HomeMy WebLinkAboutResolutions - 2021.12.09 - 35114MOAKLANDF�r
C O U NTY M I CHI GAN
BOARD OF COMMISSIONERS
December 4, 2021
MISCELLANEOUS RESOLUTION #21-501
Sponsored By: Penny Luebs
IN RE: Health & Human Services - Health Division - Grant Amendment FY 2022 Local Health
Department Agreement - Amendment #1
Chairperson and Members of the Board:
WHEREAS the Oakland County Health Division has received Amendment #1 to the Fiscal Year (FY) 2022
Local Health Department (Comprehensive) Agreement (formerly the Comprehensive Planning. Budgeting, and
Contracting agreement - CPBC) from the Michigan Department of Health and Human Services (MDHHS 1: and
WHEREAS the original agreement totaling S11.430.410 was adopted by the Board of Cormnissioners on
October 28, 2021, via Miscellaneous Resolution #21435; and
WHEREAS Amendment #1 increases the funding to S11.885,913, an increase of S455,503: and
WHEREAS the Health Division is requesting to transfer the special revenue finding assigned to one (1) Part -
Time Non -Eligible 1 PTNE) 1.000 hours per year Medical Technologist position within the Laboratory unit
(91060212-14866) from the FY 2022 Local Health Department grant (LHD) (Fund #28631) to the FY 2022
Emerging Threats Agreement grant and
WHEREAS it is requested to delete one (1) Part -Time Non -Eligible (PINE) 1.000 hours per year Special
Revenue Medical Technologist position within the Laboratory unit (#1060212-14867) due to a lack of fimdirig;
and
WHEREAS there is no grant match; and
WHEREAS the grant amendment has completed the Grant Review Process in accordance with the Grants
Policy approved by the Board at their January 21, 2021. meeting.
NONA" THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners accepts the FY
2022 Local Health Department (Comprehensive) Agreement Amendment #1 in the amount of $455.503 for the
period of October 1, 2021, through September 30.2022.
BE IT FURTHER RESOLVED to transfer the funding assigned to one (1) Special Revenue Part -Tine Non -
Eligible (PTNE) 1,000 hours per year Medical Technologist position (#1060212-14866) from the FY 2022
Local Health Department (LHD) grant (Fund #28631) to the FY 2022 Emerging Threats Agreement Grant
(Fund #28630).
BE IT FURTHER RESOLVED to delete one (1) Part -Time Non -Eligible (PTNE) 1,000 hours per year
Special Revenue Medical Technologist position within the Laboratory unit (41060212-14867) due to a lack of
funding.
BE IT FURTHER RESOLVED that the future conunitment and continuation of the Special Revenue positions
is contingent upon the level of funding associated with the agreement.
BE IT FURTHER RESOLVED that the Chairperson of the Board of Commissioners is authorized to execute
the grant agreement and to approve the grant extensions or changes, within fifteen percent (151,6) of the original
awcr , d-
BE IT FURTHER RESOLVED the Special Revenue Budgets are amended as detailed in the attached
Schedule A.
Chairperson, the following Commissioners are sponsoring the foregoing Resolution: Penny Luebs.
64 d Date: December 09, 2021
David Woodward, Commissioner
Date: December 15, 2021
Hilarie Chambers, Deputy County Executive II
Date: December 15 2021
Lisa Brown, County Clerk / Register of Deeds
COMMITTEE TRACKING
2021-11-30 Public Health & Safety - recommend to Board
2021-1 %09 Full Board
VOTE TRACKING
Motioned by Commissioner William Miller III seconded by Commissioner Robert Hoffinan to adopt the
attached Grant Amendment: FY 2022 Local Health Department Agreement - Amendment #1.
Yes: David Woodward, Michael Gingell, Michael Spisz. Karen Joliat. Kristen Nelson, Eileen Kowall,
Christine Long, Philip Weipert, Gwen Markham, Angela Powell, Thomas Kuhn. Chuck Moss, Marcia
Gershenson, William Miller III, Yolanda Smith Charles. Charles Cavell. Penny Luebs. Janet Jackson. Gary
McGillivray, Robert Hoffman. Adam Kochenderfer (21)
No: None (0)
Abstain: None (0)
Absent: (0)
The Motion Passed.
ATTACHMENTS
1. Grant Review Sign -Off
2. PH&S Health FY2022 LHD Agreement Grant Ain#1 SchA
3, FY22 LHD Agreement - Amend #1 Draft Contract REV
1. FY22 LHD Agreement - Amend #1 Attachment I
5. CSHCS Vaccination Initiative - Attachment III 11.1.2021
6. FY22 LHD Agreement - Amend #1 Attachment III
T FY22 LHD Agreement - Amend #1 Attachment IV
S. PHS - Health - LHD Amendment 1 .,write up (1)
STATE OF MICIHGAN)
COUNTY OF OAKLAND)
I, Lisa Brown, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and
accurate copy of a resolution adopted by the Oakland County Board of Commissioners on December 9, 2021,
with the original record thereof now remaining in my office.
In Testimony Whereof, I have hereunto set my hand and affixed the seal of the Circuit Court at Pontiac,.
Michigan on Thursday, December 9, 2021.
Lisa Brown, Oakland County, Clerkf Register ofDeeds
GRANT REVIEW SIGN -OFF — Health & Human Services / Health Division
GRANTNAME: r' Y GULL Local neahh 1Jeparmlem (Cowpiehi;uoivc) l.b..,......,..�
FUNDING AGENCY: Michigan Department of Health & Human Services
DEPARTMENT CONTACT: Raquel Lewis 248-858-5254
STATUS: Grant Amendment #1 (less than 15%)
DATE: 11/09/21
Please be advised the captioned grant materials have completed internal grant review. Below are the returned comments.
The Board of Commissioners' liaison committee resolution and grant amendment package (which should include this
sign -off and the grant amendment with related documentation) may be requested to be placed on the agenda(s) of the
appropriate Board of Commissioners' committee(s) for grant amendment by Board resolution.
DEPARTMENT REVIEW
Management and Budget:
Approved by M & B — Lynn Sonkiss 11/8/2021.
The draft resolution is to be updated for the applicable budgetary information/amendment
Human Resources:
Approved by Human Resources.- Heather Mason 1 1 /3/21
Impacts positions so HR action is needed.
Risk Management:
Approved by Risk Management. R.E. 11/03/2021
Corporation Counsel:
The revised draft contract is approved by Corporation Counsel (no legal issues). Sharon Kessler —
11 /4/21.
'rw Keves-Bowie Tifannv B' Smith, Stacey; Lewis Raquel; Stafford. Leich-Anne; (ornorate Counsel: Mason Heather
L; MrBmom Diana E: Erlenbeck, Robert Carl
Cc: Adonlu-Inner Fhru: (onforti Holly W Elarably, Kim K; Guzzy, Scott N; Jeri Kvie Isaac; Joss, Edward P; 6uz2v,
Scott N; Suit. Julie; 'cover Aarnn G.1 Strinnfellne, IoAnm Sergi Connie L; Stolzenfeld Tracv; Ward, Chris;
Winter Barbara; Zhou Jennv; Matthewa Hailev, Powers Andrea; Sanrhe]. Kristin L: Worthington Pamela L
Subject: RE: GRANT REVIEW FORM - Health & Human Services/Health Division - FY 2022 Local Health Department
(Comprehensive) Agreement - Amendment #1 (Less than 15%) REVISED
Date: Monday, November 8, 2021 8:03:48 PM
Attachments: FW GRANT REVIEW FORM - Health Human ServicesHealth Division - FY 2022 Local Health Department
(Comprehensive) Agreement - Amendment 01 (Less than 199%) REVTSFD msa
Approved by M & B — 11/8/2021.
The draft resolution is to be updated for the applicable budgetary Information/amendment.
Thanks,
Lynn Sonkiss
Fiscal Services Officer
Oakland County, Michigan
Phone 248.858.0940
Fax 248.858.9724
sonkisslm)oakeov.com
From: Keyes -Bowie, Tifanny B <keyesbowlet@oal<gov.com>
Sent: Wednesday, November 03, 20214:06 PM
To: Smith, Stacey <smlthsd@oakgov.com>; Lewis, Raquel <lewisra@oakgov.com>; Stafford, Leigh -
Anne <staffordl@oakgov.com>; Corporate Counsel <corpcounsel@oakgov.com>; Mason, Heather L
<masonh@oakgov.com>; McBroom, Diana E. <mcbroomd@oakgov.com>; Erlenbeck, Robert Carl
<erlenbeckr@oakgov.com>; Sonkiss, Lynn C <sonkissl@oal<gov.com>
Cc: Adoglu-Jones, Ebru <adoglu-jonese@oakgov.com>; Conforti, Holly M <confortih@oakgov.com>;
Elgrably, Kim K <elgrablyk@oakgov.com>; Guzzy, Scott N <guzzys@oakgov.com>; Jen, Kyle Isaac
<jenk@oakgov.com>; Joss, Edward P <josse@oakgov.com>; Guzzy, Scott N <guzzys@oakgov.com>;
Shih, Julie <shihj@oakgov.com>; Keyes -Bowie, Tifanny B <keyesbowiet@oakgov.com>; Snover,
Aaron G. <snovera@oakgov.com>; Stringfellow, JoAnn <stringfellowj@oal<gov.com>; Srogi, Connie L
<srogic@oakgov.com>; Stolzenfeld, Tracy <stolzenfeldt@oakgov.com>; Ward, Chris
<wardcc@oakgov.com>; Winter, Barbara <wlnterb@oakgov.com>; Zhou, Jenny
<zhouj@oakgov.com>, Matthews, Hadley <matthewshd@oakgov.com>; Powers, Andrea
<powersa@oakgov.com>; Sanchez, Kristina L<sanchezk@oakgov.com>; Worthington, Pamela L
<wo rt h i n gto n p@ o a kgov. co m>
Subject: FW: GRANT REVIEW FORM - Health & Human Services/Health Division - FY 2022 Local
Health Department (Comprehensive) Agreement - Amendment #1 (Less than 15%) REVISED
Please Note: A revised contract is attached for review.
From: Matto nramer ,
To: Keves-Bnwie. Tifannv R: Smith, Stacey; Lewis. Raquel; Stafford Leigh -Anne; Comorate CounsaP MCBr00m,
Diana E.; Frlenheck. Rnhert Carl: 5onkiss, Lynn C
Cc: Adoolu-loves Ehrn: Cnnforn, Holly M: Elarably, Kim K; Guzzy, Scott N; Jen KyIe Isaac; Joss, Edward P; Guzzy,
Scott N; Shih J nov r. Aaron .; Strinafellow, JoAnn; Srogi Connie I; Stolzenfe)d. Tracy; Ward. Cho ;
Wmter Barbara; Zhou Jenny; Matthews. Hailev: Powers Andrea; Sanchez. Kristin I . Worthmaton Pamela I
Subject: RE: GRANT REVIEW FORM - Health & Human Services/Health Division - FY 2022 Local Health Department
(Comprehensive) Agreement - Amendment #1 (Less than 15%) REVISED
Date: Wednesday, November 3, 2021 5:03:09 PM
Approved by Human Resources.
Impacts positions so HR action is needed.
Heather L. Mason
Supervisor Human Resources
Oakland Country Human Resources
L. Brooks Patterson Budding- 2100 Pontiac Lake Road, Waterford MI 48328
P 248.858,2581 1 C: 248,568.2738 I F. 248.975.9742
masnnh Giloa::anv rnm 1 www nakeov vim/ioh�
Schedule: M,W,F onslte. T, Th remote.
From: Keyes -Bowie, Tifanny B <keyesbowiet@oal<gov.com>
Sent: Wednesday, November 3, 2021 4:06 PM
To: Smith, Stacey <smithsd@oakgov.com>; Lewis, Raquel <lewlsra@oakgov.com>; Stafford, Leigh
Anne <staffordl@oakgov.com>; Corporate Counsel <corpcounsel@oakgov.com>; Mason, Heather L
<masonh@oakgov.com>; McBroom, Diana E. <mcbroomd@oakgov.com>; Edenbeck, Robert Cad
<erlenbecl<r@oakgov.com>; Sonkiss, Lynn C <sonkissl@oakgov.com>
Cc: Adoglu-Jones, Ebru <adoglu-Jonese@oakgov.com>; Confortl, Holly M <confortih@oakgov.com>;
Elgrably, Kim K <elgrablyk@oakgov.com>; Guzzy, Scott N <guzzys@oakgov.com>; Jen, Kyle Isaac
<jenk@oakgov.com>; Joss, Edward P <josse@oakgov.com>; Guzzy, Scott N <guzzys@oakgov.com>;
Shih, Julie <shihj@oakgov.com>; Keyes -Bowie, Tifanny B <I<eVesbowiet@oakgov.com>; Snover,
Aaron G. <snovera@oakgov.com>; Stringfellow, JoAnn <strmgfellowj@oal<gov.com>; Srogi, Connie L
<srogic@oakgov.com>; Stolzenfeld, Tracy <stolzenfeldt@oakgov.com>; Ward, Chris
<wardcc@oakgov.com>; Winter, Barbara <winterb@oakgov.com>; Zhou, Jenny
<zhouj@oakgov.com> Matthews, Hailey<matthewshd@oakgov.com>; Powers, Andrea
<powersa@oakgov.com>; Sanchez, Kristina L <sanchezk@oakgov.com>; Worthington, Pamela L
<worth ington p @ oakgov.com>
Subject: FW: GRANT REVIEW FORM - Health & Human Services/Health Division - FY 2022 Local
Health Department (Comprehensive) Agreement -Amendment #1 (Less than 15%) REVISED
Please Note: A revised contract Is attached for review.
From: trenoem booert cai ,
To: Keves-Bowie. Tifannv 8; Smith, Stacey; Lewis. Raquel; Stafford Leieh-Anne Comorate cnimselMason Heather
L; Mr8room Diana F ; Sonkiss Lynn C
Cc: Adoglu-Tones. Fhru: Conforti. Holly M: Elgrably Kim K; GGu:zzy, Scott N; ]en Kyle Isaac; Joss, Edward P; Guzzy.
Scott V; 51l Tull ; Snnver Aaron G.; Stnnofallow. InAnn- Srwi, Connie L; Stnhanfeld. Trarv• Ward, Cbris;
Winter. Barbara: Zhou Jenny; Matthews. Hailev; Powers Andrea; Sanrhez_ Kristin t: Worthington Pamela L
Subject: RE: GRANT REVIEW FORM - Health & Human Services/Health Division - FY 2022 Local Health Department
(Comprehensive) Agreement - Amendment #1 (Less than 15%)
Date: Wednesday, November 3, 2021 2:27:50 PM
Approved by Risk Management. R.E. 11/03/2021
Robert Erlenbeck, Insurance Risk Administrator
Risk Management
Office: 248-858-1694
Cell 248-421-9121
Office schedule: Monday through Thursday 7 00 to 5:00
From: Keyes -Bowie, Tifanny B <keyesbowiet@oakgov.com>
Sent: Tuesday, November 02, 20214:17 PM
To: Smith, Stacey <smithsd@oakgov.com>; Lewis, Raquel <lewisra@oakgov.com>; Stafford, Leigh -
Anne <staffordl@oakgov.com>; Corporate Counsel <corpcounsel@oakgov.ccm>; Mason, Heather L
<masonh@oakgov.com>; McBroom, Diana E. <mcbroomd@oakgov.com>; Erlenbeck, Robert Carl
<erlenbeckr@oakgov.com>; Sonkiss, Lynn C <sonkissl@oakgov.com>
Cc: Adoglu-Jones, Ecru <adogluJonese@oakgov.com>; Conforti, Holly M <confortih@oakgov.com>;
Elgrably, Kim K <elgrablyk@oakgov.com>; Guzzy, Scott N <guzzys@oakgov.com>; Jen, Kyle Isaac
<jenk@oakgov.com>; Joss, Edward P <josse@oakgov.com>; Guzzy, Scott N <guzzys@oakgov.com>;
Shih, Julie <shihj@oakgov.com>, Keyes -Bowie, Tlfanny B <keyesbowiet@oakgov.com>; Snover,
Aaron G. <snovera@oakgov.com>; Stringfellow, JoAnn <stringfellowj@oakgov.com>; Srogi, Connie L
<sroglc@oakgov,com>; Stolzenfeld, Tracy <stolzenfeldt@oakgov.com>; Ward, Chris
<wardcc@oakgov.com>; Winter, Barbara <winterb@oakgov.com>; Zhou, Jenny
<zhouj@oal<gov.com>; Matthews, Hadley <matthewshd@oakgov.com>; Powers, Andrea
<powersa@oakgov.conl Sanchez, Kristina L <sanchezk@oakgov.com>; Worthington, Pamela L
<wo rt h i n gto n p@ o a I<gov. co m>
Subject: GRANT REVIEW FORM - Health & Human Services/Health Division - FY 2022 Local Health
Department (Comprehensive) Agreement - Amendment #1 (Less than 15%)
GRANT REVIEW FORM
TO: REVIEW DEPARTMENTS — Lynn Sonkiss — Heather Mason — Diana MCBrOOm —
Sharon Cullen
RE: GRANT CONTRACT REVIEW RESPONSE —Health & Human Services/Health
Division
FY 2022 Local Health Department (Comprehensive) Agreement - Amendment #1
From:
To:
Cc:
Subject:
Date:
Kessler Sharon Barnes
Keves-Bowie. Tifannv B; Smith, Stacey; Lewis. Raquel; Stafford- I elah-Anne: Cornnrate Counsel: Mason Heather
L; McBronm. Diana E : Erlcnheck Rohert Carl; Sonkiss, Lynn C
Adoolu-lones Eton; Confnrtl Holiv W Eierabiv Kim K; QUzzy Scott N; Jen. Kyle Isaac; Joss, Edward P; QDZZY,
Scott N; ISh h. Julie; Snover Aaron C.r Strrnafellow. JoAnn; Srogi, Connie L; 5tolzenfeld Tracy; Ward, Chris;
Winter, Barbara, ADD, Jenny; Matthews Halley; Powers Andrea; Sanchez, Knstina L: Worthinoton, Pamela I
RE: GRANT REVIEW FORM - Health & Human Services/Health Division - FY 2022 Local Health Department
(Comprehensive) Agreement - Amendment #1 (Less than 15%) REVISED
Thursday, November 4, 2021 2:53:54 PM
The revised draft contract is approved by Corporation Counsel (no legal issues). Sharon Kessler —
21/4/21.
OAKIAND6
Sharon Barnes Kessler, Senior Assistant Corporation Counsel
Oakland County Corporation Counsel
1200 N Telegraph Road, Biog. 14 East, Courthouse West Wing Extension, 3" Floor, Pontiac, MI 48341
P. tA" ssc8 54 3'1 I F: 244 g53 1' 03 1 horn.,,,(@(,oka,.v corn
Hours: Monday— Friday; 7.30 am. to 4:00 p.m
PRIVILFCFD AND CONFIOFNTIAL —ATTORNEY CLU NT COMMUNWATION
1 his r-i natl is naendzd aaly to thop, person, to ..he.r it c;peencal:y a-ddrased Is is ]arfidrival ands smtcrl,J'a-this otton sr-rke lit pncd.ga and + su, product
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Depzr*rnet,t of Cui poi abort (Lad) R5?CSSo
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From: Keyes -Bowie, Tifanny B <keyesbowiet@oakgov.com>
Sent: Wednesday, November 3, 20214:06 PM
To: Smith, Stacey <smithsd@oakgov.com>; Lewis, Raquel <lewisra@oakgov.com>; Stafford, Leigh -
Anne <staffordl@oakgov.com>; Corporate Counsel <corpcounsel@oakgov.com>; Mason, Heather L
<masonh@oakgov.com>; McBroom, Diana E. <mcbroomd@oakgov.com>; Erlenbeck, Robert Carl
<erlenbeckr@oakgov.com>; Sonkiss, Lynn C <sonkissl@oakgov.com>
Cc: Adoglu-Jones, Ebro <adcglu-jonese@oakgov.com>; Conforti, Holly M <confortih@oakgov.com>;
Elgrably, Kim K <elgrablyk@oakgov.com>; Guzzy, Scott N <guzzys@oakgov.com>; Jen, Kyle Isaac
<jenk@oakgov.com>; Joss, Edward P <josse@oakgov.com>; Guzzy, Scott N <guzzys@oakgov.com>;
Shin, Julie <shlhj@oakgov.com>; Keyes -Bowie, Tifanny B <keyesbowiet@oakgov.com>; Snover,
Aaron G. <snovera@oakgov.com>; Stringfellow, JoAnn <stringfellowj@oakgov.com>; Srogi, Connie L
<srogic@oakgov,com>; Stolzenfeld, Tracy <stolzenfeldt@oakgov.com>; Ward, Chris
<wardcc@oakgov.corn>, Winter, Barbara <winterb@oakgov.com>; Zhou, Jenny
<zhouj@oal<gov.com>; Matthews, Halley <matthewshd@oakgov.com>; Powers, Andrea
<powersa@oakgov.com>, Sanchez, Kristina L <sanchezk@oal<gov.com>; Worthington, Pamela L
<worthington p @oakgov.com>
Subject: FW: GRANT REVIEW FORM - Health & Human Services/Health Division - FY 2022 Local
Health Department (Comprehensive) Agreement - Amendment #1 (Less than 13%) REVISED
Please Note: A revised contract is attached for review.
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1110312021
Contract #: 202203bb-UU
Amendment Number: Ito the
Between
Michigan Department of Health and Human Services
and
County of Oakland
hereinafter referred to as the "Local Governing Entity"
on Behalf of Health Department
Oakland County Department of Health and Human Services/ Health Division
AMENDMENT PURPOSE AND JUSTIFICATION
1. The purpose of this amendment is to:
1. Add/revise information in Attachment I - Annual Budget Instructions;
2. Add/revise information in Attachment III - Program Specific Assurance and
Requirements; and
3. Incorporate Attachment IV- Funding/Reimbursement Matrix as revised for the
Essential Local Public Health Service (ELPHS) and categorical budget details, output
measures and performance criteria.
4. Increase the Department's agreement amount from $11,430,410 to $11,885,913,
as shown on the Attachment B budget pages.
2. Amendment Revisions:
The following are the additions/revisions to Attachment I and III
A) The following projects include additions/revisions as highlighted in Attachment I -
Annual Budget Instructions:
No Change
B) The following projects include additions/revisions as highlighted in Attachment III -
Program Specific Assurance and Requirements:
Local Health Department - 2022, Date: 11/03/2021 Page: 1 of 13
11/03/2021
1. CSHCS Vaccine Initiative - New
2. Enviromental Health Data - New
3. Fetal Infant Mortality Review (FIMR) Interviews
4. Local Maternal Child Health (LMCH)
5. Local Public Health Tracking Network - New
6. West Nile Surviellance
7. Women Infant Children (WIC)
Following are adjustments to funding levels of the Local Health Department
agreement as reflected in Attachment IV:
Budget line item changes are reflected in the attached budgets for the
following elements:
Project Title Current Amended New Project
CSHCS Vaccine Initiative
Harm Reduction Support Services
HIV PrEP Clinic
Total Comprehensive Funding
A-mou78
—A-r
moun
0
35,329
35,329
0
150,000
150,000
132,696
270,174
402,870
132,696
455,503
588,199
Performance Level Adjustments
N/A
Budget category Adjustments
It is understood and agreed that all other conditions of the original agreement remains
the same.
Local Health Department - 2022, Dale, 11/03/2021 Page: 2 of 13
11 /03/2021
3. Signing this amendment
The individual or officer sigining this amendment certifies by his or her signature that
he or she is authorized to sign this amedment on behalf of the reponsible governing
board official or agency.
Signature Section
For Oakland County Department of Health and Human Services/ Health Division
Name (please print) Title
For the Michigan Department of Health and Human Services
Christine H. Sanches
11 /03/2021
Christine H. Sanches, Director Date
Bureau of Purchasing
Local Health Department-2022, Date. 11/0312021 Page: 3 of 13
11/03/2021
Attachments
Attachment I - Instructions for the Annual Budget
Attachment III - Program Specific Assurances and Requirements
Local Health Department - 2022, Date. 11/03/2021 Page: 4 of 13
MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
ATTACHMENT IV - Local Health Department - 2022
CONTRACT MANAGEMENT SECTION
Oakland County Department of Health and Human Services/ Health Division
Program Element/Funding Source MDHHS Fed/St
(a) Source
Adolescent STI Screening
Body Art Fixed Fee
Children's Special Hlth Care
Services (CSHCS) Care
Coordination
Children's Special Hlth Care
Services (CSHCS) Outreach &
Advocacy
Reg. Alloc. F
Calc. Amt.
Calc. Amt.
Reg. Alloc, F
Reg. Alloc.
CSHCS Medicaid Elevated Blood
Calc. Amt.
Lead Case Mgmt
CSHCS Vaccine Initiative
Reg. Alloc.
EGLE Drinking Water and Onsite
Reg. Alloc.
Wastewater Management
Emerging Threats - Hepatitis C
Reg. Alloc.
Fefal Infant Mortality Review
Calc. Amt.
(FIMR) Case Abstraction
FIMR Interviews
Calc. Amt.
Food ELPHS
Reg. Alloc.
Gonococcal Isolate Surveillance
Reg. Alloc.
Project
Reg. Alloc.
Harm Reduction Support Services
Reg. Alloc.
Hearing ELPHS
Reg. AI)oc.
HIV Data to Care
Reg. Alloc.
Funding Reimbursement
Performance
Amount Method
Target
(b)
Output
Measurement
73,000 Actual Cost
N/A
Reimbursement
250.00/Numb Fixed Unit Rate (2)
N/A
ers
150.00Nario Fixed Unit Rate (1),
N/A
us (7)
147,201 Actual Cost
N/A
Reimbursement
Contract # Date. 11/03/2( 21
Total (c)
State (d)
State Funded Minimum Contractor i
Perform
Expect
Funded
Target
Performance
Subrecepie it
Percent (f)
Perform
Number (a)
N/A
N/A
N/A
N/A Subrecepie nt
N/A
N/A
N/A
NIA Recepient
N/A
N/A
N/A
N/A Subrecepi( nt
N/A
N/A
N/A
N/A Subrecepir nt
S 147,201
201.58Nario Fixed Unit Rate (2)
N/A
N/A
N/A
N/A
N/A Subrecepinnt
us
F 35,329 Actual Cost
N/A
N/A
N/A
N/A
N/A Subrecepiont
Reimbursement
S 985,042 ELPHS (3), (6)
N/A
N/A
N/A
N/A
N/A Recepient
S 76,221 Actual Cost
N/A
N/A
N/A
N/A
N/A Recepient
Reimbursement
270.00Nario Fixed Unit Rate (2)
N/A
NIA
N/A
N/A
N/A Subrecepi,nt
us
85.00/Numbe Fixed Unit Rate (2),
N/A
N/A
N/A
N/A
N/A Subrecepient
rs (11)
S 1,176,612 ELPHS (3), (4)
N/A
NIA
N/A
N/A
N/A Recepient
F 15,750 Actual Cost
N/A
N/A
N/A
N/A
N/A Subrecep ant
Reimbursement
S 47,250
F 150,000 Actual Cost
N/A
N/A
NIA
N/A
N/A Subrecep ent
Reimbursement
L 253,969 ELPHS (3), (6)
N/A
N/A
N/A
N/A
N/A Recepien
P 128,000 Actual Cost
N/A
N/A
N/A
N/A
N/A Recepien
Reimbursement
Local Health Department - 2022, Date 11/03/2021 Page: 5 of 13
Contract# Date. 11/03/2r121
MICHIGAN DEPARTMENT OF HEALTH AND HUMAN
SERVICES
ATTACHMENT IV - Local Health Department - 2022
CONTRACT MANAGEMENT SECTION
Oakland
County Department of Health and Human Services/ Health
Division
Program ElementlFunding Source
(a)
MDHHS
Source
FedlSt
Funding Reimbursement Performance
Total (c)
State (d)
State Funded Minimum Contractor,
Amount Method Target
Perform
Funded
Subrecepie,It
(b) Output
Expect
Target
Performance
Percent (�
Measurement
Perform
Number(e)
Reg. Alloc.
S
0
HIV PrEP Clinic
Reg. Alloc.
F
130,042 Actual Cost N/A
N/A
N/A
N/A
N/A Subrecepie nt
Reimbursement
Reg. Alloy.
P
1,327
Reg. Alloc.
S
1,327
HIV Prevention
Reg. Alloy
F
22,612 Actual Cost NIA
NIA
N/A
N/A
N/A Subrecepie nt
Reimbursement
Reg. AIIoc.
P
22,612
Reg. Alloc.
S
407,021
Immunization Action Plan (IAP)
Reg. Alloy
F
501,895 Actual Cost NIA
N/A
N/A
N/A
N/A Subrecepii nt
Reimbursement
Immunization Fixed Fees
Calc. Amt.
300.00/Numb Fixed Unit Rate (2). N/A
N/A
N/A
N/A
N/A Subrecepient
ers (7)
Immunization Vaccine Quality
Reg. Alloc.
S
105,347 Actual Cost NIA
N/A
NIA
N/A
N/A Recepient
Assurance
Reimbursement
Infant Safe Sleep
Reg. Alloc.
F
7,000 Actual Cost N/A
N/A
N/A
N/A
N/A Subrecepient
Reimbursement
Reg. Alloc.
S
63,000
Laboratory Services BID
Reg. Alloc.
F
500 Actual Cost N/A
N/A
N/A
N/A
N/A Subreceplont
Reimbursement
MCH - All Other
Local MCH
S
321,457 Actual Cost N/A
N/A
N/A
N/A
N/A Subreceoient
Reimbursement
MDHHS-Essential Local Public
Reg. Alloc.
S
2,557,216 ELPHS (3),(6) N/A
N/A
N/A
N/A
N/A Recepient
Health Services (ELPHS)
Nurse Family Partnership
Reg. Alloc.
F
385,524 Actual Cost N/A
N/A
N/A
NIA
N/A Subrecepient
Services
Reimbursement
Reg. Alloc.
S
257,016
Public Health Emergency
Reg. Alloc.
F
221,778 Actual Cost N/A
N/A
N/A
N/A
N/A Subrecepient
Preparedness (PREP) 10/1 - 6130
Reimbursement
Public Health Emergency
Reg. Alloc.
F
140,707 Actual Cost N/A
N/A
NIA
N/A
N/A Subrecepient
Preparedness (PHEP) CRI 10/1 -
Reimbursement
i6/30
Local Health Department - 2022, Date: 1 V03/2021
Page !; of 13
Contract# Date11/03/2C21
MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
ATTACHMENT IV - Local Health Department - 2022
CONTRACT MANAGEMENT SECTION
Oakland County Department of Health and Human Services/ Health Division
Program Element/Funding Source
MDHHS
Fed/St
Funding Reimbursement
Performance
Total (c)
State (d)
State Funded Minimum Contractor /
(a)
Source
Amount Method
(b)
Target
Output
Perform
Expect
Funded
Target
Performance
Percent Subrecepiert
(f)
Measurement
Perform
Number (a)
Sexually Transmitted Infection
Reg. Alloy
F
33,418 Actual Cost
N/A
N/A
N/A
N/A
N/A Subrecepie 1t
(STI) Control
Reimbursement
Reg. Alloc.
S
703
Reg. Alloc.
S
36,144
Tuberculosis (TB) Control
Reg. Alloy
F
13,061 Actual Cost
N/A
N/A
N/A
N/A
N/A Subrecepient
Reimbursement
Vector -Borne Surveillance &
Reg. Alloc.
S
9,000 Actual Cost
N/A
N/A
N/A
N/A
N/A Receplent
Prevention
Reimbursement
Vision ELPHS
Reg. Alloc.
L
253,968 ELPHS (3), (6)
N/A
N/A
N/A
N/A
N/A Receplent
West Nlle Virus Community
Reg. Alloy
F
10,000 Actual Cost
N/A
NIA
N/A
N/A
N/A Subrecepie nt
Surveillance
Reimbursement
WIC Breastfeeding
Reg. Alloc.
F
261,619 Actual Cost
N/A
NIA
N/A
NIA
N/A Subrecepi¢ nt
Reimbursement
WIC Resident Services
Reg. Alloc.
F
2,615,870 Performance (8)
#Average
N/A
N/A
97
0 Subrecepif nt
Monthly
Participation
TOTAL MDHHS FUNDING 11,615,739
*SPECIFIC OUTPUT PERFORMANCE MEASURES WILL BE INCORPORATED VIA AMENDMENT
Attachment IV Notes
Local Health Department - 2022, Date 11103/2021
Page: I of 13
Contract # Date: 11 I03/2021
Project Budgets
1 Program Budget Summary
PROGRAM I PROJECT
DATE PREPARED
Local Health Department - 2022 / HIV PrEP Clinic
11/3/2021
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
BUDGET PERIOD
Health Division
From: 101112021 To : 9/30/2022
MAILING ADDRESS (Number and Street)
BUDGET AGREEMENT
1200 N. Telegraph Rd.
34 East
I` Original r Amendment
CITY
(STATE
(ZIP CODE
FEDERAL ID NUMBER
Pontiac
MI
48341-1032
38-6004876
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 I Travel
7 I Communication
8 County -City Central Services II
9 Space Costs j
10 I All Others (ADP, Con. Employees, Misc.) Ij
Total Program Expenses
TOTAL DIRECT EXPENSES
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 I Cost Allocation Plan / Other
I Total Indirect Costs
TOTAL INDIRECT EXPENSES
TOTAL EXPENDITURES
92,293.00
25,085.00
0.00
0.00
0.00
2,116.00
540.00
0.00
0.00
3,516.00
123,550.00
123,550.00
SM
35,893.00
35,893,00
35,893.00
159,443.00
AMENDMENT#
1
Amount
92,293.00
25,085.00
0.00
0.00
0.00 1
2,116.00
540.00
0.00
0.00
3,516.00
123,550.00
123,550.00
0.00
35,893.00 i
35,893.00
35,893.00
159,443.00
Local Health Department-2022, Date11/0312021 Page. 8 of 13
2 Program Budget - Source of Fund!
SOURCE OF FUNDS
Category i
I1 Source of Funds
Fees and Collections - 1 st and 2nd
Party
Fees and Collections - 3rd Party
Federal or State (Non MDHHS)
IFederal Cost Based Reimbursement
Federally Provided Vaccines
Federal Medicaid Outreach
I(Required Match - Local I]
I (Local Non-ELPHS I
(Local Non-ELPHS
ILocal Non-ELPHS
I (Other Non-ELPHS
(MDHHS Non Comprehensive
MDHHS Comprehensive
IIMCH Funding
I ILocal Funds - Other I
II Inkind Match
IIMDHHS Fixed Unit Rate
I ITotals I
Contract Date11/03/2021
Total I Amount I Cash I Inkind
0.00 0.00 0.00 1 0.00
0.00
0.00
0.00I
0.00
0.00
0.00I
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 I
0.00
0.00
II
0.00I
0.00I
0.00_I
0.00
0.00 I+
0,00 IJ
0.00
0.00
0.00 I
0.00 I
0.00
0.00 I
0.00 I
0,00 i
0.00
0.00 I
0.00 I
0.00 I
0.00
0.00 I
0.00 I
0.00 I
0.00-
132, 696.00 I
132,696.00 I
0.00 I
0.00 I+
0.00 I
0.00 I
0.00 I
0.00
26,747.00 I
0.00
26,747.00 I
0.00
0.00 i
0.00 I
0.00 i
0.00
159, 443.00 I 132, 696.00 I 26, 747.00 I 0.00
Local Health Department - 2022, Date' 11/03/2021 Page: 9 of 13
i
Contract#
Date. 11/03/2021
3 Program Budget - Cost Detail
+Line Item I
QtyI
Rate
Unitsli I
Totall
(DIRECT EXPENSES
(Program Expenses
1 Salary & Wages
Speci
Nuursealist
11.00001
4751000
0.000 FTE
47,519.00
Total `or Salary & Wages
92,293.00
2 Fringe Benefits
All Composite Rate
0.0000
27.180
92293.000
25,085.00
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
i5 Supplies and Materials
6 Travel
+
Mileage
0,0000
0.000
0.000
1,000.00
Notes : 0.56 per mile
II
Client Transportation
0,0000
0.000
0.000
1,116.00
(Total for Travel
2,116.00
i7 Communication
Telephone Communications I
0,00001
0.0001
0.0001 I
540.001
8 County -City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees,
Misc.)
IT Operations
0.0000,
0.000
0.000
3,352.001
(Total for All Others (ADP, Con. Employees, Misc.)
3,516.001
Total Program Expenses
123,550.001
TOTAL DIRECT EXPENSES
123,550.001
(INDIRECT EXPENSES
l
Local Health Department - 2022. Date11/03/2021
Page. 10 of 13
Contract
Date: 11/0312021
(Line Item
Qty
Rate l
UnitsIUOM I
total;
+Indirect Costs
1 Indirect Costs
lCost
2 Allocation Plan / Other
i
I Cost Plan I
0.0000)
0.000
0.000 I
9,146.00
Notes :llooc�ation
(Health Adm Distribution I
0.00001
0.000
0.000 I
22,590.00
(Nursing Adm Distribution I
0.00001
0.000
0.0001 I
4,157.001
(Total for Cost Allocation Plan / Other
I
35,893.001
(Total Indirect Costs
I
35,893.001
(TOTAL INDIRECT EXPENSES
I
35,893.001
(TOTAL EXPENDITURES
I
159,443.001
Local Health Department- 2022, Date: 11103/2021 Page 11 of 13
Summary of Budget
PROGRAM I PROJECT
Local Health Department - 2022 / Local Health Department -
DATE PREPARED
2022
11/3/2021
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
BUDGET PERIOD
ERR OD
Health Division
From : 10/1
MAILING ADDRESS (Number and Street)
Contract If Date. 1110312021
To : 9/30/2022
1200 N. Telegraph Rd. BUDGET AGREEMENT
34 East r Original r%—, Amendment
CIZIP CODE FEDERAL 10
Pontiac IMTATE I48341- 032 38-6 04876 NUMBER
Category
DIRECT EXPENSES
((Program Expenses
t I
Total
1 Salary & Wages 21,496,135.00
1 1 Fringe Benefits 9,684,938.00
13 Cap. Exp. for Equip & Far,
I4 Contractual
15 ISupplies and Materials
16 ITravel
17 (Communication
18 (County -City Central Services
19 (Space Costs
10 JAII Others (ADP, Con. Employees, Misc.)
(Total Program Expenses
ITOTAL DIRECT EXPENSES
(INDIRECT EXPENSES
Ilndirect Costs
IIndirect Costs
12 'Cost Allocation Plan / Other
ITotal Indirect Costs
ITOTAL INDIRECT EXPENSES
ITOTAL EXPENDITURES
SOURCE OF FUNDS
+I I Category
I1 (Fees and Collections - 1 st and 2nd
Local Health Department - 2022, Date 1110312021
Total
4,424,519.00�
1 11
782,205.00
2,118,500.00
411,489.00
279,223.00
0.00
1,194,060.00
4,109,434.00
40,075,984.00
40,075,984.00 J
1,454,992.00
5,953,161.00
7,408,153.00
7,408,153.00
47,484,137.00
AMENDMENT#
1 J
Amount
Amount Cash
0.00 4,424,519.00
21,496,135.00
9,684,938.00 I
0.00
782,205.00
2,118,500.00
411,489.00
279,223.00
0,00
1,194,060.00
4,109,434.00
40,075,984.00
40,075,984.00 II
_1I
-- J
1,454,992.00
5,953,161.00
7,408,153.00
7,408,153.00
47,484,137.00
Inkind II
0.00I
Page. 12 of 113
Party
12 Fees and Collections - 3rd Party
13 Federal or State (Non MDHHS)
14 Federal Cost Based Reimbursement
15 Federally Provided Vaccines
16 Federal Medicaid Outreach
17 Required Match - Local
18 Local Non-ELPHS
19 Local Non-ELPHS
110 Local Non-ELPHS
i11 Other Non-ELPHS
112 MDHHS Non Comprehensive
113 MDHHS Comprehensive
114 MCH Funding
115 Local Funds - Other
16 Inkind Match
17 MDHHS Fixed Unit Rate
TOTAL
363,058.00
0.00
2,468,226.00
0.00
0.00
0.00
1,444,452.00
0.00
530,890.00
530,890.00
567,139.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
11,108,953.00
11,108,953.00
321,457.00
321,457.00
25,909,998.00
0.00
0.00
0.00
345,445.00
345,445,00
47,484,137.00
12,306,745.00
Contract Date: 11/03/2021
363,058.00
0.001
2,468,226.00
0.001
0.00
0.00
1,444,452.00
0.00
0.00
0.00
567,139.00
0.001
0.00
0.00
0.00
0.001
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00�
0.00
0.00
25,909,998.00
0.001
0.00
0.00�
0.00
0.00
35,177,392.00
0.001
Local Health Department - 2022, Date: 11/03/2021 Page: 13 of 13
ATTACHMENT
MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES
Local Health Department Agreement
October 1, 2021- September 30, 2022
Fiscal Year 2022
INSTRUCTIONS
FOR THE
ANNUALBUDGET
1T1CTr?1_ 1r`T1nnjS FnR THE ANNUAL BUDGET FOR LOCAL HEALTH DEPARTMENT SERVICES
TABLE OF CONTENTS
Paqe
1. INTRODUCTION............................................................................................................ 2
II. MINIMUM BUDGETING REQUIREMENTS................................................................... 2
III. REIMBURSEMENT CHART........................................................................................... 3
IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION
PROCEDURES..............................................................................................................4
V. FORM PREPARATION - GENERAL.............................................................................. 4
VI. FORM PREPARATION - EXPENDITURE CATEGORIES ............................................. 5
VII. FORM PREPARATION -SOURCE OF FUNDS............................................................. 8
VIII. SPECIAL BUDGET INSTRUCTIONS
A. Public Health Emergency Preparedness(PHEP).................................................. 10
B. WIC........................................................................................................................ 10
C. Family Planning..................................................................................................... 11
D. Breast and Cervical Cancer.................................................................................. 13
E. CSHCS Outreach and Advocacy ............................................ 14
F. Program Budget Detail- Cost Detail Schedule Preparation .................................... 16
G. Medicaid Outreach Activities Reimbursement Procedures .................................... 20
I. Immunization 317 and VFC Allowable Expenditures ............................................. 26
1
INSTRUCTIONS FOR THE
ANNUAL BUDGET
FOR LOCAL HEALTH SERVICES
I. 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.
II. MINIMUM BUDGETING REQUIREMENTS
A. Cost Principles -Types or items of cost which will be considered for reimbursement are
generally consistent with definitions contained in 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 Funding Source Breakdown. - For purposes of development, analysis
and negotiation activities must be budgeted at the individual expenditure and funding
source category level on the Annual Budget for Local Health Services.
D. Special Budget Reauirements for Certain Categorical 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
2
NWH prinrity 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 LMCI-
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
acrniintinn procedures prescribed by the Michigan Department of Treasury, Local Financial
Management System requirements, documentation requirements of categorical program tunding
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 entry is
required for each major expenditure and source of fund categories for which costs/funds are
identified.
VI. FORM PREPARATION - EXPENDITURE CATEGORIES
Budqeted expenditures are to be entered for each program element, project or group of
services by applicable major category.
A. Salaries and Wages -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. Fringe Benefits - This category is to include, for at least the specified elements, all Grantee
costs for social security, retirement, insurance and other similar benefits for all permanent
and part-time employees assigned to the specified elements.
C. Cap Exa for Eauin & 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
i,d#iay fnr pi irrhacq nr ranovation of facilities.
D. Contractual (Subcontracts/Subrecipient) - 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 for the operation of the
program.
J. All Others (Line III - These are costs for all other items purchased exclusively for the
operation of the program element and not appropriately included in any of the other
categories including items such as repairs, janitorial services, consultant services, 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
5
reauired to have an approved indirect cost rate from a Federal Cognizant Agency. If your
Local Health Department has received an approved inairect rate from a reaerai
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 reflectthese 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 elect to
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 Budaet
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 any 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 2CFR, 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
6
(Nlri 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 1st & 2nd Partv—
L 15' 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 - 3rd Party — 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 [EPSDTj Screening, Family Planning.)
C. Federal/State Fundinq (Non-MDHHS) - 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. Required 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 4required and allowable for ELPHS
, fug nding
(C.t,J.., IIICIJll:211 CXCII IIIIICI dllu aIIJ�tIGli iiiC1iGimy oc�vi����� axpenditur1s dc_-"I'i"1nedi'-'tv
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, orfailure 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 forthe 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 outlay for 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 Hearinq — 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.
I
M. ELPHS - MDHHS Vision — This section includes all funding projected to be due under
L.Ui i i fJi di caivc AycciciTi ONciif: a; w"ihcEL . gaa!
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 Sewaqe - 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 Funding -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 Funding Contractor
Public Health Emergency U.S. Department of Health & Human Services, Centers for Disease Control
Preparedness
WIG U.S. Department of Agriculture, Food & Nutrition Service
Family Planning U.S. Department of Health & Human Services, Public Health Service
Breast and Cervical Cancer U.S. Department of Health & Human Services, Centers for Disease Control
CSHCS Outreach & Advocacy Michigan Department of Health & Human Services
Medicaid Outreach Activities Centers for Medicare and Medicaid Services
9
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 Emergencv Preparedness (PREP) Special Budqet Requirements
Local Health Departments will receive the initial FY 21/22 allocation of the CDC Public
Health Emergency Preparedness (PREP) funds in nine equal prepayments for the period
October 1, 2021 through June 30, 2022. LHDs must submit a nine -month budget and a
quarterly Financial Status Report (FSR) for each 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 Budqet Requirements
Cost/Funding Cateqories - The following local budget breakdowns are required
to fulfill WIC grant application budget requirements each fiscal year:
Salaries & Fringe Benefits
Automated Management Systems
Space Utilization Costs
Equipment
Supplies
Communications & Travel
All Other Direct Costs
Indirect Costs
All Funding Sources by Type
The WIC cost/funding categories and supporting budget detail requirements are
satisfied by completion of 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.
10
A--Q,utnmatad Infnrmation,Systems -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. Capital Expenditures of $2.500 or More - such as the cost of facilities,
equipment, including medical equipment, other capital assets and any repairs
that materially increase the value or useful life of capital assets.
C. 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. Accounting 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:
Contractual private physician providing certification data.
2. Contractual organization providing laboratory data.
3. Contractual translators and interpreters at the local Grantee level.
F. Trainino 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. Buildinci Space and Related Facilities - the cost to buy, lease or rent space in
privately or publicly owned buildings for the benefit of the program.
H. Non -Fringe Insurance and Indemnification Costs
All charges to WIC must be necessary, reasonable, allowable and allocable for
the proper and efficient administration of the program. Further information and
cost standards are provided in federal instructions including Title 2 CFR, Part
200 and 7 CFR Part 3015.
C. Family Plannina Special Budget Reauirements
CosVFundinq Categories -The following local budget breakdowns are required to
fulfill Family Planning grant application budget requirements each fiscal year:
Salaries & Wages
Fringe Benefits
Travel
Equipment
Supplies
Contractual
Construction
All Other Direct Costs
Indirect Costs
All Funding Sources by Type
The Family Planning cost/funding categories and supporting budget detail
requirements are satisfied by completion of an application budget in the MI E-Grants
I
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. Eauir)ment - including general purpose and special equipment (e.g., air
conditioning) costing $5,000 or more per unit.
E. Insurance - contributions to a reserve for a self-insurance program.
F. Public Information Service Costs — for the cost of providing public information
services.
G. Publication and Printina Costs - for the cost of publications.
H. Capital Expenditures -for land or buildings.
Indemnification Against Third Parties Costs - insurance against potential
liabilities.
J. Mass Severance Pav - involving grant -supported personnel.
K. Organization/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 Proqrammatic 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)
12
D. Breast and Cervical Cancer Control Coordination Program Special Budqet
Requirements
The Breast and Cervical Cancer Control Navigation Program (BC3NP) budget is to
bedeveloped in the following way:
Funds allocated to the Local Coordinating Agency (LCA) are to be used to budget
costs associated with coordination of the program in assuring implementation of all
minimumprogram requirements and policies and procedures. Only coordination
expenses will be reimbursed through the Comprehensive Agreement. All Direct
Service claims, and Navigation -Only Services, must be billed to the MDHHS Cancer
Prevention and Control Section for claim processing. The 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 Navigation- Only Service expenses will be reimbursed
through the comprehensive Agreement.The Coordination amount of $220 per
woman is based on a target caseload establishedfor each LCA by MDHHS.
Requirements for achieving the target caseload are updated yearly in the LCA
Coordination Funding Policy. 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 BC3NP Billing
Manual. For specific program requirements, including current fiscal year
Direct Service Reimbursement Rates refer to the current fiscal year Unit Cost
Reimbursement RateSchedule for the BC3NP issued in August of each fiscal
year. The above referenced documents are available at
https://michiaancancer.ora/beccp/
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 collecting
answers to health intake questions, WISEWOMAN screening services (height,
weight, body mass index, 2 blood pressure readings, total cholesterol, HDL
cholesterol, and fasting 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, Alc, and
one diagnostic exam. NoDirect Services expenses will be reimbursed through
the Comprehensive Agreement.
13
ThP (:nnrdination and Screening amount is $150 per woman based on a target
caseload established by MDHHS.
Performance reimbursement will be based upon the understanding that a certain
Ievelof 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 fiscalyear Special Budgeting and other Program
instructions for the WISEWOMAN Program issued in August of each fiscal year.
The above referenced documents are available atwww.michiaan.gov/cancer.
E. Children's Special Health Care Services 1CSHCSI Outreach and Advocacv - The
program element, titled CSHCS Outreach and Advocacy should be used to budget costs
associated with this program.
I. Program Budget - Online Detail Budget Application Entev
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).
1. Salary and Wanes -
a. Position Description - Select from the expenditure row look -up all position titles
orjob 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 Required - Enter the number of positions required for the program
corresponding to the specific position title or description. This entry may be
expressed as a decimal (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. Fringe 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.
14
3. Equipment - Enter a description of the equipment being purchased (including
nllmher of units And the unit value), the total by type of equipment and total of Al
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. Supplies 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
budget category exceeds 10% 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
61 Attachment 131-Program Budaet Summary
ABC Haalth Department
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goo'
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000
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R2 Atta__rhm_ent 132-Program Budget Cost Detail
Fgeuq' ABU Health DepAwoot Program Ccmprehensv' Agmement-FY 20'a(
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Hutlget Detail
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Lp�'E� _APSE N]c�
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Classification Seg 1 end l Lae hem rl Gefegorf
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18
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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.
Budget 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: 10/1-09130. 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. Expenditure Category 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)
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.
20
Expenditures related to Nurse -Family Partnership Medicaid Outreach should be reflected
11nder one program element and adhere to Section Vill, 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.
1. 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)
2. Required 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 Tvnes
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
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
21
RPnracant- 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 Tvpes
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 section on 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.
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.
22
FPrlPral MPMG,C d Oreach
Should be used to request the 50% federal administrative match for Medicaid
Outreach.
2. Required Match - Local
Should be used to report the local match for Medicaid Outreach, both the federal
and local amounts must match,
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).
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. Reauired Match - Local
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).
23
r CSHCS Medicaid 011trParh — 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. Reauired 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 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.
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.
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
24
Partnership Outreach. This should reflect the local contribution multiplied by the
Rled+ccid anro,IrF�e VcF i 3ijDC ti3n Fat x 50 federal match r2ta-
Note: CSHCS Outreach and Advocacy and CSHCS Care Coordination activities funded through the
Comprehensive Agreement are recorded as separate program element.
25
Object Class Categonl/agenses
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Section I —The Bar ics n,24
W(Al 'Zo 17
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Srctlon I —I i-te Basics p.26
IPOM 2017
30
PROJECT: CSHCS Vaccination initiative
Beginning Date: 10/01/2021
End Date: 09/30/2022
Project Synopsis
Local Health Departments are eligible to receive funding to support efforts to increase
vaccination rates among children with disabilities and special health care needs, along
with parents and family members of children with special health care needs, Eligible
activities include incorporating the promotion of adherence to MDHHS vaccination
guidelines into existing interactions and communications with CSHCS families,
accommodations for serving children with special needs into existing or established
community vaccination efforts, and additional vaccination outreach and promotion efforts
focused on child populations with special needs. Eligible activities should include a focus
on vaccinations for COVID-19 but can also include a broader focus on adherence to
recommended pediatric vaccination schedules. Children with disabilities and special
health care needs includes children enrolled in CSHCS but can also include children with
special health care needs that are not enrolled in or medically eligible for CSHCS.
Reporting Requirements (if different than contract language)
• The CSHCS vaccination initiative will be its own grant separate from Outreach and
Advocacy.
• The CSHCS vaccination initiative grant will be set up with the same budget line
categories as the outreach and advocacy grant. The CSHCS vaccination initiative
funding will be equally split between the four quarters as the grant has a set dollar
limit.
• With each quarter FSR, please submit a brief narrative with the following
information:
1. Describe how these funds have been used to promote vaccinations among
children with special needs and their family members. When feasible, include
a list of events or activities that have been supported with these funds, a total
for the number of events or activities, and an estimate of the number of families
reached through these activities.
2. Describe any local partnerships or collaborations used to reach families for
vaccinations, including partnerships with health care providers and/or provider
organizations. Please note any challenges or successes.
3. Describe any innovative or unique methods used to reach families with a child
with special health care needs to promote or encourage adherence to
recommended vaccination guidelines.
Annual Narrative Progress Report
N/A
Any additional requirements (if applicable)
NIA
ATTACHMENT III
LOCAL HEALTHAGREEMENT
Fiscal Year 1
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 2022, special requirements are applicable for the remaining program
elements listed in the attached pages.
Attachment IV Reimbursement Chart
The Program Element indicates currently funded Department programs that are included in
the Comprehensive Local Health Department Agreement.
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:
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.
i
A reimbursement method by which local health departments are reimbursed a specific amount
for each output actually delivered and reported.
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.
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.
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 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.
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 judgment in classifying each
agreement as a subaward or a procurement contract.
Recipient
A Recipient is for grant agreement with no federal funding.
Amendment Schedule
FY 2022
Original Agreement
Amendment #1 - New
Projects Only
Amendment #2
Amendment #3
Key Terms
Amendment
Request Due Date
Completed by
Program office
Completed by
program office
February 1, 2022
May 13, 2022
Anticipated
Consolidation Date
August 31, 2021
October 19, 2021
April 21, 2022
July 15, 2022
New Project Start /
Effective Date
October 1. 2021
November 1, 2021
May 1, 2022
August 1, 2022
• Amendment Request Due Date —The date amendment requests are due to the
program office.
a. Budget category amendment requests need to be submitted to the program
office.
• Anticipated Consolidation Date —The day the agreement (original/amendment) will
be released to the health department for final signature.
• New Project Start/Effective Date — The date new projects are expected to start, unless
otherwise communicated by the program office.
PROJECT
CONTRACT MANAGER
EMAIL
Administration Projects
Laura de la Rambelie
DelaRambelleLamlchlgan.gov,
Adolescent STI Screeninq
Christopher Sticknev
SticknevC(dimichigan.gov
Asthma Demonstration Project
Laura de la Rambehe
DelaRambelieLnp,michigan toy
Body Art Fixed Fee (facility, Licensinq)
Joseph Coyle
ccvlei(q)michigari
Breast & Cervical Cancer Control (BOCCE) Coordination
Polly Hader
hagerD(eDmichigan.gov
Child and Adolescent Health Center Proqram Expansion
Kim Kovalchick
Kova)chickK(e?michjgan.oi
Childhood Lead Poisoninq Prevention
Michelle Twichell
twichelim(&jmichlgan.00v
Children's Special Hlth Care Services (CSHCS) Care Coordination
Kelly Gram
Gramk2t7o,michigan.gov
Children's Special Hllh Care Services (CSHCS) Outreach & Advocacy
Kelly Gram
Gramk21d?mIchigan.gov,
CSHCS Medicaid Elevated Blood Lead Case Mgmt
Michelle Twichell
tWlchellmpmIchlgan.cov
CSHCS Medicaid Outreach
Kelly Gram
Gramk2(bimichlaari
CSHCS Vaccine Initiative
Kelly Gram
Gramk2(aJbmich1gan.cov
Diabetes and Kidney Disease in People Liv'inq with HIV
Richard Wimbedev
wimberlevrftmmhican any
Eat Safe Fish
Gerald Tiernan
TIERNANG(d.)michlgan.gev
EGLE Drinkinq Water and Onste Wastewater Management
Dana DeBwyn
debruynd(Wmichigan.gov
Emerqinq Threats- Hepatitis C
Joseph Coyle
covlel(e.michigan.gov
Ending the HIV Epididemic Implementation
Loren Powell
powelll(o),mlchigan.qov
Enviromental Health Data
Thomas Larqo
largot(av)michjgan.gov
Expandlnc, Enhanclna Emotional Health - EEEH (all locations)
Taqqert Doll
dclltcamichigari
Family Penninq Saryices
Deanna Charest
CharestD(d_)michigan.gov
Fetal Alcohol Spectrum Disorder Community Projects
Aurea Soonchamen
booncharoena gnmicngan.qov
Fetal Infant MortaOfy Review (FINIR) Case Abstraction
Deanna Chariest
CharestDarnichigan goy
FFPSA HV Expansion
Charisse Sanders
sandersc2emichlgan.gov
FIMR Interviews
Nicholas Drool
drzaH(d m chipan.Qcv
Food ELPHS
Adam Christenson
chnstensonaftmichigari
Gonococcal Isolate Surveillance Prolect
Christopher Sticknev
SticknevC(a?michigan.gov,
Harm Reduction Support Services
Joseph Coyle
eovlel(c),michlgan.ci
Hearinq ELPHS
Jennifer Dakers
DakersJ@mlchlgan.gov
HIV & STI Testmq and Prevention
Loren Powell
powellJftm,chigan. boy
HIV / STI Partner Services
Christopher Stickney
SticknevC(c,michigan.gov
HIV Care Coordination
Beverly Haske
HaskeB(aimichigari
HIV Data to Care
Beverly Haske
HaskeBamichlgan.gov
HIV Houslnq Assistance
Beverly Haske
HaskeB(obmichigan.gov,
HIV Linkage to Care
Beverly Haske
HaskeB(ilmichlgan.gov
HIV Medical Care
Beverly Haske
Haske6(gim!chlgan.gOv
HIV PrEP Clinic
Loren Powell
- powelh(d,)michiean.gov
HIV Prevention
Loren Powell
oowelll(cDr ichigan.gov
HIV Ryan White Part B
Seved9 Haske
HaskeBl,,michigan.pov
HOPWA Plus
Lynn Hendges
Hendgesl-2(5,,michigan.gov
Immunization Action Plan - Pilot
Tina Scott
SoottTl(omichlgan qov
Immunization Action Plan (IAP)
Tina Scott
Scoiji5@michiaan.aov
Immunization Field Services Rep
Tina Scott
ScottT1(&michlaan.gov
Immunization Fixed Fees
Tina Scott
ScottTl@michigan.gov
Immunization Michigan Care Improvement Registry (MCIR) Regions
Tina Scott
ScottTlidimichigan coy
Immunization Vaccine Quality Assurance
Tina Scott
ScottTl ftmichigan.gov
Infant Safe Sleep
Nicholas Drzal
drzaln(o),michigan.gov
Informed Consent
Laura de Is Rambele
DelaRambelleLr(),michigan.gov
Laboratc-v Services Bic
Martv Soehirlen
soehnlenmiamicngan.gov
Lactation Consultant
Shatona Townsend
TownsendS2(g,michlgan.gov
Lead Hazard Control
Hope McElhone
mcethoneh(a,michigan boy
Local Health Department (LHD) Sharinq Support
Laura de la Rambelie
DelaRambeIieL(d)michigan.gov
Local MCH (MCH Children and MCH -All Other)
Trudy Esch
EschTCav)michigan qov
Local Public Health Trackinq Network
Thomas Largo
laract(dimIchmari
Maternal Infant Erly Cod Home Visitinq Initiative Rural Local Home Visitinq Grp
Tiffany Kostelec
kostelect@michigan qov
Maternal Infant Env Chd Home Vistmq Initiative Rural Local Home Visitinq Grp3
Tiffany Kostelec
kostelectemichigan.gov "
MDHHS Essential Local Public Health Services (ELPHS)
Laura de Is Rambelle
DelaRambeheL(o@michigan.gov
Medicaid Outreach
Trudy Each
EschT@michigan.gov
MI Adolescent Pregnancy & Parenting Program
Hillary Brandon
brandonhfamichrgan.cov
MI Home Visitinq Initiative Rural Expansion Grant
Tiffany Kostelec
kostelect(gilmichigan.qov
MIECHVP Healthy Families America Expansion
Tiffany Kostelec
kostelectDmichigan qov
Nurse Family Partnership Services
Tiffany Kostelec
kostelect@michigari
Nurse Family Partnership Services Medicaid Outreach
Tiffanv Kostelec
kostelecter-rchigan.gov
Public Health Emergency Preparedness (PHEP) 10/1- 6/30
Mary Macqueen
macqueenm(glmich!gan.cov
Public Health Emergency Preparedness (PHEP) 7/1- 9/30
Mary Macgueen
macdueenm(dimichigari
Public Health Emerqency Preparedness (PHEP) CRI 10/1 - 6/30
Mary Macqueen
macqueenmPmichigan.gcv
Public Health Emerqency Preparedness (PHEP) CRI 7/1 - 9130
Mary Macqueen
macqueenm(a),michigan.gov
Regional Pahnatal Care System
Dawn Shanafelt
ShanafeltD(d)michigari
Seal! Michiqan Dental Sealant
Christine Farrell
farrellc@michigan.gov
Sexually Transmitted Infection (STO Control
Christopher ShckneV
StickneVC(&michigan.gov
STI Specialty Senvices
Christopher Stickney
StickneyC@michigan.gov
Takmq Pride in Prevention
Kara Anderson
andersonk10amichigan.gov
Tuberculosis (TB) Control
Peter Davidson
davidsonpPmichigan.gcv
Vector -Borne Surveillance & Prevention
Mary Grace Stobierski
stobierskim(dvimichigan.gov
Vision ELPHS
Rachel Schumann
schumannr(&michlgan.gov
West Nre Virus Community Surveillance
Emily Dinh / Kimberly Siqns
Dmh ECO),michigan.qov/Ssgnsk(dmichigan.qov
WIC Breastfeedrnq
Cecilia Hutson
HutsonC1(dmshigan.gov
WIC Migrant
Cecilia Hutson
HutsonCl@michigan coy
WIC Resident Services
Cecilia Hutson
HulsonCl(oimichigan.gov
W isewoman
Polly Hader
hagero5mlchban.dov
PROJECT TITLE: Adolescent Sexually Transmitted Infection (STI)
Screening
Start Date: 10/1/2021
End Date: 9/30/2022
Project Synopsis:
Adolescents and young adults account for approximately half of reported cases of
gonorrhea and chlamydia. The 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:
1. Test at least 100 adolescents and young adults per month, using NAAT tests for
gonorrhea and chlamydia.
2. Collect race, gender, age, test result, and treatment date for all tests.
3. Refer clients for further health evaluation if indicated.
4. Provide client centered risk reduction plan, promoting abstinence.
5. Treat all positives on site if possible.
6. Contact positive clients that are released prior to treatment with treatment options
in community.
7. Promote self -notification of partners.
8. Analyze and forward screening and treatment data to the Department quarterly:
April 15, July 15, October 15, and January 15.
9. Develop one annual slide set highlighting year end data by demographic variable
including trend data.
10. Continue to promote awareness of prevalence of STDs within adolescent and
young adult populations.
11. Participate in quarterly Michigan Infertility Prevention Project meetings; providing
quarterly screening project data.
PROJECT: asthma Demonstration
Beginning Date: 10/1/2021
End Date: 9/30/2022
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: 10/1/2021
End Date: 9/30/2022
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 December 22, 2010 and is now Public Act 375.
Reporting Requirements (if different than contract language)
The Departmentwill reimburse the Grantee on a quarterly basis according to the
following criteria:
1. Initial annual license for a Body Art Facility prior to July 1
m $275.22 (50% of state fee)
2. Initial annual license For a Body Art Facility after to July 1
6 $137.61 (50% of state fee)
3. Issue a temporary license) for a Body Art Facility
0 $123.84 (75% of state fee)
4. License renewal prior to December 1
® $275.22 (50% of state fee)
5. License renewal after to December 1
® $412,83 (50% of state fee + 50% late fee penalty)
6. Duplicate license
0 $27,51
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 FY2021
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 iicensure 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 iicensure 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, 31d Floor
Lansing, Michigan 48933
PROJECT: Breast and Cervical Cancer Control Navigation Program
Beginning Date:
10/1/2021End Date:
9/30/2022
Project Synopsis
The BC3NP (Breast and Cervical Cancer Control Navigation Program) provides
individualized assistance to low-income women, < 250% FPL, in overcoming barriers
that may impede their access to receiving breast and cervical cancer services.
Program services are targeted to women in hard -to -reach populations, such as
minorities, particularly African American, Hispanic,and Native American women, and
women aged 50-64, as well as women who have insurance but do not know how to
access the healthcare system to receive breast or cervical cancer services.
The BC3NP provides specific services to uninsured, underinsured, and insured
women bothwithin and outside the program.
Breast and/or cervical screening and diagnostic services are reimbursed for uninsured
and underinsured low-income women enrolled through the program that meet the
following criteria:
• Age 21-64; self -referred, referred from a BC3NP provider or a non-BC3NP
provider andrequires cervical cancer screening and/or diagnostic services for
an identified cervical screening abnormality.
• Age 40-64; self -referred, referred from a BC3NP provider or a non-BC3NP
provider and requires breast cancer screening and/or diagnostic services for an
identified abnormality.
• Age 21-39; referred from either a BC3NP or non-BC3NP provider with an
abnormal clinical breast exam requiring diagnostic follow-up to rule out or
confirm a breast cancerdiagnosis.
The BC3NP provides navigation services to low-income insured women, not
enrolled in the program, to assist them in accessing the healthcare system so they
can receive breast and/orcervical cancer screening, diagnostic, and/or treatment
services through their insurance provider.
Reporting Requirements (if different than contract language)
A statewide database called MBCIS is maintained by MDHHS and the Cancer
Preventign and Control Section (CPCS). Instructions for contractor use of MBCIS are
provided in manuals for programs that contribute data to this database. The CPCS will
exchange relevant program reports with appropriate contractors through a secure file
transfer system,as noted in the same program manuals.
Any additional requirements (if applicable)
For specific BC3NP requirements, refer to the most current BC3NP Policies and
ProceduresManual (link provided) http://www.michigancancer.org/bcccp/
PROJECT: CHILD AND ADOLESCENT HEALTH CENTER (CAHC)
PROGRAM EXPANSION
Start Date: 10/1/2021
End Date: 9/30/2022
Project Synopsis
A major role of the CAHC program is to provide a safe and caring place for children
and adolescents to receive needed medical care and support, learn positive health
behaviors, and prevent diseases, resulting in healthy youth who are ready and able to
learn and become educated, productive adults. CAHCs assist eligible children and
adolescents withenrollment in Medicaid and provide access to Medicaid preventive
services.
Reporting Requirements (if different than contract language)
The Grantee shall submit the following reports on the following dates
1. Annual Work Plan:
a. Due upon submission of FY initial application
b. Submit report to contract manager - Kim K. via email at
kovalchickk@michigan.gov
2. Quarterly Program Data Report: Due 30 days after the end of the reportedquarter
a. Submit report via the Child and Adolescent Health Center Clinical Reporting
Tool located at httas://cahc.knack.com/clinical-reportinq-tool,
3. Quarterly Work Plan Report: Due 30 days after the end of the reported quarter
a. Submit report to contract manager - Kim K. via email at
kovalchickk@michigan.gov
4. Annual Program Narrative: Due 30 days after the end of the grant period
a. Submit report to contract manager - Kim K. via email at
kovalchickk@michigan.gov
Any such other information as specified in the Statement of Work, shall be developed, and
submitted by the Grantee as required by the Contract Manager.
The Contract Manager shall evaluate the reports submitted for theircompleteness and
adequacy.
The Grantee shall permit the Department or its designee to visit and to make an
evaluation of the project as determined by Contract Manager.
Any additional requirements (if applicable)
Funding Eligibility
To be eligible for funding, all applicants must provide signed assurance that referrals for
abortion services or assistance in obtaining an abortion will not be provided as part of
the services (MCL §388.1766). For programs providing services on school property,
signed assurance is required that family planning drugs and/or devices will not be
prescribed, dispensed, or otherwise distributed on school property as mandated in the
Michigan School Code (MCL §380.1507). Applicants must assurecompliance with all
federal and state laws and regulations prohibiting discrimination and with all requirements
and regulations of MOE and MDHHS.
Target Populations to be Served
Proposals should focus on the delivery of health services to ages 5-21 years at school -
based sites, and 10-21 years at school -linked sites, in geographic areas where it can
be documented that health care services that are accessible and acceptable to children
and adolescents require enhancement or do not currently exist. The children (birth and
up) of the adolescent target population may also be served where appropriate. Funding
may be used to provide clinical services to students receiving special education
services up to 26 years of age.
Technology
Successful applicants are required to have an accessible electronic mail account
(email) to facilitate ongoing communication. All successful applicants will be addedto a
CAHC program list serve, which is the primary vehicle for communication from the State.
Successful applicants must have the necessary technology and equipment to support
billing and reimbursement from third party payers. Refer to Reference A, Minimum
Program Requirements which describes the billing and reimbursement requirements
for all grantees.
Training
At least one staff member is required to attend a yearly Michigan Department of Health
and Human Services CAHC Annual Meeting in the fall, as announced by the MDHHS
team.
Unallowable Expenses
The following costs are not allowed with this funding:
• The purchase or improvement of land
• Fundraising activities
• Political education or lobbying, including membership costs for advocacy or
lobbying organizations.
• Indirect cost
The following restrictions are in effect for this funding:
Funds may not be used to refer a student for an abortion or assist a studentin
obtaining an abortion (MCL §388.1766).
• Funds may not be used to prescribe, dispense, or otherwise distribute a family
planning drug or device in a public school or on public school property (MCL
§380.1507).
• Funding may not be used to serve the adult population (ages 22 years and
older), except for students up to 26 years of age who are receiving special
education services.
• Funds may not be used to supplant or replace an existing program supported with
another source of funds or for ongoing or usual activities of any organization
involved in the project.
Minimum Program Requirements
The Minimum Program Requirements document that follows is part of Attachment III.
PROJECT: Local Childhood Lead Poisoning Prevention Grant
Beginning Date: 10/1/2021
End Date: 9/30/2022
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
communities, 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.
Grantee Specific Requirements
Grantees shall:
1. Identify target areas with lower testing rates, with the assistance of CLPPP and
quarterly data reports provided to the LHDs.
Provide a workplan with a detailed overview of how your LHD plans to increase
testing rates within the grantee focus area, and explanation of target
audience/locations. Metrics for success should be strategic, measurable,
ambitious, realistic, time -bound, inclusive, and equitable. Planning for the
workplan should be done in coordination with CLPPP. CLPPP will provide
recommended activities to the grantees.
3. Conduct a quarterly review of the workplan and grant activity progress. Submit a
quarterly report to CLPPP with progress made, as well as revisions needed for
the workplan.
4. Attend meetings with CLPPP and other grantees as scheduled.
S. Ensure all communication materials that are developed and distributed by the
grantee are approved by CLPPP if MDHHS funds are used.
Reporting Requirements (if different than contract language)
1. Workplan — submitted according to due dates set by CLPPP
2. Quarterly Reports — submitted no later than thirty (30) days after the close of the
quarter.
PROJECT: CSHCS Care Management/Care Coordination
Beginning Date: 10/01/2021
End Date: 09/30/2022
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 (CHASS) 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. Beneficiariesara 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: 10/1/2021
End Date: 9/30/2022
Project Synopsis
All Local Health Departments in Michigan are eligible to participate in this program. The
local health department 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 pg/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)
Quarterly FSR and FSR Supplemental Attachment
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. Additionally, a FSR supplemental attachment form is required to
be uploaded in EGrAMS that specifies the number of children and home visits for which
reimbursement is being requested on. The FSR and the FSR supplemental attachment
form must be submitted no later than thirty (30) days after the close of the quarter.
Quarterly Case Management Loqs
A complete spreadsheet of CM activities is due quarterly, submitted electronically
through the CLPPP's secure DCH-File Transfer Site available through MiLogin, using a
template provided by CLPPP. The quarterly spreadsheet must be submitted no later
than thirty (30) days after the close of the quarter.
Annual Report
An Annual Report covering the reporting period for FY22 is October 1 — September 30.
The format for the submission will be determined by CLPPP, communicated to the local
health departments. The Annual report must be submitted no later than thirty (30) days
after the close of Quarter 4.
Reportinq Time Period
October 1 - December 31
January 1— March 31
April 1 — June 30
July 1 — September 30
Quarterly Spreadsheet Due Date
January 31
April 30
July 30
October 30
"CLPPP will review the spreadsheet and provide approval for payment within 30 days of
receipt.
Any additional requirements (if applicable)
The local health department shall:
• Have home case management conducted by a registered nurse trained by
MDHHS CLPPP.
"' To be reimbursed for a home visit, the visit must be completed by a registered nurse.
• Sign up for the DCH-File Transfer Site available through Milogin 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.
• Identify and initiate contact with families of all Medicaid -enrolled children with
EBLLs. The lists are provided weekly by CLPPP to the local health departments.
• Complete case management activities according to the MDHHS CLPPP Case
Management Guide.
• Document all required case management activities in the child's electronic file in
the HHLPPS database. Required documentation includes an initial home visit
form, follow-up visit forms, dates of chelation therapy, and plan of care.
PROJECT: CSHCS Medicaid Outreach
Beginning Date: 10/01/2021
End Date: 09/30/2022
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
N/A
Any additional requirements (if applicable)
N/A
PROJECT TITLE: CSHCS OUTREACH AND ADVOCACY
Start Date: 10/1/2021
End Date: 9/30/2022
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 a// 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
Beginning Date: 10/01/2021
End Date_ 09/30/2022
Project Synopsis
Beneficiaries enrolled in CSHCS with identified needs may be eligible to receive
reimbursable vaccination services as provided by the local health department. In
addition, beneficiaries with either CSHCS, CSHCS and Medicaid may be eligible to
receive reimbursable vaccination 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.
Reporting Requirements (if different than contract language)
The vaccine initiative will be represented as a separate line item within the
budget detail.
CYSHCN Vaccine Logs need to be submitted electronically via the FSR quarterly
submission at the coordinating budget line for our data collection.
Annual Narrative Progress Report
In the final FSR, a progress report will be uploaded in the Egrams FSR next to the
vaccine initiative budget line.
A paragraph of success/concerns/or suggestions (no template or form).
The narrative will contain information such as but not limited to:
1. Describe any local partnerships or collaborations you have used to reach
CYSHCN families for vaccinations. Please note any challenges or successes.
2. Describe any innovative or unique methods you used to promote or provide
vaccination events for CYSHCN.
Any additional requirements (if applicable)
PROJECT: Diabetes and Kidney Disease in People Living With HIV
Beginning Date: 10/1/2021
End Date: 9/30/2022
Project Synopsis:
The Ryan White HIV/AIDS Program provides a comprehensive system of HIV primary
medical care, essential support services, and medications for low-income people living
with HIV who are uninsured and underserved. The program provides funding to provide
care and treatment services to people living with HIV to improve health outcomes and
reduce HIV transmission among hard -to -reach populations. Central Michigan District
Health Department (CMDHD) will partner with MDHHS to further the goals of serving
people living with HIV and increasing access to chronic disease management and
prevention programs. CMDHD will identify patients with diabetes, identify barriers to care,
and implement strategies to increase services available for people living with HIV.
CMDHD will also support health equity and cultural competency trainings for staff and
partners per attached workplan objectives and activities and provide quarterly workplan
report using the workplan report template attached.
Reporting Requirements:
Report
Period
Due Date
How tos}
Submit Report
Quality Control Reports
Monthly
1011 of the
Department
followinq month
Staff
Daily Client Logs
Monthly
10rh of the
Department
following month
Staff
Reactive Results
As
Within 24 hours
EvalWeb
needed
of test
1
11
Non -Reactive Results
As
Within 7 days of
EvalWeb
needed
test
Linkage to Care and Partner
Services Interview (e.g. client
attended a medical care
As
Within 30 days of
EvalWeb,
appointment within 30 days of
needed
service
PSWeb
diagnosis, and was interviewed by
Partner Services within 30 days of
diagnosis)
Condom Distribution Data
Quarterly
101h of the
CTR Supplies
following month
Disposition on Partners of HIV
Ongoing
Within 30 days of
PSWeb
Cases, if applicable
service
HIV Testing Competencies
SSP Data Report, if applicetble
Annually Reviewed during
site visits
Quarterly 10th of the
following month
Department
Staff
6011M
• The Grantee will clean-up missing data by the 10th day after the end of each
calendar month.
• The Quality Control and Daily Client Logs may be sent to the Contract Manager
via:
Email - ctrsupplies(a).michigan.aov
Fax - (517) 241-5922
Mailing Address:
HIV Prevention Unit
Attn: CTR Coordinator
109 W. Michigan Ave., 10th Floor
Lansing, MI 48913
The Contract Manager shall evaluate the reports submitted for their completeness and
accuracy.
Any additional Requirements (if applicable)
Publication Rights
When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
funds, the Grantee receiving Federal funds, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state:
1. The percentage of the total costs of the program or project that will be financed
with Federal funds.
2. The dollar amount of Federal funds for the project or program.
3. Percentage and dollar amount of the total costs of the project or program that will
be financed by non -governmental sources.
Grant Program Operation
• The Grantee will participate in DHSP needs assessment and planning activities,
as requested.
• The Grantee will participate in regular Grantee meetings which may be face-to-
face, teleconferences, webinars, etc. The Grantee is highly encouraged to
participate in other training offerings and information -sharing opportunities
provided by DHSP.
Each employee funded in whole or in part with federal funds must record time and
effort spent on the project(s) funded. The Grantee must:
a. Have policies and procedures to ensure time and effort reporting.
b. Assure the staff member clearly identifies the percentage of time devoted to
contract activities in accordance with the approved budget.
c. Denote accurately the percent of effort to the project. The percent of effort
may vary from month to month, and the effort recorded for funds must
match the percentage claimed on the FSR for the same period.
d. Submit a budget modification to DHSP in instances where the percentage
of effort of contract staff changes (FTE changes) during the contract period.
e. The Grantee will receive a condom and lubrication allowance. The Grantee
must:
f. Distribute condoms and lubrication.
g. Place orders for condoms/lubrication by emailing ctrsupplies@michigan.gov
® If conducting HIV testing using rapid HIV testing, the Grantee will comply with
guidelines and standards issued by DHSP and:
a. Conduct quality assurance activities guided by written protocol and
procedures. Protocols and procedures, as updated and revised Quality
assurance activities are to be responsive to: Quality Assurance for Rapid
HIV Testing, MDHHS. See "Applicable Laws, Rules, Regulations, Policies,
Procedures, and Manuals."
b. Ensure provision of Clinical Laboratory Improvement Amendments (CLIA)
certificate.
c. Report discordant test results to DHSP.
d. Ensure that staff performing counseling and/or testing with rapid test
technologies has successfully completed rapid test counselor certification
course or Information Based Training (as applicable), test device training,
and annual proficiency testing.
e. Ensure that all staff and site supervisors have successfully completed
appropriate laboratory quality assurance training, blood borne pathogens
training and rapid test device training and reviewed annually.
f. Develop, implement, and monitor protocol and procedures to ensure that
patients receive confirmatory test results.
• If conducting PS, the Grantee will comply with guidelines and standards issued by
the Department. See "Applicable Laws, Rules, Regulations, Policies, Procedures,
and Manuals." The Grantee must:
a. Provide Confidential PS follow-up to infected clients and their at -risk
partners to ensure disease management and education is offered to reduce
transmission.
b. Effectively link infected clients and/or at -risk partners to HIV care and other
support services.
c. Work with Early Intervention Specialist to ensure infected clients are
retained in HIV care.
d. Procure TLC or a TLO-like search engine.
• If conducting SSP, the grantee will develop programs using MDHHS guidance
documents and will address issues such as identification and registration of
clients, exchange protocols, education, and trainings for staff, and referrals.
a. Grantees will participate on monthly or quarterly conference calls to discuss
best practices and identify barriers.
b. The Grantee shall permit DHSP or its designee to visit and to make an
evaluation of the project as determined by DHSP.
Record Maintenance/Retention
The Grantee will maintain, for a minimum of five (5) years after the end of the grant
period, program, fiscal records, including documentation to support program activities
and expenditures, under the terms of this agreement, for clients residing in the State of
Michigan.
Software Compliance
The Grantee and its subcontractors are required to use Evaluation Web (EvaiWeb) to
enter HIV client and service data into the centrally managed database on a secure
server.
The Grantee and its subcontractors are required to use Partner Services Web (PSWeb)
to enter Partner Services interview and linkage to care data, where appropriate.
Mandatory Disclosures
The Grantee will provide immediate notification to DHSP, in writing, including but not
limited to the following events:
a. Any formal grievance initiated by a client and subsequent resolution of that
grievance.
b. Any event occurring or notice received by the Grantee or subcontractor,
that reasonably suggests that the Grantee or subcontractor may be the
subject of, or a defendant in, legal action. This includes, but is not limited to,
events or notices related to grievances by service recipients or Grantee or
subcontractor employees.
c. Any staff vacancies funded for this project that exceed 30 days.
d. All notifications should be made to DHSP by MDHHS-
HIVSTDoperations(c)michigan.00v.
ASSURANCES
Compliance with Applicable Laws
The Grantee should adhere to all Federal and Michigan laws pertaining to HIV/AIDS
treatment, disability accommodations, non-discrimination, and confidentiality.
PROJECT: Eat Safe Fish
Beginning Date: 10/1/2021
End Date: 9/30/2022
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.
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 Unnking water and unsite foal E69c1 s fa[ it
Beginning Date: 10/1/2021
End Date: 09/30/2022
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
e 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) 2022 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 2022, 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 set -vices 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
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
8' ba.�i'13-for-peerm It appro�,'^I and/..ren dial, and issues not specif'Gall y
icyiiu cillciiw, i
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
shall be provided to the State no later than February 1 st of the year following the
calendar year for which the data has been collected.
® >"1 VviliC ti ail iiiiy iQ'fstaff tTiJivc.G ii-i ti i.. rrvgra n; as
knowledge of current regulations and internal policies and procedures and to keep
staff informed of technological improvements and advancements in Systems.
» Establish and maintain an enforcement process that is utilized to resolve violations
of the Local Entity and/or State's rules and regulations.
Maintain complaint forms and a filing system containing results of complaint
investigations and documentation of final resolution. Investigate and respond to all
complaints related to onsite wastewater in a timely manner.
iTiiil*fBUNIM
» »1111 1 1 11111 »... III I Jill Jill » » 111111
® Perform water well permitting activities, pre -drilling site reviews, random
construction inspections, and water supply system inspections for code compliance
purposes with qualified individuals classified as sanitarians or equivalent.
Assign one individual to be responsible for quarterly reporting of the data and to
coordinate communication with the assigned State staff. Reports shall be submitted
no later than fifteen (15) days following the end of the quarter on forms provided by
the State. The report form EQP2057 (07/2019) is available on the EGLE website.
All quarterly reports are submitted directly to the EGLE address noted on the form.
® Perform Minimum Program Requirements (MPRs) activities and associated
performance indicators. These are available on the EGLE website. Guidance
regarding the MPRs and indicators is available in the "Local Health Department
Guidance Manual for the Private and Type III Drinking Water Supply Systems."
The guidance manual is available online at Michigan.gov/WaterWellConstruction.
PROJECT: Food Service Sanitation (FOOD ELPHS)
Beginning Date: 10/1/2021
End Date: 09/30/2022
Project Synopsis
State funding for ELPHS shall support and the Grantee shall provide for all 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 & Improvement, Public Policy Development,
Health Services Administration, Quality Assurance, Creating & 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.
Reporting Requirements (if different than contract language)
All final amendment ELPHS funding shift request memos need to be submitted no later
than May V. Please send the memo to Laura de la Rambelje
(DelaRambeljeL@michigan.gov) and copy Carissa Reece (ReeceC(@michiaan.00v)
1. .•A
W Provide updates to MDARD on the 1 st and 15th of each month, as necessary to:
® Provide a list of food service establishments approved for licensure/license
issued.
Provide a list of food service establishment licenses that have not been
approved for licensure and are considered voided or deleted.
9 Return the actual licenses to MDARD that are to be voided or deleted.
® Return renewal license applications and licenses that require correction.
Mark the corrections on the renewal application.
Provide updates to MDARD on the 1st and 15th of each month, as necessary, to
provide:
• A copy of each temporary food establishment license issued.
• A list of lost or voided licenses by license number.
Any additional requirements (if applicable)
+..
® Accept responsibility for all licenses specified in the `Record of Licenses
Received."
s Issue licenses in accordance with the Michigan Food Law 2000, as amended.
Upon receipt, sign and return the "Record of Licenses Received° to MDARD.
Issue licenses in accordance with the Michigan Food Law 2000, as amended.
Make every effort to issue temporary food establishment licenses in numerical order.
Furnish pre-printed food service establishment license applications and pre-
printed licenses to the Grantee for each licensing year (May 1 through April 30)
using previous year active license data.
Provide a count of all licenses sent to the Grantee titled "Record of Licenses
Reprint any licenses requiring correction and send corrected copies to the
Grantee.
Bill the local health department for state fees upon notification by Grantee that
the license has been approved and issued.
b Furnish blank temporary food service license application forms (forms FI-231, FI-
231 A) and blank Combined License/Inspection forms (FI-229) upon request from
the local health department.
® Fumish a -Record of Licenses Received" with each order of Combined
Licenses/Inspection forms.
Periodically reconcile temporary food service establishment licenses sent to
the Grantee with the licenses that have been issued (copy returned to MDARD).
6 Bill the local health department for state fees upon notification by the
Grantee that the license has been approved and issued.
PROJECT: MDHHS Essential Local Public Health Services (ELPHS)
Beginning Date: 10/1/2021
End Date: 09/30/2022
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
• EGLE Drinking Water and Onsite Wastewater Management
• 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 & Improvement, Public Policy Development,
Health Services Administration, Quality Assurance, Creating & Maintaining a
Competent Work Force and Local Public Health Accreditation. These services
may be budgeted separately as part of the Administrative Budget element.
m Net allowable expenditures are the authorized actual/allowable expenditures
(total costs less specified exclusions). Available funding is also limited by state
appropriations.
a 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 FY 20/19 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 19/20, the FY 92/93 Local Maintenance of Effort Level
must be met.
Reporting Requirements (if different than contract language)
• Local maintenance of effort reports are due:
• Projected Current Fiscal Year— October 30
• Prior Fiscal Year Actual — March 31
A final statewide cost settlement will be performed to assure that all available
ELPHS funds are fully distributed and applied for required services.
All final amendment ELPHS funding shift request memos need to be submitted
no later than May 1st. Please send the memo to Laura de la Rambelje
(DelaRambelieL)D,michigan.gov) and copy Carissa Reece
(ReeceC(),michiaan.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.
PROJECT TITLE: Hearing ELPHS / Vision ELPHS
Start Date: 10/1/2021
End Date: 9/30/2022
Project Synopsis:
The Hearing and Vision Programs screen over 1 million preschool and school -age
children each year. Screening services are conducted in schools, Head Start, and
preschool centers by local health department (LHD) vision technicians. Children who
fail their vision screening are referred to a licensed eye doctor for an exam and
treatment. Follow-up is conducted by the LHD to confirm that the child gets the care
that they need. Children who do not pass their hearing screening are referred to their
primary care physician or Ear, Nose, and Throat physician for diagnosis, treatment, and
recommendations.
Reporting Requirements (if different than agreement language):
Upon completion of the FY22 contract, grantees must submit a School -Based Hearing
and Vision Program Annual Narrative Progress Report to MDHHS-Hearinq-and-
Vision ab,,michigan.gov The report must include:
1. Successes -accomplishments of the program/technician(s)
2. Challenges- issues that created difficulty in managing the program and/or
performing screening services.
3. Technical Assistance Needs- request support from the Hearing and/or Vision
Consultant.
4. Additional Feedback -questions in this section will change annually based on
relevant/current program topics/issues.
Annual Narrative Report must be approved by the MDHHS Hearing & Vision
Coordinators for their respective programs.
MDHHS will provide a template for reporting.
Each Local Health Department (coordinators and technicians) should keep an
ongoing log of Successes and Challenges to compile and share at the end of the
fiscal year.
• Final reports are submitted by the grantee to MDHHS. The reports are due 30
days after the end of the fiscal year.
For questions regarding these reports, please contact:
Jennifer Dakers, MDHHS Hearing Consultant, dakersi @,,michiaan.aov
Dr. Rachel Schumann, MDHHS Vision Consultant, schumannr(@,michigan.gov
Any additional requirements (if applicable):
Grantees must adhere to established Minimum Program Requirements for School -
Based Hearing & Vision Services as outlined in the Michigan Local Public Health
Accreditation Program 2019 MPR Indicator Guide.
PROJECT: Emerging Threats — Hepatitis C
Beginning Date: 10/1/2021
End Date: 9/30/2022
Project Synopsis
Funds are provided to grantees to increase local capacity to make improvements in
hepatitis C virus (HCV) testing, case follow-up, and linkage to care. Progress will be
tracked by monitoring case completion rates and HCV linkage to care within the MDSS
and evaluating HCV testing volumes submitted by grantees through STARLIMS.
Reporting Requirements (if different than contract language)
• Quarterly report cards/progress reports on HCV case completeness will be
complied by MDHHS and sent to grantees.
• Grantees will keep a log of MDSS IDs on client interactions and linkage to care
progress for submission to the MDHHS Viral Hepatitis Unit on a quarterly basis.
• Grantees will participate on semi -routine group conference calls and/or 1:1
technical assistance check in calls to discuss best practices and identify barriers.
• Grantees will collect and submit specimens to the MDHHS Bureau of Laboratories
for HCV testing through their public health clinics.
Target Requirements
Grantees will meet the following objectives for Hepatitis C, Chronic follow-up:
Target 1: Interview attempted on 90% of Hepatitis C, Chronic cases within 30 days of
referral date.
Target 2: Interview completed on 50% of Hepatitis C, Chronic cases within 60 days of
referral date.
Target 3: Hepatitis C RNA test result on 50% of Probable Hepatitis C, Chronic cases
within 90 days of referral date.
Violation Monitoring:
The inability to meet the metrics will elicit the following response from MDHHS related to
this funding:
• Technica4 assistance
• Corrective action/performance improvement plans with MDHHS
• Reallocation of funds.
Any additional requirements (if applicable)
• Grantees will document process for carrying out the HCV project during the
current pandemic
• Grantees will document best practices or protocols for HCV case investigation and
linkage to care
• Grantees will document pathways to link patients to medical care
• Grantees may collaborate with the State Viral Hepatitis Unit for assistance
• Grantees can submit HCV specimens to the MDHHS Bureau of Laboratories at no
cost to them or the client
PROJECT TITLE: Ending the HIV Epidemic Implementation
Start Date: 10/1/2021
End Date: 9/30/2022
Project Synopsis:
The purpose of this project is to implement activities to support the objectives of the CDC
PS20-2010 Ending the HIV Epidemic in Wayne County. The purpose of these objectives
is to reduce the incidence of HIV in and improve the overall health and well-being of
residents of Wayne County.
Reporting Requirements:
Report
Period
Due Date(s)
How to Submit Report
Quality Control Reports
Monthly
10th of the
following month
Department Staff
Daily Client Logs
Monthly
101" of the
following month
Department Staff
Reactive Results
As
Within 24 hours
APHIRM
needed
of test
Non -Reactive Results
As
Within 7 days of
APHIRM
needed
test
Linkage to Care and Partner Services
Interview (e.g. client attended a medical
care appointment within 30 days of
As
Within 30 days of
APHIRM
diagnosis, and was interviewed by
needed
service
Partner Services within 30 days of
diagnosis)
Quarterly Progress Report
Quarterly
Within 30 days of
end of quarter
Department Staff
Internet Partner Services (IPS) and
_
Partner Services Interview (e.g, client
Ongoing
Within 30 days of
APHIRM
identify dating apps used to meet
service
partners), if applicable
Disposition on Partners of HIV Cases, if
Ongoing
Within 30 days of
APHIRM
applicable
service
HIV Testing Competencies
Annually
Reviewed during
Department Staff
site visits
II
rHIV Testing Proficiencies
Annually
Reviewed during
Department Staff
I!
site visits
I SSP Data Report, if applicable
Quarterly
10th of the
Syringe Utilization
III
following month
Platform (SUP)
1. The Grantee will clean-up missing data by the 10th day after the end of each calendar
month.
2. The Quality Control and Daily Client Logs may be sent to the Contract Manager via:
® Email - ctrsuoolies(d)michiaan.gov
Fax - (517) 241-5922
Mail - HIV Prevention Unit, Attn: CTR Coordinator, PO Box 30727,
Lansing, MI 48909
GRANTEE REQUIREMENTS
Grantees will provide HIV Counseling, Testing, and Referral (CTR) and, if applicable,
Partner Services (PS), and Syringe Service Programs (SSP) within their jurisdiction,
pursuant to applicable federal and state laws; and policies and program standards
issued by the Division of HIV & STI Programs (DHSP). See "Applicable Laws, Rules,
Regulations, Policies, Procedures, and Manuals."
Publication Rights
When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
funds, the Grantee receiving Federal funds, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state:
1. The percentage of the total costs of the program or project that will be financed
with Federal funds.
2. The dollar amount of Federal funds for the project or program.
3. Percentage and dollar amount of the total costs of the project or program that will
be financed by non -governmental sources.
Grant Program Operation
1. The Grantee will participate in DHSP needs assessment and planning activities,
as requested.
2. The Grantee will participate in regular Grantee meetings which may be face-to-
face, teleconferences, webinars, etc. The Grantee is highly encouraged to
participate in other training offerings and information -sharing opportunities
provided by DHSP.
Each employee funded in whole or in part with federal funds must record time and
effort spent on the project(s) funded. The Grantee must:
a. Have policies and procedures to ensure time and effort reporting.
b. Assure the staff member clearly identifies the percentage of time devoted to
contract activities in accordance with the approved budget.
c. Denote accurately the percent of effort to the project. The percent of effort may
vary from month to month, and the effort recorded for funds must match the
percentage claimed on the FSR for the same period.
d. Submit a budget modification to DHSP in instances where the percentage of
effort of contract staff changes (FTE changes) during the contract period.
4. The Grantee will receive a condom and lubrication allowance. The Grantee must:
a. Distribute condoms and lubrication.
b. Place orders for condoms/lubrication by emailing ctrsupplies@michigan.gov
5. If conducting HIV testing using rapid HIV testing, the Grantee will comply with
guidelines and standards issued by DHSP and:
a. Conduct quality assurance activities guided by written protocol and procedures.
Protocols and procedures, as updated and revised Quality assurance activities
are to be responsive to: Quality Assurance for Rapid HIV Testing, MDHHS.
See "Applicable Laws, Rules, Regulations, Policies, Procedures, and
Manuals."
b. Ensure provision of Clinical Laboratory Improvement Amendments (CLIA)
certificate.
c. Report discordant test results to DHSP.
d. Ensure that staff performing counseling and/or testing with rapid test
technologies has successfully completed rapid test counselor certification
course or Information Based Training (as applicable), test device training, and
annual proficiency testing.
e. Ensure that all staff and site supervisors have successfully completed
appropriate laboratory quality assurance training, blood borne pathogens
training and rapid test device training and reviewed annually.
f. Develop, implement, and monitor protocol and procedures to ensure that
patients receive confirmatory test results.
`To maintain active test counselor certification, each HIV test counselor must submit one
competency per year to the appropriate departmental staff.
6. if conducting PS, the Grantee will comply with guidelines and standards issued by
the Department. See "Applicable Laws, Rules, Regulations, Policies, Procedures,
and Manuals." The Grantee must:
a. Provide Confidential PS follow-up to infected clients and their at -risk partners to
ensure disease management and education is offered to reduce transmission.
b. Effectively link infected clients and/or at -risk partners to HIV care and other
support services.
c. Work with Early Intervention Specialist to ensure infected clients are retained in
HIV care.
d. Procure TLO or a TLO-like search engine.
e. Ensure staff that are utilizing TLO or TLO-search engine complete the TLO
training to maintain and understand the confidential use of the system.
f. Effectively utilize the Internet Partner Services (IPS) Guidance to provide
confidential PS follow-up to partners named by infected clients who were
identified to have been met through the use of dating apps.
g. Ensure staff and site supervisors successfully complete the Internet Partner
Services Training.
h. Ensure staff conducting Internet Partner Services participant in monthly, bi-
monthly meetings, webinars or calls to discuss best practices and identify
barriers.
7. If conducting SSP, the grantee will develop programs using MDHHS guidance
documents and will address issues such as identification and registration of
clients, exchange protocols, education, and trainings for staff, and referrals.
8. Grantees will participate on monthly or quarterly conference calls to discuss best
practices and identify barriers.
a. The Grantee shall permit DHSP or its designee to visit and to make an
evaluation of the project as determined by DHSP.
Record Maintenance/Retention
The Grantee will maintain, for a minimum of five (5) years after the end of the grant
period, program, fiscal records, including documentation to support program activities
and expenditures, under the terms of this agreement, for clients residing in the State of
Michigan.
Software Compliance
The Grantee and its subcontractors are required to use APHIRM (formerly Evaluation
Web) to enter HIV client and service data into the centrally managed database on a
secure server.
The Grantee and its subcontractors are required to use APHIRM (formerly Partner
services Web) to enter Partner Services interview and linkage to care data, and identified
dating apps through the use of Internet Partner Services (IPS) where appropriate.
Mandatory Disclosures
The Grantee will provide immediate notification to DHSP, in writing, including but not
limited to the following events:
a. Any formal grievance initiated by a client and subsequent resolution of that
grievance.
b. Any event occurring or notice received by the Grantee or subcontractor, that
reasonably suggests that the Grantee or subcontractor may be the subject of,
or a defendant in, legal action. This includes, but is not limited to, events or
notices related to grievances by service recipients or Grantee or subcontractor
employees.
c. Any staff vacancies funded for this project that exceed 30 days.
'All notifications should be made to DHSP by MDHHS-HIVSTIoperations(a-.michiaan.00v.
Technical Assistance
To request TA, please send an email to MDHHS-HIVSTIoperations(oDmichiaan.aov.
a. This may include issues related to: APHIRM (formerly EvalWeb and PSWeb),
Intervention Database, Programs, Budget/Fiscal, Grants and Contracts, Risk
Reduction Activities, Training, or other activities related to carrying out HIV
prevention activities.
ASSURANCES
Compliance with Applicable Laws
The Grantee should adhere to all Federal and Michigan laws pertaining to HIV/AIDS
treatment, disability accommodations, non-discrimination, and confidentiality.
PROJECT: Environmental Health Data
Beginning Date: 11/1/ 2021
End Date: 9/30/2022
Project Synopsis
The purpose of this project is to fund the Western Upper Peninsula Health Department
(WUPHD) to build on its existing June 2018 Flood After Action Report and Improvement
Plan.
Reporting Requirements (if different than contract language)
WUPHD will attend bi-weekly virtual meetings to disucss project activities and progress of
the detailed year 1 workplan as submitted to and accepted by the CDC. Changes to the
workplan by WUPHD will be discussed and approved by MDHHS DEH CO-Pls and
reported to CDC prior to implementation. The WUPHD staff will provide written progress
reports at the time of the bi-weekly project team meetings.
WUPHD staff will work with MDHHS DEH staff to develop a detailed evaluation plan
within six months of the grant award from CDC. WUPHD staff will be required to collect
and report on performance evaluation measures to MDHHS DEH staff for inclusion in the
Annual Performance Report and in the CDC performance measures and evaluation
results portal. A final project report is due from WUPHD to MDHHS DEH within 30 days
from the date of termination or final expenditure. The report will include:
• Intro & Scope
1. Why was this project initiated?
2. What did we hope to accomplish?
• Goals & objectives
1. What were our intended outputs (tangible deliverables from the year 1
workplan to CDC)?
2. What were the intended outcomes (changes in: behavior, departmental
capacity, processes, partnerships, resource allocation, etc.)?
• Process
1. Who was involved and what was their role (project team, steering
committee, other agencies/stakeholders)?
2. What were the key steps in the project and when did they occur
(outreach and engagement, stakeholder meetings, drafts, etc.)?
3. What was accomplished (tangible outputs and outcomes)?
Successes & challenges
1. Compare the intended outputs and outcomes to the actual (did they
change, if so, why and how?)
2. What was successful about the project?
3. What were the challenges?
Next steps
1. How will the results be used?
2. Will this project encourage future activity in this area?
• Attach any of the final documents or notes on final processes that were
developed as a result of this funding
Any additional requirements (if applicable)
PROJECT: Expanding, Enhancing Emotional Health
(Various Locations)
Beginning Date: 10/1/2021
End Date: 9/30/2022
Project Synopsis
The E3 program funds mental health staff in schools to provide one on one therapy and
small group therapy.
Reporting Requirements (if different than contract language)
The grantee shall submit all required reports in accordance with the Michigan
Department of Health and Human Services' (the Department's) reporting requirements.
These reports shall be submitted via EGrAMS as described in the Department's
boilerplate language.
Work plans will be submitted annually, attached to the original grant application at the
beginning of the year. Quarterly work plan reports will be submitted, attached to the FSR,
within 30 days of the end of the quarter. Work plans and work plan reports can also be
submitted via e-mail to your appropriate E3 consultant:
• Gina Zerka: zerkao(a).michioan.aov
• Mario Wilcox: wilcoxm7na,michiaan.00v
MDHHS staff will evaluate all reports for completeness and adequacy.
All data previously reported will be submitted quarterly. The due dates are as follows:
Q1: Due January 315
Q2: Due April 301n
Q3: Due July 31s' and
Q4: Due September 301n
All data shall continue to be entered into the Clinical Reportinq Tool (CRT).
See below for data definitions.
The grantee shall permit the Department or its designee to visit and make an evaluation of
the project as determined by the Contract Manager.
Number of Unduplicated Users (clients) by Demographic Designation per quarter
Definition of an Unduplicated User:
An unduplicated user is an individual who has presented themselves to the E3 Program
for service with the mental health provider (minimum master's prepared and licensed
mental health provider), and for whom a record has been opened. Once per year, the
user is counted to generate the number of unduplicated clients utilizing the E3 services
for that year.
Aae Ranqe Female Male Total
0-4
5-9
10-17
18-21
Number of Unduplicated Users (clients) by Race per quarter
White
Black/African-American
Asian
Native Hawaiian or Pacific Islander
American Indian or Alaskan Native
More than One Race
Number of Unduplicated Users (clients) by Ethnicity per quarter
Arab/Chaldean
Hispanic or Latino
Definition of a Visit:
A visit is a significant encounter between an E3 provider and a new (unduplicated) user
or established (duplicated) user. Each visit should be documented as appropriate to the
visit and provider (i.e., visits include an assessment, diagnosis and treatment plan
documented in the medical record and/or other documentation appropriate to the visit). A
user will likely have multiple visits per year.
Total Visits by Provider Type per quarter
*Mental Health Provider must be minimum master's prepared and licensed
*Other Providers may include: RN, RD/Nutritionist, Health Educator, Oral Health and
other providers. Visits with other providers can only be counted after the client has been
established as an E3 user.
Visits by Type per quarter
Count the visit by type of session provided. If the client was seen individually, count as an
individual visit. If the client was seen in a therapeutic group, count as a group visit. If a
client receives both individual and therapeutic group services, count both visit types.
QUALITY INDICATORS REPORT DEFINITIONS
For each of the following Quality Measures, report the YTD NUMBER each quarter.
Each quarter, your data will likely be equal to or greater than, the previous quarter. Note
that this is different than the quarterly reporting elements, where data is reported by
quarter for that specific quarter only.
Number of Unduplicated Clients Ages 10-21 Years with an Up -to -Date Depression
Screen
Report the number of unduplicated clients up-to-date with depression screening. This
information could come directly from a behavioral health screener or risk assessment, so
the number screened (flagged) for depression may equal or be very close to the number
of behavioral health screeners and/or risk assessments completed. (Note this is not the
same as a depression assessment conducted by a provider.) Do not double count
clients who were screened (flagged) for depression using behavioral health screen or risk
assessment and who also completed a specific depression screening tool (e.g., Beck's,
PHQ-9, etc).
Number of Clients Age 12 and Up with a Positive Depression Assessment
(Diagnosis of Depression)
Report the number of clients (age 12 and older) with a diagnosis of depression according
to the score on the depression screening tool and psychosocial assessment by the
provider. Exclude the following: a) those who are already receiving documented care
elsewhere, and b) those who are referred out of the E3 site for treatment.
Number of Clients Age 12 and Up with a Diagnosis of Depression who have
Documented, Appropriate Follow -Up
Report the number of clients from the denominator who receive treatment at the E3 site
who have all of elements of an appropriate follow-up plan: a) had a psycho -social
assessment completed by 3rd visit (includes suicide risk assessment/safety plan), b) had
a treatment plan developed by 3rd visit, c) treatment plan reviewed @ 90 days (for those
on caseload for 90+ days), and d) screener re -administered at appropriate interval to
determine change in score.
For the following two quality measures, please note that you are NOT expected to
administer BOTH a behavioral health screen AND a risk assessment to each client. You
only need to administer one tool or the other as appropriate for age, developmental level
and need. Please report the number of behavioral health screens and/or risk
assessments provided to your clients:
Number of Unduplicated Clients Ages 5-21 Years with at least one Behavioral
Health Screen in the current fiscal year
Report the number of clients that receive a Behavioral Health Screen as appropriate for
age and developmental level. Examples of appropriate screening tools (to use) include
but are not limited to Pediatric Symptoms Checklist (17 or 34), Strength and Difficulties
Questionnaire.
Number of Unduplicated Clients with an Up -to -Date Risk Assessment / Anticipatory
Guidance
Report the number of clients that are complete with an annual risk assessment or
anticipatory guidance, as appropriate for age and developmental level. This may includs
clients that are UTD because they completed the risk assess ment/anticipatory guidance
in a previous fiscal year but are being seen in the E3 site in the current fiscal year.
BILLING REPORT DEFINITIONS
Reported on annual basis only:
Enter the dollar amount in claims submitted for services provided during the current
fiscal year (October 1- September 30), regardless of whether or not the claims were paid
during the fiscal year.
Enter the dollar amount received in revenue during the current fiscal year (October 1-
September 30), regardless of whether or not revenue resulted from claims filed during the
fiscal year.
For each of these entries, you will be entering data by:
• Medicaid Health Plan/Medicaid (from a drop -down menu)
• Commercial
• Self -Pay
• Other
(Vote that the Estimated Percent of Claims Paid and Unpaid (based on dollar amount, not
on number of claims) and Payor Mix will be auto totaled.
5 Most Common Reasons for Rejection of Submitted Claims
Select the five most common reasons for rejection of submitted claims from the
dropdown menu according to best -fit category.
DIAGNOSES AND PROCEDURE CODES AND FREQUENCY
Reported on annual basis only:
Mental Health Problem Diagnoses — Top 5 diagnoses from the mental health provider
CPT codes — Top 5 CPT codes - both the code and the name of procedure
Any additional requirements (if applicable)
MINIMUM PROGRAM REQUIREMENTS
October 1, 2021 - September 30, 2022
The E3 program shall be open and provide a full-time or full time equivalent mental health
provider (i.e., 40 hours) in one school building year-round. Services shall: a) fall within the
current, recognized scope of mental health practice in Michigan and b) meet the current,
recognized standards of care for children and/or adolescents.
Services provided by the mental health provider are designed specifically for children and
adolescents ages 5 through 21 years and are aimed at achieving the best possible social
and emotional health status.
Services
1. A minimum caseload of 50 clients (users) must be maintained annually.
2. In addition to maintaining a client caseload, the following services may be provided
and must be reflective of the needs of the school:
a. treatment groups using evidence -based curricula and interventions;
b. school staff training and professional development relevant to mental health.
c. building level promotion, such as school climate initiatives, bullying prevention,
suicide prevention programs, etc
d. classroom education related to mental health topics.
e. case management to and partnerships with other private/public social service
agencies
3. A Behavioral Health Screen and/or Risk Assessment will be completed for
unduplicated users at least once in the current fiscal year.
4. The use of an Electronic Medical Records system is required.
Assurances
5. These services shall not supplant existing school services. This program is not meant
to replace current special education or general education related social work activities
provided by school districts. This program shall not take on responsibilities outside of
the scope of these Minimum Program Requirements (Individualized Educational
Plans, etc.).
6. Services provided shall not breach the confidentiality of the client.
7. The E3 program shall not provide abortion counseling, services, or make referrals for
abortion services.
8. The E3 program, if on school property, shall not prescribe, dispense, or otherwise
distribute family planning drugs and/or devices.
9. E3 site will notify E3 Consultant in writing within 10 days of main mental health
provider absence.
Staffing/Clinical Care
10. The mental health provider shall hold a minimum master's level degree in an
appropriate discipline and shall be licensed to practice in Michigan. Clinical
supervision must be available for all licensed providers. For those providers that hold
a limited license working towards full licensure, supervision must be in accordance to
licensure laws/mandates and be provided by a fully licensed provider of the same
degree.
11. The E3 program shall be open during hours accessible to its target population.
Provisions must be in place for the same services to be delivered during times when
school is not in session. Not in session refers to times of the year when schools are
closed for extended periods such as holidays, spring breaks, and summer vacation.
These provisions shall be posted and explained to clients. The mental health provider
shall have a written plan for after-hours and weekend care, which shall be posted in
the center including external doors and explained to clients. An after-hours answering
service and/or answering machine with instructions on accessing after-hours mental
health care is required. If services are not able to continue during periods of not in
session, a written plan must be communicated to MDHHS for approval.
Administrative
12. Written approval by the school administration (ex: Superintendent, Principal, School
Board) exists for the following:
a. location of the E3 program within the school building;
b. parental and/or minor consent policy; and
c. services rendered through the E3 program.
A current signed interagency agreement or MOU must be established between the local
school district and mental health organization/fiduciary that defines the roles and
responsibilities of the mental health provider and of any other mental health staff working
within the school. This agreement must state a plan will be in place for transferring clients
and/or caseloads if the agreement is discontinued or expires.
13. The mental health provider or contracting agency must bill third party payors for
services rendered. Any revenue generated must be used to sustain the E3 program
and its services. E3 shall establish and implement a sliding fee scale, which is not a
barrier to health care for adolescents. No student will be denied services because of
inability to pay. E3 program funding must be used to offset any outstanding balances
(including copays) to avoid collection notices and/or referrals to collection agencies for
payment.
14. Policies and procedures shall be implemented regarding proper notification of
parents, school officials, and/or other health care providers when additional care is
needed or when further evaluation is recommended. Policies and procedures
regarding notification and exchange of information shall comply with all applicable
laws e.g., HIPAA, FERPA and Michigan statutes governing minors' rights to access
care.
15. Implement a quality assurance plan. Components of the plan shall include, at a
minimum:
a. ongoing record reviews by peers (at least semi-annually) to determine that
conformity exists with current standards of practice. A system shall be in place to
implement corrective actions when deficiencies are noted;
b. conducting a client satisfaction survey/assessment at least once annually.
16. The E3 program must have the following policies as a part of overall policies and
procedures:
a. parental and/or minor consent;
b. custody of individual records, requests for records, and release of information
that include the role of the non -custodial parent and parents with joint custody;
c. confidential services; and
d. disclosure by clients or evidence of child physical or sexual abuse, and/or
neglect.
Physical Environment
17. The E3 program shall have space and equipment adequate for private counseling,
secured storage for supplies and equipment, and secure paper and electronic client
records. The physical facility must be youth -friendly, barrier -free, clean and safe.
PROJECT TITLE: Family Planning Program
Start Date: 10/1/2021
End Date: 9/30/2022
Project Synopsis:
The Michigan Family Planning Program assists individuals and couples in planning and
spacing births, preventing unintended pregnancy, and seeking preventive health
screenings. On -site clinical services are delivered through a statewide network of local
health departments, hospital -based health systems, and federally qualified health centers.
The program's strong educational and counseling components help reduce health risks
and promote healthy behaviors. Family Planning prioritizes serving low-income men and
women, teens, and un/underinsured individuals. The Michigan Family Planning Program
serves as a safety net with providers who have been a reliable and trusted source of care,
and in many cases the only regular source of health care for individuals. Referrals to other
medical, behavorial, and social services are provided to clients, as needed. Services are
charged based on ability to pay. No one is denied services due to inability to pay.
Reporting Requirements (if different than agreement language):
Each grantee shall submit the required reporting on the following dates:
Report
Time Period
Due Date to
Department
Submit To
Work Plan
October 1 —
September 30
September 16
Mandy Luft
luftal (@michiaan.gov
Needs Assessment & Health
October 1 —
September 16
Mandy Lu ft
l
Care Plan
September 30
lufta1 @,rrichigan.gov
FPAR Mid -Year Report
January 1 —
June 30
July 15
Mandy Luft
lufta1(cDmichiaan.gov
FPAR Year -End Report
January 1 —
December 31
January 14
Mandy Luft
lufta1 @..mlchlgan.Qov
Medicaid Cost -Based October 1 — EGrAMS with Final
Reimbursement Tracking September 30 November 30 Financial Status
Form Report
Each grantee shall indicate the following project outputs:
Target Measure Total Performance State Funded Minimum
Expectation Performance Expected
Unduplicated Number
of Clinic Users
Percent I Number
95%
Any additional requirements (if applicable):
1. Each grantee must serve a minimum of 95% of proposed Title X users to
access its total amount of allocated funds. Semi-annual Family Planning
Annual Report (FPAR) data will be used to determine total Title X users
served.
2. Each grantee will be required to adhere to Federal Statue and Regulations
for Title X Family Planning Programs, including legislative mandates,
executive orders, and grant administration regulations.
3. Each grantee will be required to adhere to the current Michigan Title X
Family Planning Program Standards and Guidelines Manual.
4. Each grantee will provide MDHHS a minimum of 30 days advance notice of
any clinic site changes, including additions, closures, or changes to street
address. Service site changes can be sent to each grantee's agency
consultant.
5. Each grantee will be required to participate in program planning and
evaluation, including the completion of an Annual Plan that consists of a
needs assessment, health care plan, and work plan as detailed in the
current Standards and Guidelines Manual.
6. Each grantee will provide family planning clients with a broad range of
acceptable and effective family planning methods, including fertility
awareness -based methods and services, including basic infertility.
7. Each grantee will provide family planning services on a voluntary basis,
without coercion to accept services or any particular method of family
planning, and without making acceptance of services a prerequisite to
eligibility for any other service or assistance in another program.
8. Each grantee will provide confidential family planning and related
preventive health services to minors and will not require written consent of
parents or guardians for the provision of services to minors.
9. Each grantee will encourage family involvement in the decision of minors to
seek family planning services and must provide counseling to minors on
how to resist efforts that coerce minors into engaging in sexual activities.
10. Each grantee will comply with Michigan's Child Protection Law (Act 238 of
1975) and will be required to notify or report child abuse and neglect as
defined by the law. Confidentiality cannot be invoked to circumvent
requirements for mandated reporting.
11. Each grantee will provide family planning services in a manner which
protects the dignity of the individual.
12. Each grantee will provide family planning services without regard to religion,
race, color, height, weight, national origin, sex, number of pregnancies,
marital status, age, sexual orientation, gender identification or expression,
partisan considerations, or a disability or genetic information.
13. Each grantee will train all Title X staff on the unique social practices,
customs, and beliefs of the under -served populations within their service
area(s) at least every two years to reduce staff bias and ensure equitable
service provision.
14. Each grantee will not provide abortion as a method of family planning and
will have written policy that no Title X funds are used to provide abortion as
a method of family planning. Pregnant women will receive nondirective
counseling and medically necessary care as outlined in the current
Standards and Guidelines.
15. Each grantee will ensure that low-income individuals (i.e., :5100% of federal
poverty level) are given priority to receive family planning services.
16. Each grantee will have a sliding fee schedule, based on current Federal
Poverty Guidelines, to determine a client's ability to pay for family planning
services. No charges will be made for services provided to low-income
clients (i.e., 15100% of federal poverty level) except when that payment will
be made by a third -party, which is authorized to or is under legal obligation
to pay this charge. Donations are permissible from eligible clients, as long
as clients are not pressured to make one and donations are not a
prerequisite to family planning services or supplies.
17. Each grantee will have a schedule of fees designed to recover the
reasonable cost of providing services to clients whose income exceeds
250% of federal poverty level.
18. Each grantee where there is legal obligation or authorization for third -party
reimbursement, including public or private sources, all reasonable efforts
must be made to obtain third -party payment without application of any
discounts. Where the cost of services is to be reimbursed under title XIX,
XX, or XXI of the Social Security Act, a written agreement with the title
agency is required.
19. Each grantee will convene a Family Planning Advisory Council that will
serve as their governing board, which will be broadly comprised of the
population served and will meet at least once a year.
20. Each grantee will convene an Information and Education Committee
comprised of five to nine members who are broadly representative of the
population served or community that meets at least once a year to review
and approve all informational and educational materials prior to distribution.
21. Each grantee will provide for informational and educational programs
designed to: achieve community understanding of the objectives of the
program; inform the community of the availability of services; and promote
continued participation in the project by persons to whom family planning
services may be beneficial.
22. Each grantee will provide, to the extent feasible, an opportunity for
participation in the development, implementation, and evaluation of the
project by persons broadly representative of all significant elements of the
population to be served, and by others in the community knowledgeable
about the community's needs for family planning services.
23. Each grantee will provide for orientation and in-service training for all Title X
project personnel.
24. Each grantee will provide services without the imposition of any durational
residency requirement or requirement that the patient be referred by a
physician.
25. Each grantee will provide that family planning medical services will be
performed under the direction of a physician with special training or
experience in family planning.
26. Each grantee will provide that all services purchased for project participants
will be authorized by the project director or his/her designee on the project
staff.
27. Each grantee will have written clinical protocols that are in accordance with
nationally recognized standards of care that are reviewed and signed
annually by the medical director overseeing Family Planning.
28. Each grantee will have a quality assurance system in place for ongoing
evaluation of family planning services, including a tracking system for
clients in need of follow-up or continued care, quarterly medical audits to
determine conformity with agency protocols, quarterly chart audits/record
monitoring to determine the accuracy of medical records, and a process to
implement corrective actions for deficiencies.
29. Each grantee will have a current list of social services agencies and
medical referral resources that is reviewed and updated annually.
30. Each grantee will address clients' social determinants of health to the extent
feasible through the coordination and use of referral arrangements with
other providers of health care services, local health and welfare
departments, hospitals, voluntary agencies, and health services projects
supported by other federal programs.
31. Each grantee will offer education on HIV and AIDS, risk reduction
information, and either on -site testing or provide a referral for this service.
32. Each grantee will offer client -centered counseling services on -site or by
referral and ensure the information is medically accurate, balanced,
provided in a non -judgmental manner, and is non -coercive.
33. Each grantee will have a separate budget for Title X funds and maintain a
financial management system that meets the standards specified in 45 CFR
Part 74 or Part 92, as applicable.
34. Each grantee assures that Title X funds will be expended solely for the
purpose of delivering Title X Family Planning Services in accordance with
an approved plan & budget, regulations, terms & conditions, and applicable
cost principles prescribed in 45 CFR Part 74 or Part 92, as applicable.
35. Each grantee assures that if family planning services are provided by
contract or other similar arrangements with actual providers of services,
services will be provided in accordance with a plan, which establishes rates
and method of payment for medical care. These payments must be made
under agreements with a schedule of rates and payment procedures
maintained by each grantee. Grantees must be prepared to substantiate
these rates are reasonable and necessary.
36. Each grantee will comply with the Office of Population Affairs (OPA) FPAR
requirements, as well as MDHHS required FPAR elements, for the
purposes of monitoring and reporting performance.
37. Each grantee will have a data collection system in place to assure accurate
FPAR reporting, and will be responsible for updating their system, as
needed, to be in compliance with OPA and MDHHS FPAR reporting
standards.
38. Each grantee will use FPAR to identify program disparities and to the extent
feasible, will use program promotion, community outreach, or other
community -based strategies to address identified disparities (e.g., disparity
in men vs. women served or disparity in low-income clients vs. full -fee
clients served).
39. Each grantee will comply with the MDHHS Medicaid Cost -Based
Reimbursement (MCBR) reporting requirements and attach the MCBR
Tracking Form to their final financial status report. The MCBR Tracking
Form must be completed in its entirety and include Family Planning MCBR
and Other Medicaid MCBR financial information for all programs.
40.The funds appropriated in the current State Public Health Appropriations
Act for pregnancy prevention programs shall not be used to provide
abortion counseling, referrals or services, unless contradicts Title X Federal
Law (Title X of the Public Health Service Act).
41. Pursuant to Public Act (PA) 360 (2002) Section 333.1091, grantees qualify
as priority family planning providers who do not engage in any activities
outlined in PA 360 (2002) Section 333.1091.
42. Grantee funding cannot be used to supplant funding for an existing program
supported with another source of funds.
PROJECT TITLE: Fetal Alcohol Spectrum Disorder Community Projects
(FASDP) Special
Start Date: 10/1/2021
End Crate: 9/30/2022
Project Synopsis:
For the project period of October 1 to September 30, the Grantees will collaborate with
the Department to assist local communities with evidence -based activities, to implement
alcohol screening and prevent prenatal alcohol exposure among women of reproductive
age and to refer affected children, birth to 18 years of age, and their families to an FASD
Diagnostic Center for evaluation and intervention for the purpose of improving care and
services for women, infants and families.
Reporting Requirements (if different than agreement language):
The Grantee will collect data using the project evaluation/data tracking forms to monitor
the FASD community program effectiveness and report service numbers.
A. The Grantee shall submit the following reports electronically on the dates specified below:
Report
Time Period
Due Date Submit To
FASD
October 1 - December 31
January 15
Work Plan
January 1 - March 31
April 15 MDHHS EGrAMS
Narrative
April 1 - June 30
July 15
Report
July 1 - September 30
October 15
FASD ( October 1 - March 31 April 15
Data Email to
Evaluation April 1 — September 30 October 15 IuftAC)michioan.aov
Report
B. Any such other information as specified in the Statement of Work shall be
developed and submitted by the Grantee as required by the Contract Manager.
C. The Contract Manager shall evaluate the reports submitted as described in
Attachment C (items A and B) for their completeness and adequacy.
D. The Grantee shall permit the Department or its designee to visit and to make an
evaluation of the projects as determined by the Contract Manager.