HomeMy WebLinkAboutResolutions - 2020.10.21 - 33770Contract# Date 09/24/2020
1 Program Budget Summary
(PROGRAM/PROJECT
DATE PREPARED
Local Health Department - 2021 / HIV Data to Care
9/24/2020
CONTRACTOR NAME
D
BUDGET PERIOD
Oakland County Department of Health and Human Services/
From : 10/To : 9/30/2021
Health Division
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
AMENDMENT #
1200 N. Telegraph Rd,
0
34 East
)✓ Original r Amendment
CITY (Pontiac
ZIP CODE
I4
FEDERAL ID NUMBER
Ml
341 0432
38-600 876
I I Category
I Total I
Amount I
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
72,213.00
72,213.00
2 Fringe Benefits
43,963.00
43,963.00
3 Cap. Exp. for Equip & Fac.
0.00
0.00
4 Contractual
0.00
0.00
5 Supplies and Materials
000
0.00
6 Travel
0.00
000
7 Communication
681.00
681.00I
8 County -City Central Services
0.00
0.00
9 Space Costs
0.00
0.00
10 All Others (ADP, Con. Employees, Misc.)
2,579.00
2,579.00
Total Program Expenses
119,436.00
119,436.00
TOTAL DIRECT EXPENSES
119,436,00
119,436.00
INDIRECT EXPENSES
Indirect Costs
1
I Indirect Costs
0.00
0.00
2
Cost Allocation Plan / Other
25,657.00
25,657.00
Total Indirect Costs
25,657.00
25,657.00
TOTAL INDIRECT EXPENSES
25,657.00
25,657.00
TOTAL EXPENDITURES
146,093.00
145,093.00
Local Health Department - 2021, Date: 09/24/2020 Page: 103 of 197
Contract # Date: 09/24/2020
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category I
Total I
Amount I
Cash I
Inkind
1 1Source of FundsFees
I�
I
and Collections - 1st and 2nd
I
0.00
0.00
0.00
0.00
Party
IFees and Collections - 3rd Party
0.00 I
0.00
0.00
0.00
I(Federal or State (Non MDHHS)
000 I
0.00 I
000
0.00
II Federal Cost Based Reimbursement I
0.00 I
0.00 I
0.00 I
0.00
IIFederally Provided Vaccines I
0.00 I
0.00 I
0.00 I
0.00
I(Federal Medicaid Outreach I
0.00 I
0.00 I
0.00 I
0.00
II Required Match - Local
000 I
0.00
000 I
0.00
I1Local Non-ELPHS
0.00 I
000
0.001
0001
I(Local Non-ELPHS I
0.00
0.00 I
0.00 I
0.00 I
ILocal Non-ELPHS I
0,00
0.00
!
000 I
0.00 I
'
IOther Non-ELPHS
0.00 I
0.00
0.00
000
I(MDHHS Non Comprehensive
0.00
000 I
0.00
0.00
IMDHHS Comprehensive I
128,000.00
128,000.00
0.00 I
0.00
IMCH Funding
0.00
0.00
0.00
0.00 I
Local Funds - Other
17,093.00 I
0.00
17,093.00
0.00 I
IInkind Match
0.00 I
000 I
0.00
0.00
MDHHS Fixed Unit Rate
(Totals I
145,09300I
128,000.00I
17,093.00I
0.00I
Local Health Department - 2021, Date: 09/24/2020 Page: 104 of 197
Contract # Dale: 09/24/2020
3 Program Budget - Cost Detail
LineItemI QtyI
(DIRECT EXPENSES
(Program Expenses
1 Salary & Wages
Public Health Nurse I 1.00001
2 Fringe Benefits
All Composite Rate 0.0000
Notes: FICA, UNEMP INS,
RETIREMENT, HOSPITAL INS,
LIFE INS, VISION INS,
HEARING INS, DENTAL, WORK
COMP, SHORT/LONG TERM
DISABILITY
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
Telephone 0.00001
8 County -City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Professional Svcs-TOL Database( 0,0000
Insurance I 0.0000
(Total for All Others (ADP, Con. Employees, Misc.)
ITotalProgram Expenses
(TOTAL DIRECT EXPENSES
(INDIRECT EXPENSES
(Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan 0.0000
Notes 12.29% of salaries
Ratel UnitslUOM I Toted
72213,0001 0.0001FTE I 72,213 00
60.880 72213.000 43,963.00
00001 0.0001 I 681.00
0.000 0.000 2,408.001
0.000 0.000 171001
2,579.00
119,436 00
119,436.001
0000) 0.000 8,564.00
Local Health Department - 2021, Date: 09/24/2020 Page: 105 of 197
Contract# Date. 09/24/2020
(Line Item Qty
Rate Units UOM Total
Health Adm Distribution 0,0000
0 000 0.000 14,065.00
(Nursing Adrn Distribution 0.0000
0 000 0 000 3,028.00
(Total for Cost Allocation Plan / Other
25,657 00
(Total Indirect Costs
25,657.00
ITOTAL INDIRECT EXPENSES
25,657.00
ITOTAL EXPENDITURES
145,093.00
Local Health Department-2021, Date 09/24/2020 Page. 106 of 197
Contract # Date. 09/24/2020
1 Program Budget Summary
PROGRAM / PROJECT
DATE PREPARED
Local Health Department - 2021 / HIV PrEP Clinic
9/24/2020
CONTRACTOR NAME
BUDGET PERIOD
Oakland County Department of Health and Human Services/
From : 10/1/2020 To. 9/30/2021
Health Division
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
AMENDMENT #
1200 N. Telegraph Rd.
0
34 East
r Original I— AmendmentCITY
CODE
I48341-0432
876 L ID NUMBER
Pontiac
Mi
38 600ZIP
Category
I Total I
Amount I
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
78,871.00
78,871.00
2 Fringe Benefits
- 16,586.00
16,586.00
3 Cap. Exp. for Equip & Fac
0.00
0.00
4 Contractual
0.00
0.00I
5 Supplies and Materials
5,500.00
5,500.00
6 Travel
3,232.00
3,232.00I
7 Communication
888.00
888.00
8 County -City Central Services
000
0.00
9 Space Costs
0.00
0.00
10 All Others (ADP, Con. Employees, Misc.)
5,569.00
5,569.00
Total Program Expenses
110,646.00
110,646.00
TOTAL DIRECT EXPENSES
110,646.00
110,646.00
INDIRECT EXPENSES
Indirect Costs
1
Indirect Costs
000
0.00
2
Cost Allocation Plan / Other
25,379.00
25,379,00
Total Indirect Costs
25,379.00
25,379.00
TOTAL INDIRECT EXPENSES
25,379.00
25,379.00
TOTAL EXPENDITURES
136,025.00
136,025.00
Local Health Department - 2021, Date: 09/24/2020 Page: 107 of 197
Contract # Date. 09/24/2020
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category I
Total I
Amount I
Cash I
Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
000
000
0.00
0.00
Party
Fees and Collections - 3rd Party
0.00
0.00
0.00
0.00
Federal or State (Non MDHHS)
0.00
0.00
0.00
0.00
Federal Cost Based Reimbursement
000
0.00
0.00
0.00
Federally Provided Vaccines
0.00
0.00
000
000
Federal Medicaid Outreach
0.00
0.00
0.00
0.00
Required Match - Local
0.00
0.00
000
000
Local Non-ELPHS
0.00
0.00
0.00
000
Local Non-ELPHS
0,00
0.00
0.00
0.00
Local Non-ELPHS
0.00
000
0.00
0.00
Other Non-ELPHS
0.00
0.00
0.00
0.00
MDHHS Non Comprehensive
0.00
0.00
000
0.00
MDHHS Comprehensive
120,000.00
120,000.00
0.00
0.00
MCH Funding
0.00
0.00
000
0.00
Local Funds - Other
16,025 00
0.00
16,025.00
000
Inkind Match
0.00
0.00
0.00
0.00
MDHHS Fixed Unit Rate
Totals I
136,025.00 I
120,000.00 I
16,025.00 I
0.00
Local Health Department - 2021, Date 09/24/2020 Page: 108 of 197
Contract # Date. 09/24/2020
3 Program Budget - Cost Detail
(Line Item I
(DIRECT
Qtyl
EXPENSES
(Program Expenses
1 Salary & Wages
Specialis
tWorker I
4327
010000
(Outreach
(Total for Salary & Wages
2 Fringe Benefits
All Composite Rate
00000
Notes : Fica, Unemp Ins,
Retirement, Hospital Ins, Life Ins,
Vision Ins, Dental Ins,
Workcomp, ShorULong Term
Disability
3 Cap. Exp. for Equip & Fac.
1 4 Contractual
5 Supplies and Materials
Incentives - Gas Cards I
0.00001
1 6 Travel
Mileage
0.0000
Notes . 10,970 miles @ .575
Client Transportation
0.0000
ITotal for Travel
1 7 Communication
Telephone Communications I
0.00001
1 8 County -City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees,
Misc.)
1 Lab Fees
0.0000
Insurance
0,0000
1IT Operations
0.0000
(Total for All Others (ADP, Con. Employees, Misc.)
(Total Program Expenses
Local Health Department - 2021, Date 09/24/2020
Ratel UnitslUOM I Total
1
1
1
87728.000 0 000 FTE 37,959.001
40912,000 0.000 FTE 40,912.001
78,871.001
1
21.029 78871.000 16,586.00
1
1
00001 00001 I 5,500,001
1
0 000 0 000 1,700.00
0.000
0,000
1,532.001
3,232.001
1
0,0001
0.0001
I 888.001
1
1
0.000
0.000
1
665.001
0.000
0 000
164,001
0,000
0.000
4,740.001
5,569.001
110,646.001
Page. 109 of 197
Contract #
Date09/24/2020
(Line Item I
QtyI
Ratel
UnitsIUOM
Totall
TOTAL DIRECT EXPENSES
110,646.001
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan I Other
Cost Allocation Plan
0.0000
0.000
0.000
9,354.00
Notes: 11 86%
(Health Adm Distribution
0.0000
0.000
0.000
13,186,001
Nursing Adm Distribution
0.0000
0.000
0.000
2,839.001
(Total for Cost Allocation Plan I Other
25,379.001
(Total Indirect Costs
25,379.001
(TOTAL INDIRECT EXPENSES
25,379.001
(TOTAL EXPENDITURES
136,025.001
Local Health Department - 2021, Date: 09/24/2020 Page' 110 of 197
Contract # Date: 09/24/2020
1 Program Budget Summary
(PROGRAM / PROJECT DATE PREPARED
Local Health Department -2021 / HIV Prevention 9/24/2020 l
CONTRACTOR NAME BUDGET PERIOD 1
Oakland County Department of Health and Human Services/ From : 10/l/2020 To 9/30/2021
Health Division 1
MAILING ADDRESS (Number and Street) BUDGET AGREEMENT
1200 N. Telegraph Rd. ry
34 East Original(- Amendment
(Pontiac MI
CITY ATE ZIP CODE FEDERAL I48341-0432 38-600 876 NUMBER
Category I Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County -City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Total Program Expenses
TOTAL DIRECT EXPENSES
INDIRECT EXPENSES
Indirect Costs
1 I Indirect Costs
2 Cost Allocation Plan / Other
Total Indirect Costs
TOTAL INDIRECT EXPENSES
TOTAL EXPENDITURES
216,562.00
115,041.00
0.00
0.00
28,063.00
16,880.00
2,871.00
0.00
10,882.00
36,262.00
426,561.00
426,561 00
NOR
80,151.00
80,151 00
80,151.00
506,712.00
AMENDMENT#
0
Amount
216,562 00
116,041.00
0.00
0,00
28,063.00
16,880.00
2,871 00
0.00
10,882.00
36,262.00
426,561 00
426,561.00
0.00 1
80,151 001
80,151,001
80,151.0011
11
506,712.00 I
Local Health Department - 2021, Date: 09/24/2020 Page: 111 of 197
Contract # Date: 09/24/2020
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category I
Total I
Amount I
Cash I
Inkind
1 Source of Funds
f
Fees and Collections - 1st and 2nd I
0.00 I
000 I
0.00 I
0.00
Party I
I!
Fees and Collections - 3rd Party (
0.00 I
0,00 I
0.00 I
0.00
(Federal or State (Non MDHHS) I
000 I
0.00 I+
000
0.00
lFederal Cost Based Reimbursement !
0.00 I
0.00 I
0.00
0.00
IFecterally Provided Vaccines I
000 I
0.00 I
0.00 I
0.00
Federal Medicaid Outreach '
0.00 I
000 I
0.00 I
0.00'
Required Match - Local I
0.00,
0.00 I
0.00 I
0.00
Local Non-ELPHS I
0.00
0.00 I
0.00 I
0.00
Local Non-ELPHS +
J+
0.00
0.00 I
0.00 I
0.00
Local Non-ELPHS I
0,00
0.00 I
000 +
0.00
I(Other Non-ELPHS +
0.00
0.00
0.00 I
0.00
MDHHS Non Comprehensive I
0.00
0.00
0.00
000
MDHHS Comprehensive -
452,245.00
452,245.00
000
0.00
IMCH Funding'
0.00
0.00
0.00
0.00
IILocal Funds -Other I
54,467.00 I
000 I
54,467 00
0.00
II Inkind Match I
0.00 I
0.00 I
0.00 I
0.00
IIMDHHS Fixed Unit Rate
II
1
I(Totals I
506,712.00 I
452,245.00 I
54,467.00 I
000
Local Health Department - 2021, Date: 09/24/2020 Page. 112 of 197
Contract # Date: 09/24/2020
3 Program Budget - Cost Detail
Line Item I QtyI Rate UnitsIUOM
(DIRECT EXPENSES
(Program Expenses
1 Salary & Wages
Coordinator
(Assistant
(Public Health Nurse
(Public Health Nurse
(OVERTIME
(Total for Salary & Wages
2 Fringe Benefits
All Composite Rate
Notes: FICA
Unemployment Insurance
Retirement Insurance
Hospital Insurance
Life Insurance
Vision Insurance
Dental Insurance
Workers Comp
Short and Long Term Disability
Insurance
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies
Medical Supplies
Postage
Lab Supplies
Printing
Incentives -gas cards
Training -Ed Supplies
(Total for Supplies and Materials
1 0000
76147.000
0 000
FTE
0.7404
42834.000
0.000
FTE
0.3846
68870.000
0,000
FTE
1.0000
72213.000
0.000
FTE
0.1194
83749,000
0 000
FTE
0.0000 53.121 216562.000
0.0000
0.000
0.000
0.0000
0.000
0 000
00000
0.000
0.000
0.0000
0.000
0.000
0.0000
0.000
0.000
0.0000
0.000
0,000
00000
0.000
0.000
Total I
76,147.00
31,714 00
26,488.00I
72,213.001
10,000.00I
216,562.001
115,041.00
3,500.00
10,000.00
1,000.001
1,963.001
6,00000
3,200.00
2,400.001
28,063.001
Local Health Department-2021, Date09/24/2020 Page' 113 of 197
Contract #
Date: 09/24/2020
Line Item I
QtyI
Rate
UnitsluOM I
Total
6 Travel
Mileage
00000
0.000
0.000
6,308.00
Notes : 10,970 miles @ .575
IClientTransportation
0.0000
0.000
0,000
5,072.001
(Conferences
0.0000
0.000
0.000
5,500.001
TotalforTravel
16,880,001
7 Communication
I
Telephone I
0.00001
0,0001
00001 I
2,871.001
8 County -City Central Services
9 Space Costs
Space/Rental Costs I
0.00001
00001
0.0001 I
10,882.001
10 All Others (ADP, Con. Employees,
Misc.)
I
IT Operations
0.0000
0.000
0.000
19,131.001
IT Mangaged Print Svcs
0.0000 -
0,000
0.000
4,152.001
(Insurance
0.0000
0.000
0,000
1,055.001
LabFees0.0000
0000
0.000
1,324.001
(Advertising
0.0000
0,000
0.000
9,500 001
1Interpretation
0.0000
0.000
0.000
600.001
IWorkshops & Meetings
00000
0.000
0.000
500.001
(Total for All Others (ADP, Con. Employees, Misc.)
36,262.001
(Total Program Expenses
426,561.00
TOTAL DIRECT EXPENSES
426,561.00
INDIRECT EXPENSES
Ilndirect Costs
I
1 Indirect Costs
I
2 Cost Allocation Plan / Other
Cost Allocation Plan
0.0000
0 000
0.000
25,684.00
Notes : 12.29%
Health Adm Distribution
0.0000
0.000
0,000
54,467.O01
(Total for Cost Allocation Plan / Other
80,151 001
(Total Indirect Costs
80,151.001
ITOTAL INDIRECT EXPENSES
80,151.001
Local Health Department-2021, Date: 09/24/2020
Page: 114 of 197
Contract # Date: 09/24/2020
(Line Item Qtyl Rate UnitsIUOM Totall
TOTAL EXPENDITURES I 506,712.001
Local Health Department- 2021, Date 09/24/2020 Page: 115 of 197
Contract # Date: 09/24/2020
1 Program Budget Summary
PROGRAM/PROJECT
Local Health Department- 2021 / Immunization Action Plan
DATE
DATE PREPARED
(IAP)
NAME
lCONTRACTOR
Oakland County Department of Health and Human Services/
BUDGET PERIOD
PER
Health Division
1
From : 20 To . 9/30/2021
ADDRESS (Number and Street)
BUDGET AGREEMENT
�MAILING
1200 N. Telegraph Rd,
34 East
P, Original r Amendment
CITY
IMTATE
ZIP CODE
I4
FEDERAL ID
I38-6004876 NUMBER
IPontiac
341-0432
' I Category
I Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 I Contractual
5 I Supplies and Materials
6 Ij Travel
7 Communication
8 I County -City Central Services
9 I Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Total Program Expenses
TOTAL DIRECT EXPENSES
INDIRECT EXPENSES
Indirect Costs
1 I indirect Costs
2 Cost Allocation Plan / Other
Total Indirect Costs
TOTAL INDIRECT EXPENSES
TOTAL EXPENDITURES
296,118.00
179,932.00
0.00
000
2,500.00
2,657.00 j
3,050.00
0.00
8,249.00
16,969.00
509,475.00
509,475.00
0.001
65,108.00
65,108.00
65,108 00
574,683.00
AMENDMENT#
0
I
Amount
1
l
296,118.00
179,932.00
0.00
()DO
2,50000
2,657.00
3,050.00
000
8,249.00
16,969.00
509,475.00
509,475 00
1
0.001
65,108.00
65,108.00
65,108.00
674,583.00
Local Health Department- 2021, Date- 09/24/2020 Page: 116 of 197
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
Fees and Collections - 3rd Party
(Federal or State (Non MDHHS)
IFederal Cost Based Reimbursement
(Federally Provided Vaccines
IIFederai Medicaid Outreach
Required Match - Local
ILocal Non-ELPHS
ILocal Non-ELPHS
ILocal Non-ELPHS
I(Other Non-ELPHS
I(MDHHS Non Comprehensive
IMDHHS Comprehensive
fMCH Funding
Local Funds - Other
Inkind Match
(MDHHS Fixed Unit Rate
I (Totals
Contract # Date. 09/24/2020
Total I
Amount I
Cash
Inkind
1
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
42, 700.00
000
42, 700.00
0.00
0,001
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
I
0.00
0.00
000
0.00
0.00
0.00I
0.00I
0.00
0.00
0.00I
0.00I
0.00
0.00
000
I
0.00
0.00
0.00
0.00
0.00 I
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
501,895.00
501,895.00
0.00
0.00
0.00
0.00
0.00
0.00
29,988.00
0.00
29,988.00
0.00
0.00
I
0.00
000
I
0.00
574,583.00 I 501,895.00 I 72,688 00 I 0.00
Local Health Department-2021, Date: 09/24/2020 Page: 117 of 197
Contract# Dale, 09/24/2020
3 Program Budget - Cost Detail
LineItemI
City
Rate
UnitsIUOM
DIRECT EXPENSES
(Program Expenses
1 (Salary & Wages
Coordinator
1 0000
76147.000
0.000 FTE
Vaccine Supply Clerk
0.9375
52213,000
0,000 FTE
Notes . Shared Vaccine Quality
(Public Health Nurse
1.0000
68870.000
0 000 FTE
Office Leader
1.0000
47506.000
0.000 FTE
(Assistant
1.0000
42834.000
0.000 FTE
(OVERTIME
0.1635
72245,000
0.000
(Total for Salary & Wages
2 Fringe Benefits
All Composite Rate
0.0000
60,764
296116.000
Notes: FICA
Unemployment Insurance
Retirement Insurance
Hospital Insurance
Life Insurance
Vision Insurance
Dental Insurance
Workers Comp
Short and Long Term Disability
Insurance
3 Cap. Exp. for Equip & Fac.
4 Contractual
6 Supplies and Materials
Office Supplies
0.0000
0.000
0.000
Postage
0.0000
0.000
0.000
(Total for Supplies and Materials
6 Travel
Mileage
0.0000
0.000
0.000
Notes : 4350 miles @ .575
Conferences
0.0000
0,000
0,000
Total I
76,147.00
48,950.00
68,870.001
47,505,001
42,834.00I
11,812 001
296,118.O01
I
179,932.00
500.00
2,000.00
2,500.00
2,501.00
156.00
Local Health Department - 2021, Date 09/24/2020 Page: 118 of 197
ILine Item I
Qtyl
Rate
UnitsIUOM
ITotalfor Travel
7 Communication
Telephone I
0 00001
0.0001
0.0001
8 County -City Central Services
9 Space Costs
Building Space Rental I
0.00001
0,0001
0.0001
10 All Others (ADP, Con. Employees,
Misc.)
Equipment Repair
00000
0 000
0.000
Convenience Copier
0,0000
0,000
0.000
IT Operation
0.0000
0.000
0.000
Insurance
0,0000
0,000
0.000
(Total for All Others (ADP, Con. Employees, Misc.)
ITotalProgram Expenses
ITOTAL DIRECT EXPENSES
IINDIRECT EXPENSES
Ilndirect Costs
1 Indirect Costs
2 Cost Allocation Plan I Other
Other Cost Distributions -Nurse
0,0000
0.000
0 000
TrainNFC/AFIX
Cost Allocation Plan
0.0000
0 000
0 000
Notes: 12.79 %
Health Adm Distribution
0,0000
0.000
0.000
Nursing Adm Distribution
0,0000
0 000
0 000
(Total for Cost Allocation Plan I Other
(Total Indirect Costs
ITOTAL INDIRECT EXPENSES
ITOTAL EXPENDITURES
Contract# Date. 09/24/2020
Total I
2,657,001
3,050.00
8,249.00
200.00
3,86000
12,243.00
666.00
16,969.00
509,475.00
509,475.00
-42,700 00
35,120.00
59,818.001
12,870.001
65,108.001
65,108.001
65,108.001
674,683.001
Local Health Department-2021, Date 09/24/2020 Page: 119 of 197
Contract # Date 0912412020
1 Program Budget Summary
PROGRAM ! PROJECT
DATE PREPARED
Local Health Department - 20211 Infant Safe Sleep
9/24/2020
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
BUDGET PERIOD
D
Health Division
From : 10/To 9/30/2021
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
1200 N. Telegraph Rd
34 East
Original
ro g al I- Amendment
ICITY
IMIATE
ZIP CODE
I48341-0432
FEDERAL ID NUMBER
Pontiac
38-800 876
Category
I Total I
DIRECT EXPENSES
J Program Expenses
AMENDMENT#
0
Amount 1
1 Salary & Wages
3,868.00
3,868.00
2 Fringe Benefits
2,395.00
2,395.00
3 Cap. Exp. for Equip & Fac.
0.00
0.00
4 Contractual
I 0.00 J
0.00
5 Supplies and Materials
I 10,620.00 I
10,620.00
6 Travel
I 0.00I
0.00
7 I Communication
I 0.00 I
0.00
8 I County -City Central Services
0.00
!
0.00'
9 I Space Costs
0.00
000
10 I All Others (ADP, Con. Employees, Misc.)
5,158.00 I
5,158.00
Total Program Expenses I
22,041.00 (
22,041.00
TOTAL DIRECT EXPENSES I
22,041.00 I
22,041.00
INDIRECT EXPENSES
Indirect Costs
'
1 Indirect Costs
(
000
0.00
2 Cost Allocation Plan / Other
3,463.00
3,463.00
Total Indirect Costs I
3,46300 I
3,463.00
Jj TOTAL INDIRECT EXPENSES I
3,463.00 I
3,463.00 I(
TOTAL EXPENDITURES I
25,504.00 I
26,504.00
Local Health Dapartment-2021, Date. 09124I2020 Page: 120 of 197
Contract# Date: 09/24/2020
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category I
Total I
Amount I
Cash I
Inkind
1 Source of Funds
Fees and Collections - 1 st and 2nd
000
0.00
0.00
0.00
Party
Fees and Collections - 3rd Party I
0.00
0.00
0.00
0.00
Federal or State (Non MDHHS) I
0.00
0.00
0.00
0.00
Federal Cost Based Reimbursement I
0.00
0.00
000
0.00
(Federally Provided Vaccines I
0.00
0.00
000
0.00
(Federal Medicaid Outreach I
0.00
- 0.00
0.00
000
(Required Match - Local I
0.00 I
000
0.00
0.00
ILocalNon-ELPHS
a00
000
0.00
0.00
IILocalNon-ELPHS
0.00
0.00
0.00
000
I(Local Non-ELPHS
0.00 I
0.00
0.00
0.00
Other Non-ELPHS
0.00
0.00
0,00
0.00
MDHHS Non Comprehensive '_
000
0.00
0.00
0.00
MDHHS Comprehensive
22,500.00
22,500.00
0.00
0.00
IIMCH Funding I
0.00
0.00
0.00
0.00
ILocal Funds -Other I
3,004.00 I
0.00
3,004.00
0.00
Ilnkind Match I
0.00 I
0.00
0.00
0.00
IMDHHS Fixed Unit Rate
IITotals I
25,504.00 I
22,500 00 I
3,00400 I
0.00 I
Local Health Department - 2021, Date: 09/24/2020 Page121 of 197
Contract # Date: 09/24/2020
3 Program Budget - Cost Detail
(Line Item l City l Ratel UnitsIUOM
DIRECT EXPENSES
(Program Expenses
1 Salary & Wages
Health Educator
Notes: Step 4 GFGP
Chief Community Health Nursing
Notes : Step 5 GFGP
(Total or Salary & Wages
1 2 Fringe Benefits
All Composite Rate
Notes: FICA
Unemployment Ins
Retirement Ins
Hospital Ins
Life Ins
Vision Ins
Dental Ins
Workers Comp
ShorULong Terms Disability Ins
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Printing
Notes "We print a significant
quantity of locally developed
client education materials and
distribute them to 15,000+ WIC
clients annually, as well as our
other community outreach."
Materials and Supplies
Office Supplies
Educational Supplies
Incentives
(Total for Supplies and Materials
I6 TTravel
Local Health Department - 2021, Date, 09/24/2020
0,0601 52083.000
0.0077 95920,000
0,000 FTE
0.000 FTE
61 918 3868 000
0,000 0,000
00000
0.000
0.000
0.0000
0000
0,000
0.0000
0.000
0,000
0.0000
0 000
0 000
Total
1
l
1
3,130.00�
738.001
3,868.001
1
2,395.00
4,269.00
1,000.001
200.001
3,576.00
1,575.00
10,620.00
1
Page: 122 of 197
Contract #
Date09/24/2020
LineItemI
Qtyl
Ratel
UnitsIUOM I
Total
7
Communication
I
8
!County -City Central Services
I
9
I Space Costs
I10
IAII Others (ADP, Con. Employees,
Misc.)
(Advertising
0.00001
0.000
0.000
1,125.001
Ilnsurance
0.00001
0000
0.000
33,001
!Training
0.00001
0.000
0.000
3,000.001
IlnterpretationFees
0.00001
0000
0,000
1,000001
(Total for All Others (ADP, Con. Employees, Misc.)
5,158,001
ITotalProgram Expenses
22,041,001
(TOTAL DIRECT EXPENSES
22,041.00'
'INDIRECT EXPENSES
1
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan I Other
Cost Allocation Plan
0,0000
0.000
0.000
459.00
Notes: 12.29%
(Health Adm Distribution
0.0000
0.000
0.000
2,472.00
(Nursing Adm Distribution
0.0000
0 000
0.000
532.00
(Total for Cost Allocation Plan I Other
3,463.00
(Total Indirect Costs
I
3,46300
ITOTAL INDIRECT EXPENSES
I
3,463.00
ITOTAL EXPENDITURES
I
25,604.00
Local Health Department-2021, Date 09/24/2020 Page: 123 of 197
Contract# Date: 09/24/2020
1 Program Budget Summary
(PROGRAM/PROJECT
DATE PREPARED
Local Health Department- 2021 / Laboratory Services Bio
9/24/2020
CONTRACTOR NAME
BUDGET PERIOD
Oakland County Department of Health and Human Services/
From : 10/1/2020 To. 9/30/2021
Health Division
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
1200 N Telegraph Rd.
re Original )` Amendment
34 East
CIT(Pontiac
CDE
I48341O0432
FEDERAL6DNUMBER
MIATE
38-600487ZIP
Category
I Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County -City Central Services
9 Space Costs
1 10 All Others (ADP, Con, Employees, Misc.)
Total Program Expenses
TOTAL DIRECT EXPENSES
INDIRECT EXPENSES
Indirect Costs
1 1 Indirect Costs
2 1 Cost Allocation Plan / Other
Total Indirect Costs
TOTAL INDIRECT EXPENSES
TOTAL EXPENDITURES
3,49000
2,080.00
0.00
0.00
8,414.00
0.00
575.00
0.00
0.00
2700
14,586.00
14,586 00
,� r r
2,062.00
2,06200
2,062.00
16,648.00
AMENDMENT#
0
Amount
1
1
3,490.001
2,080 00 1
0.001
0.00 1
8,414,00 1
0 00 1
575,001
0.001
0.00
27.00
14,586.00
14,586.00
0.00 1
2,062.00 1
2,062.001
2,062.00 1
16,648.001
Local Health Department - 2021, Date: 09/24/2020 Page. 124 of 197
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
(Fees and Collections - 3rd Party
IIFederat or State (Non MDHHS)
I,Federal Cost Based Reimbursement
(Federally Provided Vaccines
(Federal Medicaid Outreach
IRequired Match - Local
(Local Non-ELPHS
Local Non-ELPHS
Local Non-ELPHS
(Other Non-ELPHS
MDHHS Non Comprehensive
(MDHHS Comprehensive
IMCH Funding
ILocal Funds - Other
Ilnkind Match
IMDHHS Fixed Unit Rate
ITotals
Contract #
Date' 09/24/2020
Total I
Amount,
Cash I
Inkind I
0.00
0.00
I
0.00 1
000
0.00
0.001
0.00
I
0.00 I
0.00
I
000 I
0.00
I
0.00
0.00
I
0.00
I
0.00
0.00
0.00
I
0.00
I
0.00
0.00
0.00
I
0.00
I
0.00
I
0.00
000
I
0.00
I
0.00
I
0.00
0.00
I
0.00
I
000
I
0.00
0.00'
I
0.00
I
0.00
I
0.00 I
0 00
0.00
I
0.00
I
000
0.00
0.00
0.00
0.00
000 I
0.00 I
0.00
000
15,000.00 I
15,000.00 I
0.00 I
000
000 I
0.00 I
0.00 I
0.00
1,648.00 I
0.00 I
1,648.00 I
000
0.00 I
0.00 I
0.00 I
0.00
16, 648.00 I
15, 000.00 I
1,648.00 I
0.00
Local Health Department-2021, Date09/24/2020
Page 125 of 197
3 Program Budget - Cost Detail
Line Item I Otyl Ratel UnitslUOM
DIRECT EXPENSES
Program Expenses
1
Salary & Wages
Supervisor I
00481
72588.000I
0.000I FTE
Notes:
2
IFringe Benefits
All Composite Rate
0,0000
59.598
3490,000
Notes: FICA
Unemployment Insurance
Retirement Insurance
Hospital Insurance
Life Insurance
Vision Insurance
Dental Insurance
Workers Comp
Short and Long Term Disability
Insurance
3
Cap. Exp. for Equip & Fac.
4
Contractual
5
ISupplies and Materials
ILab supplies I
0,00001
0,0001
0.0001
6
ITravel
7
Communication
Telephone I
0.00001
0.0001
00001
8
ICounty-City Central Services
1 9
(Space Costs
1 10
IAII Others (ADP, Con. Employees, Misc.)
Insurance I
0.00001
0.000I
0.0001
Total Program Expenses
TOTAL DIRECT EXPENSES
INDIRECT EXPENSES
Indirect Costs
Contract # Date: 09/24/2020
Total
1
1
1
3,490.00
1
2,080.00
l
I
l
8,414 001
1
575.001
1
1
1
27 001
14,586.001
14,588.001
1
1
Loca! Health Department - 2021, Date 09/24/2020 Page: 126 of 197
Contract # Date 09/24/2020
Line Item l
Qtyl
Rate l
UnitslUOM
I Totall
1 Indirect Costs
l
2 Cost Allocation Plan / Other
Cost Allocation Plan
00000
I
0.000J
0.000
I 41400
Notes 12.29%
Health Adm Distribution
000001
00001
0.0001
I 1,648.001
(Total for Cost Allocation Plan / Other
I 2,06200
(Total Indirect Costs
llj 2,06200
(TOTAL INDIRECT EXPENSES
I 2.062.00
(TOTAL EXPENDITURES
I 16,648.00�
Local Health Department - 2021, Date09/24/2020 Page: 127 of 197
Contract # Date. 09/24/2020
1 Program Budget Summary
PROGRAM/PROJECT
DATEPREPARED
Local Health Department - 2021 / MI Health and Wellness
9/24/2020
4x4 Plan - ImDlementation
CONTRACTOR NAME
BUDGET PERIOD
Oakland County Department of Health and Human Services/
From : 10/1/2020 To. 9/30/2021
Health Division
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
1200 N. Telegraph Rd.
ro Original f Amendment
34 East
CITY
STPontiac IMIATE
CODE
I4
876 NUMBER
341-0432
38-600RZIP
Category
I Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
1 8 County -City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
1 Total Program Expenses
TOTAL DIRECT EXPENSES
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
1 2 Cost Allocation Plan / Other
Total Indirect Costs
1 TOTAL INDIRECT EXPENSES
TOTAL EXPENDITURES
30,858.00
1,250.00
0.00
14,000.00
30,169.00
56000
0.00
000
0.00
11,700.00
88, 537.00
88, 537.00
r rr
12,857.00
12,857.00
12,857.00
101,394.00
AMENDMENT#
0
Amount
1
1
30,858.001
1,250.00 1
0.001
14,000 00 11
30,169.00 !
560.00
0.00
0.00
0.00
11,700.00
88,537 00
88,537.00
0.00 1
12,867,001
12,857.001
12,857.00
101,394.00 1
Local Health Department - 2021, Date 09/24/2020 Page. 128 of 197
Contract # Date: 09/24/2020
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category I
Total I
Amount I
Cash I
Inkind
1 Source of Funds
1�
Fees and Collections - 1 stand 2nd
0.00
0.00
0.00
000
Party
I
Fees and Collections - 3rd Party
0.00
000
0.00
000
Federal or State (Non MDHHS)
0.00
0.00
0.00
0.00
Federal Cost Based Reimbursement
0.00
0.00
0.00
0.001
Federally Provided Vaccines
0.00
000
0.00
0.001
Federal Medicaid Outreach
0.00
0.00
0.00
0 00 1
Required Match - Local
18,271.00
0.00
18,271.00
0.001
Local Non-ELPHS
0.00
0.00
0.00
0.00 1�
Local Non-ELPHS
0.00
0.00
0.00
0.00 f
Local Non-ELPHS
0.00
0.00
0.00
0.00
Other Non-ELPHS
0.00
0.00
0.00
0 00 1
MDHHS Non Comprehensive
0.00
0.00
0.00
0.001
1
MDHHS Comprehensive
73,084.00
73,084.00
0.00
0.00
MCH Funding
000
0.00
0.00
0001
Local Funds - Other
10,039.00
0.00
10,039.00
0,001
Inkind Match
0.00
0.00
0.00
0.001
1
MDHHS Fixed Unit Rate
Totals I
101,394.00 I
73,084.00 I
28,310.00 I
0.001
Local Health Department- 2021, Date 09/24/2020 Page: 129 of 197
Contract # Date. 09/24/2020
3 Program Budget
- Cost Detail
(Line Item
I Qtyl
(DIRECT EXPENSES
(Program Expenses
1
Salary & Wages
Health Educator
04808
Supervisor
0.0240
Notes: MATCH
Health Educator
0.0721
Notes: MATCH
Assistant
0.0144
Notes: MATCH
(Total for Salary & Wages
2 Fringe Benefits
All Composite Rate
0.0000
Notes : Fica
Unemp Ins
Retirement
Hosp Ins
Life Ins
Vision Ins
Dental ins
Work Comp
Short/Long Term Disability
Fringe not figured on Match
salaries
3 Cap. Exp. for Equip & Fac.
4 Contractual
Oakland University
0.0000
Notes: MATCH $7,000
5 Supplies and Materials
Postage
0,0000
Notes. MATCH $1,000
Printing
0.0000
Notes: MATCH $748
Office Supplies
00000
Local Health Department-2021, Date09/24/2020
Rate UnitsIUOM
49420,000 0.000 FTE
81750.000 0 000 FTE
59736.000 0.000 FTE
57406.000 0.000 FTE
4.051 30858.000
0.0001
0,000 0.000
0.000 0.000
0.000 0.000
Total
23,760.001
1,962.00
4,308.00
828.00
30,858.001
1,250.00
14,000.00
8,385.00
8,248.001
1,000.001
Page: 130 of 197
ILine item I+
Qty
Rate l
Units UOM
(Notes: MATCH $500 I
I
l
(Materials & Supplies I
0.0000
0,000I
00001
Educallotes flonal Supplies
I
0.0000I
0.0001
0.000
MATCH $1 257
(Client Support Materials I
0.00001
0.0001
0.0001
Total for Supplies and Materials
I6 Travel
Mileage
O.000D
0.000
0.000I
Notes : 800 miles @ .575
Conferences
0.0000
0.000
0.0001
ITotalforTravel
7 Communication
8 County -City Central Services
9 Space costs
I10 IAII Others (ADP, Con. Employees,
Misc.)
'Insurance
0.0000
0000
0.0001
Ilnterpretation
00000
0,000�
0.0001
(Education Programs
O.0000I
0.000
0.000
Notes: MATCH $900
IStaff Training
0.00001
0.000I
0,000I
(Advertising
0.00001
0.000I
0.000I
(Workshops & Meetings
0,0000I
0.0001
00001
(Total for All Others (ADP, Con. Employees, Misc.)
ITotalProgramExpenses
(TOTAL DIRECT EXPENSES
(INDIRECT EXPENSES
Ilndirect Costs
I1 Indirect Costs
(Cost
2 Allocation Plan / Other
(Cost Allocation Plan
0.0000
0.000�
0.000
Notes: 12.29%
(Health Adm Distribution
00000
0.000I
0.000
Contract # Date 09/24/2020
I Total`
5,832,00
2,704,00
4,000,00
30,169,00
460,00
100.00
560.00
100,00
200.00
900.00
500.001
7,500,001
2,500001
11,700.00I
88,537.00I
88,537.00I
l
2,818.00
1Q039.00
Local Health Department-2021, Date: 09/24/2020
Page: 131 of 197
Contract * Date09/24/2020
(Line Item I City
Rate UnitsIUOM Totall
(Total for Cost Allocation Plan / Other
12,857.001
(Total Indirect Costs
12,857.001
(TOTAL INDIRECT EXPENSES
12,857.00I
(TOTAL EXPENDITURES
101,394.001
Local Health Department - 2021, Dale. 09/24/2020 Page' 132 of 197
1 Program Budget Summary
PROGRAM / PROJECT Local Health Department - 2021 / Nurse Family Partnership DATEPREPARED
DATE020
Services
CONTRACTOR NAME D
PERIO
Oakland County Department of Health and Human Services/ From : 1BUDGET PERIOD
Health Division
MAILING ADDRESS 'Number d St t
Contract # Date. 09/24/2020
To: 9/30/2021
u er and1200 N. Telegraph Rd. roe ) BUDGET AGREEMENT
34 East r Original F- Amendment
ICITY TATE I4 341-0432 38-60 4876 NUMBER
pontac IM
Category I Total I
DIRECT EXPENSES
Program Expenses
1
Salary & Wages
2
Fringe Benefits
3
Cap. Exp. for Equip & Fac.
4
Contractual
5
Supplies and Materials
6
I Travel
7 I Communication
8 I County -City Central Services
9 I Space Costs
10 I All Others (ADP, Con. Employees, Misc.)
Total Program Expenses
TOTAL DIRECT EXPENSES
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2' Cost Allocation Plan / Other
Total Indirect Costs
TOTAL INDIRECT EXPENSES
TOTAL EXPENDITURES
355,509 00
r rm
18,312.00
5,827.00
6A69.00 j
4,268.00
0.00 I+
14,329.00
27,931.00
642, 540.00
642,540.00
K om
85,80600
85,806.00
85,806.00
728,346.00
(AMENDMENT #
0 11
Amount
355,509.00
209, 895.00
0.00
18,312.00
5,827.00
6,469.00
4,268.00
0.00
14,329.00
27,931 00
642, 540.00
642,540 00 1
lI
1
MM
85,806.00
85,806 00,
85,806.00
728,346.00
Local Health Department - 2021, Date 09124/2020 Page: 133 of 197
Contract # Date: 09/24/2020
2 Program Budget - Source of Funds
SOUZCE OF FUNDS
Category I
Total I
Amount I
Cash I
Inkind
7 Source of Funds
Fees and Collections - 1st and 2nd
0.00
0.00
000
0.00
Party
1
Fees and Collections - 3rd Party
0.00
0.00
0.00
0.00 I
Federal or State (Non MDHHS)
0.00
0.00
0,00
0.001 1
Federal Cost Based Reimbursement
0.00
0.00
0.00
0.00 1
Federally Provided Vaccines
0.00
0.00
0.00
0,001 1
1
Federal Medicaid Outreach
0.00
0.00
000
0.00
i11
Required Match - Local
0.00
0.00
0.00
0,00 1
Local Non-ELPHS
0.00
000
0.00
0.001
Local Non-ELPHS
0.00
0.00
000
0.001
11
Local Non-ELPHS
0.00
0.00
0.00
0.00 1
Other Non-ELPHS
0.00
0.00
0.00
0,001
MDHHS Non Comprehensive
0.00
0.00
0.00
0.00
MDHHS Comprehensive -
642,540.00
642,540.00
0.00
0.00 1
MCH Funding
0.00
000
0.00
0.00
Local Funds - Other
85,806.00
0.00
85,806.00
0,001
Inkind Match
0.00
000
0.00
0.00 1
MDHHS Fixed Unit Rate
Totals I
728,346.00I
642,540.00I
85,806.00I
0.00
Local Health Department - 2021, Date 09/24/2020 Page: 134 of 197
3 Program Budget - Cost Detail
(Line Item I gtyl
IDIRECT EXPENSES
(Program Expenses
1 IPublic
Salary & Wages
Health Nurse
IPublic Health Nurse
IPublic Health Nurse
IPublic Health Nurse
IPublic Health Nurse
OVERTIME
Notes: Overtime (PHNs)
(Coordinator
(Total for Salary & Wages
2 Fringe Benefits
All Composite Rate
Notes : Fica
Unemp Ins
Retirement
Hosp Ins
Life Ins
Vision Ins
Dental Ins
Work Comp
Short/Long Term Disability
3 ICap. Exp. for Equip & Fac.
4 Contractual
NFP National Office Program
Support
INFP Consultation
(Total for Contractual
I 5 (Supplies and Materials
Office Supplies
IClient Support Materials
(Educational Supplies
Rate UnitsIUOM
0.2500
72213.000
0 000
FTE
1.0000
72213.000
0.000
FTE
1.00001
72213.000
0 000
FTE
I100001
72213.0001
0.000I
FTE
1.00001
72213.0001
0 000
FTE
0.00961
105390.0001
0,000
FTE
I0.62501
76147,0001
0.0001FTE
0,0000 59.041 355507.000
0.0000 0,0001 0.000
0.0000 0.0001 0.000
0.0000 0.000 0 000
0.0000 0.000 0.000
0.0000 0.000 0.0001
Contract # Date: 09/24/2020
Total i
18,053.001
72,213.001
72,213,001
72,213,001
72,213.001
1.012,001
47,59Z00j
355,609.00
209, 895.00
8,328.00
9,984.001
18,312.001
l
507.001
2,000,001
3,320.001
Local Health Department -2021, Date 09/24/2D20 Page: 135 of 197
Contract # Date: 09/24/2020
I ILine Item I
QtyI
Rate
UnitslUOM
Totall
(Total for Supplies and Materials
5,827.001
6 Travel
Mileage
0,0000
0.000
0000
6,469.00
Notes : 11,250 miles @ .575
7 Communication
Telephone Communications I
0.0000I
0.0001
0.0001
I 4,268.001
8 County -City Central Services
9 Space Costs
Building Space Rental I
0.00001
0.000
0.0001
I 14,329 001
I10 All Others (ADP, Con. Employees,
Misc.)
I
Insurance
0,0000
0 000
0.000
875.O01
(Copier
0.0000
0.000
0.000
7,860.O01
IIT Operations -laptops
00000
0.000
0.000
16,320 001
IStaff Training
0.0000
0,000
0,000
2,876,001
(Total for All Others (ADP, Con. Employees, Misc.)
27,931.001
(Total Program Expenses
642,540.001
(TOTAL DIRECT EXPENSES
642,540.001
(INDIRECT EXPENSES
Ilndirect Costs
1 Indirect Costs
2 Cost Allocation Plan I Other
Health Adm Distribution (
0.0000
0.000
0.000
70,606.O01
Nursing Adm Distribution
00
0.000
0.000
15,200.001
ITotal for Cost Allocation Plan / Other
85,806.001
(Total Indirect Costs
85,806.001
(TOTAL INDIRECT EXPENSES
85,806.001
ITOTAL EXPENDITURES
728,346.001
Local Health Department - 2021, Date 09/24/2020 Page: 136 of 197
Contract # Date 09/24/2020
1 Program Budget Summary
(PROGRAM/PROJECT
DATE PREPARED
Local Health Department - 2021 / Medicaid Outreach
9/24/2020
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
BUDGET PERIOD
OD
Health Division
From : 10 0 To : 9/30/2021
ADDRESS (Number and Street)
BUDGET AGREEMENT
�MAILING
1200 N. Telegraph Rd.
34 East
r Original r Amendment
ATE
iMI
ZIP CODE
148341-0432
FEDERAL ID NUMBER
Pontiac
38-6004876
I I Category
I Total I
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 I Contractual
5 I Supplies and Materials
6 Travel
7 Communication
8 County -City Central Services
9 I Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Total Program Expenses
TOTAL DIRECT EXPENSES
INDIRECT EXPENSES
Indirect Costs
1 I Indirect Costs
2 I Cost Allocation Plan / Other
Total Indirect Costs
TOTAL INDIRECT EXPENSES
TOTAL EXPENDITURES
1,221,264.00
678,805.00
0001
0.00
0.00
0.00
0.00
000
39,627.00
0.00 Ij
1,939,696.00
1,939,696.00
r H
373,904.00
373,904 00
373,904.00
2,313,600.00
I
1
AMENDMENT#
0
Amount
l
1,221,264.00
678,805.00
0.00
0.00
0.00
0.00
0.00
0.00
39,627.00
0.00
I,939,696 00
1,939,696.00
l
l
0.001
373,904.00 J
373, 904.00
373, 904 00
2,313,600.00
Local Health Department - 202 1, Date 09/24/2020 Page137 of 197
Contract# Date: 09/24/2020
2 Program Budget - Source of Funds
SOU 2CE OF FUNDS
Category
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
Fees and Collections - 3rd Party
Federal or State (Non MDHHS)
Federal Cost Based Reimbursement
Federally Provided Vaccines
Federal Medicaid Outreach 1,
Required Match - Local 1,
Local Non-ELPHS
Local Non-ELPHS
Local Non-ELPHS
Other Non-ELPHS
MDHHS Non Comprehensive
MDHHS Comprehensive
MCH Funding
Local Funds - Other
Inkind Match
MDHHS Fixed Unit Rate
Totals
Total I Amount I Cash
000
000
0.00
000
000
000
0.00
000
000
0.00
0.00
0.00
0.00
0.00
0.00
042,269.00
1,042,269.00
0.00
042,269.00
0.00
1,042,269.00
0.00
0.00
0.00
0.00
0.00
000
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
229,062.00
0.00
229,062.00
0.00
0.00
0.00
I2, 313, 600.00 I 1, 042, 269.00 I 1,271,331 00 I
Inkind
4I,
0.00
0.00
000
000
0.00
0.00
0.00
0.00
0.00
0.00
0.00
000
0.00
0.00
0.00
r rr
Local Health Department - 2021, Date 09/24/2020 Page: 138 of 197
Contract # Date: 09/24/2020
3 Program Budget - Cost Detail
I (Line Item I City l Ratel
DIRECT EXPENSES
(Program Expenses
1 Salary & Wages
Multiple positons
Notes : Amount determined
based on time studies.
2 Fringe Benefits
All Composite Rate
Notes: FICA
UNEMPLOY
RETIREMENT
HOSPITAL
LIFE INSURANCE
VISION
DENTAL
WORKERS COMP
SHORT/LONG TERM
DISABILITY
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County -City Central Services
9 Space Costs
Office Space Rental
1,0000
1221264.000
UnitsluOM
0.000 FTE
55,582 1221267.00
0
0.00001 0.0001 0.0001
10 All Others (ADP, Con. Employees, Misc.)
Total Program Expenses
(TOTAL DIRECT EXPENSES
INDIRECT EXPENSES
IIndirect Costs
1 IndirectCosts
2 Cost Allocation Plan I Other
I Total
1
1
1,221,264.00
1
678,805 00
1
1
1
1
1
1
39,627.001
1,939,696.001
1,939,696.001
Local Health Department - 2021, Dale 09/24/2020
Page: 139 of 197
Contract# Date: 09/24/2020
Line Item Qty
Rate Units UOM Total
Cost Allocation Plan 0.0000
0.000 0.000 144,842 00
Notes . 12 29%
Health Adm Distribution I 00000
0.0001 0.000I 229,062.00I
(Total for Cost Allocation Plan I Other
I 373,904MJ
(Total Indirect Costs
I 373,904,001
TTOTAL INDIRECT EXPENSES
I 373,904,001
(TOTAL EXPENDITURES
I 2,313,600.001
Local Health Department - 2021, Date; 09/24/2020 Page: 140 of 197
Contract # Date: 09/24/2020
1 Program Budget Summary
(PROGRAM / PROJECT
DATE PREPARED
Local Health Department - 2021 / MCH - All Other
9/24/2020
CONTRACTOR NAME
BUDGET PERIOD
Oakland County Department of Health and Human Services/
From 10/1/2020 To: 9/30/2021
Health Division
.
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
AMENDMENT #
1200 N Telegraph Rd.
0
34 East
r Original r Amendment
CIT(ZIP CODE
ATE I4
FEDERAL ID NUMBER
Pontiac MI 341-0432
38-6004876
Category
Total I
Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
181,859.00
181,859.00
2 Fringe Benefits
95,325.00
95,325 00
3 Cap. Exp. for Equip & Fac.
0,00
0.00
4 Contractual
0.00
0.001
5 Supplies and Materials
7,922.00
7,922.00
6 Travel _
5,313.00
5,313.00I
7 Communication
1,701.00
1,701.00I
8 County -City Central Services
0.00
0.00
9 Space Costs
0.00
0.00
10 All Others (ADP, Con, Employees, Misc.)
7,769.00
7,769.00
Total Program Expenses
299,889.00
299,889 00
TOTAL DIRECT EXPENSES
299,889 00
299,889 00
INDIRECT EXPENSES
Indirect Costs
1 I Indirect Costs
0.00
0.00
2 Cost Allocation Plan / Other
2,478,309.00
2,478,309.00
Total Indirect Costs
2,478,309.00
2,478,309.00
TOTAL INDIRECT EXPENSES
2,478,309 00
2,478,309 00
TOTAL EXPENDITURES
2,778,198.00
2,778,198.00
Local Health Department - 2021, Date: 09/24/2020 Page: 141 of 197
Contract# Date: 09/24/2020
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category I
Total I
Amount
Cash I
Inkind
t Source of Funds
II
!�
(Fees and Collections - 1st and 2nd I
0.00 I
0.00 I
0.00 i
000
Party
Fees and Collections - 3rd Party I
0.00 I
0.00 I
0,00 I
000
IFederal or State (Non MDHHS) I
0.00 I
0.00 !
0001
0.00
IIFederal Cost Based Reimbursement I
0.001
0.00 I
0.00 I
0.001
'
II Federally Provided Vaccines
0.00
0.00 I
0.00,
coo
!Federal Medicaid Outreach
0.00
0.00 I
0.00 I
0.00
I Required Match - Local I
0.00 I
0.00,
0.00
!
0.00
I(Local Non-ELPHS
0.00
000 I
000
0.00
I(Local Non-ELPHS
0.00
0.00 I
0.00 I
0.00 I
(Local Non-ELPHS I
0.00 I
0.00 I
0.00 I
0.00
(Other Non-ELPHS
0.00 i
0.00
0.00 Ij
0.00
MDHHS Non Comprehensive
0.00
0.00
0.00 I
0.00
MDHHS Comprehensive I
0.00
0.00 I
0.00
0.00
iMCH Funding I
321,457 00
321,457 00
000
000
ILocal Funds - Other I
2,456,741.00 I
0.00,
21456,741 00 (
000
Ilnkind Match I
000 I
0.00 I
0.00 I
0.00
MDHHS Fixed Unit Rate
ITotals I
2,778,198.00 I
321,457.00 I
2,456,741.00 I
0.00
Local Health Department- 2021, Date: 09/24/2020 Page: 142 of 197
Contract# Date: 09/24/2020
3 Program Budget - Cost Detail
Line Item I City l Rate UnitsIUOM
DIRECT EXPENSES
(Program Expenses
1 (Salary & Wages
Nutritionist/Dietician
INutritionist/Dietician
IPublic Health Nurse
ICoordinator
(OVERTIME
Total 'or Salary & Wages
2 Fringe Benefits
All Composite Rate
Notes: FICA, LIFE INS,
DENTAL, UNEMPLOYMENT.
VISION, WORK COMP,
RETIREMENT,
HOSPITALIZATION,
SHORT/LONG TERM
DISABILITY
3 Cap. Exp. for Equip & Fee.
4 Contractual
5 Supplies and Materials
Office Supplies
Printing
Educational Supplies
Client Support Materials
(Total for Supplies and Materials
6 (Travel
Mileage
Notes 7,500 miles @ .575
(Conferences
ITotalfor Travel
I7 (Communication
0.4808
69372.000
0.000
FTE
1,0000
63108.000
0.000
FTE
0.7164
72216.000
0 000
FTE
03750
76147.000
0.000
FTE
0.0481
106150.000
0.000
0.0000 52.417 181859 000
0.0000
0.000
0.000
0.0000
0.000
0.000
0,0000
0.000
0.000
0.0000
0.000
0,000
0.0000
0.000
0 000
0.0000
0 000
0.000
Total I
I
1
1
33,354.001
63,108.001
51,736.001
28,555 001
5,106.001
181,859.001
1
95, 325.00
25000
1,000.00
1,309.00
5,363 00
7,922.00
4,313.00
1,000.001
5,313.001
1
Local Health Department - 2021, Date 09/24/2020
Page: 143 of 197
Contract # Date: 09/24/2020
Line Item I City Ratel UnitsIUOM I Total
Telephone
1
0.00001
00001
0,0001
( 1,701.001
8 County -City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees,
Misc.)
Info Tech Operations
0.0000
0.000
0.000
6,436.001
Insurance
0.0000
0000
0.000
433.00I
Workshops & Meetings
0.0000
0.000
0.000
500.001
Interpretation Fees
0.0000
0 000
0.000
200,001
Periodicals Books Publications
0.0000
0,000
0,000
200.001
(Total for All Others (ADP, Con. Employees, Misc.)
7,769 001
ITotalProgram Expenses
299,889.001
(TOTAL DIRECT EXPENSES
299,889.001
INDIRECT EXPENSES
Ilndirect Costs
1 Indirect Costs
2 Cost Allocation Plan I Other
Cost Allocation Plan
0.0000
0,000
0.000
21,568.00
Notes: 12 29%
IHealth AdmDistribution
0.0000
0.000
0.000
36,043,001
Other Cost Distributions -Nursing
0.0000
0.000
0,000
2,389,013.00
Notes : This distribution takes
total costs of Field Nursing and
allocates them back to various
cost centers by a time study.
The % back to MCH Is 33.27%
(Nursing Adm Distribution
0.0000
0.000
0,000
7,620.001
Other Cost Distributions-
0,0000
0.000
0.000
24,065.00
Education
Notes : this distribution takes
total costs of Education and
allocates them back to various
cost centers by a time study.
The % back to MCH is .889 %
(Total for Cost Allocation Plan / Other
2,478,309.001
Local Health Department - 2021, Date: 09/24/2020
Page: 144 of 197
Contract# Date: 00/24/2020
(Line Item I Qtyl Ratel UnitslUOM Total
Total Indirect Costs 2,478,309.00
TOTAL INDIRECT EXPENSES 2,478,309.00
TOTAL EXPENDITURES 2,778,198.00
Local Health Department-2021, Date: 09/24/2020 Page: 146 of 197
C�7h1iF.LAE���F.T[a[iF.7`ZIYZrYir]
1 Program Budget Summary
PROGRAM / PROJECT
DATE PREPARED
Local Health Department -2021 / MDHHS-Essential Local
9/24/2020
Public Health Services (ELPHS)
CONTRACTOR NAME
BUDGET PERIOD
Oakland County Department of Health and Human Services/
From: 10/1/2020 To: 9/30/2021
Health Division
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
1200 N. Telegraph Rd
r Original I —Amendment
34 East
(CITY
(STATE
(ZIP CODE
FEDERAL ID NUMBER
Pontiac
MI
48341-0432
38-6004876
Category I Total I
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County -City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
INDIRECT EXPENSES
Indirect Costs
1 1 I Indirect Costs
2 Cost Allocation Plan / Other
Total Indirect Costs
1 TOTAL INDIRECT EXPENSES
TOTAL EXPENDITURES
0.00
0.00
0.00
0.00
0.00
0.00
000
0.00
0.00
0.00
r8i re
7,711,243.00
7,711,243.00
7,711,243.00
7,711,243.00
AMENDMENT#
0
1
Amount
1
1
0.00 1
0.00 1
0.001
0.00 1
0,001
0.00 I
0.00 1
0.001
0 00 1
0.00 1
0.001
7,711,243.00 1
7,711,243.00 1
7,711,243 00 1
7,711,243.00
Local Health Department - 2021, Date. 09/24/2020 Page: 146 of 197
Contract # Date: 09/24/2020
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
Fees and Collections - 3rd Party
Federal or State (Non MDHHS)
Federal Cost Based Reimbursement
Federally Provided Vaccines 1
Federal Medicaid Outreach
Required Match - Local
Local Non-ELPHS
Local Non-ELPHS
Local Non-ELPHS
Other Non-ELPHS
MDHHS Non Comprehensive -
MDHHS Comprehensive 2
MCH Funding
Local Funds - Other 3
Inkind Match
MDHHS Fixed Unit Rate
Total I Amount
0.00 0.00
0.00
0.00
0.00
000
0.00
0.00
,444,452 00
0,00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
000
0.00
0.00
0.00
0.00
0.00
0.00
,557,216.00
2,557,216.00
0.00
000
,709,575.00
0.00
0.00
0,00
Cash
Awl
000
0.00
0.00
1,444,452.00
0.00
0.00
0.00
000
0.00
0.00
0.00
0.00
0.00
3,709,575.00
000
Totals I 7,711,243.00 1 2,557,216.00 1 5,154,027.00
Inkind
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
000
0.00
000
000
0.00
000
0.00
W
Local Health Department - 2021, Date: 09/24/2020
Page 147 of 197
Contract # Date: 09/24/2020
3 Program Budget - Cost Detail
Line Item I
(DIRECT
Qtyl
EXPENSES
IProgrim Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
6 Supplies and Materials
6 Travel
7 Communication
8 County -City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees,
Misc.)
INDIRECT EXPENSES
Indirect Costs
' 1 Indirect Costs
2 Cost Allocation Plan I Other
Health Adm Distribution
0.0000
(Nursing Adm Distribution
0,0000
Other Cost Distributions-MISC
0.0000
Distributions
Federally Provided Vaccines
0.0000
Other Cost Distributions -Non
0,0000
Community Water & Std
(Total for Cost Allocation Plan I Other
(Total Indirect Costs
(TOTAL INDIRECT EXPENSES
ITOTAL EXPENDITURES
Rate UnitslUOM
Totall
0.000
0.000
181,422.001
0.000
0.000
59,258.001
0 000
0.000
4,459,892.00
0,000
0,000
1,444,452.001
0.000
0.000
1,566,219.00
7,711,243.001
7,711,243.001
7,71 1 ,243,001
7,711,243.001
Local Health Department - 2021, Date09/24/2020 Page: 148 of 197
Contract # Date09/24/2020
1 Program Budget Summary
PROGRAM / PROJECT
DATE PREPARED
Local Health Department -2021 / FIMR Interviews
9/24/2020
CONTRACTOR NAME
PERIOD
BUDGET D
Oakland County Department of Health and Human Services/
From : 10/To : 9/30/2021
Health Division
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
AMENDMENT #
1200 N. Telegraph Rd.
0
34 East
%Original (` Amendment
ICITY CODE
I4
76D NUMBER
Pontiac Ml 341-0432
38-60048ZIP
Category
I Total I
Amount I
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
000
000
2 Fringe Benefits
0.00
0.00
3 Cap. Exp. for Equip & Fac.
0.00
0.00
4 Contractual
0.00
0.00I
5 Supplies and Materials
0.00
0.00
6 Travel
0.00
0.00
7 Communication
0.00
0.00I
8 County -City Central Services
0.00
0.00
9 Space Costs
0.00
0.00
10 All Others (ADP, Con, Employees, Misc.)
0.00
0.00
INDIRECT EXPENSES
Indirect Costs
1 I Indirect Costs
0.00
0.00
2 Cost Allocation Plan / Other
2,000.00
2,00000
Total Indirect Costs
2,000.00
2,000.00
TOTAL INDIRECT EXPENSES
2,00000
2,000.00
TOTAL EXPENDITURES
2,000.00
2,000.00
Local Health Department - 2021, Date: 09/24/2020 Page: 149 of 197
Contract# Date 09/24/2020
(Line Item I Qtyl Rate UnitsIUOM Total
(TOTAL INDIRECT EXPENSES-3,296,493.001
(TOTAL EXPENDITURES 1,335,847,001
Local Health Department - 202 1, Date: 09/24/2020 Page. 178 of 197
Contract # Date: 09/24/2020
1 Program Budget Summary
PROGRAM! PROJECT
DATE PREPARED
Local Health Department - 20211 WIC Breastfeedinq
9/24/2020
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
BUDGET PERIOD
Health Division
From : 10/PERIO To : 9/30/2021
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
1200 N. Telegraph Rd.
�Fy,
34 East
Original r Amendment
(CITY (STATE (ZIP CODE (FEDERAL
ID NUMBER
Pontiac MI 48341-0432
38-6004876
Category
I Total I
DIRECT EXPENSES
Program Expenses
1 I Salary & Wages
2 I Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 I Supplies and Materials
6 1 Travel
7 1 Communication
8 1 County -City Central Services
9 Space Costs
10 I All Others (ADP, Con. Employees, Misc.)
Total Program Expenses
iTOTAL DIRECT EXPENSES
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 I Cost Allocation Plan / Other
Total Indirect Costs
TOTAL INDIRECT EXPENSES
TOTAL EXPENDITURES
AMENDMENT#
0
i
Amount I
84,764.00
84,764.001
J 33,117.00
33,117.001
0.00
0,00
J73,397.00
73,397.00
7,459.00
I
7A59
00
2,725.00
2,725.00
II
j 3,853.00
II
j
3,853.00
000
I+
0.00
0.00
I
0.00
3,831
00
3,831.00
209,146.00
209,146.00
209,146.00
I
209,146.00
1
0.00
0.00
34,140.00
34,140.00
34,140.00
I
34,140.00
34,140.00
I
34,140
00
243, 286.00
I
243, 286.00
Local Health Department - 2021, Date: 09/24/2020 Page: 179 of 197
Contract # Date: 09/24/2020
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
Fees and Collections - 3rd Party
Federal or State (Non MDHHS)
Federal Cost Based Reimbursement
Federally Provided Vaccines
Federal Medicaid Outreach
Required Match - Local
Local Non-ELPHS
Local Non-ELPHS
Local Non-ELPHS
Other Non-ELPHS
MDHHS Non Comprehensive
MDHHS Comprehensive
MCH Funding
Local Funds - Other
Inkind Match
MDHHS Fixed Unit Rate
Totals
Total I Amount I Cash I
0.00
000
0.00
0.00
0.00
0.00
0.00
0.00
000
0.00
0.00
0.00
0.00
000
0.00
000
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
000
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
219,199.00
219,199 00
0.00
0.00
0.00
0.00
24,087.00
0.00
24,087 00
0.00
0.00
0.00
243,286.00 1 219,199.00 1 24,08700
Inkind
0.00 1
0.00
000
000
0.00
0.00
0.00
000 I
000
0.001
0.00 I
0.00 I
0.00
0.001
0.00
Local Health Department - 2021, Dale 09/24/2020
Page 180 of 197
Contract# Date 09/24/2020
3 Program Budget - Cost Detail
(Line Item I City)
IDIRECT EXPENSES
(Program Expenses
1 (Salary & Wages
Lactation Specialist
Lactation Specialist
(Lactation Specialist
Lactation Specialist
IN utritionist/Dietician
INutritionist/Dietician
(Total for Salary & Wages
1 2 Fringe Benefits
All Composite Rate
Notes : FICA
UNEMP INS
RETIREMENT
HOSPITAL INS
LIFE INS
VISION INS
DENTAL INS
WORKCOMP
SHORT/LONG TERM
DISABILITY
3 Cap. Exp. for Equip & Fac.
4 Contractual
Subcontracting Agency-OLSHA
5 Supplies and Materials
Office Supplies
Printing
Medical Supplies
Postage
Educational Supplies
(Total for Supplies and Materials
I6 ITravel
Local Health Department- 2021, Date. 09/24/2020
Rate UnitsIUOM
1.0000
31223 000
0 000
FTE
0.4808
31224.000
0.000
FTE
0,4808
31224.000
0,000
FTE
0.4808
31224.000
0.000
FTE
0,0962
69341,000
0,000
FTE
0.0264
69475.000
0,000
FTE
0.0000 39 070 84764.000
0.00001
0.0001
0.0001 1
0.0000
0,000
0.000
0.0000
0.000
0,000
0.0000
0 000
0.000
0.0000
0.000
0.000
0.0000
0.000
0.000
Total l
31,223.001
15,012,00iI
15,012.001
1
15,012001
1
6,671.0011
1,834.001
84,764 001
1
33,117.00
73, 397.00
750,00
1,617 00
4,000.001
481.001
611.001
7,459.001
Page: 181 of 197
Line Item
Qty
Mileage
0.0000
Notes: 3,000 miles @ .575
Conferences
0,0000
ITotalfor Travel
1 7 Communication
Telephone Communications
I
0.00001
8 County -City Central Services
1 9 Space Costs
10 All Others (ADP, Con. Employees,
Misc.)
Insurance
0.0000
(Advertising
0,0000
1 Staff Training
0.0000
Interpretation
0,0000
(Total for All Others (ADP, Con. Employees, Misc.)
(Total Program Expenses
(TOTAL DIRECT EXPENSES
_
IINDIRECT EXPENSES
Ilndirect Costs
1 Indirect Costs
1 2 Cost Allocation Plan / Other
Cost Allocation Plan
0,0000
Notes: 12.29%
Health Adm Distribution
0.0000
(Total for Cost Allocation Plan / Other
(Total Indirect Costs
(TOTAL INDIRECT EXPENSES
(TOTAL EXPENDITURES
Rate
0.000
0,000
0.000
0,000
0.000
0,000
0.000
Contract #
Date: 09/24/2020
Units l UOM
Total
0.000
1.725.001
ME
B
0.000
0.000
0,000
0 000
0.000 0.000
0,000 0.000
1,000.00
2,725.00
3,853.00
300 001
1,000.001
2,331,001
200.001
3,831 001
209,146.001
209,146.001
1
1
1
1
10,053.00
24,087 001
34,140, 001
34,140.001
34,140, 001
243,286.001
Local Health Department- 2021, Date: 09/24/2020
Page 182 of 197
Contract # Date: 09/24/2020
1 Program Budget Summary
PROGRAM / PROJECT
DATE PREPARED
Local Health Department - 2021 / WIC Resident Services
9/24/2020
CONTRACTOR NAME
BUDGET PERIOD
Oakland County Department of Health and Human Services/
From : 10/1/2020 To : 9/30/2021
Health Division
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
1200 N Telegraph Rd.
ry Original r Amendment
34 East
CITY
(STATE
IZIP CODE
FEDERAL ID NUMBER
Pontiac
MI
48341-0432
38-6004876
Category
I Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
1,028,098.00
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County -City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Total Program Expenses
TOTAL DIRECT EXPENSES
INDIRECT EXPENSES
Indirect Costs
1 I Indirect Costs
2 1 Cost Allocation Plan / Other
Total Indirect Costs
TOTAL INDIRECT EXPENSES
TOTAL EXPENDITURES
666,290.00
M8
581,820.00
26,334.00
4,353.00
13,437.00
4 rr
86,672.00
86, 934.00
2,493,938.00
2,493,938.00
r rr
479,572.00
479,572.00
479,572.00
2,973,510.00
AMENDMENT#
0
Amount
1,028,098.00
666,290.00
0.00
581,820.00
26,334.00
4,353.00
13,437.00
000
86,672.00
86,934 00
2,493,938.00
2,493,938 00
0.00 1
479,572001
479, 572.00 1�
479,572.00 I
2,973,610.00
Local Health Department-2021, Date 09/24/2020 Page: 183 of 197
Contract # Date: 09/24/2020
2 Program Budget- Source of Funds
SOURCE OF FUNDS
Category
1 Source of Funds
Fees and Collections - 1 at and 2nd
Party
Fees and Collections - 3rd Party
Federal or State (Non MDHHS)
Federal Cost Based Reimbursement
Federally Provided Vaccines
Federal Medicaid Outreach
Required Match - Local
Local Non-ELPHS
Local Non-ELPHS
Local Non-ELPHS
Other Non-ELPHS
MDHHS Non Comprehensive
MDHHS Comprehensive 2,
MCH Funding
Local Funds - Other
Inkind Match
MDHHS Fixed Unit Rate
Total I Amount
0.00 0.00
0.00
0.00
0.00
000
000
0.00
0.00
000
0.00
0.00
0.00
0.00
0,00
0.00
0.00
000
0.00
000
0.00
0.00
0.00
0.00
615,870.00
2,615,870.00
0.00
0.00
357,640.00
0.00
0.00
0.00
Totals 2,973,510.00 1 2,615,870.00
Cash
� ��
0.00
000
0.00
0.00
0.00
000
0.00
0.00
0.00
0.00
000
0.00
0.00
357,640.00
000
357,640.00 I
Inkind
0.00
0.00
0.00
0.00
0.00
0.00
0.00
000
0.00
0.00
0.00
0.00
0.00
I,
0.00
000
0.00
Local Health Department - 2021, Date: 09/24/2020 Page184 of 197
Contract # Date. 09/24/2020
3 Program Budget - Cost Detail
(Line Item I City
DIRECT EXPENSES
Program Expenses
1 (Salary & Wages
Supervisor
(Supervisor
Supervisor
IOutreach Worker
(Outreach Worker
IOutreach Worker
(Outreach Worker
IOutreach Worker
IOutreach Worker
IOutreach Worker
(Technician
(Technician
(Technician
(Technician
Technician
ITechnician
INutritionisUDieticlan
INutrltionist/Dietician
INutritionisUDieticlan
INutritionist/Dietician
IHealth Educator
(OVERTIME
Total for Salary & Wages
2 Fringe Benefits
All Composite Rate
Notes: FICA
Unemployment Ins
Retirement
1 0000
1.0000
1.0000
1.0000
1,0000
1.0000
10000
1.0000
10000
1.0000
1,0000
1.0000
1 0000
1,0000
1,0000
1.0000
0.9038
1.0000
1.0000
1.0000
1.0000
0.1803
r rrr�
Rate
80011.000
51190.000
61871.000
44217.000
44217.000
33951.000
36002.000
36002.000
40110.000
38058.000
46573.000
37925.000
40089.000
46573.000
35762.000
46573.000
64870.000
61871,000
61871.000
68016.000
45837.000
70716,000
UnitsIUOM
0,000 FTE
0.000 FTE
0,000 FTE
0.000 FTE
0 000 FTE
0,000 FTE
0.000 FTE
0.000 FTE
0.000 FTE
0.000 FTE
0.000 FTE
0 000 FTE
0.000 FTE
0 000 FTE
0.000 FTE
0 000 FTE
0,000 FTE
0,000 FTE
0.000 FTE
0.000 FTE
0.000 FTE
0.000 FTE
64.808 1028098.00
0
Total
80,011.001
51,190.001
61,871.001
44,217.0011
44,217.001
33,951.001
36,002 001
36,002.0011
40,110 001
38,058.001
46,573.001
37,925.00111
40,089.001
46,573 001
35,762.001
46,573 001
58,630.001
61,871,001
61,871.001
68,016.001
45,837.001
12,749.00
1,028,098.00
666, 290.00
Local Health Department - 2021, Dale: 09/24/2020
Page: 185 of 197
'
Line Item
Qty
Hospital Ins.
Life Ins.
Vision Ins.
Hearing Ins.
Dental Ins.
Work Comp
Short/Long Term Disability
3
Cap. Exp. for Equip & Fac.
4
Contractual
Subcontracting Agency-OLSHA-
0.0000
WIC svcs in Oakland Co
Notes : Average caseload 3065
@ $180/client
5
Supplies and Materials
Office Supplies
0.0000
Medical Supplies
0.0000
Educational Supplies
0.0000
Postage
0,0000
Printing
0.0000
Materials & Supplies
0.0000
Computer Supplies
0.0000
(Total
for Supplies and Materials
6
Travel
Mileage
0.0000
Notes : 6,700 miles @ .575
(Conferences
00000
ITotal
for Travel
7
Communication
Telephone I
0 00001
8
County -City Central Services
9
Space Costs
Space/Rental Costs I
0.00001
I10
All Others (ADP, Con. Employees,
Misc.)
I
Insurance I
0.00001
Contract # Date: 09/24/2020
Rate Units UOM Totall
0.000 0.000 581,820.00
0.000
0,000
5,575001
0,000
0.000
9,659.001
0,000
0.000
5,000001
0.000
0.000
850.001
0.000
0.000
4,000.001
0.000
0.000
500 001
0.000
0.000
750.001
26,334.001
0.000
0.000
3,853.00
0.000
0.000
500001
4,353.001
0.0001 0.0001 1 13,437.00
00001 0.0001 I 86,672.00
0.0001 0.0001 I 3,580.00
Local Health Department-2021, Date. 09/24/2020 Page: 186 of 197
Contract #
Dale09/24/2020
Item
Qty
Rate
Units UOM
Total
(Line
Equipment Repair
00000
0.000
0 000
950.001
Info Tech Print Managed Svcs
0.0000
0.000
0.000
5,750.001
IT Operatons
00000
0.000
0 000
72,804.00
(Advertising
0.0000
0.000
0.000
1,000.00
(Staff Training
00000
0,000
0.000
1,00000
(interpretation
0.0000
0.000
0.000
400.001
(Laundry & Cleaning
0.0000
0.000
0.000
850.001
IExpendableEquipment
0.0000
0,000
0000
500.001
(Freight & Express
0.0000
0.000
0.000
100.001
(Total for All Others (ADP, Con. Employees, Misc.)
86,934,001
(Total Program Expenses
2,493,938.001
(TOTAL DIRECT EXPENSES
2,493,938.001
II+
(INDIRECT EXPENSES
Ilndirect Costs
1 Indirect Costs
�
2 Cost Allocation Plan I Other
Cost Allocation Plan -
0.0000
0.000
0.000
121,932.001
Notes: 12.29%
1
Health Adm Distribution -
0.0000
0.000
0,000
287,448,001
Other Cost Distributions-Misc
0,0000
0 000
0.000
70,192 00
Distributions
(Total for Cost Allocation Plan / Other
479,572 00
(Total Indirect Costs
479,572.001
(TOTAL INDIRECT EXPENSES
479,572.001
TOTAL EXPENDITURES
2,973,610.001
Local Health Department - 2021, Date: 09/24/2020 Page: 187 of 197
Contract # Date. 09/24/2020
1 Program Budget Summary
PROGRAM / PROJECT
DATE PREPARED
Local Health Department - 2021 / West Nile Virus
9/24/2020
Community Surveillance
CONTRACTOR NAME
BUDGET PERIOD
Oakland County Department of Health and Human Services/
From : 5/1/2021 To : 9/30/2021
Health Division
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
1200 N. Telegraph Rd.
ry Original (` Amendment
34 East
CITY
(STATE
(ZIP CODE
FEDERAL ID NUMBER
Pontiac
MI
48341-0432
38-6004876
Category
I Total
1 DIRECT EXPENSES
Program Expenses
1 Salary & Wages
4,868.00
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6
Travel
7
Communication
8
County -City Central Services
1 9 Space Costs
10 All Others (ADP, Con Employees, Misc.)
1 Total Program Expenses
TOTAL DIRECT EXPENSES
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
1 2 1 Cost Allocation Plan / Other
Total Indirect Costs
1 TOTAL INDIRECT EXPENSES
TOTAL EXPENDITURES
3,16800
0.00
0.00
1,373.00
0.00
0.00
0.00
0.00
14.00
9,423.00
9,423.00
M
1,676.00
1,67600
1,676.00
11,099.00
AMENDMENT#
0
Amount I
4,868.00 1
3,168.001
0,001
0.001 1
1,373 00 1
0.001
M
0.00 1
0.001
14001
9,423.001 1
9,423.00 1
0.00 1
1,676 00 1
1,676.001
1,676.00 1
11,099.001
Local Health Department - 2021, Date 09/24/2020 Page: 188 of 197
Contract #
Date: 09/24/2020
2 Program Budget- Source of Funds
SOUZCE OF FUNDS
Category I
Total I
Amount I
Cash I
Inkind
1 Source of Funds
1
Fees and Collections - 1st and 2nd
0.00
0.00
0.00
0.00 1
Party
Fees and Collections - 3rd Party
0.00
0.00
0.00
0.00 1I
Federal or State (Non MDHHS)
0.00
0.00
0.00
0.00 I
Federal Cost Based Reimbursement
0.00
0.00
0.00
0.00
Federally Provided Vaccines
000
0.00
000
0.00
Federal Medicaid Outreach
0.00
0.00
0.00
0.00
Required Match - Local
000
0.00
000
0.00 1�
Local Non-ELPHS
0.00
0.00
0.00
000
Local Non-ELPHS
000
0.00
0.00
0.00 )
Local Non-ELPHS
0.00
000
0.00
0001
Other Non-ELPHS
000
0.00
000
0.00 1
MDHHS Non Comprehensive
0.00
000
0.00
0,001
MDHHS Comprehensive
10,000.00
10,000.00
0.00
0.00 1
MCH Funding
0.00
000
0.00
0.001
Local Funds - Other
1,099,00
0.00
1,099.00
0.00
Inkind Match
0.00
0.00
0.00
0.00
MDHHS Fixed Unit Rate
Totals I
11,09900I
10,000.00 I
1,09900 I
0.00
Local Health Department - 2021, Date: 09/24/2020 Page: 189 of 197
Contract # Date09/24/2020
3 Program Budget - Cost Detail
(Line Item I
Cityl
(DIRECT EXPENSES
(Program Expenses
1
Salary & Wages
Sanitarian
0.0336
(Technician
0.0447
(Total for Salary & Wages
2 Fringe Benefits
All Composite Rate
0.0000
Notes: FICA, UNEMP INS,
RETIREMENT, HOSP INS, LIFE
INS, VISION INS, HEARING
INS, DENTAL INS, WORK
COMP, SHORT/LONG TERM
DISABILITY
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Testing Materials
I
0.00001
6 Travel
7 Communication
8 County -City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees,
Misc.)
Insurance I
0,00001
(Total Program Expenses
(TOTAL DIRECT EXPENSES
IINDIRECT EXPENSES
Ilndirect Costs
1 Indirect Costs
2 Cost Allocation Plan I Other
Cost Allocation Plan
0.0000
Notes: 12 29%
Rate UnitslUOM
73950.000 0.000 FTE
53303,000 0000
65.078 4868 000
0.0001 00001
Total l
2,485.001
2,383,001
4,868.001
I
3,168.00
I
I
I
1,373.001
I
0.0001 0.0001 14.00
9,423.00
9,423.00
0,0001 0.0001 I 577.00
Local Health Department - 2021, Date: 09/24/2020 Page' 190 of 197
Contract # Date: 09/24/2020
Line Item Clty Rate Units
Tota
(Health AdnnDistribution 0.0000 000 0000IUOM 1,099.00,
Total for Cost Allocation Plan I Other 1,676,001
(Total Indirect Costs 1,676.001
(TOTAL INDIRECT EXPENSES 1,676.001
TTOTAL EXPENDITURES I 11,099.0011,
Local Health Department - 2021, Date: 09/24/2020 Page: 191 of 197
Contract # Date: 09/24/2020
1 Program Budget Summary
PROGRAM / PROJECT
DATE PREPARED
Local Health Department - 2021 / EGLE Drinking Water and
9/24/2020
Onsite Wastewater Manaqement
CONTRACTOR NAME
BUDGET PERIOD
Oakland County Department of Health and Human Services/
From : 10/1/2020 To 9/30/2021
Health Division
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
AMENDMENT #
1200 N. Telegraph Rd.
ry Original r Amendment
0
34 East
CITY (Pontiac
ZIP CODE
I48341-0432
FEDERAL ID NUMBER
Ml
386004876
Category
I Total I
Amount 1�
DIRECT EXPENSES
I
Program Expenses
1 Salary & Wages
0.00
0.00
2 Fringe Benefits
0.00
000
3 Cap. Exp. for Equip & Fac.
0.00
0.00
4 Contractual
0.00
0.00I
5 Supplies and Materials
0.00
0.00
6 Travel
0.00
000
7 Communication
000
000
8 County -City Central Services
0.00
000
9 Space Costs
0.00
0.00
10 All Others (ADP, Con. Employees, Misc.)
0.00
0.00
INDIRECT EXPENSES
l
Indirect Costs
1
Indirect Costs
000
0.00
2
Cost Allocation Plan / Other
2,569,002.00
2,569,002.00
Total Indirect Costs
2,569,002.00
2,569,002 00
TOTAL INDIRECT EXPENSES
2,569,002.00
2,569,002.00
TOTAL EXPENDITURES
2,569,002.00
2,569,002.00
Local Health Department- 2021, Date 09/24/2020 Page. 192 of 197
Contract # Date 09/24/2020
2 Program Budget - Source of Funds
OF FUNDS
(SOURCE
I Category
I Total I
Amount I
Cash I
Inkind'
1 Source of Funds
7
Fees and Collections - 1st and 2nd
1
0.00
000
0.00 I
0.00
Party
(Fees and Collections - 3rd Party I
0.00
0.00
0.00 I
0.00
( Federal or State (Non MDHHS) ,
0.00 I
0.00 I
0,001
0.001
IFederal Cost Based Reimbursement I
0.00 I
0.00 I
0.00 I
0.00
II Federally Provided Vaccines I
0.00I
0.00
!
000,
0.00'
IIFederal Medicaid Outreach I
0.00 I
0.00
0.00 I
0.00 I
IIRequired Match - Local '
0,00
0.00 I
000 I
0.00 I
I(Local Non-ELPHS I
JI
0,00 I
0.00 I
0.00 I
0.00 I
I(Local Non-ELPHS
000 I+
0.00 I
0.00
000 I
I(Local Non-ELPHS I
0.00
0.00 I
0.00
0.00
IiOther Non-ELPHS I
0.00
0.00 I
0.00
0.00
IIMDHHS Non Comprehensive I
0.00
0.00
0,00
0,00 I
IIMDHHS Comprehensive - I
985,042.00
985,04200
0.00 I
0.00I
IIMCH Funding I
0.00 I
0.00 I
000 I
0.00
IILocal Funds - Other I
1,583,960.00 I
000 I
1,583,960,00 I
0.00
linkind
IMatch I
0.00 I
0.00 I
000 I
0.00
I MDHHS Fixed Unit Rate
IITotals I
2,569,002.00 I
985,042.00 I
1,583,960.00 I
0.001
Local Health Department - 2021, Date, 09/24/2020 Page. 193 of 197
CQTiTI'F.LSFi��F.iia[49f'k!£I�Y_��7
3 Program Budget -Cost Detail
l lLine Item l Cityl
1DIRECT EXPENSES
Progrm Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4
Contractual
1 5
Supplies and Materials
6
Travel
7
Communication
1 8
County -City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
(INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan I Other
Environmental Hlth Adm 0.0000
Distribution
IHealth AdmDistribution 0.0000
(Other Cost Distributions-Misc 00000
Distribution
(Total for Cost Allocation Plan I Other
(Total Indirect Costs
(TOTAL INDIRECT EXPENSES
TTOTAL EXPENDITURES
Rate UnitslUOM I Totall
1
1
1
11
lI
I
0000 0.000 1,762,582.00
0.000 0 000 657,790.00
0.000 0.000 148,630.00
2,569,002.001
2,569,002 001
2,569,002.001
2,569,002.001
Local Health Department - 2021, Date 09/24/2020 Page: 194 of 197
Contract # Date 09/24/2020
Summary of Budget
PROGRAM / PROJECT
PREPARED
DATE DATE020
Local Health Department - 2021 / Local
Health Department - 2021
CONTRACTOR NAME
BUDGET PERIOD
PERT OD
Oakland County Department of Health and
From: 10 0 To : 9/30/2021
Human Services/ Health Division
11
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
#
1200 N. 34 East Telegraph Rd.
i✓ Original C' Amendment
(AMENDMENT
0
CITY (STATE ZIP CODE
48341-
FEDERAL ID NUMBER
Pontiac MI
0432
38-6004876
Category
Total
Amount
DIRECT EXPENSES
(Program Expenses
I
11 Salary & Wages
19,961,874.00
19,961,874.001
12 Fringe Benefits
10,105,566.00
10,105,566.001
13 Cap. Exp. for Equip & Fac.
5,606.00
5,606.00
14 Contractual
2,118,056.001
2,118,056.00
15
ISupplies and Materials
1,814,050.00
I
1,814,050.00
16
ITravel
338,431.00
338,431.00
17
(Communication
424,400.00
424,400.00
I8
ICounty-City Central Services
0.00
I
0.00
19
ISpace Costs
1,209,714.00
1,209,714.00I
110 IAII Others (ADP, Con. Employees, Misc.)
3,295,592.00
3,295,592.00
(Total Program Expenses I
39,273,289.00
39,273,289.00
TOTAL DIRECT EXPENSES 1
39,273,289.00
I
39,273,289.00
IINDIRECT EXPENSES
Ilndirect Costs
11
Indirect Costs
1,363,701.00
1,363,701.00
12 Cost Allocation Plan / Other
4,335,159.00
4,335,159.00
Local Health Department-2021, Date. 09/24/2020
Page: 105 of 197
Total Indirect Costs
TOTAL INDIRECT EXPENSES
TOTAL EXPENDITURES
5,698,860.00
5,698,860.00
44,972,149.00
Contract # Date 09/24/2020
5,698,860.001
5,698,860.001
44,972,149.00 I
SOURCE OF FUNDS
Category
Total
Amount
Cash
Inkind
1
Fees and Collections - 1st
4,424,519.00
0.00
4,424,519.00
0.00�
and 2nd Party
(Fees and Collections - 3rd
241,000.00
0.00�
241,000.00
I
0.00
f
I2
Party
3
Federal or State (Non
2,258,791.00
I
0.00
1
2,258,791.00
0.00
MDHHS)
lReFederal
I O.00i
0.00I
0.001
0.00
I4
mbursementsed
+5
IFederally Provided Vaccines
11,444,452.001
0.00
1,444,452.001
0.001
�6
iFederal Medicaid Outreach 111158,403.00i
1,158,403.0
0.00
0.00
II
II
0
I7
(Required Match - Local 11,214,053.001
0.00
1,214,053.00
0.001
18
ILocal Non-ELPHS I
0.001
0.00
0.001
0.001
19
Local Non-ELPHS
0.00
0.00
0.001
0.001
110
Local Non-ELPHS
0.00
0.001
0.00
0.001
I11
Other Non-ELPHS
0.00
0.001
0.00
0.001
112
(MDHHS Non Comprehensive
0.00
0.001
0.00
0.001
I13
(MDHHS Comprehensive
14,205,606.0
14,205,606.
0.00
0.00
14
MCH Funding
321,457.00
321,457.00
0.00
0.00
I15
Local Funds - Other
19,371,816.0
0.00
19,371,816.0
0.00
0
0
116
Ilnkind Match I
0.001
0.001
0.001
0.00
Local
Health Department- 2021, Date: 09/24/2020
Page: 106 of 197
Contract # Date. 09/24/2020
17 MDHHS Fixed Unit Rate 332,052.00 332,052.00 0.00 0.00
TOTAL 44,972,149.0 16,017,518. 28,954,631.0 0.00
0 00 0
Local Health Department-2021, Date 09/24/2020 Page. 197 of 197
ATTACHMENT
MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES
Local Health Department Agreement
October 1, 2020- September 30, 2021
Fiscal Year 2021
INSTRUCTIONS
FOR THE
ANNUALBUDGET
INSTRUCTIONS FOR THE ANNUAL BUDGET FOR LOCAL HEALTH DEPARTMENT SERVICES
TABLE OF CONTENTS
Paqe
I.
INTRODUCTION............................................................................................................2
II.
MINIMUM BUDGETING REQUIREMENTS...................................................................2
Ill.
REIMBURSEMENT CHART............................................................................................3
IV.
LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION
PROCEDURES., ................................................ .. ... ...
4
V.
FORM PREPARATION - GENERAL...............................................................................4
VI.
FORM PREPARATION - EXPENDITURE CATEGORIES..............................................4
VIL
FORM PREPARATION - SOURCE OF FUNDS..............................................................7
Vill.
SPECIAL BUDGET INSTRUCTIONS
A. Public Health Emergency Preparedness(PHEP)...................................................10
B. WIC.........................................................................................................................10
C. Family Planning.....................................................................................................12
D. Breast and Cervical Cancer...................................................................................13
E. CSHCS Outreach and Advocacy...........................................................................15
F. Program Budget Detail- Cost Detail Schedule Preparation.....................................16
G. Medicaid Outreach Activities Reimbursement Procedures.....................................20
H. Michigan Colorectal Cancer -Screening Program...................................................25
I. Immunization 317 and VFC Allowable Expenditures..............................................26
1
INSTRUCTIONS FOR THE
ANNUAL BUDGET
FOR LOCAL HEALTH SERVICES
INTRODUCTION
The Annual Budget for Local Health Services is completed on a state fiscal year basis and is
used to establish budgets for many Department programs. In the Annual Budget, the Department
consolidates many of its categorical programs' funding and Essential Local Public Health
Services (ELPHS) (formerly known as the local public health operation's funding) into a single,
Comprehensive Agreement for local health departments. The Department's Plan and Budget
Framework serves as a principal reference point for budget development.
The Annual Budget for Local Health Services must be completed in accordance with and adhere
to the established requirements as specified in these instructions and submitted to the
Department as required by the agreement.
MINIMUM BUDGETING REQUIREMENTS
A. Cost Principles - Types or items of cost which will be considered for reimbursement are
generally consistent with definitions contained in Title 2 Code of Federal Regulations CFR,
Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements
for Federal Awards.
B. Federal Block Grant Funds - Maternal & Child Health and Preventive Health Block Grant
funds may not be used to: provide inpatient services; make cash payments to intended
recipients of health services; purchase or improve land; purchase, contract or permanently
improve (other than minor remodeling defined as work required to change the interior
arrangements or other physical characteristics of any existing facility or installed
equipment when the cost of the remodeling incident does not exceed $2,000) any building
or other facility; or purchase major medical equipment (any item of medical equipment
having a unit cost of over $10,000 and used in the diagnosis or treatment of patients,
excluding equipment typically used in a laboratory); satisfy any requirement for the
expenditure of non-federal funds as a condition for the receipt of Federal funds; or provide
financial assistance to any entity other than a public or nonprofit private entity.
C. Expenditure and Fundina Source Breakdown - For purposes of development, analysis
and negotiation activities must be budgeted at the individual expenditure and funding
source category level on the Annual Budget for Local Health Services.
D. Special Budget Requirements for Certain Cateaorical Proaram Elements - The
Annual Budget for Local Health Services is completed in the MI E-Grants System
through the application budget to include details for all program elements (excluding
Administration and Grantee Support).
E. Local MCH - Local MCH funds can be used to support the health of women, children,
and families in communities across Michigan. Funding addresses one or more Title V
Maternal and Child Health Block Grant national and state priority areas and/or a local
MCH priority need identified through a needs assessment process. Priority areas are
developed into Local MCH Work Plans which are described in the Annual Local MCH
Plan. These funds are to be budgeted as a funding source in two project categories.
The Local MCH projects need to be budgeted separately. Please note only two LMCH
project titles can be used:
MCH — Children
MCH — All Other
These funding sources cannot be used under the WIC element except in extreme
circumstances where a waiver is requested in advance of expenditures, and evidence
is provided that the expenditures satisfy all funding requirements. Local health
departments are encouraged to select only one to two performance measures and
delve deeper into the strategies in an effort to "move the needle."
III. REIMBURSEMENT CHART
A. Program Element/Fundina Source
The Program Element/Funding Source column has been moved to Attachment III and
provides the listing of all currently funded MDHHS programs that are included in the
Comprehensive Local Health Department Agreement.
B. Tvpe of Proiect
The type of project designation is indicated by footnote and is used if the project meets the
Research and Development Project criteria. Research and Development Projects are
defined by Title 2 CFR, Section 200.87, Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards.
Research and development (R&D) means all research activities, both basic and applied,
and all development activities that are performed by non -Federal entities. Research is
defined as a systematic study directed toward fuller scientific knowledge or understanding
of the subject studied. The term research also includes activities involving the training of
individuals in research techniques where such activities utilize the same facilities as other
research and development activities and where such activities are not included in the
instruction function. Development is the systematic use of knowledge and understanding
gained from research directed toward the production of useful materials, devices, systems,
or methods, including design and development of prototypes and processes.
C. Reimbursement Chart
The Reimbursement Chart notes elements/funding sources, applicable payment methods,
target levels, output measures for each program/element having a performance
reimbursement option. In addition, the chart also provides the subrecipient, contractor, or
recipient designations, as in prior years:
IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION
PROCEDURES
As in past years, no additional accounting system detail is being required beyond local uniform
accounting procedures prescribed by the Michigan Department of Treasury, Local Financial
Management System requirements, documentation requirements of categorical program funding
sources and any local requirements. Some agencies may already have separate cost centers in
their accounting system to directly identify costs and related funding of required services, but
such breakdowns are not essential to being able to meet minimum reporting requirements if
proper allocation procedures are used and adequate documentation is maintained. All
allocations must have clearly measurable bases that directly apply to the amounts being
allocated, must be documented with work papers that will provide an adequate audit trail and
must result in a representative reporting of costs and funding for affected programs. More
specific guidance can be found in Title 2 CFR, Part 200 Appendix V State/Local Government and
Indian Tribe -Wide Central Service Cost Allocation Plans and the brochure published by the
Department of Health and Human Services entitled "A Guide for State, Local and Indian Tribal
Governments: Cost Principles and Procedures for Developing Cost Allocation Plans and Indirect
Cost Rates for Agreements with the Federal Government.
V. FORM PREPARATION - GENERAL
The MI E-Grants System on-line application, including the budget entry forms, are utilized to
develop a budget summary for each program element administered by the local Grantee. The
system is designed to accommodate any number of local program elements including those
unique to a particular local Grantee. Applications, including budget forms, are completed for all
program elements, regardless of the reimbursement mechanism, including Agency
administration(s) fee for service program elements, categorical program elements, performance -
based program elements and Medicaid Outreach associated program elements. Budget entryis
required for each major expenditure and source of fund categories for which costs/funds are
identified.
VI. FORM PREPARATION -EXPENDITURE CATEGORIES
Budaeted expenditures are to be entered for each program element, project or group of
services by applicable major category.
A. Salaries and Waaes- This category includes the compensation budgeted for all permanent
and part-time employees on the payroll of the Grantee and assigned directly to the program.
This does not include contractual services, professional fees or personnel hired on a private
contract basis. Consulting services, vendor services, professional fees or personnel hired on a
private contracting basis should be included in "Other Expenses." Contracts with secondary
recipient organizations such as cooperating service delivery institutions or delegate agencies
should be included in Contractual (Sub -contract) Expenses.
B. Frinae Benefits - This category is to include, for at least the specified elements, all Grantee
costs for social security, retirement, insurance and other similar benefits forall permanent and
part-time employees assigned to the specified elements.
C. Can Exp for EauiD & Fac -This category includes expenditures for budgeted stationary and
movable equipment used in carrying out the objectives of each program element, project or
service group. The cost of a single unit or piece of equipment includes necessary
accessories, installation costs, freight and other applicable expenses associated with the
purchase of the equipment. Only budgeted equipment items costing $5,000 or more may be
reported under this category. Small equipment items costing less than $5,000 are properly
classified as Supplies and Materials or Other Expenses. This category also includes capital
outlay for purchase or renovation of facilities.
D. Contractual (Subcontracts/Subrecit)ient) - Use for expenditures applicable to written
contracts or agreements with secondary recipient organizations such as cooperating service
delivery institutions or delegate agencies. Payments to individuals for consulting or
contractual services, or for vendor services are to be included under Other Expenses. Specify
subcontractor(s) address, amount by subcontractor and total of all subcontractors.
E. Supplies and Materials - Use for all consumable items and materials including equipment -
type items costing less than $5,000 each. This includes office, printing, janitorial, postage and
educational supplies; medical supplies; contraceptives and vaccines; tape and gauze;
prescriptions and other appropriate drugs and chemicals. Federal Provided Vaccine Value
should be reported and identified on in Other Cost Distributions category. Do not combine
with supplies.
F. Travel - Travel costs of permanent and part-time employees assigned to each program
element. This includes costs of mileage, per diem, lodging, meals, registration fees and other
approved travel costs incurred by the employee. Travel of private, non -employee consultants
should be reported under Other Expenses.
G. Communication Costs - These are costs for telephone, Internet, telegraph, data lines,
websites, fax, email, etc., when related directly to the operation of the program element.
H. County/City Central Services -These are costs associated with central support activities of
the local governing unit allocated to the local health department in accordance with Title 2
CFR, part 200.
I. Space Costs -These are costs of building space necessary forthe operation of the program.
J, All Others (Line 111 - These are costs for all other items purchased exclusively for the
operation of the program element and not appropriately included in any ofthe other categories
including items such as repairs, janitorial services, consultant services, vendor services,
equipment rental, insurance, Automated Data Processing (ADP) systems, etc.
K. Total Direct Expenditures — The MI E-Grants System sums the direct expenditures
budgeted for each program element, project or service grouping and records in the Total
Direct Expenditure line of the Budget Summary.
L. Indirect Cost— These cost categories are used to distribute costs of general administrative
operations that have not been directly charged to individual subrecipient programs. The
Indirect Cost expenditures distribute administrative overhead costs to each program element,
project or service grouping. Two separate local rates may apply to the agreement period (i.e.,
one for each local fiscal year). Use Calendar Rate 1 to reflect the rate applicable to the first
part of the agreement period and Calendar Rate 2 for the rate applicable to the latter part.
Indirect costs are not allowed on programs elements designated as vendor relationship
An indirect rate proposal and related supporting documentation must be retained for audit in
accordance with records retention requirements. In addition, these documents are reviewed
as part of the Single Audit, subrecipient monitoring visit, or other State of Michigan reviews.
Following is further clarification regarding indirect rate and/or cost allocation approval
requirements to distribute administrative overhead costs, in accordance with Title 2 CFR Part
200 (formerly Circular A-87 2 CFR Part 225, Appendix E), for Local Health Departments
budgeting indirect costs:
1. Local Health Departments receiving more than $35 million in direct Federal awards are
required to have an approved indirect cost rate from a Federal Cognizant Agency. If your
Local Health Department has received an approved indirect rate from a Federal Cognizant
agency, attach the Federal approval letter to your MI E-Grants Grantee Profile.
2. Local Health Departments receiving $35 million or less in direct Federal awards are
required to prepare indirect cost rate proposals in accordance with Title 2 CFR and
maintain the documentation on file subject to review.
3. Local Health Departments that received approved indirect cost rates from another State of
Michigan Department should attach their State approval letter to their MI E-Grants
Grantee Profile.
4. Local Health Departments with cost allocation plans should reflect these allocations in the
Other Cost Distributions budget category. See Section M. Other Cost Distribution for
budgeting guidance.
5. As a Subrecipient of federal funds from MDHHS, a Local Health Department that has
never received a negotiated indirect cost rate, your Local Health Department may electto
charge a de minimis rate of 10% of modified total direct costs (MTDC) based on Title 2
CFR part 200 requirements.
MTDC includes all direct salaries and wages, fringe benefits, supplies and materials,
travel, services, and contractual expenses up to the first $25,000 of each contract. MTDC
excludes all equipment, capital expenditures, charges for patient care, rental costs, tuition
remission, scholarships and fellowships, participant support costs, and portions
subcontractual/subaward expenses in excess of $25,000 per contract.
Attach a current copy of the letter stating the applicable indirect costs rate or calculation
information justifying the de minimis rate calculation to you MI E-Grants Grantee profile.
Detail on how the indirect costs was calculated must be shown on the Budget Detail,
Schedule.
The amount of Indirect Cost should be allocated to all appropriate program elements with the
total equivalent amount reflected as a credit or minus in the Administration projects.
M. Other Cost Distributions — Use to distribute various contributing activity costs to appropriate
program areas based upon activity counts, time study supporting data or other reasonable
and equitable means. An example of Other Cost Distributions is nursing supervision. The
distribution process permits costs reflected in a single program element to be subsequently
distributed, perhaps only in part, to other programs or projects as appropriate. If an allocation
is made, the charges must be reflected in the appropriate program element and the offsetting
credit reflected in the program element being distributed. There must be a documented,
well-defined rationale and audit trail for anv cost distribution or allocation based upon.
Title 2 CFR. Part 200 Cost Principles Local Health Departments using the cost distribution
or cost allocation must develop the plan in accordance with the requirements described in
Title 2 CFR, Part 200, Local Health Departments should maintain supporting documentation
for audit in accordance with record retention requirements. The plan should include a
Certification of Cost Allocation plan in accordance with Title 2 CFR, Part 200 Appendix V. The
cost allocation plan documentation is not required to be submitted unless specifically
requested.
Cost associated with the Essential Local Public Health Services (ELPHS), Maternal and Child
Health (MCH) Block Grant and Fixed Fee may be budgeted in the associated program
element and distributed to the associated projects.
Federal Provided Vaccine Value should be reported on a separate line and clearly identified.
N. Total Direct & Admin. Expenditures — The MI E-Grants System sums the indirect
expenditures program element and records in the Total Indirect Expenditure line of the Budget
Summary,
O. Total Expenditures —The MI E-Grants System sums the direct and indirect expenditures and
records in the Total Expenditure line of the Budget Summary.
VII. FORM PREPARATION -SOURCE OF FUNDS
Source of Funds are to be entered for each program element, project or group of services by
applicable major category as follows:
A. Fees & Collections - Fees list & 2nd Party—
L 1st party funds projected to be received from private payers, including patients, source
users and any member of the general population receiving services.
ii. 2nd party funds received from organizations, private or public, who might reimburse
services for a group or under a special plan.
iii. Any Other Collections
B. Fees & Collections - 31d Partv — 3rd Party Fees - Funds projected to be received from private
insurance, Medicaid, Medicare or other applicable titles of the Social Security Act directly
related to the cost of providing patient care or other services (e.g., includes Early Periodic
Screening, Detection and Treatment [EPSDT] Screening, Family Planning.)
C. Federal/State Fundinct (Non-MDHHSI - Funds received directly from the federal government
and from any state Contractor other than MDHHS, such as the Department of Natural
Resources and Environment (MDNRE). This line should also be used to exclude state aid
funds such as those provided through the Michigan Department of Treasury under P.A. 264 of
1987 (cigarette tax).
D. Federal Cost Based Reimbursement — Funds received for Federal Cost Based
Reimbursement which should be budgeted in the program in which they were earned.
E. Federally Provided Vaccines — The projected value of federally provided vaccine.
F. Federal Medicaid Outreach — (Please note: to be used only for Medicaid Outreach, CSHCS
Medicaid Outreach or Nurse Family Partnership Medicaid Outreach program elements.)
Funds projected to be received from the federal government for allowable Medicaid Outreach
activities. This amount represents the anticipated 50% federal administrative match of local
contributions.
G. Reauired Match - Local — Funds projected to be local contribution for programs that have
a match contribution requirement (Please note: for Medicaid Outreach, CSHCS Medicaid
Outreach, or Nurse Family Partnership Medicaid Outreach, this amount represents the 50%
matching local contribution for allocable Medicaid Outreach Activities. Federal Medicaid
Outreach and Required Local match amounts should equal each other.)
H. Local Non-ELPHS - Local funds budgeted for the following expenditures:
1. Expenditures for services not designated as required and allowable for ELPHS funding
(e.g., medical examiner and inpatient maternity services); expenditures determined notto
be reasonable; and, expenditures in excess of the maximum state share of funds
available.
2. Any losses arising from uncollectible accounts and other related claims. Under -recovery
of reimbursable expenditures from, or failure to bill, available funding sources that would
otherwise result in exclusions from ELPHS funding, if recovered.
However, no exclusion is required where the local jurisdiction has made and documented
a decision to have local funds underwrite:
a. The cost of uncollectible accounts or bad debts incurred in support of providing
required or allowable health services. An example of this condition would be for
services provided to indigents who are billed as a matter of procedure with little chance
for receipt of payment.
b. Potential recoveries or under -recoveries from other sources for the principal purpose of
providing required and allowable health services at free or reduced cost to the public
served by the Grantee. An example would be keeping fees for services at a reduced
level for the benefit of the people served by the Grantee while recognizing that to do so
limits recovery from third parties for the same types of services.
3. Contributions to a contingency reserve or any similar provisions for unforeseen events.
4. Charitable contributions and donations.
5. Salaries and other incidental expenditures of the chief executive of a political subdivision
(i.e., county executive and mayor).
6. Legislative expenditures, such as, salaries and other incidental expenditures of local
governing bodies (i.e., county commissioners and city councils). Do not enter board of
health expenses.
7. Expenditures for amusements, social activities and other incidental expenditures related
to, such as, meals, beverages, lodging, rentals, transportation and gratuities.
8. Fines, penalties and interest on borrowings.
9. Capital Expenditures - Local capital outlayfor purchase of facilities and equipment (assets)
are excluded from ELPHS funding.
I. Other Non- ELPHS - Funds budgeted from sources other than state, federal and local
appropriations to the extent that they are not eligible for ELPHS (e.g., funding from local
substance abuse coordinating grantee, local area on aging grantees).
J. MDHHS - NON -COMPREHENSIVE - Funds budgeted for services provided under separate
MDHHS agreements. Examples include funding provided directly by the Community
Services for Substance Abuse for community grants, etc.
K. MDHHS - COMPREHENSIVE - This section includes all funding projected to be due under
the Comprehensive Agreement from categorical programs and needs to equal the allocation.
L. ELPHS - MDHHS Hearina — This section includes all funding projected to be due under
Comprehensive Agreement specific to the ELPHS MDHHS Hearing program and has to equal
the MDHHS ELPHS Hearing allocation. Additional ELPHS to be budgeted for the Hearing
Program must be entered into ELPHS — MDHHS Other. Hearing allocations may only be
spent on the Hearing Program.
M. ELPHS - MDHHS Vision — This section includes all funding projected to be due under
Comprehensive Agreement specific to the ELPHS MDHHS Vision program and has to equal
the ELPHS MDHHS Vision allocation. Additional ELPHS to be budgeted for the Vision
Program must be entered into ELPHS — MDHHS Other. Vision allocations may only be spent
on the Vision Program.
N. ELPHS — MDHHS Other — This section includes all funding projected to be due under
Comprehensive Agreement specific to the ELPHS MDHHS Other program for eligible program
elements. Please note: The MI E-Grants System validates the ELPHS MDHHS Other
budgeted funds across the applicable program elements to assure the agreement does
exceed the ELPHS — MDHHS Other allocation.
O. ELPHS — Food - This section includes all funding projected to be due under Comprehensive
Agreement specific to the ELPHS Food program and has to equal the ELPHS Food allocation.
P. ELPHS — Drinkinq Water - This section includes all funding projected to be due under
Comprehensive Agreement specific to the ELPHS Drinking Water program and has to equal
the ELPHS Drinking Water allocation.
Q. ELPHS — On -site Sewaae - This section includes all funding projected to be due under
Comprehensive Agreement specific to the ELPHS On -site Sewage program and has to equal
the ELPHS On -site Sewage allocation.
R. MCH Fundina - This section includes all funding projected to be due under Comprehensive
Agreement specific to the MCH eligible program elements. Please note: The MI E-Grants
System validates the MCH budgeted funds across applicable program elements to assure the
agreement does exceed the MCH allocation.
S. Local Funds - Other - Enter all local support in the appropriate element, project or service
group column. This may include local property tax, and other local revenues (does not include
fees).
T. Inkind Match — Enter Local Support from donated time or services.
U. MDHHS Fixed Unit Rate — Select the type of fee -for -services from the lookup to correspond
with the program element.
Vlll. SPECIAL BUDGET INSTRUCTIONS
Certain elements are supported by federal or other categorical program funds for which special
budgeting requirements are placed upon grantees and subgrantees. These include:
Element Federal or Other Fundinq Contractor
Public Health Emergency U.S. Department of Health & Human Services, Centers for
Preparedness Disease Control
WIC U.S. Department of Agriculture, Food & Nutrition Service
Family Planning U.S. Department of Health & Human Services, Public Health
Service
Breast and Cervical U.S. Department of Health & Human Services, Centers for
Cancer Disease Control
CSHCS Outreach & Michigan Department of Health & Human Services
Advocacy
Medicaid Outreach Centers for Medicare and Medicaid Services
Activities
In general, subgrantee budgets must provide sufficient budget detail to support grantee budget
requests and be in a format consistent with grantor Contractor requirements. Certain types of
costs must receive approval of the federal grantor Contractor and/or the grantee prior to being
incurred.
A. Public Health Emerqencv Preparedness (PHEP1 Special Budget Requirements
Local Health Departments will receive the initial FY 20/21 allocation of the CDC Public
Health Emergency Preparedness (PHEP) funds in nine equal prepayments for the period
October 1, 2020 through June 30, 2021. LHDs must submit a nine -month budget and a
quarterly Financial Status Report (FSR) foreach of the following COMPREHENSIVE Local
Health Department program elements:
1. Public Health Emergency Preparedness (PHEP) (October 1 — June 30)
2. Public Health Emergency Preparedness (PHEP)— Cities of Readiness (October 1 —
June 30)
3. Laboratory Services - Bioterrorism (October 1 — September 30)
B. WIC Special Budget Requirements
1. Cost/Fundina Cateqories - The following local budget breakdowns are required to
fulfill WIC grant application budget requirements each fiscal year:
Salaries & Fringe Benefits
in
Automated Management Systems
Space Utilization Costs
Equipment
Supplies
Communications & Travel
All Other Direct Costs
Indirect Costs
All Funding Sources by Type
The WIC cost/funding categories and supporting budget detail requirements are
satisfied by completion of an application budget form in the MI E-Grants System.
General instructions for these forms are contained at the end of this section.
Agencies receiving WIC -USDA Infrastructure grants must budget these funds as a
separate element. Agencies must track and report expenditures separately on the
FSR.
Agencies receiving WIC -USDA Breastfeeding Peer Counselor funds must budget
these funds as a separate element. Agencies must track and report expenditures
separately on the FSR. And comply with special reporting requirements.
2. Costs Allowable Only With Prior Approval - The following costs are allowable only
with prior review/approval of the Michigan Department of Health & Human Services as
specified by the U.S. Department of Agriculture, Food and Nutrition Service (Ref.: 7
CFR Part 246, and USDA -WIC Administrative Cost Handbook 3/86). Prior approval is
accomplished by providing appropriate detail in the budget request approved by
MDHHS or subsequently in a written request approved in writing by MDHHS.
A. Automated Information Svstems - which are required by a local Grantees except
for those used in general management and payroll, including acquisition of
automated data processing hardware or software whether by outright purchase or
rental -purchase agreement or other method of acquisition.
B. Caoital Exoenditures of $2.500 or More - such as the cost of facilities, equipment,
including medical equipment, other capital assets and any repairs that materially
increase the value or useful life of capital assets.
C. Manaaement Studies - performed by agencies or departments other than the local
Grantee or those performed by outside consultants under contract with the local
Grantee.
D. Accountino and Auditino Services - performed by private sector firms under
professional service contracts for purposes of preparation or audit of program and
financial records/reports.
E. Other Professional Services - rendered by individuals or organizations, not a part
of the local Grantee, such as:
1. Contractual private physician providing certification data.
2. Contractual organization providing laboratory data.
3. Contractual translators and interpreters at the local Grantee level.
11
F. Trainina and Education - provided for employee development, which directly or
indirectly benefits the grant program, to the extent that such training is contracted
for or involves out -of -service training over extended periods of time.
G. Buildina Space and Related Facilities - the cost to buy, lease or rent space in
privately or publicly owned buildings for the benefit of the program.
H. Non-Frinqe Insurance and Indemnification Costs
All charges to WIC must be necessary, reasonable, allowable and allocable for
the proper and efficient administration of the program. Further information and
cost standards are provided in federal instructions including Title 2 CFR, Part 200
and 7 CFR Part 3015.
C. Family Plannina Special Budaet Requirements
Cost/Fundina Catectories - The following local budget breakdowns are required to
fulfill Family Planning grant application budget requirements each fiscal year:
Salaries & Wages
Fringe Benefits
Travel
Equipment
Supplies
Contractual
Construction
All Other Direct Costs
Indirect Costs
All Funding Sources by Type
The Family Planning cost/funding categories and supporting budget detail
requirements are satisfied by completion of an application budget in the MI E-Grants
System. General instructions for these forms are contained at the end of this section.
2. Costs Allowable Only With Prior Approval - The following costs are allowable only
with prior review/approval of MDHHS. Prior approval is accomplished by providing
appropriate detail in the budget request approved by MDHHS or subsequently in a
written request approved in writing by MDHHS.
A. Alterations and Renovations - to change the interior arrangements or other
physical characteristics of existing facilities or installed equipment, to the extent
that such changes cost more than $1,000 each.
B. Audiovisual Materials and Activities - acquired, produced, presented, or
disseminated to the general public.
C. Consultant Contracts for General Support Services - including equipment and
supplies, that will cost in excess of $25,000 or 10% of the total direct cost budget
(whichever is greater).
D. Equipment - including general purpose and special equipment (e.g., air
conditioning) costing $5,000 or more per unit.
E. Insurance - contributions to a reserve for a self-insurance program.
12
F. Public Information Service Costs — for the cost of providing public information
services.
G. Publication and Printina Costs - for the cost of publications.
H. Caoital Expenditures - for land or buildings.
I. Indemnification Against Third Parties Costs.- insurance against potential liabilities.
J. Mass Severance Pav - involving grant -supported personnel.
K. 0roan ization/Reorganization Costs - allocable to the program.
L. Overtime Premium - involving grant -supported personnel.
M. Patient Care Costs — re -budgeting out of or reduction in patient care costs
(considered a change in scope).
N. Professional Services - in connection with Patent/Copyright Infringement
Litigation.
O. Trailers or Modular Units — for costs of trailers and modular units.
P. Transfers Between Construction and Non -construction -for approved construction
funds.
Q. Transfers Between Indirect and Direct Costs - for amounts awarded for indirect
costs to absorb increases in direct costs.
R. Transfers for Substantive Programmatic Work - to a third party, by contracting, or
any other means used for the actual performance of substantive programmatic
work.
All charges to Family Planning must be necessary, reasonable, allowable, and
allocable, for the proper and efficient administration of the program. Further
information and cost standards are provided in federal instructions including 2 CFR,
Part 225 (OMB Circular A-87), A-102 Common Rule and 2 CFR, Part 215 (OMB
Circular A-110)
D. Breast and Cervical Cancer Control Coordination Proaram Soecial Budget,
Requirements
i. The Breast and Cervical Cancer Control Navigation Program (BCCCNP) budget is
to be developed in the following way:
BCCCNP Coordination should be used to budget costs associated with
coordination of the program in assuring implementation of all minimum program
requirements and policies and procedures. Only coordination expenses will be
reimbursed through the Comprehensive Agreement. All Direct Service claims,
including MTA Navigation Services and Navigation -Only Services, must be billed to
the MDHHS Cancer Prevention and Control Section for claim processing. The
Local Coordinating Agency (LCA) and/or direct service providers with contracts or
letters of agreement with the LCA will be responsible for billing Direct Service
claims to the MDHHS Cancer Prevention and Control Section. No Direct Services
or MTA Navigation or Navigation -Only Service expenses will be reimbursed
through the Comprehensive Agreement.
13
The Coordination amount $200 per woman based on a target caseload established
by MDHHS.
There is no longer a match requirement. Match is recorded by the program and
reported to MDHHS.
For specific billing requirements refer to the most recent BCCCNP Billing
Manual. For specific program requirements, including current fiscal year
Direct Service Reimbursement Rates and documentation related to the match
requirement, refer to the current fiscal year Special Budgeting and Other
Program Instructions for the BCCCNP issued in August of each fiscal year.
The above referenced documents are available at
www.michioancancer.ora/BCCCNP.
2. The Well -Integrated Screening and Evaluation for Women Across the Nation
(WISEWOMAN) budget is to be developed in the following way:
WISEWOMAN Coordination and Screening should be used to budget costs associated
with coordination of the program and delivery of the initial screening and risk reduction
counseling to WISEWOMAN participants. This includes administration and
interpretation of health risk instrument, WISEWOMAN screening services (height,
weight, body mass index, 2 blood pressure readings, total cholesterol, HDL
cholesterol, and glucose or Al C), and delivery of risk reduction counseling.
All Direct Service claims must be billed to the MDHHS Cancer Prevention and Control
Section for claim processing. The Local Coordinating Agency (LCA) and/or direct
service providers with contracts or letters of agreements with the LCA will be
responsible for billing Direct Service claims to the MDHHS Cancer Prevention and
Control Section. This includes follow-up fasting lipid panel, fasting glucose, A1c, and
one diagnostic exam. No Direct Services expenses will be reimbursed through the
Comprehensive Agreement.
The Coordination and Screening amount is $200 per woman based on a target
caseload established by MDHHS.
Performance reimbursement will be based upon the understanding that a certain level
of performance (measured by outputs) must be met. There is a 95% caseload
performance requirement for this project.
For specific billing requirements refer to the most recent Billing Manual. For
specific program requirements, including current fiscal year Direct Service
Reimbursement rates and documentation related to the match requirement, refer
to the current fiscal year Special Budgeting and other Program instructions for
the WISEWOMAN Program issued in August of each fiscal year. The above
referenced documents are available at www.michigan.gov/cancer.
14
E. Children's Special Health Care Services (CSHCS1 Outreach and Advocacv - The
program element, titled CSHCS Outreach and Advocacy should be used to budget costs
associated with this program.
I. Proaram Budaet - Online Detail Budget Application Entry
Complete the appropriate budget forms contained within the MI E-Grants System for each
program element. An example of this form is attached (see Attachment 1 for reference).
Salary and Waaes -
a. Position Description - Select from the expenditure row look -up all position titles or
job descriptions required to staff the program. If the position is missing from the
list, please use Other and type in the position in the drop -down field provided.
b. Positions Reauired - Enter the number of positions required for the program
corresponding to the specific position title or description. This entry may be
expressed as a decimal (e.g., Full -Time Equivalent — FTE) when necessary. If
other than a full-time position is budgeted, it is necessary to have a basis in terms
of time reports to support time charged to the program.
c. Amount —The MI E-Grants System calculates the salary for the position required
and records it on the Budget Detail. Enter this amount in the Amount column.
d. Total Salary —The MI E-Grants System totals the amount of all positions required
and records it on the Budget Summary.
e. Notes - Enter any explanatory information that is necessary for the position
description. Include an explanation of the computation of Total Salary in those
instances when the computation is not straightforward (i.e., if the employee is
limited term and/or does not receive fringe benefits).
2. Frinae Benefits — Select from the expenditure row look -up applicable fringe benefits
for staff working in this program. Enter the percentage for each. The MI E-Grants
system updates the total amount for salary and wages in the unit field and calculates
the fringe benefit amount. If the "Composite Rate" fringe benefit item is selected from
the expenditure row look up, record the applicable fringe benefit items (i.e. FICA, Life
insurance, etc.) in the "Notes" tab.
3. EauiDment- Enter a description of the equipment being purchased (including number
of units and the unit value), the total by type of equipment and total of all equipment
purchases.
4. Contractual - Specify subcontractor(s)/subrecipient(s) working on this program,
including the subcontractor's/subrecipient's address, amount by
subcontractor/subrecipient and total of all subcontractor(s)/subrecipient(s). Multiple
small subcontracts can be grouped (e.g., various worksite subcontracts).
5. SuuDlies and Materials - Enter amount by category. A description is required if the
budget category exceeds 10% of total expenditures.
6. Travel - Enter amount by category. A description is required if the budget
category exceeds 10% of total expenditures.
7. Communication - Enter amount by category. A description is required if the
15
budget category exceeds 10%B of total expenditures.
8. County -City Central Services -Enter amount by category and total for all categories.
9. Space Costs - Enter amount by category and total for all categories.
10. Other Expenses - Enter amount by category and total for all categories. A
description is required if the budget category exceeds 10% of total expenditures.
11. Indirect Cost Calculation - Enter the base(s), rate(s) and amount(s).
12. Other Cost Distributions - Enter a description of the cost, percent distributed to this
program and the amount distributed.
13. Total Exp. - MI E-grants totals the amount of all positions required and records it on
the Budget Summary.
F. Program Budget -Cost Detail Schedule Preparation
131 Attachment 131-Proaram Budaet Summary
:Agency ABC Health Dapadmenl
Program
6omprehensivehgreement FY20Xf(
APPLOto. Eamlly Plannlog Benlcsa SAMPLE
Chow Daeonnenis
ialool"of � CeN&aLons i Bad'0 '
ldlacxllnneoo, ; loda. 1X
civae
'e��O Ci Vanda[v I'I,�
�POF Rg COPr
LShow➢e� 11Il�J
Budges Summary
DIRECT EXPENSES
Program Expanaaa
Salary&Cdpges
83,41900
83,41900
000
0,00
FFoap Denefts
34,202.00;
34,202001,
0.00:
000
GaP EaP (or E4Jp & Fac
1oat,lftndl
I
0
Snppllea and vloanala
1 23,275001
III
2327500I
000
aon [�
Travel
3.340 GO:
3,34000�
000'1
000 FRI
COI11mgr'.Uon
7,262001
7,262.60:
000'1
1, 000
I> .... t',GIB, Cont.
Spaca Cosls
10,13100:
10,131A0
0001
1i 000 El
.Al OtWrs(ADP, Can Eniplayeos, iMOc
3,89400i
3,69400,
000'1
0001
Total Program Expenses
165,523001:
165,62300',
00011
000
TOTAL DIRECT EXPENSES
165523001,i 1,
iG052300',
0001i
000'
INDIRECT EXPEH SES
mmreet costa
Indnerl Cods
2940500111 1
19,40500,1
0001
0001
Other l:oils Olsfnhutmns
_—
1,68500',; 1,
e0
00011
0.001,
Total Indirect Costs
31,096 GO,: 1
31,0900011 ----
--000111
00011
TOTAL INDIRECT EXPENSES
31,0900011
31,090001i
00011
0001
TOTAL EXPENDINRES
I06813 DO1i 1
196,61100f;
O.00I
00011 -
16
Source of Funds
ABanry ABC Health DapV,etanl
P roan Co pehenaNG
Ay m t f1 .0 hk
t appl¢allen Family Plann109 ervlWs BAMpLE
-
ShoNDOcumonLl
F , ry i L 1 PMII[eLons putl9el 1.115cBllane0uk Intlex
--
FX Close,
O Sbvee 05evb; Lri YallJele r (j - COPY
t,5h—Trae j[I(,I
$OnICa O(fpIN19
(TOTAL E%PEUDITURES
196,61300
JOO
090i
196.61306
; SOVraa Ol FMtls
Fees and C11ledI0n8-let and 2n0 PaM
0 00 i
000
000�
000III p
h Fa9, xntl CmlecA0ns 31d Pat1V
OJ0
66,JJ0 OO
OOO
6d,OW.OD Q J j
Federal Or Stale Ilion UDCH)
000'
GOO!
000„
pu0',
Y Federal C,,It Baeed Ralmdureemenl
000
19,00000
000
19,00000
(Federally ProNdetl Vacane,
000,1
0001,
0091
OOO
Fade,al l ledrtald Oupead,
0Goj
OOO
DOD
000'
Requlredl.Ialch LOC31 '
000'i
000'
000
O00„
'Local 11m ELPHS
U00 1
0001
coo 1
0001 m _
L0eal Plop-ELPHS
090
_ 900I
0001
OOOI 0
OIOe, NmELPHS
0,00
000II
000
0,00, Ej
I,IDCHIfo6 Comprahaneire
000'
000
0001
OOG ✓3 -
>- MUCH ComprehenalVa
65 613001
0001
060
86,813 G01 0
ELPHS-41DCHHeating
0Do!
000',
Goo,
0Do ci
ELPHS-MUCH VIalOn
00&1
000
000,
000 Q _
(ELPHS -IdOCH ON.,
010, j
OOp',
000I
00011 0
ELPHS-F00d
OGO!
0.00°,
000'
000
ELPHS- DOngng Olale, _
COO(
00011 _
000
0.0011 C7
�ELPHS-On-S11a Saivage
DDiv 1
00,
DPO,
ODO
FI
�CH Funding
0001
GDo
a00"i
000 G
> LOCal F111d,-01her
0001
44,60004i
coo,
44800 UOi [}
'Ilnl Intl l,IalU
Goo!
0,00'
0001I
0Go
IR@CH Head Unit Rate
1 - - - ---
0001
0DO!
000
000. j
17
B2 Attachment 82-Proaram Budaet Cost Detail
- - --- --- ------------- - -
IA9ency ABC HeaItNDepadma0l ProgramCompfebenaNe Agreement-FY 20 k1(
NppllCagon Family Planning SeMces SAMPLE
FoeasNeel CertlfihMhxrs I endear I INseallanevuf too..
■Bare ■Sorer dVa Gdale LI 91CI Q, Cvpyl
Budget Detail
Crown,' Program Expanses - Salary d Ws es T)ye Fxpendllufe
CldesdlCdtlan Seg 1 Sub Type Dlad
Instructions Saba the pedwn descrpllon Idenllly the gnnntry Be FrEs Menhy the fall as average coal per Fre
slmwlTronnenis
X Clvnv
g show lies. 1 (r )
IlaffdllYe
1■�I,I , I
iw,� y
� „i il„ JWYxy
❑ X ipurse Padllloner IE) 0191
91600000[FTE ❑,
17,29000
17,290 o01 000 000 L.-1
❑ X 1 Pub11C Health Nurse - is _ _ _ 0461
3493243DIFTE ❑,
16,06900
16,06900, 0,00, 000 e)
❑> Ceordindt0r is 041,
5103600DIFTE r❑',,
20S2500',
20,925 DO: 000 sea L)
❑XliCled; It E) I09I
26729240'IFTE 0,
20,13500
20,135001 0.00' 000 e)
■Sere ■sago C7 VUIWaIe Fj— PPDF Qn'-1 CapY
Lei Snvw I-I)(I)
real Detail
,Program Expenses- Cap End for Cquip S Fee
Type
'Elpendllum
�Calegoty
COC.11lCaLon See 11
Sub Type
IDlred
ranou'ukhmi
_---
Eeugmenlbde(med ea the cost of a smgla FeroveWed a155,000
or mg, and Me a useful
of mom than
— —_—I4anain. _
one yea, Costa should lncNde lee tlem and any
whodhle o"aneea ench as neellabbn male mamtedmre lees
at, new rnstmg noes
men ss 000 agent he entered Imo Na eupolea end maladals Ins
❑
❑
o
e)
n safe 10 Save hot Va Dram ISp P MF I ED Copy
Ii snow Trav `l f i)
Budget Detail
Categoy
PrhOam Expenses-CDOOCAUM
T}pe Expendnom
Ctasadrypi'm Seg
1
Sub Type Direct
Nau.Wa
tuslrudipns
Ieonirncuml rotors to xund" map Mmgenmbmns only Pke aenlarele
onnteel mldmrehnn
Conauhanls end euppodmA sernCe suhconlmds aM1ouM da budOebaE untler0o o0mr e.pmse Imo
in ■=ave.o C11 Vallslale rOLPOF]COpY
Budgetgetall
Category 'Program Expenses- Supplies and Malenale
Classlfcallon deg 1 I Laval r, t-mo Bem OCalegery
Imondona OeeslM1alcmtlem.0an5`.,000
o',
n, PI
Type Erpendloge
Sub Type Thred Noo.lNe 0
❑ >"Pnneng
rJ
toe DD
10000:
ga
Poe
O
TD000'
10000',
Sava< C2Velidatvi CIE �LPDF Qm Cvpy
Budget Detail
CslegCC. Program EtpCoOos-T..el
Type:
EapendlWa
'.. Classification Seg' 1 Level G)Llne Item! I Crow,
Sub Type
IDirect
I, 1nswNpns I
❑ X
3,00000 1
3,00000'
❑ >' IConmances
340001
340001
000 coo
000 coo ei
L snow free (i 1 (i)
gaframe' Cj
II Lu��
000 cool
000 000 eJ
18
O Save 0 �Valldate LI= wPDF Qad Copy
Budget Damll
Cate9enr Pmgram Openses-Cammunlcatlon Type PpandlWre
ClasalOcatle"o, :1 Level Line Item.(.Category _ Sub Ty0e Dow
b Shaw Triteli)j�l
1_lafraWe
-
El IOme- � - __—
__-
)26_Ga , zznz CD:,
I�n ,,
GDG oGG etlotones
and Tunes
---
—
-
e5ara Vaginal. I
IOPDF Qly copy
I li Shaw Tree) f./ I rj
Budget Dotal
Calegery 'Program Eepenses- Counb-Clly
Central Senlces ',
ida. Expenditure
Cleadl hon Seq : 1,1 Level
Line Ilan I ICalag0p'
SUb TypeDlmct
llauabVe 0
El
E)l
❑ 1
e 5aye LgSave I NJT V. lidam l LJ_ ' ISPPDF 14h CaPY
IG show Treat
Budget Detail
Category Program Etpensee - Spate Coats
Type Etpendilure
ClasslG[abon 3eq <DLinellin QCalegol}'
—
B07,P. 'Dl,.0
llanoWe
Insuagbons'
---_ - -__--- --_
IR nl
- ..I6.923GGG
� G923 aG1 U0;
CgG i'_7
ri Diber - - - _ -
IQ
000 000 IT.1
Iluatlea
a Saye 18 Santa LqVa hdatil Fi"""' jPPDF 4$ijSml
Ile show Tr eel ` l�
Butlget Detall
Category :Program Expenses-Mi Olhem IROP, Con Employees, Idler,
Type 6pendlWra
Claranktlon Sol 't Level it Llneltem ()Categgr/
Snb Type Dart
Napam.
Inatrudlons
&J'itug(A Milk
El } Su Mces --�-
OOI_ 2.2J9.n0I
2300
OGO _ _ 000 EpJ~
—-
} IL bFees
0 000 �' 3GG OOI
000 OGO {dl
n }"nmcr
on inn DO
nnn nnn Nl
e SavajInill e^ ld Velldnr� I a: ., ., I LRPDF I III] Cnpv
t•5lrow� (tl of
Budget Detall
--
rCategory: rallied Costs-Indimtl Costs
Type Erpenditure
ClasslAcatlon Bee 13 :
Bub Type Incited
NarrsllVa. 0
damni0ne
❑ O1176210-- Do: ILJ
ElT I�Fiscal Year Rate -- 25DOG � 29A0500 - 001 000 0,I L_J
C Sayo ESaee4 C�Validale I��PDFCopy IE Shpw tree (�1I (11
goagal0atall _
Caiegmy Indimd Costs-DNer Costs Dlsllibullons Type 'Expenditure
Classl0cabon Son 3 Sub Ttpe. Inclined 1_larrabre
madrudlons
p c
rim l Ill ahAam0laln title. _ --' I, 1685001 lci 'c -- - - 05Do ❑
19
G. Medicaid Outreach Activities Reimbursement Procedures
Medicaid Outreach Activities that are funded by local dollars and meet federal requirements are
eligible for reimbursement at a 50% federal administrative match rate. Local Health Departments
must maintain proper documentation of the activities performed and those activities must conform
with the activities outlined in MSA Bulletin 05-29. Medicaid Outreach Activities funding is a
subrecipient relationship.
I. Budaet Preparation
A. Medicaid Outreach Activities
Complete the MI E-Grants application and budget forms for the application Medicaid
Outreach Activities that occur during the fiscal year: 10/1-09/30. Reimbursable activities
included in the budget must conform to the requirements as specified in the MSA Bulletin 05-
29. Complete the MI E-Grants application and budget forms for this program.
1. Exoenditure Cateaory Tab
Enter the expenditures budgeted for the fiscal year: 10/01-09/30. Expenses budgeted
for each of the listed expenditure categories are allowable and must be specific to the
Medicaid program as described in MSA Bulletin 05-29. Outreach activities must not be
part of direct service. Expenditures must be reflected in the cost allocation plan.
2. Source of Funds Tab
Budget the amount expected from the federal government for allowable Medicaid
Outreach Activities. Federal Medicaid Outreach represents the anticipated 50%
federal administrative match of local contributions. Budget the local contribution.
Required Match - Local represents the 50% matching local contribution for Medicaid
Outreach activities. These two amounts must match
3. Sources of Local Funds Tvpes
Local Health Departments may utilize their county appropriation, any earned income,
funds received from local or private foundations, local contributors or donators, and
from other non-state/non-federal grant agreements that are specific to Medicaid
outreach or are to be used at the discretion of the Health Department as a source for
matching funds. Other state and/or federal grant awards for Medicaid Outreach must
be recorded on the appropriate line as indicated in the Comprehensive Budget
Instructions - Attachment I.
B. Nurse -Family Partnership Outreach (applicable only for Berrien, Calhoun, Ingham,
Kalamazoo, Kent, Oakland, and Saginaw)
20
Complete the MI E-Grants application and budget forms for the application titled Nurse -Family
Partnership Medicaid Outreach for the timeframe: 10/01-09/30. Complete the MI E-Grants
application and budget forms for this program.
Expenditures related to Nurse -Family Partnership Medicaid Outreach should be reflected
under one program element and adhere to Section VIII, Special Budget Instructions section
found in the Comprehensive Budget Instructions - Attachment I. The budget should reflect the
entire fiscal year period: 10/1-09/30.
Federal Medicaid Outreach
Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the
LHD Nurse -Family Partnership program has been applied. The formula for calculating the
federal funding is as follows:
Federal funding = (Local funds x % of Medicaid Participation Rate) x 50% Federal
Administrative Match rate)
Reouired Match - Local
Represents the 50% match of local contributions. Budget the local match contribution in
Required Match — Local. Federal Medicaid Outreach and Required Match — Local must
equal each other. Additional local contribution related to service provision for non -
Medicaid eligible participants which are not eligible for the 50% federal match
should be reported in Local Funds — Other.
3. Sources of Local Fund Tvves
Local Health Departments may utilize their county appropriation, funds received from
local or private foundations, local contributors or donators, and from other non-state/non-
federal grant agreements that are specific to Medicaid Outreach or are to be used at the
discretion of the Health Department as a source for matching funds.
C. CSHCS Medicaid Outreach
Complete the MI E-Grants application and budget forms for the application titled CSHCS
Medicaid Outreach for the timeframe: 10/01-09/30.
Expenditures related to CSHCS Medicaid Outreach should be reflected under one program
element and adhere to Section IV, Special Instruction Section found in the Comprehensive
Budget Instructions - Attachment I. The budget should reflect the entire fiscal year period: 10/1-
09/30.
1. Federal Medicaid Outreach.
21
Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the
LHD CSHCS program has been applied. A table containing each health jurisdiction
Medicaid Participation Rate is located in the MI E-Grants site. The formula for calculating
the federal funding is as follows:
Federal funding = (Local funds x % of Medicaid Participation Rate) x 50% Federal
Administrative Match rate)
2. Required Match - Local
Represents the 50% match of local contributions. Budget the local match contribution.
Federal Medicaid Outreach and Required Match — Local must equal each other.
Additional local contribution that is not eligible for the 50% federal match should
be reported on the Local Funds — Other line.
3. Sources of Local Fund TVDes
Local Health Departments may utilize their county appropriation, funds received from local
or private foundations, local contributors or donators, and from other non-state/non-federal
grant agreements that are specific to Medicaid Outreach or are to be used at the
discretion of the health department as a source for matching funds to be used at the
discretion of the health department as a source for matching funds.
4. Comprehensive CSHCS Outreach and Advocacv and Case Management/Care
Coordination Funds
Should be reported in a separate program element.
D. Indirect Costs
There are three (3) options for indirect costs. They are:
1. an approved federal or state indirect rate
2. a 10% de minimis rate; or
3. a cost allocation/distribution plan
Most Health Departments will use the cost allocation plan for indirect costs. For further detail, go
to VI. Form Preparation, L. Indirect Cost, on page 5 of this document.
E. Cost Allocation Certification
The Cost Allocation Certification remains on file with the Department until there is a change in the
Cost Allocation Plan. When the cost allocation plan on file with the program (MDHHS-Medicaid-
Outreach), the local health department must: 1) submit a copy of the revised cost allocation plan
with the budget request; and 2) complete a revised cost allocation methodology certification. Both
documents are to be attached to a Detailed Budget line in EGrAMS.
22
II. Financial Status Report (FSR) — LHDs seeking 50% federal administrative match must
request reimbursement by submitting their actual expenses for allowable Medicaid Outreach
activities on their quarterly FSRs through MI E-Grants.
A. Quarterly and Final FSR
LHDs must reflect the actual Medicaid Outreach expenses incurred on the quarterly and
final FSR. Actual expenses incurred must be specific to Medicaid Outreach as defined by
the MSA Bulletin 05-29 and not part of a direct service. All expenses should be supported
by an approved methodology and appropriate support documentation.
Federal Medicaid Outreach
Should be used to request the 50% federal administrative match for Medicaid
Outreach.
2. Reauired Match - Local
Should be used to report the local match for Medicaid Outreach, both the federal
and local amounts must match.
3. Source of Funds CateQorV
Other source of funds that are non -reimbursable for Medicaid Outreach (i.e., other
federal grants, other MDHHS grants, etc.) should be reported on the appropriate
line has indicated in the Comprehensive Budget Instructions - Attachment I (e.g.,
Local non-ELPHS or Local Funds — Other).
Total Source of Funds must equal Total Expenditures.
B. Nurse -Family Partnership Medicaid Outreach — Quarterly and Final FSRs
For Quarters 1-3, LHDs must reflect the actual Medicaid Outreach expenses incurred in a
separate program element titled Medicaid Outreach. Actual expenses incurred for each of the
listed expenditure categories are allowable but must be specific to Medicaid Outreach as
defined by MSA Bulletin 05-29 and not part of a direct service. Expenses should be supported
by a time study or other federally approved methodology.
1. Federal Medicaid Outreach
Should be used to request the 50% federal administrative match. Match is
determined by multiplying local contribution for the program by the percentage of
Medicaid enrollees. This product is then multiplied by 50% in order to determine the
eligible federal administrative match.
2. Required Match - Local
23
Should be used to report the remaining portion of the local contribution for the
Medicaid Outreach Match. Both lines should equal. Additional local contribution
related to service provision for non -Medicaid eligible participants which are
not eligible for the 50% federal match should be reported in Local Funds -
Other.
3. Source of Funds Cateaory
Other source of funds that are non -reimbursable for Medicaid Outreach (i.e., other
federal grants, other MDHHS grants, etc.) should be reported on the appropriate line
has indicated in the Comprehensive Budget Instructions - Attachment I (e.g., Local
non-ELPHS or Local Funds — Other).
C. CSHCS Medicaid Outreach — Final FSR
CSHCS Medicaid Outreach billing may occur before the final FSR through the MI E-Grants
system after Comprehensive Agreement CSHCS Outreach and Advocacy funds have been
fully expended. Local contributions eligible for the Medicaid Outreach match should be
cost distributed to the CSHCS Medicaid Outreach program element from the CSHCS
Outreach and Advocacy program element and reported as indicated below.
1. Federal Medicaid Outreach
Should be used to request the 50% federal administrative match. Match is
determined by multiplying local contribution for the program by the percentage of
Medicaid enrollees. This product is then multiplied by 50% in order to determine the
eligible federal administrative match.
2. Required Match - Local
Should be used to report the remaining portion of the local contribution for the
Medicaid Outreach Match. Additional local contribution that is not eligible for the
50% federal match should be reported in Local Funds - Other.
3. Source of Funds CateaorV
Other source of funds that are non -reimbursable for Medicaid Outreach (i.e., other
federal grants, other MDHHS grants, etc.) should be reported on the appropriate line
has indicated in the Comprehensive Budget Instructions - Attachment 1.
4. Comprehensive CSHCS Outreach and Advocacv and Care Coordination,
Should be billed as separate program element.
III. Comprehensive Local Health Department Agreement Obligation Report — filed in
September.
=4
The Obligation report is used to estimate the payable amount due to Local Health
Departments from MDHHS for each program element.
A. In the Estimate Column, enter the maximum projected federal administrative match
earnings for allowable Medicaid Outreach Activities to be earned from Medicaid Outreach
on the Federal Medicaid Outreach row.
B. In the Estimate Column, enter the maximum projected federal administrative match
earnings for allowable Medicaid Outreach activities to be earned from CSHSC — Medicaid
Outreach. This should reflect the local contribution multiplied by the Medicaid enrollment
participation rate x 50% federal match rate.
C. In the Estimate Column, enter the maximum projected federal administrative match
earnings for allowable Medicaid Outreach activities to be earned from Nurse Family
Partnership Outreach. This should reflect the local contribution multiplied by the Medicaid
enrollment participation rate x 50% federal match rate.
Note: CSHCS Outreach and Advocacy and CSHCS Care Coordination activities funded through the
Comprehensive Agreement are recorded as separate program element,
H. Michigan Colorectal Cancer Screening Program — The Michigan Colorectal Cancer Early
Detection program (MCRCEDP) budget is to be developed in the following ways:
This budget is intended to cover all staffing and coordination for the program. All
allowable expenses will be reimbursed through the Local Health Department
Agreement.
• All direct service claims must be billed through the MDHHS Cancer Prevention and
Control Section. The LHD and/or direct service providers with contracts or letters of
agreement with the LHD will be responsible for billing.
The staffing, coordination and direct service total amount is $255 per woman or
man based on a target caseload established by MDHHS. Performance
reimbursement will be based upon the understanding that a certain level of
performance (measured by outputs) must be met. There is a 90% performance
requirement for this program. The performance target output measure is the
number of women and men that complete a screening test for colorectal cancer.
• For specific program requirements, including current direct service reimbursement
rates and other documentation refer to the most current MCRCEDP manual.
25
Pbject Class CategoryNxPellses
VFC-only site visits
AFIX-only site visifs
Combined (AFIX & VFC site visits)
1 Perinatal hospital record rtMeAvs
Equipment*
Fax machines fir vaccine ordcnng
i Vaccine storag-, equipment for VFC
Vaccine
Copy machines
4.Equipmert.- wy amle of tangible
riona7'endable personal property having
usefid file of more d7an one var and air
acquisition COSI 0)'15.000 or more 1per
?)nit fevsr is below this threshold
amount, item ma;.- be inclm&?d in
SuPpUes.
Supplies
Vaccirit administration supplies
(inclrdin& but not limited to, nasal
plia-wigeat �7vabs, syI Lnges for
emergency vacernatrori Cl�mics-[
Office supptics-computGT57 a
_-cneml offic,-
fpcns, paper, paper clips. U,
cartdd.ges.. calculators
Personal computers i Lapu^.5 i Tablets
Pink Books, Re.: BoLks. Yellow BoQcs
Printers
Allowable
Allowable
Allowable
Allowable
Allowable
Allwablewith
Allowable
with 317
with VFC-
with t')ZC
- with
with Pan
VFC Distribution
with PrIff
operations
operation
ordering
VFChIkM
no funds
foods
funds
funds
S toads
funds
funds
wlqapparcawe)
V
V
i
✓
V,
V
V
I
V
—T S�tiolll lheBasicsp.'111
✓
✓
ObjectCtasssCategoMrtxpenses i
:Allowable
_Allowable
Allowable Allowable
Allowable- Allowablewith
' -Allowable
i
with 31-1
witb V-FC
wifih'4BC j - with
wlthPau VFC.Ab^trbution
with PMF
operations
operation
ordering I, NTCIAFIX
Flu funds fonds
funds
funds
sfunds
funds funds
(whereappCrerll.)
Laboratory Supplies (tr£iuenza mhures
and PClts. culut€es and rualccular. lab
✓
me-dia serat)Tina1
Di tat da a lagge- with valid cerkifcare
J
✓
efcalibraticn`valii;rtivn.'trstin�reFtrt
!
Vaccine 3hi in^ su lies istora
✓
✓
containers, ice packs, bobble wrap, etc.) 1.
Contractual
Stawe ocal ctmferences cspcnses
(conference ;ite, materials primir,-, hotel
acc.rimodations of perscs. speaker fees)
Fcac." c st s rotli
1tepienabLecal meeting;
Genera: contractual sm ices (eq., IAPs- !
:Dczl hca;th denarmencs, + ontracrutl
staff, advisor}- committee media,
pre` der rmininp
GSA Contractual services (CDC
R:ana�sCd�
j Ogler IIS contractual agreements
(support, enhancemet;t. cpgades)
Financial Assistance (FA)
\o-i-CDC Ccntract vaccines
31"va=ine iurel•_ mus:be requested in funding
an-E=den i`zGrA1"151 under 3 S; FA Y3ccines
i
4.`162016 Section I —Re Basics p.23
IPOM 2017
Object Class CategorglEspeosec
Allowable
Idth 317 .
operations
funds
Indirect
lnairecr+:cst,
✓
1•Iiscellaneouus
Acrauntinq services
✓
Advertising (restricted to rc-ruitment of j
staffs>rtra;nees, procurement ofgocds
✓
and services, disposal of scrap or sarplu: i
materials]
I Aadit Fees
✓
BRFSS Survey
✓
Comm tree meetings (rooms, rc u
cq uipment rcn a', ctc,)
✓
C crumurication (cicctronkc'cornputer
t=snittal, rnessenger, postage, local and '
long distance telcghonc)
Cansurierinformationaetivides
✓
CCn54aner?providri-boa:d participation
(travel MTIZ ureeuaentl
✓
Data processing
✓
Laboratory services (tests conducted for j
immunization program)
41
Local Semi Ce delivery gelivities i
✓
Mahamance,operarionvrep-airs
✓
%Ipm;tice insurance for voluntccrs
✓
�4rnabcrshipy'suascripticns
✓
NIS 0VrrSamplirse
✓
Pagcrs'ccll phones
✓
Printing oS vaccine accountabi:ity forms
Allowable f Allowable
with NTC wA VAC
operation 'r ordeiing
sfunds f 'funds
d ✓
d'
✓
✓
✓
J
✓
Allowable ' Allowable I Allowable with -Allowable 1I
wrath _' wsithYau 9FCD-tstribution- wrth.ppBr f
'v ClAM Fla funds funds ,#ands
funds i (whereQppUwhk)
I
d i ✓ I ✓
✓ i i
Secti;an 1—Tor Basics
TOM "017
Object Class Catehorr.7Expcnses
,Allowable
Allowable
Allowable
Allowable " Allowable !
Allowabiewith
Allowable !
with317
with `F'C
P With NTC
with WA PA i
"V� C:Distribot,on
with PPH1
operations
operation
ordering
vFCI.4LX Plu funds !I
. funds
funds ;
funds
S funds _
i fand5 -
fnntls
(witere applicable)
" "
PiLressional aeraice Grits direciiti related
!
to immunization activities (limited term
✓
satt), .Attnmev Genera! Office servicea
_—
Public relations
✓
Publicationlrrinting costs (all ether
immumization related eublianion and
✓
✓
✓
printing expensesl
Rent (requires explanation o` vhv These I
!
f
Costs are not included in the EndireC€ GCS
✓
n=-=Dare arsa i ri�n
rate aereement or cost allocation Plan)
Shipping for materials fo[her than
✓
✓
V""aGGIT:eJ
shipping (vaccine)
Scf;vrarelicenserRen-wals(ORACLE,
✓
etG.l
ird rr1v1
SfiPerld Rcambursements
✓
✓
Toli-frec phone lines for vaczirx
f
ordering
1
a2kilnv cosrg ® StatcvViAe, Staff,
''
`�
✓ '�
providers
Translations (mnsiatirm materials)
✓
V ehiele lease (restricted to awardees i' M
policies that pfohibit lncal travel
✓
reirp.bursementl
"
-
V"FC enrollment materials
f
✓
V'FC provider feedback sclnels
v`
�
VIS ,: am er-ready copiesJ
✓
Section I —The Basics p:-S
1PO114 =Q17
Non -Allowable Expenses with Federal
Immunization Funds
-- - - ------ - --- -- .
T.xpense Cdfl'i' allowable with federal
Inatnnati�ation t`ns{ds
tTnnoraria ✓
Ad+'c.rtisinr, costs flt,, vam,ferrihanr, rA px7- aslelhitc, nmaiaar;5, ✓
uiennir'el.''ulifa• hijhv, .t'.num'rJle'N�
,Alcoholic
Building parcliase_s, comtr'action, capiti'il inillrnvements- -- —
Land 7atreltttse_s---------- . ,-----_-- --
Bonding
reciation on a e➢large5
fundmising
Interest (At luaaes IUl` ➢lse F061(I II IS Won anal/or modurnimition of
art existing, bui Ming
( linical c.iru nnvirev)
F?ntcrlainnicnt
Payment of had dch{
L)ryctaaitin�
vehicle Purchase
Pcomotional anlVor lncentivc Mawria➢s (e.&, plagues, rh,llatnah and -
rrna»Irrru+r'utirm Henls.vedf ud puns, magaA.aeru.Juldrlm4irlins,
rrmf,'owl" haco)
Purchase of t'oud fishes pmi r➢frrquh'rtf errnal,rxrdrum o"u)
Sil€ier [Y.Stl7etitxtri Which must bo taken info accomic While wridng the hildgvt:
J
r FIInds ill n}' be spCilt LYnly for acti v'il lu3 and I'rert:Uililel co, S that ale dirvCLly related to the
Immunization and Vaccines for t'blldren C'ooperative.Agreement. Funding requests not
directly related to bnnnini',alion cictivitics; lac oukside the scope of this cooperaeive
ag reement program and will tint be fimaled.
Pre-ar uni cords will ]Not lac; teilntaarscll,
').r 16/2016
Section 1—The Basses p.26
[PONI 2017
30
ATTACHMENT III
MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES
LOCAL HEALTH DEPARTMENT AGREEMENT
October 1, 2020 — September 30, 2021
Fiscal Year 2021
PROGRAM SPECIFIC ASSURANCES AND REQUIREMENTS,
Local health service program elements funded under this agreement will be
administered by the Grantee and the Department in accordance with the Public
Health Code (P.A. 368 of 1978, as amended), rules promulgated under the Code,
minimum program requirements and all other applicable Federal, State and Local
laws, rules and regulations. These requirements are fulfilled through the following
approach:
A. Development and issuance of minimum program requirements, further
describing the objective criteria for meeting requirements of law, rule,
regulation, or professionally accepted methods or practices for the purpose of
ensuring the quality, availability and effectiveness of services and activities.
B. Utilization of a Minimum Reporting Requirements Notebook listing specific
reporting formats, source documentation, timeframes and utilization needs for
required local data compilation and transmission on program elements funded
under this agreement.
C. Utilization of annual program and budget instructions describing special
program performance and funding policies and requirements unique to each
State fiscal year.
D. Execution of an agreement setting forth the basic terms and conditions for
administration and local service delivery of the program elements.
E. Emphasis and reliance upon service definitions, minimum program
requirements, local budgets and projected output measures reports, State/local
agreements, and periodic department on -site program management evaluation
and audits, while minimizing local program plan detail beyond that needed for
input on the State budget process.
Many program specific assurances and other requirements are defined within the
referenced documents including Minimum Program Requirements established for the
following program elements as of October 1, 2006:
1. Breast and Cervical Cancer Control
2. Clinical Laboratory
3. CSHCS
4. EGLE Drinking Water and Onsite Wastewater Management
5. Family Planning
6. Food ELPHS
7. Hearing ELPHS
8. HIV/STD Prevention Treatment
9. MDHHS Essential Local Public Health Services (ELPHS)
10. Michigan Care Improvement Registry
11. Vision ELPHS
12. WIC
For Fiscal Year 2021, special requirements are applicable for the remaining program
elements listed in the attached pages.
Attachment IV Reimbursement Chart
Program Element:
The Program Element indicates currently funded Department programs that are
included in the Comprehensive Local Health Department Agreement.
Reimbursement Methods
The Reimbursement Methods specifies the type of method used for each of the
program element/funding sources. Funding under the Comprehensive Local Health
Department Agreement can generally be grouped under four (4) different methods of
reimbursement. These methods are defined as follows:
Performance Reimbursement
A reimbursement method by which local agencies are reimbursed based upon the
understanding that a certain level of performance (measured by outputs) must be met in
order to receive full reimbursement of costs (net of program income and other
earmarked sources) up to the contracted amount of state funds prior to any utilization of
local funds. Performance targets are negotiated startino from the last year's negotiated
target and the most recent year's actual numbers except for programs in which
caseload targets are directly tied to funding formulas/annual allocations. Other
considerations in setting performance targets include changes in state allocations from
past years, local fiscal and programmatic factors requiring adjustment of caseloads, etc.
Once total performance targets are negotiated, a minimum state funded performance
target percentage is applied (typically 90% unless otherwise specified). If local Grantee
actual performance falls short of the expectation by a factor greater than the allowed
minimum performance percentage, the state maximum allocation for cost
reimbursement will be reduced equivalent to actual performance in relation to the
minimum performance.
Fixed Unit Rate Reimbursement
A reimbursement method by which local health departments are reimbursed a specific
amount for each output actually delivered and reported.
ELPHS
A reimbursement method by which local health departments are reimbursed a share of
reasonable and allowable costs incurred for required Essential Local Public Health
Services (ELPHS), as noted in the current Appropriations Act,
Grant Reimbursement
A reimbursement method by which local health departments are reimbursed based
upon the understanding that State dollars will be paid up to total costs in relation to the
State's share of the total costs and up to the total state allocation as agreed to in the
approved budget. This reimbursement approach is not directly dependent upon
whether a specified level of performance is met by the local health department.
Department funding under this reimbursement method is allocable and a source before
any local funding requirements unless a special local match condition exists.
Performance Level If Applicable
The Performance Level column specifies the minimum state funded performance target
percentage for all program elements/funding sources utilizing the performance
reimbursement method (see above). If the program elements/funding source utilizes a
reimbursement method other than performance or if a target is not specified, N/A (not
available) appears in the space provided.
Performance Target Output Measures
Performance Target Output Measure column specifies the output indicator that is
applicable for the program elements/ funding source utilizing the performance
reimbursement method. Output measures are based upon counts of services delivered.
Relationship Designation
The Subrecipient, Contractor, or Recipient Designation column identifies the type of
relationship that exists between the Department and grantee on a program -by -program
basis. Federal awards expended as a subrecipient are subject to audit or other
requirements of Title 2 Code of Federal Regulations (CFR). Payments made to or
received as a Contractor are not considered Federal awards and are, therefore, not
subject to such requirements.
Subrecipient
A subrecipient is a non -Federal entity that expends Federal awards received from a
pass -through entity to carry out a Federal program, but does not include an
individual that is a beneficiary of such a program; or is a recipient of other Federal
awards directly from a Federal Awarding agency. Therefore, a pass -through entity
must make case -by -case determinations whether each agreement it makes for the
disbursement of Federal program funds casts the party receiving the funds in the
role of a subrecipient or a contractor. Subrecipient characteristics include:
• Determines who is eligible to receive what Federal assistance;
• Has its performance measured in relation to whether the objectives of a Federal
program were met;
• Has responsibility for programmatic decision making;
• Is responsibility for adherence to applicable Federal program requirements
specified in the Federal award; and
• In accordance with its agreements uses the Federal funds to carry out a
program for a public purpose specified in authorizing status as opposed to
providing goods or services for the benefit of the pass -through entity.
Contractor
A Contractor is for the purpose of obtaining goods and services for the non -Federal
entity's own user and creates a procurement relationship with the Grantee. Contractor
characteristics include:
• Provides the goods and services within normal business operations;
• Provides similar goods or services to many different purchasers;
• Normally operates in a competitive environment;
• Provides goods or services that are ancillary to the operation of the Federal
program; and
• Is not subject to compliance requirements of the Federal program as a result
of the agreement, though similar requirements may apply for other reasons.
In determining whether an agreement between a pass -through entity and another non -
Federal entity casts the latter as a subrecipient or a contractor, the substance of the
relationship is more important than the form of the agreement. All of the characteristics
listed above may not be present in all cases, and the pass -through entity must use
I udgment in classifying each agreement as a subaward or a procurement contract.
Recipient
A Recipient is for grant agreement with no federal funding.
PROJECT
CONTRACT MANAGER
PHONE
EMAIL
Administration Projects
Odarld, Todd/ Lawn de la Nampa,
(517)335-93771(517)284-90I12
totldo@mmnigan gov l DelaRambel)eL@mlohigan Mov
Adolescent STD Screening
Patnua Vllegas
(517) 2414341
mllegasp@michigan gov
Asthma Demonstration Pm,.m
Ctlantlo Todd / Laura de la Rambelje
(517) 335-93771(517) 284-9002
m0do@miehlgan gov, I DelaRambel,L@mlchlgan gov
Body Art Fixed Fee reality, Licensing)
Joseph Coyle
(51]) 2844A15
coylej@michgan gov
Breast & Cervical Cancer Control (BCCCP) Coordination
U Siegl
(517) 335-8814
smgle@mlchlgan gov
Childhood Lead Poaching Prevent0n
Michelle Tvncdell
(517)254-0053
MachaJim@mshigan no
Children. Speuel HIM Care Services (CSHCS) Care Coordination
Kelly Gram
(517) 33"630
Gramk2@mlchlgan gov
Children's Special HIM Care Services (CSHCS) Outreach & Advocacy
Kelly Gram
(517) 335-8630
Gramk2@michigan gov
COVID-19 Response
Orlando Todd l L.Q. de la Rambelje
(517)335-9377/(517)284-9002
totldo@mchigan gov I DelidRambelpl-@michigan gov
CSHCS Medicaid Elevated Blood Lead Case Mgmt
Michelle TArchell
(517) 2840053
pachellm@mlchlgan gov
CSHCS Medicaid Outreach
i Gram
(517) 31
Gramk2@m¢Mgan gov
Eat Safe Fish
Jennifer Gray/Hope Bartlett
(517) 281 -3483 1 (517) 21)49610
grayj@mlchigan gov/ Bartletti-2@mlchigan gov
DOLE Dnnking Water and Chains Wasteeater, Management
Dana DeBruyn
(517) 930-6483
debmynd@mmhig,mgoV
Emerging Threats - HepatitisC
Joseph Coyle
(517)2844915
o0y1ej@michigan gov
Family Planning Services
Steve Utter
1517)241-0114
utters@michigan gov
Fetal Alcohol Spectrum Disorder Community Projedta
Aurea Samo amen
(517) 335-9750
bacronargera@m¢rogan gov
Fetal Infant Mortality Review(FIM R) Case Abstmot0n
Nicholas Dral
(517)241-5380
drzaln@michigan gov
FIMR Interview
Nicholas Deal
(517) 241-5380
tlaaln@mchigan gov
Food! ELPHS
Adam Christenson
(517) 284-5706
cm tensona@michigan gov
Gondcoome Isolate Surveillance Project
Kral Tumier
(313) 456-4426
judo tuinierk@michigan gov
Hann Reduction
JOsaph Coyle
(517)284-4915
ooylej@michrgan gov
Harm Reduction Support Services
Joseph Coyle
(517) 284 915
co to y j@michigan gov
Hearing ELPHS
Jennifer Damns
(517) 335-8353
DakemJ@michigan gov
HIV & STD Testing and Prevention
Thomas Dunn
(617) 37&3725
dunnQ@michigan gov
HIV I STD Partner Services
Thomas Dunn
(517) 373-3725
dunn12@michigan gov
HIV Care Coordination
Thomas Dunn
(517)373L3725
dunn12@1mMgan gov
HIV Data to Care
Thomas Dunn
(517) 373-3725
dunm2@michigan gov
HIV Housing Assistance
Loren Powell
(517) 33E 9857
p0we111@michgan gov
HIV PrEP Clinic
Thomas Dunn
(517) 373-3725
dunnV@michigan gov
HIV Prevention
Thomas Dunn
(517) 373-3725
dunot2@michigan gov
HIV Prevention Non Categorical
Thomas Dunn
(5171373-3725
dunnl2@michigan gov
HIV Ryan White Part B
Thomas Dunn
(517)373-3725
dunm2@michigan gov
HIVIAIDS Lmkage to Care Project
Thomas Dunn
(517j 373-3725
dunnt2@michigan gov
knmun¢anoh Acton Plan - Wlot
Tausha Gingench
(517) 284-4881
gingericht@michigan gov
Immurr ation Action Plan (AP)
Tausha Gingerich
(517) 284-0081
gmgencht@mmhigan gov
Immunization Feld Services Rep
Tausha Gingench
(517) 2641881
gmgencht@michigan goo
Immumzabon Fixed Fees
Tausha Gingench
(517) 2M-4881
gingencnt@michigan gov
Immunization Michigan Care Improvement Registry (MCIR) Regions
Tausha Gmgench
(517) 28 81
gingencht@michlgan gov
Immunization Vaccine Quality Assurance
Tausha Gingenoh
(517) 284-4851
gingencht@michigan gov
Infant Safe Sleep
Nicholas Doal
1517)241-5380
drzaln@Michigan gov
Informed Consent
Drlam Todd I Laura de Is Rambel)e
(517) 335-9377 / (517) 284-9002
toddo@Michigan gov / DelaRambely L@michigan gov
Laboratory Services Bio
Shannon Sham
(517) 335-9653
sharysl@mlchigan gov
Lactation Consultant
Snatoria Townsend
(517)373-6406
TewnsendS2@michigan gov
Local Health Department (LHD) Sharing Support
Oral Todd I Laum de la Rambel)e
(517) 335-9377 / (517) 284-9002
toddo@Michigan gov I DelaRambegeL@michigan gov
Local MCH(MCH Children antl MICH - All Other)
Trudy Each l Robin Orsbom
(517)241-3593/(517)335-8976
MDHHS-Matemal-Child-Health@michigan gov
Maternal Infant Edy Cho Home Visiting Initiative Rural Local Home Visiting Grp
Chansse Sanders
(517) 241-1676
sandersc21gmichigan gov
Maternal Infant Edy Cho Home Visiting Initiative Ruml Local Home Vsdmg Cron
Charles. Santlers
(517) 241-1676
sandersc2@mlchlgan gov
Maternal Infant Erly Childhood Home Visiting hiibative Local Home Visiting Grp
Chansse Sanders
(517) 241-1676
sandersc2@mmhrgan gov
MDHHS Essential Local Public Health Services (ELPHS)
Odantlo Todd I Laura de, la Rambelle
(517) 335-9377 / (517) 204-9002
toddo@mmhrgan gov I DelaRambelpL@michigan gov
Medicaid Outreach
Robin Orsbcm
(517) 335-0976
ombomr@mlchlgan gov
MI Adolescent Pregnancy & Parenting Program
Hit granted
(517) 335-5928
brandonh@michigan gov
MI Home Misting Initiative Fund Expansion Grant
Chansse Sanders
(517) 241-1 Wfi
sandersc2@mlchlgan gov
Ml Implementation ofthe Health and Wellness 4x4 Plan
Scott Ball
(517)335-9300
bellsi@mlchlgan gov
Michigan Colorectal Cancer Early Detection Program
Robin Roberts
(517) 335-1178
robertcre@michigan gov
MIECHVP Healthy Famines Amenea Expansion
Charlsse Sanders
1517) 241-1676
sandersc2@michigan gov
Nurse Family Partnership Servlces
Chansse Sanders
(517) 241-1676
sandersc2@mlchlgan gov
Nurse Family Partnership Services Medicaid Outreach
Chansse Santlers
(517) 241-1676
sacd.mc2@michigan gov
Gbesty Prevention
Scott Bell
(517)336-9300
bellsi@michigan gov
Public Health Emergency Preparedness (PREP)10/1-=0
Tera Poag
(517)335-9018
PoagT1@Mrchrgan gov
Public Health Emergency Preparedness (PREP) CRI 1011 -650
Tera Poag
(517) 335-9018
PoagTl@miGngan.gov
Regional Pennatel Care System
Dawn Shanafelt
(517) 3351945
ShanafeftD@michigan gov
Sealy Michigan Dental Sealant
Christine Farrell
(517) 335-8388
fanellc@michigan gov
Sexually Transmitted Disease (STD) Control
Thomas Dunn
(517) 37&3725
dumb?@michigan gov
Tuberculosis (TER Control
Peter Davidson
(517) 28"922
davidsenp@michigan gov
Vision ELPHS
Rachel Schumann
(517) 3358596
schumannr@michigan gov
West Nile Virus Community Surveillance
Emily Dinh / KImbedy Signs
(517)21 I (517) 2841951
DmhE@michigan govlsignsk@michigan gov
WIC Breasdeeding
Cache Hutson
(517) 335-8625
HutsonCl@michigan gov
WIC Migrant
Cecelia Hutson
(517)3215-8525
HumorQ1@mmhrgan gov
WIC Resident Services
Cecilia Hinson
(517) 335-8625
HutsenCl@michigan gov
Wise Choices
Robin Roberts
(517) 3351178
mbertsr6@michigan gov
Wiseweman
Robin Roberts
(517) 335-1178
mberts6@mmh,ter gev
Adam Christenson
(517) 284-5706
christensona@michigan.gov
Trudy Esch / Robin Orsborn
(517)241-3593 / (517) 335-8976
MDHHS-Maternal-Child-Health@michigan.gov
Emily Dinh / Kimberly Signs
(517)284-4961 / (517) 284-4951
DinhE@michigan gov/signsk@michigan.gov
Akia Burnett
(517) 335-8082
BurnettA@michigan.gov
Allan Marshall
(517) 335-9026
MarshalIA11@michigan.gov
Amber Daniels
(517) 241-9107
danielsa3@michigan.gov
Angela McFall
(517) 335-9420
mcfalla@michigan.gov
Angela Medina
(517) 284-4266
medinaa@michigan.gov
Anthony Spagnuolo
(248)787-6497
SpagnuoloA@michigan.gov
Arcelia Richardson
(517) 335-2828
nchardsona6@michigan.gov
Audra Brummel
(517) 335-9017
BrummelA@michigan.gov
Aurea Booncharoen
(517) 335-9750
booncharoena@michigan.gov
Barbara Derman
(517) 335-8696
dermanb@michigan.gov
Betsie Creger
(517) 335-9221
cregere@michigan.gov
Beth Anderson
(517) 335-9785
AndersonB@michigan.gov
Brenda Fink
(517)335-8863
fnkb@michigan.gov
Brenda Jegede
(517)335-9483
jegedeb@michigan.gov
Brittany LaRue
(517)335-8625
LaRueB@michigan.gov
Bruce Turnbull
(517)241-5183
Turnbull B@michigan.gov
Carrie Tarry
(517)335-8906
tarryc@michigan.gov
Cecilia Hutson
(517) 335-8625
HutsonCl@michigan.gov
chansse sanders
(517) 241-1676
sandersc2@michigan gov
Chelsea Walker
(517) 335-3921
walkerc23@michigan.gov
Christine Farrell
(517) 335-8388
farrellc@michigan.gov
Christopher Finch
(517) 241-9364
fnchc2@michigan.gov
Colleen Nelson
(517) 335-1954
nelsonc7@michigan.gov
Dana DeBruyn
(517) 930-6463
debruynd@miehigen.gov
Daniel Albright
(517)284-4791
albrightd@michigan.gov
Dawn Lukor i
(517) 335-5205
lukomskid@michigan.gov
Dawn Marie McCune
(517) 241-6686
mccunedl@michigan.gov
Dawn Shanafelt
(517) 335-4945
ShanafeltD@michigan.gov
Deborah MacKenzie Taylor
(517) 284-4799
mackenzie-taylord@michigan.gov
E.J. Siegl
(517) 335-8814
siegle@michigan.gov
Elaine Hewitt
(517)393-8371
HewittEl@michigan.gov
Elaine Lyon
(517) 719-7667
lyone@michigan.gov
Emily Goerge
(517)241-4816
GoergeE@michigan.gov
Erik Foster
(517)284-4961
fostere@michigan.gov
Farid Shamo
(517) 335-8021
shamof@michigan.gov
Gwendolyn Murphy
(517) 335-8872
murphygl@michigan.gov
Hillary Brandon
(517) 335-5928
bmndonh@michigan.gov
Holly Wilson
(517) 373-8602
wilsonhl@michigan.gov
Hope MCElhone
(517) 284-4831
mcelhoneh@michigan.gov
James Gamble
(517)897-1508
gamblejl@mchigan.gov
James Mueller
(517)294-2472
muellerj@michigan.gov
Janine O'Donnell
(517)241-0295
jodonnell@michigan.gov
Janine Whitmire
(517) 284-4027
whitmirej@michigan.gov
Jennifer Gray/Hope Bartlett
(517) 281-3483 / (517) 294-9610
grayj@michigan.gov/ BartlettH2@michigan.gov
Jennifer Dakers
(517)335-8353
DakersJ@michigan.gov
Jennifer DeLaCruz /Ayanna Madison
(517) 373-8571 / (517) 241-2384
DeLaCruzJ@michigan.gov / MadisonA2@michigan.gov
Jennifer Jnzmeier
(517)241-5861
linzmeier@michigan.gov
Jessica Altenbernt
517-284-8016
AltenberntJ@michigan.gov
Jessica Grzywacz
(517) 335 8627
grzywaczj@michigan.gov
Jill Moore
(517) 373-4943
moorejl4@michigan.gov
Jim Collins/Shannon Johnson
(517)284-4911/(517) 284-4941
CollinsJ12@michigan.gov/JohnsonS61@michigan.gov
Joseph Coyle
(517) 284-4915
coyleJ@michigan.gov
Jon Villasurda
(517) 241-7193
villasurdaj@michigan.gov
Julia Hitchingham
(517) 335-8381
hitchinghamj@michigan.gov
Justin Hill
(517) 373-3427
hillj29@michigan.gov
Kara Anderson
(517) 335-1158
andersonkl0@michigan.gov
Karen Brown
(517) 335-8803
brownk34@michigan.gov
Karen Krabill Yoder
(517) 335-8908
yoderk@michigan.gov
Karen Lishinski
(517) 284-4824
lishinskik@michigan.gov
Kathryn Macomber
(517) 335-8365
macomberk@michigan.gov
Kelly Piggott
(517) 373-9891
piggottkl@michigan.gov
Kelly Gram
(517)335-8630
Gramk2@michigan.gov
Kim Raiford
(517)335-8180
raifordk@michigan.gov
Kimberly Signs
(517)335-8165
signsk@michigan.gov
Kory Groetsch
(517) 335-9935
groetschk@michigan.gov
Kristine Tuinier
(313)456-4426
Judd-tuinierk@michigan.gov
Larry Scott
(517)335-0174
scottlll@michigan.gov
Linda Scarpetta
(517) 335-8397
scarpettal@mchigan-gov
Linda Scarpetta /Tracy Liichow
(517) 335-8397 / (517) 373-3267
scarpettal@michigan.gov / LiichowT@michigan.gov
Linda Scott
(517) 335-8284
scott112@michigan.gov
Lisa Simmer
(517) 335-1486
simmerl@michigan gov
Lissa Smith
(517) 335-8901
smithl77@michigan.gov
Lonnie Barnett
(517) 241-2963
BarnettL@michigan gov
Loren Powell
(517) 335-9857
powelll@michigan.gov
Lorraine Cameron
(517) 284-4795
cameronL@michigan.gov
Lucie Taylor
(517) 202-0675
taylorl22@michigan.gov
Lynn Hendges
(517) 284-8018
HendgesL2@michigan gov
Lynn Nee
(517) 275-2791
neel@michigan.gov
Mahad Adawe
(517) 335-8058
adawem@michigan.gov
Margaret Cyrul
(517)373-6486
cyrulm@michigan.gov
Martha Mello
(517) 335-2828
mellom@michigan.gov
Martha Stanbury
517-284-4820
stanburym@michigan.gov
Marty Soehnlen
(517)335-8064
soehnlenm@michigan.gov
Mary Grace Brandt
(517) 284-4928
brandtm4@michigan.gov
Mary Lou Searls
(517) 335-9349
searlsm@michigan.gov
Mary Macqueen
(517) 335-9401
macqueenm@michigan.gov
Mary -Grace Brandt
(248)424-7913
brandtm4@michigan.gov
Michelle Twichell
(517)284-0053
tw¢hellm@michigan.gov
Michelle Woolf
(517) 388-6286
woolfm@michigan.gov
Molly Cotant
(989)619-1304
cotantm@michigan.gov
Nancy Peeler
(517) 335-9230
peelern@michigan.gov
Nicholas Drzal
(517)241-5380
drzaln@michigan.gov
Orlando Todd / Laura de la Rambelje
(517) 335-9377 / (517) 284-9002
toddo@michigan.gov / DelaRambelieL@michigan.gov
Patricia Heiler
(517) 335-1265
heilerp@michigan gov
Patricia Kelly
(517) 335-5911
kellyp2@michigan.gov
Patricia Smith
(517) 335-9703
SmithP40@michigan.gov
PATRICIA VILLEGAS
(517) 241-7341
villegasp@michigan.gov
Patrick Guysky
(517) 335-8150
guyskypl@michigan.gov
Paula Kaiser VanDam
(517) 241-0638
kaiserp@michigan gov
Paulette Dunbar
(517) 335-8903
dunbarp@michigan.gov
Penny Eisfelder
(517) 373-2039
eisfelderp@michigan gov
Peter Davidson
(517) 284-4922
davidsonp@michigan.gov
Polly Hager
(517) 335-9729
hagerp@michigan.gov
Rachel Schumann
(517) 335-6596
schumannr@michigan.gov
Rebecca Start
(517) 241-7198
startr@michigan.gov
Richard Wimberley
(517) 335-8369
wimberleyr@michigan.gov
Robert Swanson
(517)335-8934
Swansonr@Michigan gov
Robin Orsbom
(517) 335-8976
orsbornr@michigan.gov
Robin Roberts
(517) 335-1178
robertsr6@michigan.gov
Robyn Corey
(517) 335-9526
coreyrl@michigan.gov
Sandip Shah
(517)335-8067
shahs@michigan.gov
Sandra Riddle
(517) 241-5900
riddlesl@michigan.gov
Sandra Walker
(517)284-5712
walkers9@michigan.gov
Scott Bell
(517) 335-9300
bellsl@michigan.gov
Shannon Sharp
(517) 335-9653
sharpsl@michigan.gov
Shatoria Townsend
(517) 373-6486
Townsend52@michigan.gov
Sheyonna Watson
(517) 241-6195
watsons4@michigan.gov
Sonji Revis
(517) 335-9898
smithsl@michigan.gov
Steve Utter
(517) 241-0114
utters@michigan.gov
Taggert Doll
(517) 335-9720
dollt@michigan gov
Tausha Gingerich
(517)284-4881
gingericht@michigan.gov
Tera Poag
(517) 335-9018
PoagTl@michigan gov
Terri Adams
(517) 335-8641
adamst2@michigan.gov
Theresa Scorcia-Wilson
(517) 335-9124
scorciawilsont@michigan.gov
Katie Dunkle /Allan Marshall
(517) 335-9972 / (517) 335-9026
DunkleK@michigan.gov/ Marshal IAll@michiga n.gov
Thomas Dunn
(517) 373-3725
dunnt2@michigan.gov
Thomas Largo
(517) 284-4806
largot@michigan.gov
Tiffany Henderson
(517) 335-9970
hendersontl@michigan.gov
Tiffany Kostelec
(517) 335-4663
kostelect@michigan.gov
Tory Doney
(517) 335-8854
DoneyT@michigan.gov
Tosan Erenshay
(517) 862-2640
ErenshayT@mchigan.gov
Tracy Liichow
(517) 373-3267
liichowt@michigan.gov
Trudy Esch
(517)241-3593
EschT@michigan.gov
PROJECT TITLE: Adolescent Sexually Transmitted Disease (STD)
Screening
Start Date: 10/1/2020
End Date: 9/30/2021
Project Synopsis:
Adolescents and young adults account for approximately half of reported cases of
gonorrhea and chlamydia. The Oakland County Adolescent STD Project provides
targeted screening activities in venues with access to this vulnerable populations to
ensure early diagnosis and treatment.
Reporting Requirements (if different than agreement language):
• Quarterly Report of screening and treatment activity should be submitted no later
than 15 days after the end of the quarter.
• Report should be emailed to the MDHHS contract liaison
Any additional requirements (if applicable):
Grant Program Operation
Project Summary: Individuals 15-24 years of age will be screened for chlamydia and
gonorrhea at the following Oakland County sites:
1. Oakland County Main Jail
2. Oakland County Work Release
3. Oakland County Community Sites where Priority Population Gathers
Utilizing the identified project sites:
• Test at least 100 adolescents and young adults per month, using NAAT tests for
gonorrhea and chlamydia.
• Collect race, gender, age, test result, and treatment date for all tests.
Refer clients for further health evaluation if indicated.
Provide client centered risk reduction plan, promoting abstinence.
• Treat all positives on site if possible.
• Contact positive clients that are released prior to treatment with treatment options
in community.
• Promote self -notification of partners.
• Analyze and forward screening and treatment data to the Department quarterly:
April 15, July 15, October 15, and January 15.
• Develop one annual slide set highlighting year end data by demographic variable
including trend data.
• Continue to promote awareness of prevalence of STDs within adolescent and
young adult populations.
• Participate in quarterly Michigan Infertility Prevention Project meetings; providing
quarterly screening project data.
PROJECT: Asthma Demonstration
Beginning Date: 10/1/2020
End Date: 9/30/2021
Project Synopsis:
Provide evidence -based asthma management education to families and providers in an
attempt to decrease hospitalizations and emergency room utilization for individuals with
asthma.
Reporting Requirements (if different than contract language)
Progress report updates are required twice per year per CDC reporting requirements.
Any additional requirements (if applicable)
PROJECT: Body Art Fixed Fee
Beginning Date: 10/1/2020
End Date: 9/30/2021
Project Synopsis
This agreement is intended to establish a payment schedule to the Grantee, following
notification of a completed inspection and recommendation for issuance of license.
The intent is to help offset costs related to the licensing of a body art facility, when
fees are collected from the respective Grantee's jurisdiction in accordance with
Section 13101-13111 of the Public Health Code, Public Act 149 of 2007, which was
updated on December22, 2010 and is now Public Act 375.
Reporting Requirements (if different than contract language)
The Department will reimburse the Grantee on a quarterly basis according to the
following criteria:
• Initial annual license for a Body Art Facility prior to July 1
o $273.85 (50% of state fee)
• Initial annual license for a Body Art Facility after to July 1
o $136.93 (50% of state fee)
• Issue a temporary license) for a Body Art Facility
o $123.22 (75% of state fee)
• License renewal prior to December 1
o $273.85 (50% of state fee)
• License renewal after to December 1
o $410.78 (50% of state fee + 50% late fee penalty)
• Duplicate license
o $27,38
Payment will be made for those body art facilities that have applied and paid in full to
the Department, following notification of a completed inspection and recommendation for
issuance of license. Please note that the fees in the list above are based on FY2020
reimbursement rates and are subject to change with the Consumer Price Index.
Any additional requirements (if applicable)
The Grantee is authorized to enforce PA 375 and conduct an inspection of all body art
facilities under its jurisdiction, investigate complaints, and enforce licensing regulations
and requirements. The Grantee must complete a Body Art Facility Inspection Report
[DCH-1468 (07-09)], as provided by the Department, or other report form approved by
the Department that meets, at minimum, all standards of the state inspection report.
Only body art facilities that have applied for licensure should be inspected. All body art
facilities must be inspected annually. Licenses will only be released from the
Department following notification of a completed inspection and upon recommendation
by the Grantee.
Completed inspection reports should be signed by the facility owner and
recommendation for licensure should be forwarded to the Department within two to four
weeks following the inspection. Reports should be entered via the online interface or
can be sent to:
HIV/STD and Body Art Section
Division of Communicable Diseases
333 S. Grand Ave, 3rd Floor
Lansing, Michigan 48933
PROJECT: Childhood Lead Poisoning and Prevention
Beginning Date: 10/1/2020
End Date: 9/30/2021
Project Synopsis
MDHHS CLPPP's mission is "to prevent childhood lead poisoning across the state
through surveillance, outreach and health services". This grant provides local health
departments the opportunity to prevent and address lead poisoning within their
community, with support of CLPPP. The overall goal of the grant is to increase testing for
children under the age of 6, specifically capillary to venous testing rates within the
grantees focus area. Grantees could achieve this goal through:
1) Educating providers about testing, risk factors, this can include:
• Distribution of toolkits
Promotion of an online training module for health care providers
Hosting provider forums/trainings
2) Educating parents about testing, cleaning, risk factors, this can include:
Establishing a protocol for following up with families to get a venous
confirmatory test after an elevated capillary test.
3) Outreach to at -risk populations, this can include:
• Non -Medicaid children — providing nursing case management home visits
Foreign adoptees, refugees, migrants, immigrants, and foster children
Targeted communities (Adrian, Dearborn, Detroit, Flint, Grand Rapids,
Hamtramck, Highland Park, Jackson, Lansing, Leoni Township, Muskegon,
Muskegon Heights)
Reporting Requirements (if different than contract language)
Provide a workplan with a detailed overview of how your LHD plans to increase
capillary to venous rates within the grantee focus area, and explanation of target
audience/locations
Submit quarterly reports
• CLPPP support will include:
o LHD report cards
o Nursing and Public Health Consultant technical assistance as requested
o miclppp.org website with educational materials re: testing, cleaning
o Online training module for health care providers
Any additional requirements (if applicable)
Attend quarterly call/in-person meetings
Ensure all communication materials that are developed and distributed by the grantee are
approved by CLPPP if MDHHS funds are used.
Grantees Focus Areas:
• Bay County Health Department— Region 5
• Detroit Health Department — City of Detroit
• District Health Department #10 — Regions 2/3
• Genesee County Health Department —City of Flint
• Ingham County Health Department — Region 7 w/ additional focus on City of
Lansing
• Jackson County Health Department — Region 9 w/ additional focus on City of
Jackson and Leoni Township
• Kalamazoo County Health and Community Services Department — Region 8 w/
additional focus on City of Kalamazoo
• Kent County Health Department Region 4 w/ additional focus on City of Grand
Rapids
• Lenawee County Health Department — Adrian
• Muskegon County Health Department — Muskegon and Muskegon Heights
• Wayne County Department of Health, Veterans, and Community Wellness —
Region 10 w/ additional focus on Hamtramck, Dearborn, Highland Park
• Public Health, Delta & Menominee Counties — Region 1
• St. Clair County Health Department — Region 6
PROJECT: COVID-19 Response
Beginning Date: 10/1/2020
End Date: 09/30/2021
Project Synopsis:
This project allows the Local Health Departments to respond to the COVID response in their
community. Response may include testing, outreach, community education, tracing contacts, and
data collection. Funding is intended to support staff time and supplies associated with COVID-19
response in the LHD jurisdiction.
Reporting Requirements (if different than contract language)
Any additional requirements (if applicable)
PROJECT: CSHCS Care Management/Care Coordination
Beginning Date: 10/01/2020
End Date: 09/30/2021
Project Synopsis
Beneficiaries enrolled in CSHCS with identified needs may be eligible to receive Care
Coordination Services as provided by the local health department. In addition,
beneficiaries with either CSHCS, CSHCS and Medicaid, or Medicaid only (no CSHCS)
may be eligible to receive Case Management services if they have a CSHCS medically
eligible diagnosis, complex medical care needs and/or complex psychosocial situations
which require that intervention and direction be provided by the local health department.
LHD staff includes registered nurses (RNs), social workers, or paraprofessionals under
the direction and supervision of RNs. Services are reimbursed on a fee for services
basis, as specified in Attachment IV Notes.
Reporting Requirements (if different than contract language)
See Attachment I for specific budget and financial requirements.
Case Management and Care Coordination services within a specific Case Management
role cannot be billed during the same LHD billing period, which is usually a fiscal quarter
Care Coordination and Case Management Logs are submitted electronically via the
Children's Healthcare Automated Support Services (CRASS) Billing Module to the
Contract Manager. Quarterly logs must be submitted with the financial status report.
The Contract Manager shall evaluate the reports for their completeness and adequacy.
The Contract Manager will conduct case management and care coordination log audits
on a quarterly basis.
Annual Narrative Progress Report
N/A
Any additional requirements (if applicable)
Case Management services address complex needs and services and include an initial
face-to-face encounter with the beneficiary/family. Case Management requires that
services be provided in the home setting or other non -office setting based on family
preference. Beneficiaries are eligible for a maximum of six billing units per eligibility year.
Services above the maximum of six require prior approval by MDHHS. To request
approval, the LHD must submit an exception request, including the rationale for additional
services, to MDHHS. Limitations on the need for and number of Case Management
service units are set by MDHHS and must be provided by a specific Case Management
role, in accordance with training and certification requirements.
Staff must be trained in the service needs of the CSHCS population and demonstrate skill
and sensitivity in communicating with children with special needs and their families.
Care Coordination is not reimbursable for beneficiaries also receiving Case Management
services during the same LHD billing period, which is usually a calendar quarter. In the
event Care Coordination services are no longer appropriate and Case Management
services are needed, the change in services may only be made at the beginning of the
next billing period.
PROJECT: CSHCS Medicaid Elevated Blood Lead Case Management
Beginning Date: 10/1/2020
End Date: 9/30/2021
Project Synopsis
All Local Health Departments in Michigan are eligible to participate in this program.
The grantee will complete in -home elevated blood lead (EBL) case management (CM)
services, with parental consent, for children less than age 6 in their jurisdiction enrolled
in Medicaid with a blood lead level equal to or greater than 4.5 micrograms per deciliter
(>_4.5 lag/dL) as determined by a venipuncture test. EBL CM will be conducted according
to the "Case Management Guide for Children with Elevated Blood Lead Levels" that is
provided by the Childhood Lead Poisoning Prevention Program (CLPPP), Michigan
Department of Health and Human Services (MDHHS). For each child eligible for EBL
CM, efforts to contact the family to provide CM services and specific services provided
must be documented in the child's electronic record in the Healthy Homes and Lead
Poisoning Prevention (HHLPPS) database maintained by CLPPP-MDHHS.
Reporting Requirements (if different than contract language)
The Grantee shall submit:
Annual Report
Reporting period for FY21 is October 1, 2020 — September 30, 2021.
Quarterly Case Management Logs
A log of CM activities for is due quarterly, submitted electronically through the CLPPP's
secure File Transfer Site, using a spreadsheet template provided by CLPPP that
specifies the information to be provided on each child for which reimbursement is being
requested on the quarterly Supplemental Attachment to the CPBC FSR. The quarterly
logs will be submitted no later than thirty (30) days after the close of the quarter.
Quarter Reporting Time Period
1 st October 1- December 31
2nd January 1— March 31
3rd April 1 — June 30
4th July 1 — September 30
Quarterlv Loos Due Date
January 31
April 30
July 30
October 30
The CLPPP EBL CM Project Manager will review the logs for their completeness and
adequacy and provide approval for payment within 30 days of receipt.
Any additional requirements (if applicable)
The grantee shall:
• Have home case management conducted by a registered nurse trained by
MDHHS CLPPP. Training addresses general principals of lead poisoning and lead
poisoning prevention, the Case Management protocol and the use of the HHLPPS
database.
• Sign up for the secure FTP site maintained by MDHHS CLPPP, to be used for
data sharing of confidential information.
• Have an agreement with all Medicaid Health Plans in their jurisdiction that allows
for sharing of Personal Health Information regarding the Plan's children with
EBLLs.
• Identify and Initiate contact with families of all Medicaid venous -confirmed EBLL
children from the lists provided by MDHHS CLPPP to the grantee.
• Complete case management activities according to requirements in the MDHHS
CLPPP Case Management Guide.
• Document all case management activities in the child's electronic file in the
HHLPPS database.
• Provide quarterly summaries of case management activities for all eligible EBLL
children using a spreadsheet template provided by MDHHS CLPPP.
• Submit request for reimbursement through the EGrAMS system based on the
"fixed unit rate" method. The fixed rate for case management services is $201.58
per home visit, for up to 6 home visits.
CLPPP-MDHHS shall provide the Grantee with:
• Weekly list of children in their jurisdiction with a laboratory report received in the
prior week and a faxed report for children with blood lead levels =>20 pg/dl the
day the report is received at MDHHS.
• Written Case Management protocol.
• Instructions for billing and documentation of services for participation in this
project.
Spreadsheet template for log of CM activities
Access to HHLPPS database.
Access to the CLPPP FTP site for secure file transfer.
Training in the basics of lead exposure and poisoning, conduct of CM, use of the
HHLPPS database, and use of FTP site for transmission of confidential
information.
6 On -going technical support and consultations from an MDHHS CLPPP nurse.
PROJECT: CSHCS Medicaid Outreach
Beginning Date: 10/01/2020
End Date: 09/30/2021
Project Synopsis
Local Health Departments may perform Medicaid Outreach activities for
CSHCS/Medicaid dually enrolled clients and receive reimbursement at a 50% federal
administrative match rate based upon their CSHCS Medicaid dually enrolled caseload
percentage and local matching funds.
Reporting Requirements (if different than contract language)
See Attachment I for specific budget and financial requirements.
Annual Narrative Progress Report
IU
Any additional requirements (if applicable)
N/A
PROJECT TITLE: CSHCS OUTREACH AND ADVOCACY
Start Date: 10/1/2020
End Date: 9/30/2021
Project Synopsis:
Local Health Departments (LHDs) throughout the state serve children with special health
care needs in the community. The LHD acts as an agent of the CSHCS program at the
community level. It is through the LHD that CSHCS succeeds in achieving its charge to
be community -based. The LHD serves as a vital link between the CSHCS program, the
family, the local community and the Medicaid Health Plan (as applicable) to assure that
children with special health care needs receive the services they require covering every
county in Michigan.
LHD is required to provide the following specific outreach and advocacy services:
• Program representation and advocacy
• Application and renewal assistance
• Link families to support services (e.g. The Family Center, CSHCS Family Phone Line,
the CSHCS Family Support Network (FSN), transportation assistance, etc.)
Implement any additional MPR requirements
• Care coordination
• Budget and Agreement Requirement and Grantee
• Submission of all documents via the document management portal, as required
Reporting Requirements (if different than agreement language):
Annual Narrative Progress Report
A brief annual narrative report is due by November 15 following the end of the fiscal year.
The reporting period is October 1 — September 30. The annual report will be submitted to
the Department and shall include:
• Summary of successes and challenges
Technical assistance needs the Grantee is requesting the Department to address
Brief description of how any local MCH funds allocated to CSHCS were used (e.g.
CSHCS salaries, outreach materials, mailing costs, etc.), if applicable
The unduplicated number of CSHCS eligible clients assisted with CSHCS enrollment.
The unduplicated number of CSHCS clients assisted in the CSHCS renewal process.
Definitions
Unduplicated Number of CSHCS Eligible Clients Assisted with CSHCS Enrollment
is defined as:
Number of CSHCS eligible clients the Grantee provided one-on-one (in person or via
telephone) substantial assistance to complete the CSHCS enrollment process during the
fiscal year. This assistance includes, but is not limited to, helping the family obtain
necessary medical reports to determine clinical eligibility, completing the CSHCS
Application for Services, completing the CSHCS financial assessment forms, etc.
Unduplicated Number of CSHCS Clients Assisted in the CSHCS Renewal Process
is defined as:
Number of CSHCS enrollees the Grantee provided one-on-one (in person or via
telephone) substantial assistance to complete and/or submit documents required for the
Department to make a determination whether to continue/renew CSHCS coverage during
the fiscal year. "Assisted" may also include collaboration with the client's Medicaid Health
Plan.
Any additional requirements (if applicable):
Relationship between Grantees and Medicaid Health Plans:
The Grantee must establish and maintain care coordination agreements with all Medicaid
Health Plans for CSHCS enrollees in the Grantees service area. Grantees and the
Medicaid Health Plans may share enrollee information to facilitate coordination of care
without specific, signed authorization from the enrollee. The enrollee has given consent
to share information for purposes of payment, treatment and operations as part of the
Medicaid Beneficiary Application.
Care coordination agreements between Grantees and the Medicaid Health Plans will be
available for review upon request from the Department.
The agreement must address all the following topics
• Data sharing
• Communication on development of Care Coordination Plan
• Reporting requirements
• Quality assurance coordination
• Grievance and appeal resolution
• Dispute resolution
• Transition planning for youth
PROJECT: Eat Safe Fish
Beginning Date: 10/1/2020
End Date: 9/30/2021
Project Synopsis
The Grantee will collaborate with the Department and the EPA Region V Saginaw
Community Information Office to deliver a uniform message for the Saginaw River and
connected waters regarding the fish and wild game consumption advisories within the tri
county area (Midland, Saginaw, and Bay).
Bay County Health Department (BCHD) will develop a plan to distribute that message
using existing health department programs, the medical community, special events, and
community service providers to communicate with the at -risk population.
Bay County Health Department (BCHD) will get approval from the Department program
manager and for any changes to the Saginaw and Bay County Cooperative Agreement
Scope of Work including budget and budget narratives
Reporting Requirements (if different than contract language)
Track and report output measures.
Write and Submit quarterly reports and an annual report to the Department.
Submit draft quarterly reports within 15 days after the end of each
quarter.
i Annual reports upon request.
Any additional requirements (if applicable)
The Grantee will provide appropriate staff to fulfill the following objectives and outputs as
detailed:
• Comply with the Saginaw and Bay County Cooperative Agreement budget
and budget narratives as describe in the scopes of work provided to the
BCHD program manager as applicable from October 1 to September 30.
0 Provide 30 hours of health education and community outreach per week.
• Conduct health education and community outreach in Saginaw, Midland, and
Bay Counties. Activities will include, but not be limited to, internal BCHD
distribution, health care provider outreach, and key event participation.
Track hours to comply with cost recovery requirements.
• Development, Printing, and Distribution of Outreach Materials and implementation
of Display Booth.
Identify, track, and record of materials distributed at additional locations within
Midland, Bay, and Saginaw Counties.
• Make payment for the replacement of signage on the Tittabawasse and Saginaw
Rivers.
• Conduct Capacity Building in Saginaw, Midland and Bay Counties
• Actively seek out new community partners in Saginaw, Midland and Bay Counties.
• Participate in monthly SBCA teleconference.
• Provide Presentation of display booth at select community events in coordination
with EPA Region V Saginaw Community Information Office.
Conduct Outreach though existing BCHD Programs such as WIC, Immunizations,
programs for young mothers, or other programs reaching the target population.
• Assist the EPA Region V Saginaw Community Information Office with community
outreach.
Outreach to Health Care Providers.
PROJECT: EGLE Drinking Water and Onsite Wastewater Management
Beginning Date: 10/1/2020
End Date: 09/30/2021
Project Synopsis
State funding for ELPHS shall support, and the Grantee shall provide for, all of the following
required services in accordance with P.A. 368, of 1978 and P.A. 92 of 2000, as amended,
Part 24 and Act No. 336, of 1998 Section 909:
• Infectious/Communicable Disease Control
• Sexually Transmitted Disease
• Immunization
• On -Site Wastewater Treatment Management
• Drinking Water Supply
• Food Service Sanitation
• Hearing
• Vision
• State funding for ELPHS can support administrative cost for the eight required
services including allowable indirect cost, or a Grantee's cost allocation plan.
• ELPHS funding can also be used to fund other core health functions including:
Community Health Assessment and Improvement, Public Policy Development,
Health Services Administration, Quality Assurance, Creating and Maintaining a
Competent Work Force and Local Public Health Accreditation. These services may
be budgeted separately as part of the Administrative Budget element.
• Net allowable expenditures are the authorized actual/allowable expenditures
(total costs less specified exclusions). Available funding is also limited by state
appropriations.
• First and second party fees earned in each required service program may be used
only in that required service program.
• State ELPHS funding is subject to local maintenance of effort compliance.
Distribution of state ELPHS funds shall only be made to agencies with total local
general fund public health services spending in fiscal year (FY) 2021 of at least
the amount expended in FY 92/93. To be eligible for any of the State funding
increases from FY 94/95 through FY 2021, the FY 92/93 Local Maintenance of
Effort Level must be met.
Reporting Requirements (if different than contract language)
All final amendment ELPHS funding shift request memos need to be submitted no
later than May 1. Please send the official memo to request ELPHS funding shifts by
email to Laura de la Rambelje (DelaRambeljeL@michigan.gov) and copy Carissa Reece
(ReeceC@Michigan.gov).
Any Additional Requirements (if applicable)
• Assure the availability and accessibility of services for the following basic health
services: Prenatal Care; Immunizations; Communicable Disease Control; Sexually
Transmitted Disease (STD) Control; Tuberculosis Control; Health/Medical Annex of
Emergency Preparedness Plan.
• Fully comply with the Minimum Program Requirements for each of the required
services.
• Grantee will be held to accreditation standards and follow the accreditation process
and schedule established by the Department for the required services to achieve
full accreditation status. Grantees designated as "not accredited" may have their
Department allocations reduced for Departmental costs incurred in the assurance
of service delivery. The accreditation process is based upon the Minimum Program
Standards and scheduled on a three-year cycle. The Minimum Program Standards
include the majority of the required Department reviews. Some additional reviews,
as mandated by the funding agency, may not be included in the Program
Standards and may need to be scheduled at other times.
Onsite Wastewater Management
The Grantee shall perform the following services for private single -and two-family
homes and other establishments that generate less than 10,000 gallons per day of
sanitary sewage:
• Maintain an up-to-date regulation for on -site wastewater treatment systems
(Systems). The regulation shall be supplemented by established internal policies
and procedures. Technical guidance for staff that defines site suitability
requirements, the basis for permit approval and/or denial, and issues not specifically
addressed by the regulation shall be provided.
Evaluate all parcels to determine the suitability of the site for the installation of
initial and replacement Systems in accordance with applicable regulation(s).
These evaluations shall be conducted by a trained sanitarian or equivalent and
shall consist of a review of the permit application for the installation of a System
and a physical evaluation of the site to determine suitability.
• Accurately record on the permit to install the initial or replacement System or on an
attachment to the permit the site conditions for each parcel evaluated including soil
profile data, seasonal high-water table, topography, isolation distances, and the
available area and location for initial and replacement Systems. The requirement
for identifying a replacement System applies to issuance of new construction
permits only.
• Issue a permit, prior to construction, in accord with applicable regulation(s) for
those sites that meet the criteria for the installation of a System. The permit shall
include a detailed plan and/or specification that accurately define the location of the
initial or replacement System, System size, other pertinent construction details, and
any documented variances.
Provide and keep on file formal written denials, stating the reason for denial, for
those applications where site conditions are found to be unsuitable.
Conduct a construction inspection prior to covering each System to confirm that the
completed System complies with the requirements of the permit that has been
issued. Maintain, on file, an accurate individual record of each inspection
conducted during construction of each system. In limited circumstances where
constraints prohibit staff from completing the required construction inspection in a
timely manner, an effective alternate method to confirm the adequacy of the
completed System shall be established. The effective alternative method shall be
utilized for no more than ten (10) percent of the total number of final inspections
unless specific authorization has been granted by the State for other percentage.
The results of all such inspections or an alternate method shall be clearly
documented.
• Maintain an organized filing system with retrievable information that includes
documentation regarding all site evaluations, permits issued or denied, final
inspection documentation, and the results of any appeals.
• Conduct review and approval or rejection of proposed subdivisions, condominiums
and also land divisions under one acre in size for site suitability according to the
statutes and Administrative Rules for Onsite Water Supply and Sewage Disposal
for Land Divisions and Subdivisions.
• Utilize the State's "Michigan Criteria for Subsurface Sewage Disposal" (Criteria) for
Systems other than private single- and two-family homes that generate less than
10,000 gallons per day. Systems treating less than 1,000 gallons per day may be
approved in accordance with the Grantee's regulation. Advise the State prior to
issuance of a variance from the Criteria. Variances are only to be issued by the
Director of Environmental Health of the Grantee after consultation with the State.
Appeals of any decision of the Grantee pursuant to the Criteria including systems
treating less than 1,000 gallons evaluated in accordance with the Grantee's
regulation shall only be made to the State.
• Maintain quarterly reports that summarize the total number of parcels evaluated,
permits issued, alternative or engineered plans reviewed, and number of appeals,
number of inspections during construction, number of failed systems evaluated,
and number of sewage complaints received and investigated for each residential
(single and two-family homes) and non-residential properties. The report forms
EQP2057a.1 (Non -Residential) and EQP2057b.1 (Residential) are available on the
EGLE website. All quarterly reports are to be submitted directly to EGLE, to the
address noted on the form, within fifteen (15) days following the end of each
quarter.
• Review all engineered or alternative System plans. Conduct adequate
inspections during the various phases of construction to ensure proper installation.
• Collect data at the time of permit issuance when a System has failed to document
the System age, design, site conditions, and other pertinent factors that may have
contributed to the failure of the original System. Evaluations shall record
information indicated on the EGLE Onsite Wastewater Program Residential and
Non -Residential Information forms. The results for all failed Systems evaluated
shall be maintained in a retrievable file or database and summarized in an annual
calendar year data report. Annual summaries of failed system data shall be
provided to EGLE for input into the state-wide failed system database. The EGLE
Onsite Wastewater Program Residential and Non -Residential Information forms