community members (Oct- Sept). 4. Implement survey & 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, & method of delivery. 6. Analyze secondary target population data (Ongoing). Data will demonstrate: A. Trainers: statistically significant increase in knowledge. Page 60 MDCH/CMS 6/05 ATTACHMENT III B. Trainers: statistically significant increase in positive attitudes. C. Trainers: improved facilitation skills. D. Trainers: 80% will be satisfied with TOT facilitator(s), content, & method of delivery. E. Presentation participants: statistically significant increase in knowledge. F. Presentation participants: 80% will be satisfied with facilitator(s), content & method of delivery. 7. Conduct project review using evaluation data (Sept). 8, Provide 4-year (10/01/03 — 9/30/06) evaluation report to MDCH project officer, partners & other interested parties by October 31, 2006. 9. Participate in 1 grantee meeting (dates/locations to be determined). 10. Investigate options to ensure project viability after September 30, 2006. A. Market project-related information F/CBOs & schools (Oct-Jan). B. Develop partnerships resulting from TOT workshops (Ongoing). 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. 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). Page 61 MDCH/CMS 6/05 ATTACHMENT III SMOKEFREE WORKPLACE PROJECT SPECIAL REQUIREMENTS (BENZIE-LEELANAU DISTRICT HEALTH DEPARTMENT) Contractor Specific Requirements Module: Eliminating Tobacco-Related Disparities Program Goal: Eliminating Tobacco-related Disparities Objective: Increase by three the number of smoke-free worksites in Leelanau County. Activity 1: By the end of the first period, Coordinator and staff will gather a list of the approximately 700 worksites located within the county. Activity 2: By the end of the first period, Coordinator will establish a database of all the worksites contacted for the project. Activity 3: By the end of the second period, Coordinator will recruit, hire and train two youth to assist with the project, including assisting with surveys, business contact communication and educational activities. Activity 4: By the end of the second period, Coordinator and staff will conduct a survey of at least 70 worksites via phone, mail or person. Activity 5: By the end of the second period, Coordinator and staff will identify contact people for each site. Activity 6: By the end of the agreement, Coordinator and staff will identify which worksites are already smoke-free. Activity 7: By the end of the agreement, Coordinator and staff will implement strategies to publicly acknowledge worksites that are smoke-free. Activity 8: By the end of the agreement, Coordinator and staff will identify worksites that are interested in receiving information about becoming smoke-free. Activity 9: By the end of the agreement, Coordinator and staff will provide policies, information, materials and technical support to those sites that want to become smoke-free. Activity 10: By the end of the agreement, Coordinator and staff will implement strategies to educate sties that do not want to be smoke-free. Activity 11: By the end of the agreement, Coordinator and staff will collect and evaluate project data. Activity 12: Throughout the agreement period, Coordinator and staff will promote the Smoke- free Home Pledge program. Activity 13: Throughout the agreement period, Coordinator and staff will provide information and resources for the tobacco addiction recovery program. Activity 14: Throughout the agreement period, the Coordinator will track meeting dates and times for the coalition meetings, trainings and conferences attended. Module: Eliminating Tobacco-Related Disparities Objective: Support the structure and activities of established tobacco control groups in Michigan. Activity 1: Activity 2: Activity 3: Coordinator will attended Tobacco Section sponsored trainings and meetings. Coordinator will participate in the regional clean indoor air networking group. Coordinator will participate in the regional tobacco reduction coalition. Page 62 MDCH/CMS 6/05 ATTACHMENT HI TB CONTROL (DOT) SPECIAL REQUIREMENTS General Requirements Directly Observed Therapy (DOT) is defined by the CDC Core Curriculum on Tuberculosis 2004 as: "a health care worker or another designated person watches the TB patient swallow each dose of the prescribed drugs.' The 2003 American Thoracic Society (ATS) document Treatment of Tuberculosis regards DOT as "the preferred core management strategy for all patients with tuberculosis". 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/week (excluding holidays) for daily regimens, and 2 or 3 days/week for intermittent regimens. Contract 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. For each patient enrolled in DOT, submit evidence (i.e. DOT logs) monthly to the MDCH TB Program that DOT was accomplished. 3. For each patient enrolled in DOT, submit RVCT II forms (Completion of Therapy) to the MDCH TB 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 >95% completion rate for treatment of all TB cases. The determination of whether or not treatment has been completed is based on the total number of doses taken, not solely on the duration of therapy. Consult the 2003 ATS document Treatment of Tuberculosis for guidance in both the number of doses needed and also in regards to length of treatment following any interruptions in therapy. 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-477) which will then be returned to MDCH. Page 63 MDCH/CMS 6/05 ATTACHMENT III 5. The Agency in accordance with the general purposes and objectives of this agreement, will comply with the federal regulations requiring that any individual that embezzles, willfully misapplies, steals or obtains by fraud, any funds, assets or property provided, whether received directly or indirectly from the USDA, that are of a value of $100 or more, shall be subject to a fine of not more than $25,000. WIC EBT SPECIAL REQUIREMENTS (JACKSON COUNTY HEALTH DEPARTMENT) Contractor Requirements Funding is provided to continue the support of contractual staff responsible for assisting with and coordinating the implementation and operation of the WIC EBT pilot project at the local health department, including: 1. Coordinating participant training and local agency staff training; 2. Conducting site evaluation and preparation; 3. Coordinating card stock storage and security; adjust coupon inventory and storage; 4. Developing the conversion plan for the local agency; 5. Providing EBT overview sessions for the county staff; 6. Coordinating outreach activities to the community regarding the WIC EBT pilot project; 7. Assessing workloads and recommending adjustments; and 8. Performing other EBT activities and duties as mutually determined. Department Requirements Upon completion of FY 06 closeout and the local health department's submission of the final FY 06 Financial Status Report (FSR), the Department will seek to identify any unspent WIC EBT funds. If funding is determined to be available and needed, the Department will work with the local health department to reallocate these special USDA grant funds for use in FY 07. WIC — USDA INFRASTRUCTURE GRANT (BERRIEN COUNTY HEALTH DEPARTMENT, CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT, CHIPPEWA COUNTY HEALTH DEPARTMENT, DISTRICT HEALTH DEPARTMENT #10, GENESEE COUNTY HEALTH DEPARTMENT, GRAND TRAVERSE COUNTY HEALTH DEPARTMENT, JACKSON COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY HEALTH DIVISION AND SHIAWASEE COUNTY HEALTH DEPARTMENT) Budget and Agreement Requirements Local Health Departments receiving the USDA Infrastructure Grant funds are required to budget funds as a separate element. Expenditures and funds must be tracked separately and reported accordingly on the Financial Status Report (FSR) form. Contractor Requirements Submit a work plan that contains measurable objectives and timelines associated with the USDA funded project. Reporting Requirements 1. Progress reports should be submitted by April 7, 2006 and October 7, 2006. Page 64 MDCH/CMS 6/05 ATTACHMENT 111 2. Progress reports must include the amount of funding spent year-to-date as well as account for obligated dollars. 3. Progress reports must should report on the status of the project based upon the project's goals and objectives. WELL-INTEGRATED SCREENING AND EVALUATION FOR WOMEN ACROSS THE NATION (VVISEWOMAN) 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 most current WISEWOMAN Program Policies and Procedures Manual. MDCH/CMS 6/05 Page 65 ATTACHMENT III Oakland County Health Department FY 2006-2006 CPBC AGREEMENT MDCH Funding Allocations/Reimbursement Mechanisms Matrix Attachment IV Total (c) State (d) State Funded Minimum MDCH Funding Reimbursement Method Performance Target Perform. Funded Target Performance Percent Vendor / Sub Program Element/Funding Source (a) Source Amount (b) Output Measurement Expect. Perform. Number (e) recipient (f) Program for Local MCH to be determined based on plan Local MCH (3) $332,964 After Program approval, applicable Local MCH funding will be incorporated under the program elements selected in the plan, along approval with approved output performance measures, via amendment AIDS/HIV Prevention Categorical Reg. Moo. $497,900 Staffing (6),(16) N/A N/A N/A N/A NA Subrecipient — - Bioterrorism Emergency Preparedness Bioterrorism Reg. Alioc. $464,765 Staffing (6) N/A N/A NA N/A N/A Subrecipient Cities Readiness Initiatives Reg. Alloc. $279,525 Staffing (6) N/A N/A N/A N/A N/A Subrecipient Regional EPI Workspace Reg. Alloc. $10,000 Staffing (6) N/A N/A NIA N/A N/A Subrecipient r CSHCS Case Mgt/Care Coordination Calc. Amt. Various Fixed Unit Rate (1),(7) N/A N/A N/A N/A NIA Vendor , CSHCS Outreach & Advocacy Reg. Alloc, $187,500 Staffing (6) N/A N/A N/A NA N/A Vendor Childhood Lead Poisoning Prevention Reg. Alloc. $70,000 Staffing (6) N/A N/A N/A N/A WA Subrempient Early Warning Infectious Disease Surveillance Reg. Mac. $5,000 Staffing (6) N/A N/A N/A N/A NIA NIA Immunizations Assessment Feedback Incentive Exchange Calc. Amt. $50/each Fixed Unit Rate (2),(7) N/A N/A N/A WA N/A Vendor Immunization Action Plan Reg. Alloc. $510,906 Staffing (6) N/A N/A N/A N/A N/A Subrecipient Nurse Education Calc. Amt. $125/each Fixed Unit Rate (2),(7) N/A NA NA NIA NIA Vendor Vaccine Replacement/Handling Reg. Moo. $121,879 Staffing (6) N/A N/A N/A N/A NA Subrecipient VFC Provider Site Visits Cale. Amt. $200/each Fixed Unit Rate (2),(7) N/A N/A N/A N/A NA Vendor _ Infant Mortality Coalition Support Reg. Alloc. $130,000. Staffing (6) N/A NIA N/A N/A N/A Vendor Informed Consent Calc. Amt. $50/each Fixed Unit Rate (2),(7) N/A N/A N/A N/A N/A Vendor Laboratory Services Bioterrorism Lab Reg. Alloc. $126,286 Staffing (6) N/A N/A N/A N/A N/A Subrecipient 1 Local Public Health Operations MDCH Reg. Alloc. $2,276,272 LPHO (3),(4) N/A NIA N/A N/A N/A N/A MDA Reg. Alioc. $853,593 Performance % of Food Service N/A 75% N/A NIA N/A Licensees receiving required inspections , Nurse Family Partnership Reg. Moe. $324,155 Staffing (6),(14) NA N/A N/A NIA N/A Subrecipient MDCH/CMS 3/05 Page 1 TOTAL MDCH FUNDING 67,854,416 Oakland County Health Department FY 2005-2006 CPBC AGREEMENT MDCH Funding Allocations/Reimbursement Mechanisms Matrix Attachment IV Total (c) State (d) State Funded Minimum MDCH Funding Reimbursement Method Performance Target Perform. Funded Target Performance Percent Vendor/Sub Program Element/Funding Source (a) Source Amount (b) Output Measurement Expect. Perform. Number (e) recipient (t) Sexually Transmitted Disease (STD) Control Reg. Alloc. $109,696 Performance # Persons Examined or * 90% Vendor investigated SIDS Calc. Amt. $85 each Fixed Unit Rate(2),(11) N/A N/A NIA NIA NA Vendor TB Control (DOT) Reg. Alloc. $49,724 Performance Number of persons who 90% . Vendor have been enrolled in DOT and who have completed treatment for active tuberculosis _ WIC Resident Services Reg. Alloc. $1,460,085 Performance (8) #Average Monthly N/A 97% Subrecipient Participation Special Project Reg. Alloc. $44,166 Staffing (6) N/A N/A N/A N/A N/A Subrecipient *SPECIFIC OUTPUT PERFORMANCE MEASURES WILL BE INCORPORATED VIA AMENDMENT MDCH/CMS 3105 Page 2 FY 05/06 Attachment IV Footnotes NOTES: (a) Refer to Plan and Budget Framework for element definitions. (b) Refer to master comprehensive agreement and program and budget instructions package for further explanation of applicability of these reimbursement methods. (c) Negotiated starting from the average of the past two complete years' actual number where available. (d) Calculated by multiplying the "Total Performance Expectation" column by the ratio of the elements total State funding (DCH 0410, Line 24) to "Total Expenditures" (DCH 0410, Line 17). Prior to calculation, adjustments will be made for unallowable cost, equipment funded by local funds, and MDCH reimbursement not performance based (i.e., fixed unit rate, staffing). (e) Calculated by multiplying the "State Funded Element Target Performance" column by the "Percent" column. (f) Refer to master comprehensive agreement and budget instructions package for further explanation regarding these designations. (1) CSHCS Care Coordination 1. Case Management A. Maximum of six (6) services per year B. Reimbursement - $201.58 per service provided face-to-face in the home setting. 2. CARE COORDINATION A. LEVEL I PLAN OF CARE 1. Annual Plan of Care in the home or home-like setting that requires the Care Coordinator to travel to a non-LHD site $150 2. Annual Plan of Care over the telephone $100 B. LEVEL II CARE COORDINATION 1. Level li Care Coordination is reimbursed at $30.00 per unit 2. A maximum of 10 units per beneficiary per eligibility year will be reimbursed. (2) Reimbursement Chart for Fixed Rates AIDS/HIV Prevention $8,50 per blood draw for non-categorical health departments. Limited annually to $2,000. Non-Categorical Assessment Feedback $50 per site visit, not to exceed the maximum set for each individual contractor. Incentive Exchange (AM) Immunization Nurse $125 per session, upon completion and submission of Provider Contracts and Report Forms. Reimbursement can Education only be made for one in-service module session per physician clinic site per year. Immunization VFC $200 per site visit, not to exceed the maximum set for each individual Contractor, Provider Site Visits 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. FY 05/06 Attachment IV Footnotes Laboratory Services - $2.85 for each specimen for diagnosis of gonorrhea and chlamydia infections using a nucleic acid amplification assay. STD & AIDS Dental - Special Project Provide reimbursement for services provided to the target population as stipulated in the Funding Announcement. SIDS $85 for each family support visit. A maximum of six (6) visits per infant death is reimbursable. (3) Allocation to be reflected in individual programs during budgeting process. (4) Funding Source (not a single element). (5) Subject to Statewide Maintenance of Effort requirement for Title X. (6) State funding is first source (after fees and other earmarked sources). (7) Fixed unit rate subject to actual costs. (8) Performance reimbursement target will be the base target caseload established by MOCH. (9) Subject to a match requirement (hard or in-kind) of $1 for each $4 of MDCH agreement funding for coordination. (10) Fixed unit rate limited to contract amount. (11) Up to six (6) visits per family. (12) Subject to match requirement (hard or in-kind) of 50% of MDCH agreement funding. (13) Subject to match requirement (hard or in-kind) of $1 for each $4 of MDCH agreement funding for coordination, and direct service funding paid by the program third party administrator to the local health department and/or the local health department's contracted providers. (14) Subject to a match requirement (hard or in-kind) of $2:50 for each $10 of MDCH agreement. (15) Western UP District Health Department's and Northwest Community Health Department's reimbursement mechanisms are staffing; all others are subject to a fixed unit rate funding mechanism. (16) Categorical funded Health Departments include: Allegan County Health Department, Berrien County Health Department, Calhoun County Health Department, Detroit Department of Health and Wellness, Genesee County Health Department, Ingham County Health Department, Jackson County Health Department, Kalamazoo County Health Department, Kent County Health Department, Macomb County Health Department, Muskegon County Health Department, Oakland County Health Department, Saginaw County Health Department, Van Buren/Cass District Health Department, Washtenaw County Health Department and Wayne County Health Department. (17) Non-categorically funded Health Departments will be reimbursed at $8.50 per HIV test conducted up to a maximum of $2,000 annually. NOTE: Some footnotes may not apply to this agency. FISCAL NOTE (MISC. #05247) September 22, 2005 BY: FINANCE COMMITTEE, CHUCK MOSS, CHAIRPERSON IN RE: DEPARTMENT OF HUMAN SERVICES/HEALTH DIVISION - 2005/2006 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 $7,854,416 for the period of October 1, 2005 through September 30, 2006. This award reflects a 3.14 96 ($254,759) decrease from the FY2004/2005 amended funding allocation of $8,109,175. 2. Total Health Fund Revenue is as follows: Michigan Dept. of Community Health $2,276,272 Food Protection 853,593 Sexually Transmitted Disease 109,696 Total Health Fund 3,239,561 3. Total Grant Fund Revenue is as follows: Aids Prevention $ 497,900 Bioterror Coordinator 464,765 Cities Readiness Initiative 279,525 EPI Planner Workplace 10,000 Childhood Lead 70,000 Early Warning Infestious Dis. Surv. 5,000 Immunization Action Plan 510,906 CSHCS Outreach & Advocacy 187,500 Infant Mortality Coalition Support 130,000 Maternal & Infant Support 312,872 Child Health Conference 20,092 TB Control 49,724 Laboratory Program 126,286 Vaccine Replacement/Handling 121,879 Nurse Family Partnership 324,155 WIC Residential Services 1,504,251 Total Grant 4,614,855 Grand Total $7,854,416 4. The FY 2006 Adopted Budget will be amended after finalization of the CPBC funding structure. FINANCE COMMITTEE FINANCE COMMITTEE Motion carried unanimously on a roll call vote. Resolution #05207 September 22, 2005 Moved by Moss supported by Gregory the resolutions on the Consent Agenda, be adopted (with accompanying reports being accepted). AYES: Coleman, Coulter, Crawford, Douglas, Gershenson, Gregory, Hatchett, Jamian, Kowall, Long, Melton, Middleton, Molnar, Moss, Nash, Palmer, Patterson, Potter, Scott, Wilson, Woodward, Zack, Bullard. (23) NAYS: None. (0) A sufficient majority having voted in favor, the resolutions on the Consent Agenda were adopted (with accompanying reports being accepted). "RIM I MEN ARROW TIE FORMS MOTO! 7/2._ ti ) STATE OF MICHIGAN) COUNTY OF OAKLAND) I, Ruth Johnson, 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 22, 2005, with the original record thereof now remaining in my office. In Testimony Whereof, I have hereunto set my hand and affixed the seal of the County of Oakland at Pontiac, Michigan this 22nd day of September, 2005. n, County Clerk