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HomeMy WebLinkAboutResolutions - 2007.12.13 - 28392MISCELLANEOUS RESOLUTION 107282 December 13, 2007 BY: General Government Committee, Christine bong, Chairperson IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION - 2007/2008 SUBSTANCE ABUSE GRANT ACCEPTANCE To the Oakland County Board of Commissioners Chairperson, Ladies and Genilemen: WHEREAS the Michigan Departmbht of Communty Health (MDCH) has awarded the Health Division $4,742,245 in Substance Abuse Grant Funds for the period of October 1, 2007 through Sepember 30, 2008; and WHEREAS the 2007/2008 drant award includes $4,742,245 in grant revenue and expenditures for thiS program, an increase of $41,216 from the previous year; and WHEREAS these funds a:-e used to subcontract with agencies to Prevent and reduce the incidence of drug and alcohol abuse and dependency; and WHEREAS these contra cts were awardea through the County's competitive bidding process; and WHEREAS acceptance of this grant does not obligate the County to any future commitment; and WHEREAS the grant Agreement has been submitted through the County Executive's Contract Revl_ew E.usess. NOW THEREFORE BE IT RESOLVEL', that the Oakland County Board of Commissioners accepts the 2007/2006 Substance Abuse Grant from the Michigan Department of Community Health in the amount of '$-4,742,245. BE IT FURTHER RESOLVED that the Chairperson ot the Board of Commissioners is authorized to execute the grant agreement and to approve minor changes and grant extensions, not to exceed fifteen (15) percent variance from the original award. BE IT FURTHER RESOLVEO that the future level of service, including personnel, be contingent upph rho level of fundInc for this program. BE IT FURTHER RESOLVED that the Oakland County Board of Commissioners authorizes its Chairperson p ecute this Agreement subject to the following additional condition: That 1_1:e County's approval for entering into this Agreement is specifically conditioned :_h:O Premised upon the acceptance, approval and execution of the Agreement pehtaining Addendum A, by the Michigan Department of Community Health, and that the tallo.re of the Mich±ojan Department of Community Health to execute the Agrec-ent as specified shall, wEthout any further act of the Oakland County Board of Commissioners, automatically negate and void the County's approval and/or apoeptahce of this agreement as provided for in this resolution. Chairperson, on behalf of the General Government Committee, I move the adoption of the foregoing re:3oution. GENERAL GOVERNMENT COMMITTEE GENERAL GOVERNMENT COMMITTEE VOTE: Motion carried on a roll call vote with Suarez absent. DEPARTMENT OF HEALTH AND HUMAN SERVICES/ HEALTH DIVISION FY 2007/2008 SUBSTANCE ABUSE GRANT ACCEPTANCE • The Substance Abuse Grant is funded by the Michigan Department of Community Health (MDCH) to the Office of Substance Abuse in the Health Division. The purpose of the grant is to reduce the incidence of drug and alcohol abuse and dependency, and/or to provide comprehensive treatment services to the substance abusing population. The Office of Substance Abuse is designated as the Coordinating Agency for Oakland County and also includes the PACE Unit, which is an Access Assessment and Referral Service. • This grant acceptance from MDCH provides for substance abuse treatment services for Oakland County residents who are low income, uninsured, non-Medicaid recipients. • PACE provides a central point of entry; determines financial eligibility; provides assessments, referrals and case management services. The Coordinating Agency assures a continuum of substance abuse prevention and treatment services, based on local needs, and federal and state requirements. The continuum of treatment services made available to uninsured clients in Oakland County include detoxification, short- term residential, long-term residential, intensive outpatient and outpatient services. • Prevention services are targeted to high-risk populations such as school dropouts, pregnant women and teens, economically disadvantaged children of substance abusers, and community coalitions. Other services include general prevention, regional HIV education, and HIV early intervention. • The Coordinating Agency subcontracts through a competitive bid process with substance abuse prevention and treatment providers to provide the above services. They serve as expert resources on substance abuse within the Health Division and in collaboration with other units of county government. • New funding with this grant from the Strategic Prevention Framework/State Incentive Grant (SPF/SIG) Prevention Project to conduct a needs assessment, develop a strategic plan and begin implementation for prevention services targeting underage drinking and alcohol related traffic crash deaths. The grant acceptance is for $4,742,245 and covers the period of October 1, 2007 through September 30, 2008. GRANT REVIEW SIGN OFF — Human Services/Health Division GRANT NAME: FY 07-08 MDCH — Local Health Department Substance Abuse Agreement FUNDING AGENCY: Michigan Department of Community Health DEPARTMENT CONTACT PERSON: Tom Fockler / 452-2151 STATUS: Grant Acceptance DATE: November 21, 2007 Pursuant to Misc. Resolution #01320, please be advised the captioned grant materials have completed internal grant review. Below are the returned comments. The captioned grant materials and grant acceptance package (which should include the Board of Commissioners' Liaison Committee Resolution, the grant agreement/contract, Finance Committee Fiscal Note, and this Sign Off email containing grant review comments) may be requested to be placed on the appropriate Board of Commissioners' committee(s) for grant acceptance by Board resolution. DEPARTMENT REVIEW Department of Management and Budget: Approved. — Laurie Van Pelt (11/14/2007) Department of Human Resources: Approved by HR. — Jennifer Mason (11/16/2007) Risk Management and Safety: Approved By Risk Management - Andrea Plotkowski (11/20/2007) Corporation Counsel: I have reviewed the Substance Abuse Services Agreement with the State of Michigan and see no legal issues or concerns that need to be addressed except for possibly General Provisions. III. D. Debarment and Suspension. As the Health Division had no problem providing an identical assurance with last year's Substance Abuse Agreement, I will assume Health remains comfortable in again providing the same assurance this year. ff I am incorrect in this assumption please advise as this matter will have to be reassessed. — John Ross (11/19/2007) COMPLIANCE The grant agreement references a number of specific federal and state regulations. Below is a list of these specifically cited compliance related documents for this grant. For the main Agreement and General Provisions sections; • Federal Office of Management and Budget (OMB) Circular No. A-87, A-102, and A- 133 http://www.whitehouse.Rov/omb/circulars/index.html • Michigan Human Subjects Regulation — httn://www.michigan.gov/mdch/0.1607.7- 132-2945 32550-99784--,00.html, • Lobbying Disclosure Act of 1995. (2 USC 1601) http://www.senate.gov/reference/resourcestedf/contactingl 0465 pelf • Michigan Elliott-Larsen Civil Rights Act — "Act 453 of 1976" h_ ://wwwle ov/ u3btnr55z2uiwv45 /aaggaiazhjag— e_tob'_e_c_t 8coblectname=mcl-Act-453-of-19768cqueryid=14718540 • Michigan Persons with Disabilities Civil Rights Act — "Act 220 of 1976" http://www.legis1ature.mi.govftuq3lxgeltmri5z55z2aiwv451/mileg.aspx?page=getobject &obiRctnarne----mcl-Act-220-of-19768cqueryid=14718589 • Federal Government-Wide Debarment and Suspension Non-procurement 45 CFR Part 76 htto://www.access.goo.gov/nara/cfr/waisidx 05145cfr76 05.html • Federal Environmental Tobacco Smoke "Pro-Children Act of 1994" htto://www.cdc.gov/tobacco/research data/vouth/464119.htm • Federal Hatch Act - Political Activity of Certain State and Local Employees http://www.osc.gov/hatchact.htm • Civil Service Reform Act (42 ITSC 4728) http://frwebgate3.access.gpo.gov/cgi- bin/waisgate.cgi?WAISdoc11)--9083898162+0+0+0&VVAISaction —retrieve • Federal Health Insurance Portability and Accountability Act of 1996 (111PAA, Title II) htto://www.cms.hhs.gov/HIPAAGenInfo/Downloads/HIPAAlawdetail.pdf JENNIFER M. GRAM-IOW GOVERNOR STATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTH LANSING JANET OLSZEWSKI CNRECTOR September 14, 2007 Lisa McKay-Chiasson, MPH, Chief of S.A. Services Oakland County Health Division Office of Substance Abuse Services 250 Elizabeth Lake Road, Suite 1550 Pontiac, MI 48341 -1 050 Dear Ms. McKay-Chiasson: Subject: Fiscal Year (FY) 2008 Projected Allocations This letter transmits projected allocations for your agency from the Michigan Department of Community Health, Office of Drug Control Policy (MDCH/ODCP) for FY 2008. These allocations are subject to the availability of funds, the Appropriations Act for the Department for FY 2008, Department approval, and approval by the State Administrative Board. The allocation line amounts and the total allocation amount of state-administered funds are as follows: ., , % , _ ., - RAZ lE. --DRAtill '— ,, : 'cATEG I Community Grant 93.959 80% 20% $3,267,517 ' Women's Specialty „ Target: $81,000 Communicable .. : Diseases R 0% 100% $239,498 :. . Prevention E 93.959 80% 20% $958,839 SPF/SIG Project E 93.243 100% 0% $100,000 State Disability , . . . Assistance SDA E 0% 100% $176,391 TOTAL ALLOCATION , ., , $4,742,245 CODES: E = Earmarked Funding R = Restricted Funding LEWIS CASS BUILDING • 320 SOUTH WALNUT STREET • LANSING, MICHIGAN 48913 www.michigan.gov • (517) 373-3500 Lisa McKay-Chlasson, MPH September 14, 2007 Page 2 of 3 Earmarked and restricted funds must be used as specified in the MDCH/CA agreement. The amounts allocated must also be the amounts budgeted. Any changes must be agreed to in writing by the Department and the CA. Earmarking is based on legislation or requirements of funding awards to the Department. Restrictions are based on departmental administrative decisions. All allocations must be budgeted and expended consistent with requirements contained in the annual agreement. Communicable Diseases The CA is required to assure that HIV/AIDS and other communicable disease services as described in the MDCH/CA agreement are provided. Budget Flexibility As described in the FY 2007 final agreement amendment, the CA may increase or decrease ODCP-administered funds for administration, treatment, prevention, and communicable diseases by up to $50,000. This can be done by transferring funds among these four budget categories, provided that the CA continues to meet all applicable requirements. Any change that is greater than $50,000 must be approved in writing. Please notify your contract manager during the budget development process if you are interested in revising any of the initial allocation amounts. Prevention Allocations There are no separate allocations for Tobacco Vendor Education or Non-Synar Tobacco Retailers Inspections. CAs are expected to use their Prevention allocations to meet tobacco-related performance objectives and to accomplish other Prevention plans developed through the APG. As in FY 2007, $1,500 is added to each CA's Prevention allocation to help support the Synar survey process that is conducted each July, and to support other prevention activities. SPF/SIG Project The CA is given an initial FY 2008 allocation of $100,000 in SPF/SIG funds. This allocation is intended to enable continuity of project activity into the new fiscal year. The CA may continue Phase 1 activity that has received written approval from ODCP, and/or may begin approved Phase 2 activity, using these funds. Women's Specialty Funds Each CA's Women's Specialty funds are again combined with the Community Grant allocation. For the purpose of assuring statewide compliance with the SAPT Block Grant minimum expenditure requirement for Women's Specialty services, each CA is given a minimum expenditure target for these services, entered in the above allocation table. This expenditure target is the same as for the prior year. All program/services objectives related to Women's Specialty services remain in place. Lisa McKay-Chlasson, MPH September 14, 2007 Page 3 of 3 The expenditure target can be reached through the expenditure of a combination of SAPT Block Grant and state funds for specialty treatment services for eligible women. Eligible women are those who are pregnant, who have dependent children, or who are seeking to regain custody of dependent children. State funds include state funds allocated through this agreement, including SDA funds, as well as the state share amount of Medicaid funds. In FY 2008, Medicaid state share is 41.9%. Use of federal and state funds must be consistent with applicable contract requirements. Attainment of the expenditure target and program/services objectives will be a contract performance requirement. The target can be amended by mutual agreement. The Department will not approve amendments that appear to create risk of failing to meet the Women's Specialty Maintenance of Effort. Elimination of the separate budget category coupled with the applicability of state funds will make it easier to reach the expenditure target. It will also give CAs greater flexibility in the use of their overall funds. It is hoped that this approach to financing will retain a necessary degree of emphasis on Meeting spending requirements, but more importantly will increase the emphasis on effective substance abuse treatment and on improving the health and functioning of the target population. Single Audit Federal Percentages In order to comply with federal Single Audit Act requirements, MDCH has identified above the estimated federal and state allocated funding. CA Administration is estimated at 45 percent federal and 55 percent state. Auditors may use these percentages to complete the Schedule of Federal Financial Assistance. If you have any questions concerning your allocation, please contact your contract manager. Sincerely, -444-deld/J-t-- Donald L. Allen, Jr., Director Office of Drug Control Policy Contract #: 2008- Grant Agreement Between Michigan Department of Community Health hereinafter referred to as the "Department" and CA NAME ADDRESS CITY, MI ZIP Federal I.D.#: hereinafter referred to as the "Contractor" for Substance Abuse Services Part I 1. Period of Agreement: This agreement shall commence on October 1, 2007 and continue through September 30, 2008. This agreement is in full force and effect for the period specified. 2. Program Budget and Agreement Amount A. Agreement Amount The total amount of this agreement is $ . The Department under the terms of this agreement will provide funding not to exceed $ The federal funding provided by the Department is $ , as follows: Federal Program ' Catalog of Federal CFDA # Federal Federal Amount Title Domestic Agency Grant Award Assistance (CFDA) Name Number Title 1 n I SAPT Block Block Grant for 93.959 Department of 08 61 MI $0 Grant Prevention and Health and SAPT Treatment of Human Substance Abuse Services — DCH-0665FY2008 2/07 (W) Page 1 of 17 Federal Program Catalog of Federal CFDA # Federal Federal Amount Title Domestic Agency Grant Award Assistance (C FDA) Name Number Title Infrastructure Strategic Prevention 93.243 Department of 5 U79 $0 Program for Framework State Health and SP11196-01 Substance Incentive Grants Human Abuse Services , Prevention Total FY 2008 Federal Funding $0 The grant agreement is designated as a: subrecipient relationship; or L.. vendor relationship. B. Equipment Purchases and Title Any contractor equipment purchases supported in whole or in part through this agreement must be listed in the supporting Equipment Inventory Schedule. 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 items 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. Deviation Allowance A deviation allowance modifying an established budget category by $10,000 or 15%, whichever is greater, is permissible without prior written approval of the Department. Any modification or deviations in excess of this provision, including any adjustment to the total amount of this agreement, must be made in writing and executed by all parties to this agreement before the modifications can be implemented. This deviation allowance does not authorize new categories, subcontracts, equipment items or positions not shown in the attached Program Budget Summary and supporting detail schedules. 3. Purpose: The focus of the program is to provide for the administration and coordination of substance abuse services within the designated coordinating agency region, consisting of County(ies). 4. Statement of Work: The Contractor agrees to undertake, perform and complete the services described in Attachment A, which is part of this agreement through reference. 5. Financial Requirements: The financial requirements shall be followed as described in Part II of this agreement and Attachments B and D. which are part of this agreement through reference. Item 2.B is not applicable. Item 2.0 is not applicable. DCH-0665FY2008 2/07 (W) Page 2 of 17 6. Performance/Progress Report Requirements: The progress reporting methods, as applicable, shall be followed as described in Attachment C, which is part of this agreement through reference. 7. General Provisions: The Contractor agrees to comply with the General Provisions outlined in Part II, which is part of this agreement through reference. The Contractor also agrees to comply with the requirements described in Attachment E: Other Requirements, which is part of this agreement through reference. 8. Administration of the Agreement: The person acting for the Department in administering this agreement (hereinafter referred to as the Contract Manager) is: Mark Steinberg, Manager ODCP, Substance Abuse Contract Management Section Lewis Cass Building, 5th floor, Lansing, MI (517) 335-0180 SteinbergM@michigan.qov Name Location/Building Title Telephone No. Email Address 9. Contractor's Financial Contact for the Agreement: The person acting for the Contractor on the financial reporting for this agreement is: Name Title E-Mail Address Telephone No. 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. This agreement is conditionally approved subject to and contingent upon the availability of funds. C. The Department will not assume any responsibility or liability for costs incurred by the Contractor prior to the signing of this agreement. D. The Contractor is required by PA 533 of 2004 to receive payments by electronic funds transfer. DCH-0665FY2008 2/07 (W) Page 3 of 17 Name (Please print) Title 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 CONTRACTOR Signature Date For the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH Nick Lyon, Deputy Director, Operations Administration Date DCH-0665FY2008 2/07 (W) Page 4 of 17 Part II General Provisions Responsibilities - Contractor The Contractor in accordance with the general purposes and objectives of this agreement will: A. Publication Rights 1. 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. 2. 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. 3. The Contractor shall give recognition to the Department in any and all publications papers and presentations arising from the program and service contract herein; the Department will do likewise. B. Fees Make reasonable efforts to collect 1 st and 3rd party fees, where applicable, and report these as outlined by the Department's fiscal procedures. Any underrecoveries of otherwise available fees resulting from failure to bill for eligible services will be excluded from reimbursable expenditures. C. Program Operation Provide the necessary administrative, professional, and technical staff for operation of the program. D. Reporting Utilize all report forms and reporting formats required by the Department at the effective date of this agreement, and provide the Department with timely review and commentary on any new report forms and reporting formats proposed for issuance thereafter. E. Record Maintenance/Retention Maintain adequate program and fiscal records and files, including source documentation to support program activities and all expenditures made under the terms of this agreement, as required. 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 DCH-0665FY2008 2/07 ON) Page 5 of 17 from the date of termination, the date of submission of the final expenditure report or until litigation and 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 This section only applies to Contractors designated as subrecipients. Contractors designated as vendors are exempt from the provisions of this section. 1. Required Audit or Notification Letter Contractors must submit to the Department either a Single Audit, Financial Statement Audit, or Audit Status Notification Letter as described below. If submitting a Single Audit or Financial Statement Audit, Contractors must also submit a Corrective Action Plan for any audit findings that impact MDCH-funded programs, and management letter (if issued) with a response. a. Single Audit Contractors that expend $500,000 or more in federal awards during the Contractor's fiscai year must submit to the Department a Single Audit prepared consistent with the Single Audit Act Amendments of 1996, and Office of Management and Budget (OMB) Circular A-133, "Audits of States, Local Governments, and Non-Profit Organizations," as revised. The Contractor must comply with all requirements in the MDCH Substance Abuse Prevention and Treatment Audit Guidelines, current edition, as issued by the MDCH Office of Audit. b. Financial Statement Audit Contractors exempt from the Single Audit requirements that receive $500,000 or more in total funding from the Department in State and Federal grant funding must submit to the Department a Financial Statement Audit prepared in accordance with generally accepted auditing standards (GAAS). Contractors exempt from the Single Audit requirements that receive less than $500,000 of total Department grant funding must submit to the Department a Financial Statement Audit prepared in accordance with DCH-0665FY2008 2/07 (W) Page 6 of 17 GAAS if the audit includes disclosures that may negatively impact MDCH-funded programs including, but not limited to fraud, going concern uncertainties, financial statement misstatements, and violations of contract and grant provisions. c. Audit Status Notification Letter Contractors exempt from both the Single Audit and Financial Statement Audit requirements (a. and b. above) must submit an Audit Status Notification Letter that certifies these exemptions. The template Audit Status Notification Letter and further instructions are available at htto://www.michigan.qov/mdch by selecting Inside Community Health — MDCH Audit. 2. Due Date and Where to Send The required audit and any other required submissions (i.e. Corrective Action Plan and management letter with a response), or audit Status Notification Letter must be submitted to the Department within nine months after the end of the Contractor's fiscal year to: Michigan Department of Community Health Office of Audit Quality Assurance and Review Section P.O. Box 30479* Lansing, Michigan 48909-7979 *For Express Delivery: Capital Commons Center 400 S. Pine Street Lansing, Michigan 48933 Alternatives to paper filing may be viewed at http://www.michigan.gov/mdch by selecting Inside Community Health — MDCH Audit. 3. Penalty a. Delinquent Single Audit or Financial Statement Audit If the Contractor does not submit the required Single Audit reporting package, management letter (if issued) with a response, and Corrective Action Plan; or the Financial Statement Audit and management letter (if issued) with a response within nine months after the end of the Contractor's fiscal year and an extension has not been approved by the cognizant or oversight agency for audit, the Department may withhold from the current funding an DCH-0665FY2008 2/07 (W) Page 7 of 17 amount equal to five percent of the audit year's grant funding (not to exceed $200,000) until the required filing is received by the Department. The Department may retain the amount withheld if the Contractor is more than 120 days delinquent in meeting the filing requirements and an extension has not been approved by the cognizant or oversight agency for audit. The Department may terminate the current grant if the Contractor is more than 180 days delinquent in meeting the filing requirements and an extension has not been approved by the cognizant or oversight agency for audit. b. Delinquent Audit Status Notification Letter Failure to submit the Audit Status Notification Letter, when required, may result in withholding from the current funding an amount equal to one percent of the audit year's grant funding until the Audit Status Notification Letter is received. 4. Other Audits The Department or federal agencies may also conduct or arrange for "agreed upon procedures" or additional audits to meet their needs. 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 establish requirements to ensure compliance for for— profit subrecipients as required by OMB Circular A-133, Section .210(e) The Contractor must ensure that transactions with vendors comply with laws, regulations, and provisions of contracts or grant agreements in compliance with OMB Circular A-133, Section .210(f). Notification of Modifications Provide timely notification to the Department, in writing, of any action by its governing board or any other funding source that would require or result in DCH-0665FY2008 2/07 ('N) Page 8 of 17 significant modification in the provision of services, funding or compliance with operational procedures. J. Software Compliance The Contractor must ensure software compliance and compatibility with the Department's data systems for services provided under this agreement including, but not limited to: stored data, databases, and interfaces for the production of work products and reports. All required data under this agreement shall be provided in an accurate and timely manner without interruption, failure or errors due to the inaccuracy of the Contractor's business operations for processing date/time data. K. Human Subjects The Contractor agrees that prior to the initiation of the research, the Contractor will submit institutional Review Board (IRB) application material for all research involving human subjects, which is conducted in programs sponsored by the Department or in programs which receive funding from or through the State of Michigan, to the Department's IRB for review and approval, or the IRB application and approval materials for acceptance of the review of another IRB. All such research must be approved by a federally assured 1RB, but the Department's IRB can only accept the review and approval of another institution's IRB under a formally-approved interdepartmental agreement. The manner of the review will be agreed upon between the Department's IRB Chairperson and the Contractor's IRB Chairperson or Executive Officer(s). II. Responsibilities - Department The Department in accordance with the general purposes and objectives of this agreement will: A. Reimbursement Provide reimbursement 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 provide to the Contractor any new report forms and reporting formats proposed for issuance thereafter at least ninety (90) days prior to their required usage in order to afford the Contractor an opportunity to review and offer comment. DCH-0665FY2008 2/07 (W) Page 9 of 17 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-Lobbvinq 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 section of the FY 1997 Omnibus Consolidated 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. In the performance of any contract or purchase order resulting herefrom, the Contractor agrees not to discriminate against any employee or applicant for employment or service delivery and access, with respect to their hire, tenure, terms, conditions or privileges of employment, programs and services provided or any matter directly or indirectly related to employment, because of race, color, religion, national origin, ancestry, age, sex, height, weight, marital status, physical or mental disability unrelated to the individual's ability to perform the duties of the particular job or position or to receive services. The Contractor further agrees that every subcontract entered into for the performance of any contract or purchase order resulting herefrom will contain a provision requiring non-discrimination in employment, service delivery and access, as herein specified binding upon each subcontractor. This covenant is required pursuant to the Elliot-Larsen Civil Rights Act, 1976 PA 453, as amended, MCL 37.2201 et seq., and the Persons with Disabilities Civil Rights Act, 1976 PA 220, as amended, MCL 37.1101 et seq., and any breach thereof may be regarded as a material breach of the contract or purchase order. 2. Additionally, assurance is given to the Department that proactive efforts will be made to identify and encourage the participation of minority owned and women owned businesses, and businesses DCH-0665FY2008 2/07 (W) Page 10 of 17 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 it, its employees and its 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 Act 1. Assurance is hereby given to the Department that the Contractor will comply with Public Law 103-227, also known as the Pro- Children Act of 1994, 20 USC 6081 et seq, which requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted by and used routinely or regularly for the provision of health, day care, early childhood development services, education or library services to children under the age of 18, if the services are funded by federal programs either directly or through state or local governments, by federal grant, contract, loan or loan guarantee. The law also applies to children's services that are provided in indoor facilities that are constructed, operated, or maintained with such federal funds. The law does not apply to children's services provided in private residences; portions of facilities used for inpatient drug or alcohol treatment; service providers whose sole source of applicable federal funds is DCH-0665FY2008 2/07 (W) Page 11 of 17 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, 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. 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 within 30 days of execution of the agreement. 2. That any executed subcontract to this agreement 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; b. Restates provisions of this agreement to afford the Contractor the same or substantially the same rights and privileges as the Department; or DCH-0665FY2008 2/07 (W) Page 12 of 17 c. Requires the subcontractor to perform duties and/or services in less time than that afforded the Contractor in this agreement. 3. That the subcontract does not affect the Contractor's accountability to the Department for the subcontracted activity. 4. That any billing or request for reimbursement for subcontract costs is supported by a valid subcontract and adequate source documentation on costs and services. 5. That the Contractor will submit a copy of the executed subcontract if requested by the Department. H. 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. Health Insurance Portability and Accountability Act To the extent that this act is pertinent to the services that the Contractor provides to the Department under this agreement, the Contractor assures that it is in compliance with the Health Insurance Portability and Accountability Act (HIPAA) requirements including the following: 1. The Contractor must not share any protected health data and information provided by the Department that falls within HIPAA requirements except to a subcontractor as appropriate under this agreement. 2. The Contractor must require the subcontractor not to share any protected health data and information from the Department that falls under HIPAA requirements in the terms and conditions of the subcontract. 3. The Contractor must only use the protected health data and information for the purposes of this agreement. 4. The Contractor must have written policies and procedures addressing the use of protected health data and information that falls under the HIPAA requirements. The policies and procedures must meet all applicable federal and state requirements including the HIPAA regulations. These policies and procedures must include restricting access to the protected health data and information by the Contractor's employees. DCH-0665FY2008 2/07 (W) Page 13 of 17 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. Agreement 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. Financial Requirements A. Operating Advance The Department will not issue an operating advance under this agreement. B. Reimbursement Method The Department will make prepayments equal to the Contractor's prepayment schedule that has been approved by the Department and the Contractor. The prepayments will be monthly, paid up to the total Department allocation as agreed to in the approved budget. Prepayments may be adjusted quarterly based upon expenditure reports. Expenditure reporting procedures are described in Attachment B to this agreement. C. Revenue and Expenditure Report Submission Revenue and Expenditure Reports (RERs) shall be prepared as indicated in Attachment B, and submitted to: Michigan Department of Community Health Bureau of Finance Accounting Division, Expenditure Operations Section P.O. Box 30720 Lansing, Michigan 48909 RERs must be submitted on a quarterly basis, no later than the last day of the month following the end of each fiscal quarter. RERs must reflect total actual program expenditures. reaardless of the source nf fiind Attachment B contains the RER form and instructions. Failure to meet financial reporting responsibilities as identified in this agreement may result in withholding future payments. DCH-0665FY2008 2/07 (W) Page 14 of 17 D. Reimbursement Mechanism All contractors must sign up through the on-line vendor registration process to receive all State of Michigan payments as Electronic Funds Transfers (EFT)/Direct Deposits, as mandated by PA 533 of 2004. Vendor registration information is available through the Department of Management and Budget's web site: • http://www.cpexpress.state.mi.us/ E. Final Obligations and Financial Status Report Requirements 1. Preliminary Close-out Report A Preliminary Close-out Report, based on annual guidelines, must be submitted by the due date using the format provided by the Department's Accounting Division. The Contractor must provide an estimate of total expenditures for the entire agreement period. The information on the report will be used to record the Department's year-end accounts payables and receivables for this agreement. 2. Final RER The final RER is due as stated in Attachment C to this agreement. The final RER must be clearly marked "Final". Final RERs not received by the due date may result in the loss of funding requested on the Preliminary Close-out Report and may result in the potential reduction in the subsequent year's agreement amount. 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. 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 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 or an official of the Contractor or an owner is convicted of any activity referenced in Section III.D. of this agreement during the term of this agreement or any extension thereof. DCH-0665FY2008 2/07 ON) Page 15 of 17 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 this agreement. The Department will make payments to the Contractor for allowable reimbursable costs not covered by previous payments or other state or federal programs. The Contractor shall immediately refund to the Department any funds not authorized for use and any payments or funds 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. Any change proposed by the Contractor which would affect the Department funding of any project, in whole or in part in Part I, Section 2.C. of the agreement, must be submitted in writing to the Department for approval immediately upon determining the need for such change. IX. Liability A. All liability to third parties, loss, or damage as a result of claims, demands, costs, or judgments arising out of activities, such as direct service delivery, to be carried out by the Contractor in the performance of this agreement shall be the responsibility of the Contractor, and not the responsibility of the Department, if the liability, loss, or damage is caused by, or arises out of, the actions or failure to act on the part of the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor, provided that nothing herein shall be construed as a waiver of any governmental immunity that has been provided to the Contractor or its employees by statute or court decisions. B. All liability to third parties, loss, or damage as a result of claims, demands, costs, or judgments arising out of activities, such as the provision of policy and procedural direction, to be carried out by the Department in the performance of this agreement shall be the responsibility of the Department, and not the responsibility of the Contractor, if the liability, loss, or damage is caused by, or arises out of, the action or failure to act on the part of any Department employee or agent, provided that nothing herein shall be construed as a waiver of any governmental immunity by the State, its agencies (the Department) or employees as provided by statute or court decisions, C. In the event that liability to third parties, loss, or damage arises as a result of activities conducted jointly by the Contractor and the Department in DCH-0665FY2008 2/07 (W) Page 16 of 17 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. Xl. State of Michigan Agreement This is a State of Michigan Agreement and is governed by the laws of Michigan. Any dispute arising as a result of this agreement shall be resolved in the State of Michigan. XII. Confidentiality Both the Department and the Contractor shall assure that medical services to and information contained in medical records of persons served under this agreement, or other such recorded information required to be held confidential by federal or state law, rule or regulation, in connection with the provision of services or other activity under this agreement shall be privileged communication, shall be held confidential, and shall not be divulged without the written consent of either the patient or a person responsible for the patient, except as may be otherwise required by applicable law or regulation. Such information may be disclosed in summary, statistical, or other form, which does not directly or indirectly identify particular individuals. DCH-0665FY2008 2/07 (W) Page 17 of 17 Version: Substance Abuse Services MICHIGAN DEPARTMENT OF COMMUNITY HEALTH FY 07/08 AGREEMENT ADDENDUM A This addendum adds the following section to Part I and Renumbers existing 11 Special Certification to 12 and existing 12 Signature Section to 13: Part I 11. Agreement Exceptions and Limitations Notwithstanding any other term or condition in this Agreement including, but not limited to, any provisions related to any services as described in the Annual Action Plan, any Contractor (Oakland County) services provided pursuant to this Agreement, or any limitations upon any Department funding obligations herein, the Parties specifically intend and agree that the Contractor may discontinue, without any penalty or liability whatsoever, any Contractor services or performance obligations under this Agreement when and if it becomes apparent that State or Department funds for any such services will be no longer available. Notwithstanding any other term or condition in this Agreement, the Parties specifically understand and agree that no provision in this Agreement shall operate as a waiver, bar or limitation of any kind, on any legal claim or right the Contractor may have at any time under any Michigan constitutional provision or other legal basis (e.g., any Headlee Amendment limitations) to challenge any State or Department program funding obligations; and, the parties further agree that no term or condition in this Agreement is intended and no such provision shall be argued to state or imply that the Contractor voluntarily assumed or undertook to provide any services as described in the Annual Action Plan, and thereby, waived any rights the Contractor may have had under any legal theory, in law or equity, without regard to whether or not the Contractor continued to perform any services herein after any State or Department funding ends. Version; Substance Abuse Services 2. This addendum modifies the following sections of Part II, General Provisions: Part ll 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. III. Assurances A. Compliance with Applicable Laws. This first sentence of this paragraph will be stricken in its entirety and replace with the following language: The Contractor will comply with applicable Federal and State laws, and lawfully enacted administrative rules or regulations, in carrying out the terms of this agreement. I. Health Insurance Portability and Accountability Act. The provisions in this section shall be deleted in their entirety and replaced with the following language: Contractor agrees that it will comply with the Health Insurance Portability and Accountability Act of 1996, and the lawfully enacted and applicable Regulations promulgated there under. IX. Liability. Paragraph A. will be deleted in its entirety and replaced with the following language. A. Except as otherwise provided 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 of the actions or failure to act on the part of the Contractor, its employees, officers or agents. Version: Substance Abuse Services 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. 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. 4. 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 ATTACHMENT A STATEMENT OF WORK Please note: Items in this Statement of Work have been placed into one of three categories; General; Administrative and Financial; and Services. This categorization is for convenience of reference only. It is not intended, and should not be interpreted, as limiting the applicability or scope of any item or items. General 1. General Statement of Work The general responsibilities of the coordinating agency (CA) under this Agreement, based on P.A. 368 of 1978, as amended, are to; a. Develop comprehensive plans for substance abuse treatment and rehabilitation services and prevention services consistent with guidelines established by the Department. b. Review and comment to the Department on applications for licenses submitted by local treatment, rehabilitation, and prevention organizations. c. Provide technical assistance for local substance abuse service organizations. d. Collect and transfer data and financial information from local organizations to the Department. e. Submit an annual budget request to the Department for use of state administered funds for its city, county, or region for substance abuse treatments and rehabilitation services and prevention services in accordance with guidelines established by the Department. f. Make contracts necessary and incidental to the performance of the Agency functions. The contracts may be made with public or private agencies, organizations, associations, and individuals to provide for substance abuse treatment and rehabilitation services and prevention services. g. Annually evaluate and assess substance abuse services in the city, county, or region in accordance with guidelines established by the Department and federal goals. 2. Action Plan The CA will carry out its responsibilities under this Agreement consistent with the CA's most recent Action Plan as approved by the Department. 3. Substance Abuse Prevention and Treatment (SAPT) Block Grant Requirements and Applicability to State Funds Federal requirements deriving from Public Law 102-321, as amended by Public Law 106-310, and federal regulations in 45 CFR Part 96 are pass-through FY2008 Page 1 of 32 (09.14.07) ATTACHMENT A requirements. Federal Substance Abuse Prevention and Treatment (SAPT) Block Grant requirements that are applicable to states are passed on to CAs unless otherwise specified. 42 CFR Parts 54 and 54a, and 45 CFR Parts 96, 260, and 1050, pertaining to the final rules for the Charitable Choice Provisions and Regulations, are applicable to CAs as stated elsewhere in this Agreement. Sections from PL 102-321, as amended, that apply to CAs and contractors include but are not limited to: 1921(b); 1922 (a)(1)(2); 1922(b)(1)(2); 1923; 1923(a)(1) and (2), and 1923(b); 1924(a)(1)(A) and (B); 1924(c)(2)(A) and (B); 1927(a)(1) and (2), and 1927(b)(1); 1927(b)(2); 1928(b) and (c); 1929; 1931(a)(1)(A), (B), (C), (D), (E) and (F); 1932(b)(1); 1941; 1942(a); 1943(b); 1947(a)(1) and (2). Selected specific requirements applicable to CAs are as follows: a. Block Grant funds shall not be used to pay for inpatient hospital services except under condition specified in federal law. b. Funds shall not be used to make cash payments to intended recipients of services. C. Funds shall not be used to purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling) any building or any other facility, or purchase major medical equipment, d. Funds shall not be used to satisfy any requirement for the expenditure of non-Federal funds as a condition for the receipt of Federal funding. e. Funds shall not be used to provide individuals with hypodermic needles or syringes so that such individuals may use illegal drugs. f. Funds shall not be used to enforce state laws regarding the sale of tobacco products to individuals under the age of 18. g. Funds shall not be used to pay the salary of an individual at a rate in excess of Level I of the Federal Executive Schedule, or approximately $186,600. SAPT Block Grant requirements also apply to the Michigan Department of Community Health (MDCH) administered state funds, unless a written exception is obtained from MDCH. 4: Staff Qualifications anci-Rrefessio-nal-Development TO BE DETERMINED The Office of Drug Control Policy (ODCP), in cooperation with CAs and t e' -e. 'e e e.. e - e.. _-• 2" Reciw-ecity Consortium (ICRC) certification standards as applicable to the M-13G-1=1-funded public substance abuse provider network. Recognition will be FY2008 Page 2 of 32 (09.14.07) ATTACHMENT A GeritingeR4-13R-the ompletion of planning and analysis, and the establishment of a. Require all treatment provider panel members to establish and maintain a services. b. Enstlfe-tliet-er-iwifie.1-136.skg round check are conducted as-a-se-Rel-ition-of crimiRel feeesEl should Recessarily bar employment. serious communicable diseases. 5. Licensure of Subcontractors The CA shall enter into agreements for prevention and treatment services only with providers appropriately licensed for the service provided as required by Section 6231 of P.A. 368 of 1978, as amended. The CA must ensure that network providers residing and providing services in bordering states meet all applicable licensing and certification requirements within their states, that such providers are accredited per the requirements of this Agreement, and that provider staff are credentialed per the requirements of this Agreement. 6. Accreditation of Subcontractors The CA shall enter into agreements for treatment services provided through outpatient, early intervention, inteRsive outpatient, Methadone, sub-acute detoxification and residential providers treatment services only with providers accredited by one of the following accrediting bodies: Joint Commission on Accreditation of Health Care Organizations (JCAH0); Commission on Accreditation of Rehabilitation Facilities (CARF); the American Osteopathic Association (AOA); Council on Accreditation of Services for Families and Children (COA); or National Committee on Quality Assurance (NCQA). The CA must determine compliance through review of original correspondence from accreditation bodies to providers. Accreditation is not needed in order to provide access management system (AMS) services, whether these services are operated by a CA or through an agreement with a CA or for the provision of broker/generalist case FY2008 Page 3 of 32 (09.14.07) ATTACHMENT A management services. Accreditation is required for AMS providers that also provide treatment services and for case management providers that either also provide treatment services or provide therapeutic case management. Accreditation is not required for peer recovery or recovery support services when these are provided through a prevention license. If the CA plans to purchase case management services or recovery support services, and only these services, from an agency that is not accredited per this agreement, the CA may request a waiver of the accreditation requirement. 7. SAMHSA/DHHS License The federal awarding agency, Substance Abuse and Mental Health Services Administration, Department of Health and Human Services (SAMHSA/DHHS), reserves a royalty-free, nonexclusive and irrevocable license to reproduce, publish or otherwise use, and to authorize others to use, for federal government purposes: (a) The copyright in any work developed under a grant, sub-grant, or contract under a grant or sub-grant; and (b) Any rights of copyright to which a grantee, sub-grantee or a contractor purchases ownership with grant support. 8. Cooperation with External Medicaid Evaluation The CA is expected to cooperate with Department efforts in external evaluation of Medicaid services, if the CA administers Medicaid services. The CA is expected to ensure that CA-funded providers will provide necessary data and will facilitate access to individuals' files and other records as required. 9. Monitoring of Subcontractors The CA is required to assure that subcontractors comply with all applicable requirements contained in this agreement. To this end, the CA must adopt written policy and must implement procedures regarding monitoring of subcontractors. The monitoring policy and procedures must be consistent with requirements in this agreement, with the current MDCH substance abuse audit guidelines, and with applicable federal Office of Management and Budget (OMB) circulars. The CA must prepare a report of monitoring findings, and must make this report available to the public at least biannually. Part 11 of the agreement, section 1.H on Sub-recipient/Vendor Monitoring, requires that contractors conduct monitoring and risk-based assessments of sub- recipients during the period of the agreement. The CA must conduct monitoring and risk-based assessments of all subcontractors, during the period of the agreement, including subcontractors that are vendors. FY2008 Page 4 of 32 (09.14.07) ATTACHMENT A Administrative and Financial 1. Match Rules Pursuant to Section 6213 of Public Act No. 368 of 1978, as amended, Michigan has promulgated match requirement rules. Rules 325.4151 through 325.4153 appear in the 1981 Annual Administrative Code Supplement. In brief, the rule defines allowable matching fund sources and states that the allowable match must equal at least ten percent of each comprehensive CA budget (see Attachment B to the Agreement) - less direct federal and other state funds. Match requirements apply both to budgeted funds during the agreement period and to actual expenditures at year-end. "Fees and collections" as defined in the Rule include only those fees and collections that are associated with services paid for by the CA. If the CA is found not to be in compliance with Match requirements, or cannot provide reasonable evidence of compliance, the Department may withhold payment or recover payment in an amount equal to the amount of the Match shortfall. 2. Reporting Fees and Collections Revenues The CA is required to report on the Revenue and Expenditures Report (RER) all fees and collections revenue received by the CA and all fees and collections revenue received and reported by its contracted services providers (see Attachment B to this Agreement). "Fees and collections" are as defined in the Annual Administrative Code Supplement, Rule 325.4151 and in the Match Rule section of this Attachment. 1 Management of Department-Administered Funds The CA shall manage all Department-administered funds under its control in such a way as to assure reasonable balance among the separate requirements for each funds source. 4. Sliding Fee Scale The CA shall implement a sliding fee scale. All treatment providers shall utilize the scale. The CA must adopt written policies and implement procedures for determining when an individual has no ability to pay for services and for determining when payment liability is to be waived. Financial information needed to determine ability to pay (financial responsibility) must be reviewed annually or at a change in an individual's financial status, whichever occurs sooner. FY2008 Page 5 of 32 (09.14.07) ATTACHMENT A The CA sliding fee scale must be applied to all persons (except Medicaid, MIChild, and ABW recipients) seeking substance use disorders services funded in whole or in part by the CA. The CA has the option to charge fees for AMS services, or not to charge. If the CA charges for AMS services, the same sliding fee scale as applied to treatment services must be used. The CA must assure that all available sources of payments are identified and applied prior to the use of Department-administered funds. The CA must have written policies and procedures to be used by network providers in determining an individual's ability to pay, and in identifying all other liable third parties. The CA must also have policies and procedures for monitoring providers and for sanctioning noncompliance. 5. Inability to Pay Services may not be denied because of inability to pay. If a person's income falls within the CA's regional sliding fee scale, clinical need must be determined through the standard assessment and patient placement process. If a financially and clinically eligible person has third party insurance, that insurance must be utilized to its full extent. Then, if benefits are exhausted, or if the person needs a service not fully covered by that third party insurance, or if the co-pay or deductible amount is greater than the person's ability to pay, Community Grant funds may be applied. Community Grant funds may not be denied solely on the basis of a person having third party insurance. 6. Subcontracts with Hospitals Funds made available through the Department shall not be made available to public or private hospitals which refuse, solely on the basis of an individual's substance use disorders or substance dependence, admission or treatment for emergency medical conditions. 7. Residency in CA Region The CA may not limit access to the programs and services funded by this Agreement only to the residents of the CA's region, because the funds provided by the Department under this Agreement come from federal and statewide resources. Members of federal and state-identified priority populations must be given access to AMS and/or treatment services, consistent with the requirements of this Agreement, regardless of their residency. However, for non-priority populations, the CA may give its residents priority in obtaining services funded under this Agreement when the actual demand for services by residents eligible for services under this Agreement exceeds the capacity of the programs funded under this Agreement. FY2008 Page 6 of 32 (09.14.07) ATTACHMENT A 8. Out-of- Network and Out-of-Region Services The CA must have written policies and procedures for authorizing and purchasing treatment services from out-of-network and out-of-region providers for residents of the CA region who need care from such providers. 9. Reimbursement Rates for Community Grant, Medicaid and Other Services The CA must pay the same rate when purchasing the same service from the same provider, regardless of whether the services are paid for by Community Grant funds, Medicaid funds, or other Department administered funds, including Adult Benefit Waiver (ABW) and MIChild funds. 10. Reimbursement for Primary Health Care with 1-1-1V---Eafly—Intervention Pr-og-ram-(E-IP) Communicable Diseases (CD) Funds CD funds shall not be used to purchase primary health care unless the Department approves such use in writing. 11. Minimum Criteria for Reimbursing for Services to Persons with Co- Occurring Disorders Department funds made available to the CA through this Agreement, and which are allowable for treatment services, may be used to reimburse providers for integrated mental health and substance use disorder treatment services (in to persons with co-occurring substance use and mental health disorders. The CA may reimburse a Community Mental Health Services Program (CMHSP) or Pre-paid Inpatient Health Plan (PIHP) for substance use disorders treatment services for such persons who are receiving mental health treatment services through the CMHSP or PIHP. The CA may also reimburse a provider, other than a CMHSP or PIHP, for substance use disorders treatment provided to persons with co-occurring substance use and mental health disorders. As always, when reimbursing for substance use disorders treatment, the CA must have an agreement with the CMHSP (or other provider); and the CMHSP (or other provider) must meet all minimum qualifications, including licensure, accreditation and data reporting. 12. Media Campaigns A media campaign, very broadly, is a message or series of messages conveyed through mass media channels including print, broadcast, and electronic media. Messages regarding the availability of services in the CA region are not considered to be media campaigns. Media campaigns must be compatible with MDCH values, be coordinated with MDCH campaigns whenever feasible and FY2008 Page 7 of 32 (09.14.07) El-te-MDCHIODCP 9-Fe{40-P ATTACHMENT A costs must be proportionate to likely outcomes. media campaign using MDCH funding preapproval by MDCH. 13. Notice of Funding Excess or Insufficiency The CA shall not finance any without The CA 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. 14. Subcontractor Information to be Retained at the CA a. Budgeting Information for Each Service. b. Documentation of How Fixed Unit Rates Were Established: The CA shall maintain documentation regarding how each of the unit rates used in its agreements was established. The process of establishing and adopting rates must be consistent with criteria in OMB Circular A-87 or A-122, whichever is applicable, and with the requirements of individual fund sources. c. Indirect Cost Documentation: The CA shall review subcontractor indirect cost documentation in accordance with OMB Circular A-87 or A-122, as applicable. d. Equipment Inventories: The CA must follow record keeping and reporting procedures, as indicated in Part I, 2.B., and in Attachment B to this Agreement. e. Fidelity Bonding Documentation: The CA shall maintain fidelity bonding documentation. 15. Reporting Requirements a. General Requirements Requirements concerning specific reports are contained elsewhere in the Agreement, including in Attachment C. The following requirements generally pertain 1. Each report must be submitted by the specified due date. Reports successfully e-mailed or uploaded to the Electronic Grants Administration and Management System (EGrAMS) by the due date are considered timely. 2. Reports must be sent to the addressee and via the submission route (e.g., uploaded, e-mailed, etc.) specified in this Agreement. FY2008 Page 8 of 32 (09.14.07) ATTACHMENT A Reports that are not sent to the specified addressee are subject to being determined not timely or not received. 3. Reports must be submitted on the form and in the format specified in this Agreement (if form and format are specified). accepted. b. Legislative Reports (LRs) and Final Financial Reports (RERs) If the contractor does not submit the LR or the final RER within fifteen (15) calendar days of the due date, the Department may withhold from the current year funding an amount equal to five (5) percent of that funding (not to exceed $100,000) until the Department receives the required report. The Department may retain the amount withheld if the contractor is more than forty-five (45) calendar days delinquent in meeting the filing requirements. c. Data Reporting Timeliness and Completeness Standards MDCH monitors the timeliness of submission for all required reports. Reports that arrive after the established due date are recorded as late. If the submission arrives more than five (5) calendar days past due, a letter will be sent to the CA Director to notify the CA of the lack of compliance with the published due date. Sanctions for noncompliance (depending on the severity and frequency) may include a requirement for a corrective action plan or may include an adjustment in prepayments. For data transactions that are submitted via the Date Exchange Gateway (DEG), including admission, discharge, and encounter batches, the processing system logs the dates and times the batches were transferred and processed. When the system is in production, monthly submissions by the CAs are required. Data submissions are monitored daily by MDCH staff. d. Data Completeness The CA is responsible for submitting 100% of required records. Initial submissions combined with error corrections and resubmissions must result in an accuracy rate of 100%. On the second working business day of every calendar month, the Department will send to the CA an error rate or acceptance rate notification based on the number of errors in its error master file. This notification will serve as an advisory for both MDCH and the CA. FY2008 Page 9 of 32 (09.14.07) ATTACHMENT A On or before April 30, the CA is required to submit a live count (e-mail transaction) from its information system noting the first six-month total counts of admissions, discharges, and encounters (by code). This is required for consultation purposes to identify whether the CA's submissions to MDCH show shortages compared to its local counts. The Department will notify the CA of its acceptance rate. If the CA's acceptance rates are less than 98% for admission/discharge data and less than 95% for encounters, the Department will notify the CA that improvement is needed. On or before November 30, the CA is required to submit the full 12-month FY total counts of admissions, discharges, and encounters (by code). This will also be submitted via e-mail. MDCH will calculate and acceptance rate for all three, and generate a report back to the CA. Once the acceptance rates are returned, if the 98% (admissions and discharges) or 95% (encounters) acceptance thresholds are not met, out of compliance CAs will have until December 31 to meet the acceptance threshold. The FY data sets will be finalized the first week of January, and shortages in admissions, discharges, and/or encounters will be reflected in all of MDCH's reports both to the public and to the legislature. e. National Outcome Measures (NOMS) The emergence of the NOMS increases the importance of the data completeness, accuracy and timeliness of admissien—and--disdharge records all treatment and prevention data that are necessary for ODCP to meet federal reporting requirements. Concerning the Treatment NOMS, it is the responsibility of the CA to ensure that the client information reported on these records accurately reflects client status at admission and on the last day of service. f. Prevention Data Set Beginning October 1, 2007, CAs are required to implement the collection of the state-required prevention data elements throughout the prevention provider network either through participation in the Prevention Data Set or through upload of the state-required prevention data records to the state system on a monthly basis. CAs are responsible for monitoring the accuracy of the reported data. FY2008 Page 10 of 32 (09.14.07) ATTACHMENT A 16. Critical Incidents and Sentinel Events The CA must require all of its residential treatment providers to prepare and file critical incident reports arid sentinel event reports that include the following components: 1. Provider determination whether critical incidents are sentinel events. 2. Following identification as a sentinel event, the provider must ensure that a root cause analysis or investigation takes place. 3. Based on the outcome of the analysis or investigation, the provider must ensure that a plan of action is developed and implemented to prevent further occurrence of the sentinel event. The plan must identify who is responsible for implementing the plan, and how implementation will be monitored. Alternatively, the provider may prepare a rationale for not pursuing a preventive plan. The CA is responsible for oversight of the above processes. Requirements for reporting data on Sentinel Events are contained in Attachment E. These reporting requirements are narrower in scope than the responsibility to identify and follow up on critical incidents and sentinel events. A Critical Incident is any of the following that should be reviewed to determine whether it meets the criteria for a sentinel event below: 1. Death of a recipient. 2. Serious illness requiring admission to hospital. 3. Alleged cause of abuse or neglect. 4. Accident resulting in injury to recipient requiring emergency room visit or hospital admission. 5. Behavioral episode. 6. Arrest and/or conviction. 7. Medication error. A Sentinel Event is an "unexpected occurrence involving death or serious physical or psychological injury", or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, "or risk thereof' includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome." (JCAHO, 1998) FY2008 Page 11 of 32 (09.14.07) ATTACHMENT A 17. Claims Management System The CA shall make timely payments to all providers for clean claims. This includes payment at 90% or higher of clean claims from network providers within 60 days of receipt, and 99% or higher of all clean claims within 90 days of receipt. A clean claim is a valid claim completed in the format and time frames specified by the CA and that can be processed without obtaining additional information from the provider. It does not include a claim from a provider who is under investigation for fraud or abuse, or a claim under review for medical necessity. A valid claim is a claim for services that the CA is responsible for under this Agreement. It includes services authorized by the CA. The CA must have a provider appeal process to promptly and fairly resolve provider-billing disputes. 18. Care Management The CA may pay for care management as a service designed to support CA resource allocation as well as service utilization. Care management is in recognition that some clients represent such service or financial risk that closer monitoring of individual cases is warranted. Care management must be purchased and reported consistent with the instructions for the Administrative Expenditures Report in Attachment B to this agreement. Services 1. General Services a. 12-Month Availability of Services The CA shall assure that, for any subcontracted treatment or prevention service, each subcontractor maintains service availability throughout the fiscal year for persons who do not have the ability to pay. b. Persons Associated with the Corrections System When the CA or its AMS services receives referrals from the Michigan Department of Corrections (MDOC), the CA shall handle such referrals as per all applicable requirements in this agreement. This would include determining financial and clinical eligibility, authorizing care as appropriate, applying admissions preferences, and other steps. MDOC referrals may come from probation or parole agents, or from MDOC Central Office staff. FY2008 Page 12 of 32 (09.14.07) ATTACHMENT A When persons who are on parole or probation seek treatment on a voluntary basis from the CA's AMS services or from a panel provider, these self-referrals must be handled like any other self-referral to the MDCH-funded network. AMS or provider staff may seek to obtain releases to communicate with a person's probation or parole agent but in no instance may this be demanded as a condition for admission or continued stay. The CA may collaborate with MDOC, and with the Office of Community Corrections (OCC) within MDOC, on the purchase of substance use disorders services and supports. This may include collaborative purchasing from the same providers, and for the same clients. In such situations, the CA must assure that: 1. All collaborative purchasing is supported by written agreements among the participants. 2. Rates paid to providers, whether by a single purchaser or two or more purchasers, do not exceed provider costs. 3. Rates paid to providers are documented and are developed consistent with applicable OMB Circular(s). 4. No duplication of payment occurs. c. State Disability Assistance (SDA) MDCH continues to allocate SDA funding and to delegate management of this funding to the CA. The SDA funding is identified in the CA's allocation letter. The CA is responsible for allocating these funds to qualified providers. Minimum provider qualifications are MDCH licensure as a residential treatment provider and accreditation by one of the five approved accreditation bodies (identified elsewhere in this Agreement). A provider may be located within the CA's region or outside of the region. SDA funds shall not be used to pay for room and board in conjunction with sub-acute detoxification services. When a client is determined to be eligible for SDA funding, the CA must arrange for assessment and authorization for SDA room and board funding and must reimburse for SDA expenditures based on billings from providers, consistent with CA/provider agreements. In addition, the CA may authorize such services for its own residents at providers within or outside its region. The CA shall not refuse to authorize SDA funds for support of an individual's treatment solely on the basis of the individual's current or past involvement with the criminal justice system. FY2008 Page 13 of 32 (09.14.07) ATTACHMENT A Qualified providers may be reimbursed up to twenty-four dollars ($24.00) per day for room and board costs for SDA-eligible persons during their stays in Residential treatment. To be eligible for MDCH-administered SDA funding for room and board services in a substance use disorders treatment program, a person must be determined to meet Michigan Department of Human Services' (MDHS) eligibility criteria; determined by the CA or its designee to be in need of residential treatment services; authorized by the CA for residential treatment when the CA expects to reimburse the provider for the treatment; at least 18 years of age or an emancipated minor, and in residence in a residential treatment program each day that SDA payments are made. The CA may employ either of two methods for determining whether an individual meets MDHS eligibility criteria: 1. The CA may refer the individual to the local MDHS office. This method must be employed when there is a desire to qualify the individual for an incidental allowance under the SDA program. Or, 2. The CA may make its own determination of eligibility by applying the essential MDHS eligibility criteria. See this DHS link for details: htto://www.michioan.aov/dhs/0,1607,7-124-5453 5526---,00.html For present purposes only, these criteria are: • Residency in substance use disorders residential treatment. • Michigan residency and not receiving cash assistance from another state. • U.S. citizenship or have an acceptable alien status. • Asset limit of $3,000 (cash assets only are counted). Regardless of the method used, the CA must retain documentation sufficient to justify determinations of eligibility, The CA must have a written agreement with a provider in order to provide SDA funds. d. Persons Involved With the Michigan Department of Human Services (MDHS) The CA must work with the MDHS office(s) in its region to facilitate access to prevention, assessment and treatment services for persons involved FY2008 Page 14 of 32 (09.14.07) ATTACHMENT A with MDHS, including families in the child welfare system and public assistance recipients. e. Primary Care Coordination The CA must take all appropriate steps to assure that substance use disorders treatment services are coordinated with primary health care. In the case of CAs that are under contract with PIHPs for the Medicaid substance abuse program, CAs are reminded that coordination efforts must be consistent with these contracts. Treatment case files must include, at minimum, the primary care physician's name and address, a signed waiver release of information for purposes of coordination, or a statement that the client has refused to sign this waiver. Care coordination agreements or joint referral agreements, by themselves, are not sufficient to show that the CA has taken all appropriate steps related to coordination of care. Client case file documentation is also necessary. f. Cultural Competence CA must have a written cultural competency plan implemented in practice at their agency and at all provider agencies. The plan must include: 1. The CA's identification and assessment of the cultural needs of potential and active clients based on population served. 2. The CA's identification of how access to services is facilitated for persons with diverse cultural backgrounds and Limited English Proficiency (LEP). 3. The CA's identification standards for the recruitment and hiring of culturally competent staff members. 4. The CA's identification of how ongoing staff training needs in cultural competency will be assessed and met and the evidence that staff members receive training. 5. The CA's process for ensuring that panel providers comply with all applicable requirements concerning the provision of culturally competent services. 6. The CA's process for annually assessing its compliance with the CA's cultural competence plan. FY2008 Page 15 of 32 (09.14.07) g. ATTACHMENT A Charitable Choice The September 30, 2003 Federal Register (45 CFR part 96) contains federal Charitable Choice SAPT block grant regulations, which apply to both prevention and treatment providers/programs. In summary, the regulations require: 1) that the designation of religious (or faith-based) organizations as such be based on the organization's self-identification as religious (or faith based), 2) that these organizations are eligible to participate as providers—e.g. a "level playing field" with regard to participating in the CA provider panel, 3) that a program beneficiary receiving services from such an organization who objects to the religious character of a program has a right to notice, referral, and alternative services which meet standards of timeliness, capacity, accessibility and equivalency—and ensuring contact to this alternative provider, and 4) other requirements, including-exclusion of inherently religious activities and non-discrimination. The CA is required to comply with all applicable requirements of the Charitable Choice regulations. The CA must ensure that treatment clients and prevention service recipients are notified of their right to request alternative services. Notice may be provided by the AMS or by providers that are faith-based. Notification must be in the form of the model notice contained in the final regulations, or the CA may request written approval from MDCH of an equivalent notice. The CA must also ensure that its AMS administer the processing of requests for alternative services. The model notice contained in the federal regulations is: "No provider of substance abuse services receiving Federal funds from the U.S. Substance Abuse and Mental Health Services Administration, including this organization, may discriminate against you on the basis of religion, a religious belief, a refusal to hold a religious belief, or a refusal to actively participate in a religious practice. If you object to the religious character of this organization, Federal law gives you the right to a referral to another provider of substance abuse services. The referral, and your receipt of alternative services, must occur within a reasonable period of time after you request them. The alternative provider must be accessible to you and have the capacity to provide substance abuse services. The services provided to you by the alternative provider must be of a FY2008 Page 16 of 32 (09.14.07) ATTACHMENT A value not less than the value of the services you would have received from this organization." h. Americans with Disabilities Act The CA and its contractors must comply with applicable provisions of the Americans with Disabilities Act (the ADA). Further information may be found at: Nondiscrimination on the Basis of Disability in State and Local Government Services: United States Code of Federal Regulations, Title 28, Part 35, Washington, D.C. (1991). 28cfr35 main 02.tol i. Limited English Proficiency The CAs must insure a current Limited English Proficiency (LEP) policy is in place and in practice. The CA must also have documentation that all providers have implemented the required LEP policy and procedures and are in compliance with related Federal and State requirements. The LEP policies and procedures must include the following, as required by the Office of Civil Rights. 1. Procedures for identifying and assessing the language needs of the CA, individual provider and the geographic area served. Needs must be based on current local and regional census data, as well as other state and regional data. 2. Identified range of oral language assistance options appropriate to the CAs circumstances. 3. How the CA provides notice to LEP persons, in their primary language, of the right to free language assistance. 4. What staff training and program monitoring is performed related to LEP policies and procedures. 5. Provisions for written materials in language other than English where a significant number or percentage of the affected population needs services or information in a language other than English, to communicate effectively. 6. Provisions for language interpreters who are trained and competent. FY2008 Page 17 of 32 (09.14.07) ATTACHMENT A 7. Statements explaining timely assistance. 8. Statements explaining there will be no charge to the LEP recipient for these services. 9. Provisions regarding use of family member and/or friend as a language interpreter must not be required. Should the consumer choose to use family or friend as an interpreter, both the offering of other resources, and the consumer's choice, must be documented in writing. Availability of consumer family and friends as translator/interpreter will not waive other LEP requirements herein described. 2. Treatment Services a. Medical Necessity Criteria For Substance Use Disorders Supports And Services The CA must assure that treatment service authorization and reauthorization decisions are consistent with the following Medical Necessity Criteria. These criteria are substantively the same as the applicable criteria for substance use disorders Medicaid services. 1.0 Medical Necessity Criteria 1.1 "Medically necessary" substance abuse services are supports, services, and treatment: 1.1.1 Necessary for screening and assessing the presence of substance use disorder; and/or 1.1.2 Required to identify and evaluate a substance use disorder; and/or 1.1.3 Intended to treat, ameliorate, diminish or stabilize the symptoms of a substance use disorder; and/or 1.1.4 Expected to arrest or delay the progression of a substance use disorder; and/or 1.1.5 Designed to assist the individual to attain or maintain a sufficient level of functioning in order to achieve his/her goals of community inclusion and participation, independence, recovery or productivity. 1.2 The determination of a medically necessary support, service or treatment must be: 1.2.1 Based on information provided by the individual, individual's family, and/or other individuals (e.g., FY2008 Page 18 of 32 (09.14.07) ATTACHMENT A friends, personal assistants/aide) who know the individual; and 1.2.2 Based on clinical information from the individual's primary care physician or clinicians with relevant qualifications who have evaluated the individual; and 1.2.3 Based on individualized treatment planning; and 1.2.4 Made by appropriately trained substance abuse professionals with sufficient clinical experience; and 1.2.5 Made within federal and state standards for timeliness; and 1.2.6 Sufficient in amount, scope and duration of the service(s) to reasonably achieve its/their purpose. 1.3 Supports, services and treatment authorized by the CA must be: 1.3.1 Delivered in accordance with federal and state standards for timeliness in a location that is accessible to the individual; and 1.3.2 Responsive to particular needs of multi-cultural populations and furnished in a culturally relevant manner; and 1.3.3 Provided in the least restrictive, most integrated setting. Residential or other segregated settings shall be used only when less restrictive levels of treatment, service or support have been, for that beneficiary, unsuccessful or cannot be safely provided; and 1.3.4 Delivered consistent with, where they exist, available research findings, health care practice guidelines and standards of practice issued by professionally recognized organizations or government agencies. 1.4 Using criteria for medical necessity, a CA may: 1.4.1 Deny services a) that are deemed ineffective for a given condition based upon professionally and scientifically recognized and accepted standards of care; b) that are experimental or investigational in nature; or c) for which there exists another appropriate, efficacious, less-restrictive and cost- effective service, setting or support, that otherwise satisfies the standards for medically-necessary services; and/or 1.4.2 Employ various methods to determine amount, scope and duration of services, including prior authorization for certain services, concurrent utilization reviews, centralized assessment and referral, gate-keeping arrangements, protocols, and guidelines. FY2008 Page 19 of 32 (09.14.07) ATTACHMENT A 1.4.3 A CA may not deny services solely based on PRESET limits of the cost, amount, scope, and duration of services; but instead determination of the need for services shall be conducted on an individualized basis. This does not preclude the establishment of quantitative benefit limits that are based on industry standards and consistent with 1.3.4 above, and that are provisional and subject to modification based on individual clinical needs and clinical progress. b. Clinical Eligibility: DSM IV-TR Diagnosis In order to be eligible for treatment services purchased in whole or part by state-administered funds under the agreement, an individual must be found to meet the criteria for one or more selected substance use disorders found in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR). These disorders are listed below. This requirement is not intended to prohibit use of these funds for family therapy. It is recognized that persons receiving family therapy do not necessarily have substance use disorders. 303.90 305.00 303.00 291.80 304.40 305.70 292.89 292.00 304.30 305.20 292.89 304.20 305.60 292.89 292.00 304.50 305.30 292.89 304.60 305.90 292.89 304.00 305.50 292.89 Alcohol Dependence Alcohol Abuse Alcohol Intoxication Alcohol Withdrawal Amphetamine Dependence Amphetamine Abuse Amphetamine Intoxication Amphetamine Withdrawal Cannabis Dependence Cannabis Abuse Cannabis Intoxication Cocaine Dependence Cocaine Abuse Cocaine Intoxication Cocaine Withdrawal Hallucinogen Dependence Hallucinogen Abuse Hallucinogen Intoxication Inhalant Dependence Inhalant Abuse Inhalant Intoxication Opioid Dependence °plaid Abuse Opioid Intoxication FY2008 Page 20 of 32 (09.14.07) ATTACHMENT A 292.00 304.60 305.90 292.89 304.10 305.40 292.89 292.00 304.90 305.90 292.89 292.00 Opioid Withdrawal Phencyclidine Dependence Phencyclidine Abuse Phencyclidine Intoxication Sedative, Hypnotic, or Anxiolytic Dependence Sedative, Hypnotic, or Anxiolytic Abuse Sedative, Hypnotic, or Anxiolytic Intoxication Sedative, Hypnotic, or Anxiolytic Withdrawal Other (or Unknown) Substance Dependence Other (or Unknown) Substance Abuse Other (or Unknown) Substance Intoxication Other (or Unknown) Substance Withdrawal c. Outpatient Level of Care Continuum TO BE DETERMINED d. Satisfaction Surveys The CA shall assure that all network subcontractors providing treatment conduct satisfaction surveys of persons receiving treatment at least once a year. Surveys may be conducted by individual providers or may be conducted centrally by the CA. Clients may be active clients or clients discharged up to 12 months prior to their participation in the survey. Surveys may be conducted by mail, telephone, or face-to-face. The CA must compile findings and results of client satisfaction surveys for all providers, and must make findings and results, by provider, available to the public. e. MIChild MIChild Covered Services The CA must use its standardized assessment process, including the American Society of Addiction Medicine (ASAM) Patient Placement Criteria, to determine clinical eligibility for services based on medical necessity. Substance use disorders services are covered when medically necessary as determined by the CA. This benefit should be construed the same as are medical benefits in a managed care program. Inpatient (hospital- based) services are covered, but the CA is permitted to substitute less costly services outside the hospital if they meet the medical needs of the patient. In the same way, the CA may substitute services for inpatient or residential services if they meet the child's needs and they are more cost effective. FY2008 Page 21 of 32 (09.14.07) ATTACHMENT A Covered services are as follows: 1. Outpatient Treatment 2. Residential Treatment 3. Inpatient Treatment 4. Laboratory and Pharmacy These benefits apply only when a CA's employed or contracted physician writes a prescription for pharmacy items or lab. Eligibility Eligible persons are persons of age 18 or less who are determined eligible for the MIChild program by the MDCH and enrolled by the Department's administrative vendor and live in the region covered by the CA. The CA is responsible for determining eligibility and for charging all authorized and allowable services to the MIChild program up to the CA's annual MIChild revenues. Per Enrolled Child Per Month Quarterly, MDCH will provide the CA with the federal share of MIChild funds as a per capita payment based upon a Per Enrolled Child Per Month (PECPM) methodology for MIChild covered services. Included with these funds will be an electronic copy of the names of the MIChild enrollees forming the basis of these calculations. In consideration for accepting the federal funding pushed to the CA, the CA agrees to redirect existing state general fund dollars to match the MIChild federal FMAP funds (Title XXI State Children's Health Insurance Program) and carry out the associated substance use disorders program requirements. The PEPCM rate is $0.47 (47 cents) per month. For the current fiscal year, the federal share is 69.47 70.67%, or approximately 33 cents per month, and the state share is 30,53 29.33%, or approximately 14 cents. The PECPM funding is a per capita payment for medically necessary MIChild-covered services including outpatient, residential and inpatient services as authorized by the CA. If the MIChild capitation is not sufficient to serve the MIChild enrollees, use of state-allocated Community Grant funds is allowed. Federal SAPT Block Grant funds may not be used for inpatient care. Data Collection and Reporting The CA must account separately for expenses related to MIChild enrollees. Reporting of MIChild revenues and expenditures will be FY2008 Page 22 of 32 (09.14.07) ATTACHMENT A through the Revenues and Expenditures Report as indicated in Attachment B to this Agreement. In the event that program costs are less than PECPM revenues, the CA may retain the balance as local funds. Enrollees who receive substance use disorders services must be entered into the Substance abuse Statewide Client Data System following the instructions in the data reporting specifications. For the required reporting of encounters for MIChild eligible clients, the CA will report these encounters via the 837 as follows: 2000B Subscriber Hierarchical Level SBR Subscriber Information SBRO4 Insured Group Name: Use "MIChild" for the group name. Access Timeliness Access timeliness requirements are the same as those applicable to Medicaid substance use disorders services, as specified in the agreement between MDCH and the PIHPs. Access must be expedited when appropriate based on the presenting characteristics of individuals. f. Adult Benefit Waiver In consideration for accepting the federal funding pushed to the CA for the State Medical Program (SMP) eligible under an approved Health Insurance Flexibility and Accountability (HIFA) Adult Benefit Waiver (ABW), the CA agrees to redirect existing state general fund dollars to match the ABW federal FMAP funds (Title XXI State Children's Health Insurance Program) and carry out the associated substance use disorders program requirements. Program requirements are contained in this agreement and in the Department's Medicaid Provider Manual's chapter on Adult Benefits Waiver I, which is available at the Department's web site, www.michigan.gov/mdch . The ABW program is contingent on continued federal approval of the program. The total ABW funding applied to program expenditures (federal plus general fund match) shall not exceed $3.80 per enrolled eligible member per month (PEPM). MDCH shall push the federal portion of the eligible amount to the CA (PEPM X $3.80 X .6-947 .7067) based on program enrollment. MDCH will issue the payment for each month not later than the second Wednesday of that month. The amount of general fund dollars applied by the CA to program costs shall equal 40,53 29.33 percent of the total PEPM during the agreement period following the date of program initiation. In the event that program costs are less than the federal and state applicable match requirement amount, the CA shall FY2008 Page 23 of 32 (09.14.07) ATTACHMENT A retain the balance as local dollars. In the event that program costs are greater than the federal and state match amount, the CA may use other State Agreement funds budgeted for treatment in this Agreement. Use of these funds must be consistent with requirements pertaining to these other State Agreement funds. ABW Covered and Discretionary Services ABW covered and discretionary services, as contained in the Medicaid Provider Manual, are listed below. Covered Services: 1. Initial assessment, diagnostic evaluation, referral and patient placement; 2. Outpatient Treatment; 3. Intensive Outpatient Treatment; and 4. Federal Food and Drug Administration (FDA) approved pharmacological supports for Methadone. ABW Discretionary Services: 1. Other substance use disorders services may be provided, at the discretion of the CA, to enhance outcomes. The CA is required to pay for medically necessary and requested covered services, within applicable benefit limitations, for the enrolled population in excess of the combined federal and applicable match funds. The CA may apply available SAPT Block Grant funds and state general funds to pay for ABW covered services when ABW funds (federal and state shares combined) have been exhausted. The CA may also choose to pay for non-covered and discretionary services for ABW beneficiaries with other available funds. Any use of SAPT Block Grant and state general funds to pay for discretionary or non- covered services must be consistent with provisions in this agreement that are applicable to these funds. ABW beneficiaries who receive ABW covered services shall be treated according to all applicable requirements of the ABW program, regardless of source of funds for these services. ABW beneficiaries who receive ABW discretionary services shall be treated according to applicable ABW program requirements when the source of funds is ABW funds. The CA may not charge fees or co-pays to ABW beneficiaries for covered services or for discretionary services purchased with ABW funds. FY2008 Page 24 of 32 (09.14.07) ATTACHMENT A ABW funds may not be used to purchase care for persons who are residents in institutions for mental diseases (IMDs). Access Timeliness Access timeliness requirements are the same as those applicable to Medicaid substance use disorders services, as specified in the agreement between MDCH and the PIHPs. Access must be expedited when appropriate based on the presenting characteristics of individuals. Appeals by ABW Enrollees ABW beneficiaries must be provided written notice of right to appeal proposed denials, reductions, suspensions or terminations of covered services through the administrative hearing process, as described in All Provider Bulletin 03-10. Encounter Data and Quality Improvement Data Enrollees who receive substance use disorders services must be entered into the Substance abuse Statewide Client Data System following the coding instructions in the data reporting specifications. For the required reporting of encounters for ABW Eligible clients, the CA will report these encounters via the 837 as follows: 2000B Subscriber Hierarchical Level SBR Subscriber Information SBRO4 Insured Group Name: Use "ABW" for Adult Benefits Waiver. The combined federal share and the GF match share amounts should be reported separately by using the Primary, Secondary, and Tertiary Payer guidelines under the 2000B Loop (Subscriber Hierarchical Loop SBRO1 Data Element — Payer Responsibility Sequence Number Code). These codes were covered at the Health Insurance Portability and Accountability Act (HIPAA) Readiness Seminars in 2003. Revenue and Expenditures Reporting Revenue and expenditures reporting requirements are contained in Attachment B to this Agreement. Benefit Limits FY2008 Page 25 of 32 (09.14.07) ATTACHMENT A This is a limited benefit program. Utilization control procedures consistent with best practice standards and the three criteria stated below must be used. The CA may provide or authorize ABW covered and discretionary services only when these services: 1. Meet the medical necessity criteria contained in this Agreement; 2. Are based on individualized determination of need; and 3. Meet the AMS service requirements contained in this Agreement, including a level of care determination based on an evaluation of the six assessment dimensions of the current ASAM Patient Placement Criteria. The CA must assure that all persons admitted to treatment have an individualized treatment plan that emphasizes appropriate treatment and recovery. The CA shall not discontinue or interrupt ABW services when ABW beneficiaries have been admitted to treatment, have exhausted their ABW benefit, and are financially and clinically eligible for continued treatment under the Community Grant program. Initial AssARAmpnt niaanostic Evaluation. Referral and Patient Placement The CA will perform a screening and when warranted by the screening results, the CA will perform an initial assessment and a diagnostic evaluation for ABW beneficiaries who meet medical necessity criteria. The CA will make referrals and/or patient placements based on individual need. The CA may perform or pay for no more than one assessment for a beneficiary in any six-month period. Outpatient Treatment The CA may authorize up to 15 outpatient units in a twelve-month period based on medical necessity criteria, individualized determination of need, AMS service requirements, and best practice standards. The CA may authorize additional units based on these same criteria plus: 1. The beneficiary's commitment to treatment based on participation and attendance; 2. Progress in meeting goals in the individualized treatment plan, and 3. Evidence that the beneficiary will benefit from additional units. Intensive Outpatient Treatment FY2008 Page 26 of 32 (09.14.07) ATTACHMENT A The CA may authorize up to 12 days in a twelve-month period based on Medical Necessity Criteria, individualized determination of need, AMS service requirements, and best practice standards. The CA may authorize additional units based on these same criteria plus: 1. The beneficiary's commitment to treatment based on participation and attendance; and 2. Progress in meeting goals in the individualized treatment plan; and 3. Evidence that the beneficiary will benefit from additional units. FDA Approved Pharmacological Supports for Methadone The CA may authorize up to ninety (90) days of Methadone treatment based on medical necessity criteria, individualized determination of need, AMS service requirements, best practice standards, and the criteria, contained in this Agreement, for Opioid dependent substance use disorders treatment with Methadone (Treatment Policy #05 contained in Attachment E). The CA may authorize additional treatment in increments of up to ninety (90) days each based on these same criteria. Intensive Outpatient Treatment — Weekly Format The CA may purchase Intensive outpatient treatment (10P) only if the treatment consists of regularly scheduled treatment, usually group therapy, within a structured program, for at least three days and at least nine hours per week. h. Services for Pregnant Women, Women with Dependent Children, Women Attempting to Regain Custody and Their Children The CA must assure that providers screen and/or assess pregnant women, women with dependent children, and women attempting to regain custody of their children to determine whether these women need and request the defined federal services that are listed below. All federally mandated services must be made available within each CA region. Financial Requirements The CA has been assigned an expenditure target for Women's Specialty Services in the CA's allocation letter. State general fund dollars and the state share of Medicaid dollars, as well as SAPT Block Grant dollars, can be counted toward the expenditure target. CAs must report on their g. FY2008 Page 27 of 32 (09.14.07) ATTACHMENT A RERs, in the Women's Specialty column, all allowable expenditures for Women's Specialty Services, and only allowable expenditures. Encounter Reporting Requirements TO BE DETERMINED Requirements Regarding Providers Women's Specialty Services may only be provided by providers that are gender-competent and that meet standard panel eligibility requirements. The provider may be designated by ODCP as Women's Specialty providers, but such designation is not required. The CA must continue to provide choice from a list of providers who offer gender competent treatment and identify providers that provide the additional services specified in the federal requirements. Federal Requirements Federal requirements are contained in 45 CRF (Part 96) section 96.124, and may be summarized as: Treatment programs receiving funding from the Block Grant set aside for pregnant women and women with dependent children must provide or arrange for the following: 1. Primary medical care for women, including referral for prenatal care if pregnant, and while the women are receiving such treatment, child care; 2. Primary pediatric care for their children, including immunizations; 3. Gender specific substance use disorders treatment and other therapeutic interventions for women, which may address issues of relationships, sexual and physical abuse, parenting, and childcare while the women are receiving these services; 4. Therapeutic interventions for children in custody of women in treatment, which may, among other things, address their developmental needs, issues of sexual and physical abuse, and neglect; and 5. Sufficient case management and transportation to ensure that women and their dependent children have access to the above mentioned services. Women with dependent children are defined FY2008 Page 28 of 32 (09.14.07) ATTACHMENT A to include women in treatment who are attempting to regain custody of their children. The above five types of services, including especially primary medical care, may be provided through the MDCH/CA agreement only when no other source of support is available and when no other source is financially responsible. I. Admission Preference and Interim Services The Code of Federal Regulations and the Michigan Public Health Code define priority population clients. The priority populations are identified as follows and in the order of importance: 1. Pregnant injecting drug user. 2. Pregnant. 3. Injecting drug user. 4. Parent at risk of losing their child(ren) due to substance use. 5. All others. Access timeliness standards and interim services requirements for these populations are provided in the next section. Access Timeliness Standards The following chart indicates the current admission priority standards for each population along with the current interim service requirements. Suggested additional interim services are in italics: Admission Priority Reauirements Population Admission Requirement Interim Service Requirement Authority .. Begin within 48 hours: 1) Screened and referred CFR 96.121; 1. Counseling and education on: within 24 hours CFR 96.131; a) HIV and TB 2) Detoxification,Treatment b) Risks of needle sharing Methadone or Policy #04 Pregnant c) Risks of transmission to Residential —Offer Injecting sexual partners and infants Admission within 24 Drug User d) Effects of alcohol and drug business hours use on the fetus Other Levels or Care — , Offer Admission within 48 2' Referral for pre-natal care 3. Early Intervention Clinical Business hours Services Recommended _ pA Pregnant 1) Screened and referred Begin within 48 hours CFR 96.121; Substance within 24 hours 1. Counseling and education on: CFR 96.131; I Use 2) Detoxification, a) HIV and TB J. FY2008 (09.14.07) Page 29 of 32 ATTACHMENT A Po .ulation Admission Requirement Interim Service Requirement Authority Disorders Methadone or b) Risks of transmission to Residential — Offer sexual partners and infants admission within 24 c) Effects of alcohol and drug business hours use on the fetus Other Levels or Care — 2. Referral for pre-natal care Offer Admission within 48 3. Early Intervention Clinical Recommended Business hours Services .., IMnV 1 n'n Begin within 48 hours— maximum waiting time 120 CFR 96.121; days CFR 96.126 1. Counseling and education on: Screened and referred Injecting i i a) HIV and TB wthn 24 hours; Offer Drug User b) Risks of needle sharing Admission within 14 days c) Risks of transmission to sexual partners and infants 2. Early Intervention Clinical Recommended Services ., Begin within 48 business hours Michigan Public Parent at Screened and referred Health Code Risk of within seven calendar Section 6232 Losing days. Capacity to offer Early Intervention Clinical Children Admission within 14 days Services Recommended . • CFR 96.131(a) Screened and referred — sets the order within seven calendar All Others Not Required of priority; days. Capacity to offer ODCP and CA Admission within 14 days contract j,-----Communisable-Diseases Requirements regarding communicable diseases are located in Attachment E to the agreement. See Attachment C for reporting requirements. 3. Prevention Services a. Prevention Requirements Prevention funds may be used for needs assessment and related activities. All prevention services must be based on a formal local needs assessment. The Department's intent is to move toward a community-based, consequence-driven model of prevention. In the meantime, based on needs assessment, prevention activities must be targeted to high-risk FY2008 Page 30 of 32 (09.14.07) ATTACHMENT A groups and must be directed to those at greatest risk of substance use disorders and/or most in need of services within these high-risk groups. CAs are not required to implement prevention programming for all high- risk groups. The CA may also provide targeted prevention services to the general population. The high risk subgroups include but are not limited to: children of substance abusers; pregnant women/teens; drop-outs; violent and delinquent youth; persons with mental health problems; economically disadvantaged citizens; persons who are disabled; victims of abuse; persons already using substances; and homeless and/or runaway youth. Additionally, children exposed prenatally to ATOD are identified as a high- risk subgroup. Prevention services must be provided through strategies identified by CSAP. These strategies are: information dissemination; education; alternatives; problem identification and referral; community based processes; and environmental change. Prevention-related funding limitations the CA must adhere to are: 1) A maximum of 35% of prevention funding may be used for school based activities as part of the usual school day, 2) CA expenditure requirements for prevention, including Synar, as stipulated in the CA's allocation letter, 3) 90% of prevention expenditures are expected to be directed to programs which are implemented as a result of an evidence-based decision making process, 4) Alternative strategy activities, if provided must reflect evidence-based approaches and best practices such as multi- generational and adult to youth mentoring, and 5) state-administered funds used for information dissemination must be part of a multi-faceted regional prevention strategy, rather than independent, stand-alone activity. The CA must monitor and evaluate prevention programs at least annually to determine if the program outcomes, milestones and other indicators are achieved, as well as compliance with state and federal requirements. Indicators may include integrity to prevention best practice models including those related to planning prevention interventions such as risk/protective factor assessment, community assets/resource assessment, levels of community support, evaluation, etc. A written monitoring procedure, which includes requirements for corrective action plans to address issues of concern with a provider, is required. 14.e.e Attach-ment C for reporting requirements. El-FRELMELF FY2008 Page 31 01 32 (09.14.07) ATTACHMENT A SAPT Block Grant Funds cannot be used for law enforcement inspections. ODCP assumes responsibility for monitoring compliance with this condition. b. Strategic Prevention Framework/State Incentive Grant (SPF/SIG) Prevention Project The CA's use of SPF/SIG funds is governed by terms and conditions of the SPF/SIG Notice of Award and all applicable requirements in the MDCH/CA contract agreement. GA may also usc the allocated funds preventioR programming as identified thr( with stakeholder agencies. Stakeholder 19.FE rneth-amph-etacnine, for methamphetamine specific 4140-1-14G infrastr-uctufe development activity and methamphetamine specific prevention programming. CAs must not exceed a cap of 5 percent for Agreement. FY2008 Page 32 of 32 (09.14.07) Attachment B (Printed On Agency Letterhead) Certificate of Cost Allocation Plan This is to certify that I have reviewed the Cost Allocation Plan and to the best of my knowledge and belief: (1) All costs included in this proposal to establish cost allocations or billings for October 1, 2007 through September 30, 2008 are allowable in accordance with the requirements of OMB Circular A 87, "Cost Principles for State, Local, and Indian Tribal Governments", and the Federal award(s) to which they apply. Unallowable costs have been adjusted for in allocating costs as indicated in the Cost Allocation Plan. (A-87 can be found at: http://www.whitehouse.gov/omb/circulars/a087/a87 2004.html) (2) All costs included in this proposal are properly allocable to Federal awards on the basis of a beneficial or causal relationship between the expenses incurred and the awards to which they are allocated in accordance with applicable requirements. Further, the same costs that have been treated as indirect costs have not been claimed as direct costs. Similar types of costs have been accounted for consistently. I declare that the foregoing is true and correct. Agency Name: Signature: Name of Official: Title: Date of Execution: This Certificate of Cost Allocation Plan should be used for certification of the Agency's Cost Allocation Plan. This form must be signed by the Executive Director or Finance Director of the agency. Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 3 of 17 Attachment B Initial annual budgets (expected revenue) are incorporated into agency contracts. Quarterly expenditure reports must be submitted to the Michigan Department of Community Health (MDCH)/Accounting not later than the last day of the month following the end of the quarter. Please note that the fourth quarter RER , which would be due October 31, is not required. Final annual RERs are due by January 31 following the end of the fiscal year. A copy of each quarterly and final report must be e-mailed to the address given below under XII. Distribution. Expenditure targets for selected program areas, such as Women's Specialty Services, will also be provided by MDCH/ODCP in the agency's initial fiscal year allocation letter. Revised allocations and expenditure targets will be issued, as needed. Reporting of revenues and expenditures must be consistent with Generally Accepted Accounting Principles (GAAP). II. BUDGET AMENDMENTS A. Definition A budget amendment could be either an increase or decrease to the agency's State Agreement, (Section A of RER). A budget amendment would also be required if there is either an increase or decrease to the agency's Total Agreement amount, as listed on the first page of the agency's agreement and on its RER. Please note that any appreciable increase in the agency's Total Agreement amount should be included in the agency's final amendment request. The Total Agreement amount includes ALL OTHER funding sources; i.e, Medicaid, ABW, MIChild, Fees/Collections, and Other Contracts and Sources. B. Criteria for Approving Budget Amendments The following provides some parameters of a budget amendment to the agency's agreement with MDCH: • All agencies that receive State Disability Assistance (SDA) funds and anticipate not using all of this funding, must notify MDCH/ODCP by May 1, per its current MDCH contract. This information should be included in the agency's final budget amendment request. • An agency that anticipates not meeting its Women's Specialty target amount (per its current fiscal year allocation letter), must notify MDCH/ODCP by May 1, per its current MDCH contract. This Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 4 of 17 Attachment B information should be included in the agency's final budget amendment request. C. Due Date for Budget Amendments Requests for budget amendments must be submitted in writing to the agency's contract manager not later than the due date for final amendments to this contract. This date is typically in late June annually. ODCP will notify the agency of a specific date at least 30 days in advance of the due date. III. BUDGET REVISIONS A. Definition A budget revision involves moving state-administered funds between expenditure budgets (Prevention, Treatment, Communicable Diseases, etc.) without changing the total budgeted amount of state-administered funds. B. Criteria for Approving Budget Revisions—Section A CA Discretionary Revisions The CA is granted limited discretion to revise the budgeted amounts of state-administered funds without prior approval by MDCH. This discretion is applicable only to the budget categories of CA Administration, Treatment, Prevention, and Communicable Diseases, and it is applicable only to Community Grant funds. It is not applicable to the Women's Specialty Target. The CA may decrease or increase any of the above four budget categories by up to $50,000 annually through the transfer of Community Grant funds among these budget categories. Under this discretion, $50,000 is the annual, maximum net change, up or down, that may be effected in any one of the four budget categories. Reducing the amount of budgeted Community Grant funds does not reduce or amend any requirements stated elsewhere in this contract agreement, with respect to any the four budget categories. For example, reducing the Communicable Disease budget does not reduce the CA's program or performance responsibilities regarding Communicable Diseases. The CA must inform its MDCH contract manager by e-mail of any discretionary budget revisions at the time the revisions are made (within Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 5 of 17 Attachment B ten business days). All discretionary revisions must be reported on subsequent quarterly and final RERs. NOTE: With respect to Prevention only--if the CA has received approval to reduce its Prevention budget by $50,000 or more, there is no CA option for additional reductions on a discretionary basis. Any additional reductions must be approved by the Contract Manager in writing in advance. All Other Revisions Revisions in planned (budgeted) expenditures of Section A funds must be approved in advance, in writing by the ODCP Contract Manager. Revisions must be incorporated into subsequent quarterly RERs. The following describes the parameters of a budget revision to the agency's agreement with MDCH: The Department must allocate and manage state-administered funds in a way that assures compliance with all federal and state requirements, including SAPT Block Grant expenditure requirements. The initial allocations for each fiscal year are in compliance with these requirements. Nonetheless, an agency may propose to increase or reduce its allocations for Communicable Diseases or for Prevention, within the limits of its total allocation. Though there is no separate allocation for Treatment, this flexibility applies to Treatment as well. The Department will be receptive to approving revisions in initial allocations when 1) the agency can demonstrate that all applicable planning and agreement requirements can be achieved, perhaps through the use of other available resources, for all affected program and budget areas and 2) the Department can maintain compliance with federal and state requirements. With regard to redirection of Treatment funds, the agency must be able to demonstrate that treatment needs within the catchment area are fully met and that there is adequate capacity to meet drug court and offender re-entry initiatives as well. C. Criteria for Approving Budget Revisions—Sections B-G Revisions in planned (budgeted) revenues and expenditures of funds in Sections B-G must be reported on quarterly RERs as revisions are identified, and not later than the final annual report, subject to applicable requirements in the agency's contract. D. Due Date for Budget Revisions The final annual due date to request budget revisions for Sections A-G is sixty (60) days after the end of the agreement period, that is, November Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 6 of 17 Attachment B 30 for annual contracts. By November 30, the agency must submit via e- mail its budget revision request to its ODCP contract manager. The agency must receive ODCP approval first before submitting a revised RER to its contract manager. IV. REVENUES (Column 2) For State Agreement fund sources (Section A, Rows 1-3) Revenues are as listed in the agency's allocation letter. For most other funds sources (Sections B-G), Revenues are estimates. In some cases, the agency may not be planning to expend all fiscal year Revenues. On the final RER for the fiscal year, revenues and expenditures must be actual. It is understood that, for non-State Agreement sources, total actual expenditures may be less than total Revenues. V. INITIAL OR CURRENT ANNUAL BUDGET PLAN AND AGGREGATE PLANNED (BUDGETED) EXPENDITURES For State Agreement fund sources (Section A, Rows 1-3), planned (budgeted) expenditures (pages 3 and 4 of the RER), added together, must equal the Initial Annual Budget Plan (Column 3) or the Current Annual Budget Plan (Column 4), as applicable, as entered on the RER-Composite, Page 2. For most other fund sources (Sections B-G), planned (budgeted) expenditures are estimates. In some cases, the agency may not be planning to expend all fiscal year revenues. It is not necessary that aggregate planned (budgeted) expenditures (pages 3 and 4 of the RER) equal the Initial Annual Budget Plan or the Current Annual Budget Plan, as applicable, as entered on the RER- Composite, Page 2. That is, planned (budgeted) expenditures in each row do not necessarily add to the total planned budget. On the final RER for the fiscal year, revenues and expenditures must be actual. It is understood that, for non-State Agreement sources, total actual expenditures may be less than total planned (budgeted) expenditures. Exception: Local Match. VI. REPORTING FEES AND COLLECTIONS (SECTION F) The MDCH/agency agreement requires agencies to report actual fees and collections associated with services that the agency purchases. Expected revenues from fees and collections must be reported on the initial annual RER. The final RER for the fiscal year must report actual revenues. Reporting of actual revenues on the quarterly RERs is not required. Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 7 of 17 Attachment B Some agencies reimburse providers net of co-pay amounts, whether or not the co-pays are actually collected by providers. Please do not report uncollected co- pay revenues. Report only the revenues actually earned. Food stamp revenue, in conjunction with residency, should be reported in Fees and Collections—Section F. VII. LOCAL MATCH—HOW TO BUDGET FEES/COLLECTIONS AND LOCAL FUNDS Amounts for Local Match are reported in Sections E and F of the RER. Please be sure that the amounts entered in Sections E and F meet Local Match criteria. The substance abuse services agreement (Attachment A) clarifies which fees and collections may count toward Local Match. Some agencies may be using an incorrect formula to compute the minimum, required Local Match. Please use the following worksheet to assist in computing the agency's Local Match percentage: MATCH COMPUTATION - MUST BE AT LEAST 10% a. GRAND TOTAL FUNDING (Last row of RER, page 2, Initial Annual Budget Plan Column 3) b. LESS: Section B. Medicaid subtotal Section C. ABW subtotal Section D. MIChild subtotal Section G. Other Contracts & Sources (incl. direct Federal) $ c. TOTAL (Subtotal of b.) Cs d. FUNDS SUBJECT TO MATCH (a minus c) e. MATCH FUNDS: Section E. Local Subtotal Section F. Fees & Collections Subtotal f. TOTAL MATCH FUNDS (Subtotal of e.) g. MATCH PERCENTAGE (f/d * 100 = 00.00%) VIII. MICHILD AND ABW SAVINGS MIChild and ABW savings become Local funds in the fiscal year following the year in which the savings were earned. Savings should be entered in Section E. Local, Row E-Other Local. Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 8 of 17 Attachment B IX. POSTING MEDICAID REVENUES THAT ARE TRANSFERS FROM A PIHP Some agencies receive increased Medicaid revenues in the form of transfers from a PIHP, usually late in the fiscal year. Assuming these are current year PEPM funds, these revenues and associated expenditures should be entered on the RER-Composite, Page 2 in Section B. Medicaid, Row 1, at the next RER submission. X. ADULT BENEFITS WAIVER ABW Covered Services For the Federal share of ABW PEPM revenue, please enter the amount on the RER—Composite, Page 2, in Section C. ABW row. Also enter the same amount on the RER, Page 4, under the ABW Column, Column 4 (Planned), Section C. ABW row, assuming your agency plans to spend the full amount during the fiscal year. This will eliminate double-counting the General Fund match for ABW revenue. Note that the check received by each agency each month for ABW is the Federal share only. For the State share of the ABW PEPM revenue, please enter the amount on the RER, Page 4, under the ABW Column, Column 4 (Planned) Section A.1. Community Grant row. To obtain the State share of the ABW PEPM, use the following formula: Federal PEPM = Total x State % = State Match Federal % For those agencies that plan to spend Community Grant funds over and above the combined Federal and State shares of the ABVV PEPM revenue, also include that amount on the RER, Page 4, under the ABVV Column, Column 4 (Planned), Section A.1. Community Grant row. ABW Discretionary Services If an ABW beneficiary is ABW eligible and Community Grant eligible and is provided ABW discretionary services paid for with Community Grant funds, enter those expenditures on the RER, Page 3, under the Treatment Column, Column 5 (YTD/Final), Section A., Row 1. ABW PEPM funds (federal and state) must have been exhausted first. Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 9 of 17 Attachment B The Federal and State ABW percentages for each fiscal year will be provided to the agencies by ODCP/Substance Abuse Contract Management Section. For FY 2008, the Federal percentage is 70.67% and the State percentage is 29.33%. MDCH will issue the payment for each month not later than the second Wednesday of that month For all other revenues and expenditures utilized for the ABW program, over and above the combined Federal and State shares of the ABW PEPM revenue, please enter those amounts on the RER, Page 4, under the ABW Column-- Planned & YTD. Please note that Medicaid cannot be utilized for the ABW program. MDCH wants to capture the data that reports the total revenue (source and amount) used to subsidize the ABW program. Xl. MIChild Quarterly, MDCH will provide the CA with the federal share of MIChild funds as a per capita payment based upon a Per Enrolled Child Per Month (PECPM) methodology for MIChild covered services. Included with these funds will be an electronic copy of the names of the MIChild enrollees forming the basis of these calculations. In consideration for accepting the federal funding pushed to the CA, the CA agrees to redirect existing state general fund dollars to match the MIChild federal FMAP funds (Title XXI State Children's Health Insurance Program) and carry out the associated substance abuse program requirements. The PEPCM rate is $0.47 (47 cents) per month. For the current fiscal year, the federal share is 70.67%, or approximately 33 cents per month, and the state share is 29.33%, or approximately 14 cents. The PECPM funding is a per capita payment for medically necessary MIChild- covered services including outpatient, residential and inpatient services as authorized by the CA. If the MIChild capitation is not sufficient to serve the MIChild enrollees, use of state-allocated Community Grant funds is allowed. Federal SAPT Block Grant funds may not be used for inpatient care. The federal Current Year PEPM MIChild payments will be posted on Page 4 under the MIChild column, in Row D. MIChild Current Year PEPM. XII. DISTRIBUTION The original and two (2) copies of the RER should be prepared and distributed as follows: Original - Michigan Department of Community Health Bureau of Finance/Accounting Division Expenditure Operations Section P.O. Box 30720 Lansing, MI 48909-8220 Revenues and Expenditures Report Instructions FY 2008 (09.14,07) Page 10 of 17 Attachment B One Copy - Retained by agency. One Copy Submitted by e-mail to: Denise Murray [Afr-3vel-en-4-m-iGh-iftaR4gEA One Copy - Submitted electronically via EGrAMS at http://egrams- mi.com/dch XIII. RETENTION This report should be retained for a period complying with the retention policies established in the contract. XIV. FORM PREPARATION (SEE INSTRUCTIONS LOCATED IN EGrAAIS USER MANUAL) An RER instruction example (Exhibit A), an RER completed example (Exhibit B), and an RER blank example (Exhibit C) are attached for reference. Revenue and Expenditures Report Form/Face Paqe—F'age 1 A. Contractor Name Enter the name of the agency. B. Mailing Address – Enter the street address of the agency. C. City, State, ZIP Code – Enter the City, State, and ZIP Code of the agency. D. Federal ID No. – Enter the Federal Employer Identification Number E. Budg_et Period – Enter the inclusive dates covered by the RER. F. Grant Agreement – Check either "ORGINAL" or "AMENDMENT". G. Date Prepared – Enter the date on which the RER is prepared. H. Contract No. – Enter the MDCH Contract Number, if known. Amendment No. – Enter the Amendment Number of the MDCH Contract Number, if applicable. J. Submission Type.– Check one of the five (5) boxes, identifying the period covered by the RER. K. Quarterly Reconciliation – For Section A only, enter the Total Prepayments YTD and Total Expenditures YTD for State-administered funds. Total Prepayments YTD include all payments received from the State during the current fiscal year period, which may include prior fiscal year adjustments. Total Expenditures YTD include all expenditures incurred during the current fiscal year. Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 11 of 17 Attachment B L. Certification Section: This Certification Section must be signed by an authorized official certifying: • that the agency does or does not utilize a Central Cost Allocation Plan (Check Yes or No); • that the expenditures for the fiscal year are reported accurately; and • that documentation and records are available and easily accessible in support of all the data contained on the report. The individual signing on behalf of the agency certifies by his/her signature that he/she is authorized to sign on behalf of the agency. Any item found as a result of audits to be improper or undocumented will be subject to an audit citation and generally will require a payment adjustment. M. Authorized Siqnature – Enter the signature of the official authorized to sign the RER. N. Date – Enter the date of the authorized signature. 0. Title.– Enter the title of the official authorized to sign the RER. P. Contact Person – Enter the name of the person to whom questions should be directed concerning the RER. Q. Telephone Number and E-mail Address – Enter the telephone number and e-mail address of the Contact Person. Revenue and Expenditures Report Form-Composite—Page 2 A. Contractor Name and Address – Enter the name and address of the agency. B. Agreement Period Enter the inclusive dates of the budget period. C. Contract/Amendment number/Submission Type – Enter the contract number (if assigned); Amendment number (if applicable); and Submission Type (same as on Face Page). Revenues (Column 2) D. Revenues—Column 2 For State Agreement fund sources (Section A, Rows 1-3) Revenues (Col. 2) are as listed in the agency's allocation letter. For most other funds sources (Sections B-G), Revenues (Col. 2) are estimates. In some cases, the agency may not be planning to expend all fiscal year Revenues. Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 12 of 17 Attachment B On the final RER for the fiscal year, revenues and expenditures must be actual. It is understood that, for non-State Agreement sources, total actual expenditures may be less than total Revenues (Col. 2). Budget Plans (Columns 3 and 4) E. Initial Annual Budget Plan—Column 3 For each row in Section A, enter the amount of each fund source, as listed in the agency's allocation letter. For most agencies, these fund sources will include Community Grant, State Disability Assistance (SDA), and other fund sources, as appropriate. These allocations will be provided by MDCH/ODCP at the beginning of the fiscal year in the agency's allocation letter and during the fiscal year, as needed to reflect amendments. For each row in Sections B through G, enter the amount of each fund source that the agency expects to receive during the fiscal year. These may include: Medicaid, Adult Benefits Waiver, MI Child, Local, Fees and Collections, and Other Contracts and Sources. F. Current Annual Budget Plan—Column 4 All amount changes in any fund source categories as posted for Section A only in the Initial Annual Budget Plan –Column 3 require an agreement amendment. This Current Annual Budget Plan--Column 4 will remain blank unless or until an amendment is needed. For fund sources in Sections B through G, changes in expected revenues must be entered in Column 4 and reported on quarterly and final expenditure reports. Agreement amendments are not needed for Sections B through G. Budget and expenditure requirements for Local Match remain in effect. If changes are entered in Column 4, Sections B-G, the amounts posted in Section A must be carried over into Column 4, even though those amounts did not change. When totaled, Column 4 will reflect the TOTAL Current Annual Budget Plan for the current quarter and/or final RER. Expenditures (Columns 5-6) G. Current Quarter—Column 5 For each row in Sections A through G, enter the current quarter expenditures for each fund source in Column 1. H. Year-to-Date—Column 6 For each row in Sections A through G, enter the year-to-date expenditures for each fund source in Column 1. Each amount will be the cumulative Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 13 of 17 Attachment B total expenditure amount for each budget title listed on Pages 3 and 4, under each "YTD/Final" column heading. Balance (Column 7) I. Balance For each row in Sections A through G (excluding Section B), enter the balance obtained by subtracting the amount in the Year-to-Date (Column 6) from the amount in the Current Annual Budget Plan (Column 4). If there is no amount in Current Annual Budget Plan (Column 4), then enter the balance obtained by subtracting the amount in the Year-to-Date (Column 6) from the amount in the Initial Annual Budget Plan (Column 3). For each row in Section B. Medicaid, enter the balance obtained by subtracting the amount in the Year-to-Date (Column 6) from the amount in the Revenues--Column 2. At the end of the fiscal year, the amounts entered in the Revenues–Column 2 will be updated to reflect the actual revenues for the fiscal year. Revenue and Expenditures Report Form—Page 3 Selected program area titles are pre-entered in the column headings on Pages 3 and 4. Note that the two "Other columns on Page 4 are not to be utilized by an agency, unless the agency receives prior approval from its contract manager. J. Contractor Name and Address – Enter the name and address of the agency. K. Agreement Period -- Enter the inclusive dates of the agreement period. L. Contract/Amendment number/Submission Type – Enter the contract number (if assigned); Amendment number (if applicable); and Submission Type (same as on Face Page). Expenditure Detail--Planned (Columns 2 (M), 4 (0), 6 (Q), and 8(S)) For each row in Section A, enter the planned (budgeted) expenditures for each fund source (Column 1) for the current fiscal year. These expenditures are for Administration, Treatment, Prevention and Women's Specialty. Other program expenditure areas are listed on Page 4. These planned (budgeted) expenditures must be the same as any specific allocations or spending targets stated in the ODCP allocation letters, unless revisions are approved in writing in advance by the ODCP Contract Manager. Enter the SDA planned (budgeted) expenditures under the Treatment Column/Column 4/Row A.2. Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 14 of 17 Attachment B For each row in Sections B through G, enter the planned (budgeted) expenditures of each fund source (Column 1) for the current fiscal year. Women's Specialty Services, Medicaid and SDA funds The State share of Medicaid funds can be applied toward your agency's Women's Specialty Services spending target. SDA funds can also be applied. The spending target is listed in the agency's initial, current fiscal year allocation letter. The women who are served and the services provided must meet SAPT Block Grant requirements for women's specialty services. Contact your contract manager with any questions. Enter Women's Specialty Services planned (budgeted) expenditures for the Federal and State shares of the current year Medicaid PEPM under Section B. Medicaid, Women's Specialty Column/Column 8, Rows 2 and 3, respectively. For FY 2008, the State share of Medicaid is 41.90%. Enter Women's Specialty Services planned (budgeted) expenditures for SDA under Section A, Women's Specialty Column/Column 8, Row A.2. SDA. Expenditure (Columns 3 (N), 5 (P), 7 (R), and 9 (T)) For each row in Sections A through G, enter the year-to-date expenditures for each fund source (Column 1). These expenditures are for Administration, Treatment, Prevention and Women's Specialty. Enter SDA year-to-date expenditures under the Treatment Column/Column 5/Row A.2. Column/Column 7/Row A.3. Enter Women's Specialty Services year-to-date expenditures for the Federal and State shares of the current year Medicaid PEPM under Section B. Medicaid, Women's Specialty Column/Column 9/Rows 2 and 3, respectively. For FY 2008, the State share of Medicaid is 41.90%. Revenue and Expenditures Report Form—Paue 4 U. Contractor Name and Address – Enter the name and address of the agency. V. Agreement Period Enter the inclusive dates of the budget period. W. Contract/Amendment number/Submission Ty. a – Enter the contract number (if assigned); Amendment number (if applicable); and Submission Type (same as on Face Page). Revenues and Expenditures Report Instructions FY 2008 (09,14.07) Page 15 of 17 Attachment B Ex enditL___p_________Helget_ail--Plannecl (Columns 2 (X), 4 (Z), 6 (BB) and 8 (DD)) For each row in Section A, enter the planned (budgeted) expenditures for each fund source (Column 1) for the current fiscal year. These expenditures are for Communicable Diseases, ABW, approval from its contract manager. MIChild and SPF/SIG. These planned expenditures must be the same as any specific allocations or spending targets stated in the agency's initial fiscal year allocation letter, unless revisions are approved in writing in advance by the ODCP Contract Manager. For each row in Sections B through G, enter the planned (budgeted) expenditures of each fund source (Column 1) for the current fiscal year. Expenditure Detail—YTD/Final (Columns 3 (Y), 5 (AA), 7 (CC) and 9 (EE)) For each row in Sections A through G, enter the year-to-date expenditures for each fund source (Column 1). These expenditures are for Communicable Diseases, ABW, and two columns entitled Other. Note that the two "Other" D1101 aporovai TIOrT1 contract manager. MIChild and SPF/SIG. For all rows, expenditures reported on Pages 3 and 4 must equal expenditures reported in Column 6, Page 2. Program Budget Summary Composite Attachment B.1 is a Program Budget Summary form (DCH-0385E). This form is required by MDCH. The agency's contract manager will complete this form and include it in the executed agreement to be returned to the agency. Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 16 of 17 Attachment B Revenues and Expenditures Report FINAL REPORTING Fiscal Year 2008 Please note that the fourth quarter RER, which would be due October 31, is not required. The final RER report is due by January 31 following the end of the fiscal year. The form must be marked "FINAL BUDGET" on the Face Page. This requires the agency to liquidate all accounts payable and encumbrances by January 31 (See definitions below). Exceptions may be granted for one-time obligations that cannot be liquidated within this time period. However, should this be the case, an additional fifteen (15) days may be provided if a written request for an extension, with the reason why additional time is needed, is submitted by the due date of the final RER. Please submit such requests to the same address as quarterly RERs are mailed. Failure to meet these final reporting deadlines may result in the State's inability to reimburse the full amount of the State's share of the gross expenditures. In addition to submitting RERs, other financial information will be requested to assist MDCH in properly closing the State's fiscal year (September 30). This information will help ensure sufficient funds have been reserved by the State to make reimbursement for the agreement in the State's upcoming fiscal year. The additional financial information required will include an estimate of open commitments and obligations incurred as of September 30, but not yet paid. The MDCH/Accounting Division will provide detailed instructions for reporting additional financial information by mid-August of each year. DEFINITIONS: • Accounts Payable - Obligations for goods or services received, which have not been paid for as of the end of the agreement period. • Encumbrances - Commitments at the end of the agreement period related to unperformed (executory) contracts for goods and services. Note: If an agreement does not end on September 30, it is still necessary to estimate accounts payable as of September 30. All inquiries regarding financial reporting issues should be directed to the Expenditure Operations Section of the MDCH/Accounting Division. References: Michigan Department of Management and Budget • Guide to State Government (1210.27). • Year-End Closing Guide. Federal OMB Circular A-102 (Revised & DHHS Common Rule). Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 17 of 17 ATTACHMENT C REQUIRED REPORTS—Fiscal Year (FY) 2008 New for FY2008 Due to the implementation of the Electronic Grants Administration and Management System (EGrAMS), most reports will be submitted via EGrAMS. There are three (3) types of reports: Statistical, Expenditure, and Attachment. Statistical and Expenditure Reports will be completed on-line. Attachment Reports will be uploaded to EGrAMS. Reporting instructions for FY2008 will not be updated, due to new on-line EGrAMS system. For all FY2007 reports, submit as specified in the FY2007 contract agreement and amendment. The following table indicates the reports that the Contractor is required to submit to the Department under this Agreement. The table also indicates the time period covered by each report, the report due date, where within the Department the report must be submitted, and the location or source of instructions and specifications for completing the report. The contents of the table supersede any other communication of reporting requirements. Revisions in the "Required Reports" table, which were made since prior editions, are shown in strikeout or BOLD. Contractors are responsible for submitting all reports on time and per reporting instructions. Reports transmitted on or before the due date are considered timely. Reports that require an original signature should be mailed to the appropriate addressee(s) as listed in Attachment C, with the transmission date determined by postmark or commercial carrier receipt. Reports, that are required to be sent to SACM, must be sent electronically with the as "received." FY2008 Page 1 of 5 (09.14.07) Attachment C Required Reports—Fiscal Year (FY) 2008 Document Title/Data Period Due Date Instructions & Submissions Covered Specifications Administration Expenditures Fiscal Year January 31, 2009— Contract Attachment B Report 2008 Mandatory submission (EGrAMS-Statistical Report) Audit Report Fiscal Year 9 months after close of Contract, Part II 2008 Contractor's fiscal year (Office of Audit) (EGrAMS-Attachment Report) Health Insurance Portability & As services Monthly (minimum 12 Contract Attachment E- Accountability Act (HIPAA) 837 are provided, submissions per year), 30 Supplemental Encounters records are days post adjudication of a Instructions for 837 completed. claim, submitted via DEG to Encounter Data Submissions MDCH/MIS-Operations Submission for are all monthly Substance Abuse records for Coordinating Agencies each quarter. HIV Data Report-- CA assures Monthly HIV Data submitted via Contract Attachment A HIV providers will utilize web-based system in real MDCH/HAPIS data collection time at www.hapis.orq methods, including Uniform Reporting System (URS) CareWare for case management and HIV Event System (H ES) for Counseling, Testing and Referral (CTR) and other prevention/risk reduction activity. Legislative Report/Section 408 Fiscal Year January 31, 2009—for prior Instructions will be (formerly entitled Substance 2008 fiscal year (EGrAMS- issued by December Abuse Entity Inventory/ Statistical Report) 10 annually. Legislative Report) Notice of Excess or Insufficient Fiscal Year May 1, 2008 Contract Attachment A Funds 2008 (EGrAMS-Attachment Report) Performance Indicators Quarterly (Oct- Two months following the Contract Attachment E Dec; Jan- end of the quarter: March; April- February 28, May 31, June; July- August 31, and November Sept) 30, 2007 (EGrAMS- _ Statistical Report) FY2008 Page 2 of 5 (09.14.07) Attachment C Required Reports—Fiscal Year (FY) 2008 Document Title/Data Period Due Date Instructions & Submissions Covered Specifications Preliminary Closeout Report Fiscal Year September 2008 Contract-Part II Schedule 2008 (BFA/Accounting) (TBD Report) Determined by DMB at year-end closing Prevention Data Set Fiscal Year Upload monthly, if not TBD 2008 using State System (due date TBD) Prevention Expenditures by Fiscal Year January 31, 2009 Contract Attachment E Strategy Report 2008 (EGrAMS-Statistical Report) Fiscal Year TBD TBD 2006 Prevention Report for (Required) SAPT/Block Grant Fiscal Year TBD TBD 2007 (Optional) Prevention Services Population Fiscal Year TBD TBD Report 2008 Priority Populations Waiting List Monthly End of the month following Contract Attachment E Deficiencies Report the month in which the exceptions occurred. (EGrAMS-Statistical Report) Revenues and Expenditures Quarterly (Oct- Last day of the month, Contract Attachment B Report (RER) —Quarterly Dec; Jan- following the end of the NOTE: The 4I RER is March; April- quarter: January 31, April not required to be submitted. June)---First 30, and July 31. 3 qtrs only. (BFA/Accounting) (EGrAMS-Expenditures Report) Revenues and Expenditures Fiscal Year January 31, 2009 Contract Attachment B Report (RER)--Final 2008 (BFA/Accounting) (EGrAMS-Expenditures Report) FY2008 Page 3 of 5 (09.14.07) Attachment C Required Reports—Fiscal Year (FY) 2008 Document Title/Data Period Due Date Instructions & Submissions Covered Specifications Sentinel Events Data Report Semi-Annual Last day of the month Contract Attachment E (residential treatment only) CA Summary following the end of the 2nd & 4th quarters: April 30, 2008 and October 31, 2008 (EGrAMS-Statistical Report) State Prevention Fiscal Year Due date: TBD Contract Attachment Framework/State Incentive 2008 (EGrAMS-Attachment E (TBD) Grant (SPF/SIG) Report) Tobacco/Formal Synar July 1-31, August 15, 2008 Instructions to be Compliance Inspection Surveys 2008 (EGrAMS-Attachment issued in June 2008 by Report) Prevention Section Tobacco Retailer Listing— Annual March 31, 2008 Contract Attachment E Improved (EGrAMS-Attachment Report) Treatment Episode Data Set Monthly Last day of each month, Contract Attachment E (TEDS) submitted via DEG to MDCH/MIS-Operations Women's Specialty Services Fiscal Year January 31, 2009 --TBD Contract Attachment E- Report--TBD 2008 (EGrAMS-Attachment -TBD Report) Youth Access to Tobacco Fiscal Year October 31, 2008 Contract Attachment E Activity Annual Report 2008 (EGrAMS-Statistical Report) Bureau of Finance/Accounting (BFA/ACCOUNTING) reports should be sent to: U.S. mail— Michigan Department of Community Health Bureau of Finance/Accounting Division Expenditure Operations Section P.O. Box 30720 Lansing, Michigan 48909 Overnight services (UPS, Fed. Ex.)-- Michigan Department of Community Health Bureau of Finance/Accounting Division Expenditure Operations Section Lewis Cass Building, 4th Floor 320 W. Walnut Street Lansing, MI 48913 FY2008 Page 4 of 5 (09,14.07) Attachment C Required Reports—Fiscal Year (FY) 2008 Client Admission and Discharge Client records must be sent electronically to: Michigan Department of Community Health Michigan Department of Information Technology Data Exchange Gateway (DEG) For admissions: put c:\4823 4823dchbull For discharges: put c:\4824 4824(dchbull Office of Audit reports should be sent to: U.S. mail-- Michigan Department of Community Health Office of Audit Quality Assurance and Review Section P.O. Box 30479 Lansing, MI 48909-7979 Overnight services (UPS, Fed. Ex.)-- Michigan Department of Community Health Office of Audit Quality Assurance and Review Section Capitol Commons Center 400 S. Pine Street Lansing, MI 48933 Lewis Cass Building, 5th Floor 320 S. Walnut Street Lansing,Mishigan-4-891-3 d-r-1-2-Vd-efk©41:1464:140-24z1-4710A FY2008 Page 5 of 5 (09.14.07) Attachment B Revenues and Expenditures Report Completion Instructions Michigan Department of Community Health Office of Drug Control Policy Fiscal Year (FY) 2008 NEW FOR FY 2008 Due to the implementation of the Electronic Grants Administration and Management System (EGrAMS), the form preparation instructions will be located in the EGrAMS user manual. Because of this conversion, there may be differences in the locations of rows/columns on the RER in EGrAMS. I. INTRODUCTION The main purposes and applications of this Revenue and Expenditures Report (RER) include the following: • Display revenue sources and expected amounts, and how these are budgeted at the start of a fiscal year; • Enable management and monitoring of federal and state spending requirements; and • Enable reconciliation of prepayments and expenditures on a quarterly and annual basis. The RER is part of the Office of Drug Control Policy (ODCP)/CA and ODCP/direct contractor agreements. With the exception of a single Program Budget Summary Composite sheet, it replaces the Program Budget Summary and Cost Detail forms and Financial Status Reports (DCH-0385/0386 and DCH 0384, respectively). This RER is available in Microsoft Excel and will be provided by MDCH/ODCP. The "Subtotal" and "Grand Total of Subtotals A-G", and "Year- to-Date" cells contain formulas that will calculate automatically. Agencies must use the forms provided. Alternate forms or software may not be used. All amounts entered on the RER must be whole dollars. The RER is used to provide a standardized format for reporting the financial status of individual programs. All expenditures and revenues (including Medicaid, Adult Benefits Waiver [ABW1, MI Child, Local, Fees and Collections, and Other Contracts and Sources) for the particular program are reported on the RER . Requirements Regarding Administrative Budgets and Expenditures-- Agency budgets and expenditures for Administration must be reasonable, prudent, and commensurate with meeting the requirements of this agreement, consistent with OMB Circular A-87 or A-122, as applicable. If the Administration budget for a contractor that is a local government entity contains a central cost allocation amount or rate, this allocation must have been Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 1 of 17 Attachment B developed consistent with OMB Circular A-87, Attachment C. Payments are subject to recovery, based on audit findings. Contractors that are non-profit entities cannot have central cost allocations under this agreement. On the Face Page, please note the revised Certification Section regarding whether the CA uses a Central Cost Allocation Plan. When there is a central cost allocation, the CA must also submit, on CA letterhead, a Certificate of Cost Allocation Plan (next page) whenever a central cost allocation is introduced or is revised, or every two years, whichever is sooner. This Certificate of Cost Allocation Plan form is available electronically (in WORD) from the ODCP contract manager. Revenues and Expenditures Report Instructions FY 2008 (09.14.07) Page 2 of 17 ATTACHMENT E OTHER REQUIREMENTS I. DATA REQUIREMENTS Data Collection/Recording and Reporting Requirements—Revised August 2005 Instructions for Treatment Episode Data Set (TEDS) Submission for Substance Abuse Services Coordinating Agencies-- TO BE REVISED Performance Indicators for Substance Abuse Services: Electronic Submission Forms--Revised August 2007 Sentinel Event Reporting Guidance—Revised August 2007 Substance Abuse Encounter Reporting: HCPCS arid Revenue Codes-- August 2007 (New) Supplemental Instructions to Substance Abuse Coordinating Agencies for 837 Encounter Data Submission—Revised August 2007 II. LICENSING SERVICE CATEGORY DETAIL--TO BE REVISED III. METHADONE REQUIREMENTS Treatment Policy #03, Buprenorphine--Effective October 1, 2006 Treatment Policy #04, Off-site Dosing Requirements for Medication-Assisted Treatment--Effective December 1, 2006 Treatment Policy #05, Enrollment Criteria for Methadone Maintenance and Detoxification Program—Effective October 1, 2005 IV. PREVENTION REQUIREMENTS Prevention Policy #01, Synar—Effective October 1, 2006 Prevention Policy #02, Addressing Communicable Disease Issues in the Substance Abuse Network—Effective October 1, 2006 Strategic Prevention Framework/State Incentive Grant (SPF/SIG) Project Requirements--TO BE DETERMINED FY2008 Page 1 of 3 (09.14.07) Attachment E—Other Requirements Table of Contents (Continued) V. REPORTING REQUIREMENTS Communicable Disease Provider Information Plan/Report and Instructions— Revised August 2007 Prevention Expenditures by Strategy Report—August 2005 Prevention Report for SAPT Block Grant--TO BE DETERMINED Prevention Services Population Report— TO BE DETERMINED Priority Populations Waiting List Deficiencies Report—August 2005 (Revised January 1, 2006) Women's Specialty Services Report--TO BE REVISED Youth Access to Tobacco Activity Annual Report—August 2005 VI. STAFF QUALIFICATIONS Staff Qualifications for Providing Substance Abuse Services-- TO BE REVISED Certification Requirements for the CA Provider Network-- TO BE DETERMINED VII. TECHNICAL ADVISORIES Contract Technical Advisory #01, Local Advisory Council Guidelines—Issued August 9, 1990—Reissued September 18, 2006 Treatment Technical Advisory #01, Suboxone Use in an Opioid Treatment Program—Issued December 1, 2005 Treatment Technical Advisory #03, Implementing Case Management Services— Issued September 20, 2006 Treatment Technical Advisory #04, Fetal Alcohol Spectrum Disorders—Issued December 20, 2006 FY 2008 Page 2 of 3 (09.14.07) Attachment E—Other Requirements Table of Contents (Continued) Treatment Technical Advisory #05, Welcoming--Issued September 20, 2006 Treatment Technical Advisory #06, Counseling Requirements for Clients Receiving Methadone Treatment—Issued August 10, 2007 VIII. TREATMENT REQUIREMENTS Treatment Policy #02, Acupuncture—Effective May 1, 1994—Reissued March 2007 Treatment Policy #06, Individualized Treatment Planning—Effective October 1, 2006 Treatment Policy #07, Access Management System—Effective November 1, 2006 FY 2008 Page 3 of 3 (09.14.07) FISCAL NOTE 107282 December 13, 2007 BY: FINANCE COMMITTEE, MIKE ROGERS, CHAIRPERSON IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION - 2007/2008 SUBSTANCE ABUSE GRANT 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 Department of Health and Human Services/Health Division has been awarded by the Michigan Department of Community Health (MDCH) $4,742,245 in Substance Abuse Grant funds. 2. Funds will be used to subcontract with agencies to prevent and reduce the incidence of drug and alcohol abuse and dependency. 3. The grant period extends from October 1, 2007 through September 30, 2008. 4. An amendment to the Fiscal Year 2008 Special Revenue budget is recommended as follows: FY2008 FY2008 FY2008 Amended Adopted Adjustment Budget Fund 28249 Revenue 1060261-134790-610313 Federal $4,642,245 $100,000 $4,742,245 Expense 1060261-133685-730373 Contract Sys. 0 1060261-133405-730373 Contract Sys. 387,898 1060261-133950-730366 Contract Adm. 239,498 1060261-134790-730366 Contract Adm. 337,754 1060261-134790-730373 Contract Sys. 3,132,154 1060261-134790-730373 Indirect Cost 22,221 1060261-134800-730366 Contract Adm. 522,720 Total Expense $4,642,245 100,000 100,000 387,898 239,498 337,754 3,132,154 22,221 522,720 100,000 $4,742,245 FINANC COMMITTEE 4,4 AP FINANCE COMMITTEE Motion carried unanimously on a roll call vote with Zack absent. Ruth '';Idhrgon, County Clerk Resolution #07282 December 13, 2007 Moved by KowaII supported by Middleton the resolutions (with fiscal notes attached) on the Consent Agenda be adopted. AYES: Burns, Coulter, Crawford, Douglas, Gershenson, Gingell, Gosselin, Gregory, Greimel, Hatchett, Jacobsen, KowaII, Long, Middleton, Nash, Potter, Potts, Rogers, Scott, Spector, Woodward, Zack, Bullard. (23) NAYS: None. (0) A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the Consent Agenda were adopted. I HEREBY APPR9VE THE FOREGOING RESOLUTKIN 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 December 13, 2007, with the original record thereof now remaining in my office. In Testimony Whereof, I have hereunto set my hand and affixed the seal of tILLg_çounty of Oakland at Pontiac, Michigan this 13th day of December, 2007.