HomeMy WebLinkAboutResolutions - 2022.07.19 - 37489BOARD OF COMMISSIONERS
July 19, 2022
MISCELLANEOUS RESOLUTION #22-262
Sponsored By: Penny Luebs
Health & Human Services - Health Division - Grant Application with the Michigan Department of
Health and Human Services for the FY 2023 Local Health Department Emerging Threats Agreement
Chairperson and Members of the Board:
WHEREAS the Oakland County Health Division is applying for funding through the Michigan Department of
Health and Hunan Services (MDHHS) Fiscal Year (FY) 2023 Emerging Threats Local Health Department
Agreement in the amount of $10,835,066 for the period October 1, 2022 through September 30, 2023; and
WHEREAS funding will support COVID-19 Immunization, Contact Tracing, Investigation, Testing
Coordination, Monitoring and Infection Prevention, and COVID Workforce Development, ELC SEWER
Network, PFAS Response, and Home Visitation; and
WHEREAS funding continues to support the development of a Regional Lab in an effort to modernize and
expand COVID-19 testing and response capabilities; and
WHEREAS the application requests funding for the continuation of a Full -Time Eligible (FTE) Special
Revenue (SR) Public Health Nurse III position (#15618) and a Part -Time Non -Eligible (PINE) 1,000 hours per
year Special Revenue (SR) Medical Technologist position (#14866); and
WHEREAS the application requests funding to create a Full -Time Eligible (FTE) Special Revenue (SR)
Medical Technologist position; and
WHEREAS no County match is required; and
WHEREAS this grant application has completed the Grant Review Process in accordance with the Grants
Policy approved by the Board of Commissioners at their January 21, 2021 meeting.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners hereby
authorizes the Fiscal Year 2022 Emerging Threats Local Health Department agreement application totaling
$10,835,066 for the period of October 1, 2022 through September 30, 2023.
BE IT FURTHER RESOLVED that application and future acceptances of this grant does not obligate the
county to any future commitment and continuation of this program is contingent upon continued future levels of
grant funding.
BE IT FURTHER RESOLVED that no budget amendment is required at this time.
Chairperson, the following Commissioners are sponsoring the foregoing Resolution: Penny Luebs.
Date: July 19, 2022
David Woodward, Commissioner
{��lj� au�+�+ Date. July 25, 2022
Hilarie Chambers, Deputy County Executive II
Date: July 26, 2022
Lisa Brown, County Clerk / Register of Deeds
COMMITTEE TRACKING
2022-07-12 Public Health & Safety - Recommend and Forward to Finance
2022-07-13 Finance - Recommend to Board
2022-07-19 Full Board
VOTE TRACKING
Motioned by Commissioner Kristen Nelson seconded by Commissioner Michael Gingell to adopt the attached
Grant Application: with the Michigan Department of Health and Human Services for the FY 2023 Local Health
Department Emerging Threats Agreement.
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)
Passed
ATTACHMENTS
l . Grant Review Sign -off - FY23 LHD Emerging Threats Application
2. MDHHS Fiscal Year (FY) 2023 Project Allocations for Emerging Threats- Local Health Department-
2023
3. Boilerplate contract - FY23 LHD Emerg Threats (2)
4. Att 1
5. Att III
6. ATT IV
7. ATT B3
8. Add A
9. DeMinimisRate FY23 (4)
10. Laws and regs
11. Fiscal Questionnaire FY 2023 (1)
STATE OF MICHIGAN)
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 July 19, 2022, with
the original record thereof now remaining in my office.
In Testimony Whereof, I have hereunto set my h4nd and affixed the seal of the Circuit Court at Pontiac,
Michigan on Tuesday, July 19, 2022.
i
Lisa Brown, Oakland County Clerk/Register of Deeds
Please Note: The attached Miscellaneous Resolution is subject to further revision once posted to the Board of
Commissioners' Civic Clerk site.
GRANT REVIEW SIGN -OFF — Health & Human Services/Health Division
GRANT NAME: FY 2023 Emerging Threats - Local Health Department Agreement
FUNDING AGENCY: Michigan Department of Health & Human Services
DEPARTMENT CONTACT: Raquel Lewis 248 858-5254
STATUS: Grant - Application (Greater than $50,000)
DATE: 06/28/2022
Please be advised the captioned grant materials have completed internal grant review. Below are the returned comments.
You may now obtain the Board Chair's signature for submittal of the application. The grant application package (which
should include this sign -off and the grant application with related documentation) as well as the Report from Fiscal
Services to the Board Chairperson may be submitted to the Board of Commissioners for placement on the agenda(s) of the
appropriate Board of Commissioners' committee(s)
DEPARTMENT REVIEW
Management and Budget:
Approved by M & B - Lynn Sonkiss 06/24/2022 based on the additional email that was provided that summarized the
preliminary budget breakdown. I asked that this be included in the grant application package.
Human Resources:
Approved by Human Resources. No FIR action needed on this item until grant acceptance. I recommend the following
changes to the MR:
WHEREAS the application requests funding for the continuation of a Full -Time Eligible (FTE) Special Revenue (SR)
Public Health Nurse III position (#15618) and a Part -Time Non -Eligible (PTNE) 1,000 hours per year Special Revenue
(SR) Medical Technologist position (414866); and
WHEREAS the application requests funding to create a Full,Time Eligible (FTE) Special Revenue (SR) Medical
Technologist position; — Heather Mason 06/23/2022
Risk Management;
Approved — Robert Erlenbeck 06/27/2022
Corporation Counsel:
Approved by CC - Heather Lewis 06.27.22 based on the additional email that was provided that summarized the
preliminary budget breakdown which Lynn Sonkiss asked to be included in the grant application package and Heather
Mason's recommended changes to the resolution regarding positions.
From:
nnrenlv(a)enrams-mi net
To:
Smith, Starev
Cc:
FSRMDHHS(dlmichioan oov
Subject:
MDHHS Fiscal Year (FY) 2023 Project Allocations for Emerging Threats- Local Health Department- 2023
Date:
Friday, June 17, 2022 11:44:46 AM
CAUTION: This message is from a sender outside of the Oakland County organization.
Do not click links or open attachments unless you recognize the sender and know the
content is safe.
June, 17 2022
Stacey Smith, Administrator
Oakland County Department of Health and Human Services/ Health Division
1200 N. Telegraph Rd.
Pontiac, MI 48341 1032
Dear Stacey Smith:
The following chart is a list of the Emerging Threats- Local Health Department- 2023 allocations for your Local
Health Department (LHD) for funding administered by the Michigan Department of Health and Human Services
(MDHHS) through the Agreement. These allocations are based on anticipated FY 2023 Appropriations for MDHHS
and are subject to the availability of funds, MDHHS's Appropriation Act for FY 2023, MDHHS approval, and State
Administrative Board approval.
Please complete the applications, including the budgets, for these projects and submit your
applications through EGrAMS within six weeks. When each individual project application is
completed, please have your Authorized Official submit it. This will facilitate timely
processing of your agreement. If you are not able to submit your application within this time
period, please contact your Grants Section team member, Clarissa Reece, at
reeceC(a�michipan.pov. All allocations must be budgeted and expended consistent with the
requirements contained in the Agreement. The effective date for the executed agreement is
based on the Grantee's signature or October 1, 2022, whichever is later.
Allocation Table
1PROJECT TITLE ALLOCATION AMOUNTI
mencan Rescue Plan
189,404.001
COVID Immunization
5,163,603.001
COVID Workforce Development
172,605.001
IELC Contract Tracing, Investigation, Testing Coord., and Infection Prevention
3,826,390.001
IELC Regional Lab
512,420,001
Sewer Network
909,057.00
PAS
PPAS Response -Airport
80,390 00
IPFAS Response - Falk Rd
1,197 00
[TOTAL - .�,......,�e»._a...-.,.,..
10,835,066.001
The next steps in the EGrAMS system for completing your budgets and submitting
your Emerging Threats- Local Health DOpartment- 2023 for MDHHS approval are as follows:
The Project Manager will assign the agency users to the Emerging Threats- Local Health
Department- 2023 program.
2. For your convenience, you can access the "Grantee: Comprehensive Agreement
Instructions" material on the home page by clicking "About EGrAMS" and downloading the
PDF. Access the system using the URL httn://eerams-mi.com/mdhhs.
3. Login to the EGrAMS system at the URL httn://eerams-mi.com/mdhhs.
4. Access the application using the dropidown menus "Grantee>Grant Application>Enter
Grant Application" and click on "Go."
5. Select the ETLHD-2023 / Emerging Threats- Local Health Department- 2023 program and
click on the "Go" button.
6. Select the hyperlink titled "Emerging Threats- Local Health Department- 2023.
7. Complete the face sheet, including the fiscal month, day, and contact information. Click the
"Save" button before advancing to the next screen(s). New this year: The DUNS number has
been replaced by the Unique Entity Identifier (UEI). Please ensure the face sheet of your
agency's application includes your agency's UEI. If your agency needs to apply for a new
UEI, please visit httn://www.sam.gov.
8. Select the hyperlinks to the various program elements and complete the application,
including the face sheet, certifications, and budget.
9. When completing the "Budget" tab, it is highly recommended that you use the "Copy"
button to initially populate the data and modify the information to fit the current -year spending
plan.
10. When the application has been entered, validated, and is error -free, it is ready for
submission by the Authorized Official.
Additional Guidance
A blank version of the FY 2023 Comprehensive Boilerplate and attachments is available on
the MI E-Grants home page (httn://eerams-m i.com/MDFIHS/). To access documents, click "
(grant_cat _desc}" located under the "Current Grants" header. Select the hyperlink for the
ETLHD-2023 agreement and click on the "Documents" tab to access the documents.
New this year: Grantees can generate the Schedule of Finance Assistance on -demand using MDHHS EGrAMS.
Grantees that have worked with MDHHS in the past have previously found this information in the grant agreement.
To generate the Schedule of Finance Assistance, access MDHHS EGrAMS at httn://eerams-mi.com/mdhhs. Once
logged in, path to Grantee > Grant Application > Schedule of Finance Assistance. Click Generate, enter 2023 in the
Fiscal Year field, and click Find. The Schedule can be saved as either an Excel or PDT using the available buttons
on the screen. The Schedule will reflect the most up-to-date funding information at the time it is generated, and
MDHHS recommends generating revised versions periodically to capture any funding updates.
Technical ASsistancQ
Technical Assistance to complete the budgets is available, through your Grants Section team member, Carissa Reece,
at reeceCrinnichipan.env or (517) 335-0940. In addition, you may refer to your training materials, the yellow book,
and help icons within MI E-Grants for assistance.
Thank you for your cooperation and support. Please contact your Grants Section team member
if you have any questions.
Sincerely,
Jeanette Hensler, Grants Division Director
Bureau of Grants and Purchasing
Michigan Department of Health and Human Services
Agreement #:
Agreement Between
Services
hereinafter referred to as the "Department"
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
1200 N. Telegraph Rd. 34 East
Pontiac, MI 48341 0432
Federal I.D.#: 38-6004876, DUNS #: 136200362
hereinafter referred to as the "Grantee"
for
The Delivery of Public Health Services under
the Local Health Department Agreement
Part 1
1. Purpose
This Agreement is entered into for the purpose of setting forth a joint and cooperative
Grantee/Department relationship and basis for facilitating the delivery of public health
services to the citizens of Michigan under their jurisdiction, as described in the
attached Annual Budget, established Minimum Program Requirements, and all other
applicable federal, state and local laws and regulations pertaining to the Grantee and
the Department. Public health services to be delivered under this Agreement include
Essential Local Public Health Services (ELPHS) and Categorical Programs as
specified in the attachments to this Agreement.
2. Period of Agreement
This Agreement will commence on the date of the Grantee's signature or October 1,
2022, whichever is later, and continue through September 30, 2023. Throughout the
Agreement, the date of the Grantee's signature or October 1, 2022, whichever is
later, will be referred to as the start date. This Agreement is in full force and effect for
the period specified.
3. Program Budget and Agreement Amount
A. Agreement Amount
In accordance with Attachment IV - Funding/Reimbursement Matrix, the total
State budget and amount committed for this period for the program elements
-gverad by this Agreemept is a
Date. 05/23/2022 Page: 1 of 34
B. Equipment Purchases and Title
Any Grantee equipment purchases supported in whole or in part through this
Agreement must be listed in the supporting Equipment Inventory Schedule
which should be attached to the Final Financial Status Report. Equipment
means tangible, non -expendable, personal property having a useful life of
more than one year and an acquisition cost of $5,000 or more per unit. Title to
items having a unit acquisition cost of less than $5,000 will vest with the
Grantee upon acquisition. The Department reserves the right to retain or
transfer the title to all items of equipment having a unit acquisition cost of
$5,000 or more, to the extent that the Department's proportionate interest in
such equipment supports such retention or transfer of title.
C. Budget Transfers and Adjustments
1. Transfers between categories within any program element budget
supported in whole or in part by state/federal categorical sources of
funding will be limited to increases in an expenditure budget category by
$10,000 or 15% whichever is greater. This transfer authority does not
authorize purchase of additional equipment items or new subcontracts
with state/federal categorical funds without prior written approval of the
Department.
2. Except as otherwise provided, any transfers or adjustments involving
state/federal categorical funds, other than those covered by C.1,
including any related adjustment to the total state amount of the budget,
must be made in writing through a formal amendment executed by all
parties to this Agreement in accordance with Section IX. A. of Part 2.
3. The CA and C.2 provisions authorizing transfers or changes in local
funds apply also to the Family Planning program, provided statewide
local maintenance of effort is not diminished in total.
Any statewide diminishing of total local effort for family planning and/or
any related funding penalty experienced by the Department will be
recovered proportionately from each local Grantee that, during the
course of the Agreement period, chose to reduce or transfer local funds
from the Family Planning program.
4. Agreement Attachments
A. The following documents,are attachments to this Agreement Part 1 and Part 2
- General Provisions, which are part of this Agreement:
1. Attachment I - Annual Budget
2, Attachment III -Program Specific Assurances and Requirements
3. Attachment IV - Funding/Reimbursement Matrix
Date05/23/2022 Pagel 2 of 34
5. Statement of Work
The Grantee agrees to undertake, perform and complete the activities described in
Attachment III - Program Specific Assurances and Requirements and the other
applicable attachments to this Agreement which are part of this Agreement.
6. Financial Requirements
The financial requirements must be followed as described in Part 2 and Attachment I
- Annual Budget and Attachment IV - Funding/Reimbursement Matrix, which are part
of this Agreement.
7. Performance/Progress Report Requirements
The progress reporting methods, as applicable, must be followed as described in part
2 and Attachment III, Program Specific Assurances and Requirements, which are part
of this Agreement.
8. General Provisions
The Grantee agrees to comply with the General Provisions outlined in Part 2, which is
part of this Agreement.
9. Administration of the Agreement
The person acting for the Department in administering this Agreement (hereinafter
referred to as the Contract Consultant) is:
Name: Carissa Reece
Title: Department Analyst
E-Mail Address ReeceC@michigan.gov
The financial contact acting on behalf of the Grantee for this Agreement is:
{fin_name}
Name Title
{fin_email}
E-Mail Address Telephone No.
Date: 05/23/2022 Page, 3 of 34
10. Special Conditions
A. This Agreement is valid upon approval and execution by the Department which
may be contingent upon approval by the State Administrative Board and
signature by the Grantee.
B. This Agreement is conditionally approved subject to and contingent upon
availability of funding and other applicable conditions.
C. Based on the availability of funding, the Department may specify the amount of
funding the Grantee may expend during a specific time period within the
Agreement Period.
D. The Department has the option to assume no responsibility or liability for costs
incurred by the Grantee prior to the start date of this Agreement.
E. The Grantee is required by 2004 PA 533 to receive payments by electronic
funds transfer.
11. Special Certification
The individual or officer signing this Agreement certifies by their signature that they
are authorized to sign this Agreement on behalf of the responsible governing board,
official or Grantee.
12. Signature Section
For {agency_name}
{auth_name}
Name Title
For the {dept_name}
Christine H. Sanches {current —date}
Christine H. Sanches, Director , Date
Bureau of Grants and Purchasing
Date: 05/23/2022 Page: 4 of 34
Part 2
General Provisions
Responsibilities - Grantee
The Grantee, in accordance with the general purposes and objectives of this
Agreement, must:
A. Publication Rights
1. Copyright materials only when the Grantee exclusively develops books,
films or other such- copyrightable materials through activities supported
by this Agreement. The copyrighted materials cannot include recipient
information or personal identification data. Grantee provides the
Department a royalty -free, non-exclusive and irrevocable license to
reproduce, publish and use such materials copyrighted by the Grantee
and authorizes others to reproduce and use such materials.
2. Obtain prior written authorization from the Department's Office of
Communications for any materials copyrighted by the Grantee or
modifications bearing acknowledgment of the Department's name prior
to reproduction and use of such materials. The state of Michigan may
modify the material copyrighted by the Grantee and may combine it with
other copyrightable intellectual property to form a derivative work. The
state of Michigan will own and hold all copyright and other intellectual
property rights in any such derivative work, excluding any rights or
interest granted in this Agreement to the Grantee. If the Grantee ceases
to conduct business for any reason or ceases to support the
copyrightable materials developed under this Agreement, the state of
Michigan has the right to convert its licenses into transferable licenses
to the extent consistent with any applicable obligations the Grantee has.
3. Obtain written authorization, at least 14 days in advance, from the
Department's Office of Communications and give recognition to the
Department in any and all publications, papers and presentations
arising from the Agreement activities.
4. Notify the Department's Bureau of Grants and Purchasing 30 days
before applying to register a copyright with the U.S. Copyright Office.
The Grantee must submit an annual report for all copyrighted materials
developed by the Grantee through activities supported by this
Agreement and must submit a final invention statement and certification
within 60 days of the end of the Agreement period.
5. Not make any media releases related to this Agreement, without prior
written authorization from the Department's Office of Communications.
B. Fees
1. Guarantee that any claims made to the Department under this
Agreement will riot be financed by any sources other than the
Department under the terms of this Agreement. If funding is received
Date: 05/23/2022 Page5 of 34
through any other source, the Grantee agrees to budget the additional
source of funds and reflect the source of funding on the Financial Status
Report.
2. Make reasonable efforts to collect 1st and 3rd party fees, where
applicable, and report those collections on the Financial Status Report.
Any under recoveries of otherwise available fees resulting from failure to
bill for eligible activities will be excluded from reimbursable
expenditures.
C. Grant Program Operation
Provide the necessary administrative, professional and technical staff for
operation of the grant program. The Grantee must obtain and maintain all
necessary licenses, permits or other authorizations necessary for the
performance of this Agreement.
Use an accounting system that can identify and account for the funds received
from each separate grant, regardless of funding source, and assure that grant
funds are not commingled.
D. Reporting
Utilize all report forms and reporting formats required by the Department at the
start date of this Agreement and provide the Department with timely review
and commentary on any new report forms and reporting formats proposed for
issuance thereafter.
E. Record Maintenance/Retention
Maintain adequate program and fiscal records and files, including source
documentation, to support program activities and all expenditures made under
the terms of this Agreement, as required. The Grantee must assure that all
terms of the Agreement will be appropriately adhered to and that records and
detailed documentation for the grant project or grant program identified in this
Agreement will be maintained for a period of not less than four years from the
date of termination, the date of submission of the final expenditure report or
until litigation and audit findings have been resolved. This section applies to
the Grantee, any parent, affiliate, or subsidiary organization of the Grantee and
any subcontractor that performs activities in connection with this Agreement.
F. Authorized Access
1. Permit within 10 calendar days of providing notification and at
reasonable times, access by authorized representatives of the
Department, Federal Grantor Agency, Inspector Generals, Comptroller
General of the United States and State Auditor General, or any of their
duly authorized representatives, to records, papers, files, documentation
and personnel related to this Agreement, to the extent authorized by
applicable state or federal law, rule or regulation.
2. Acknowledge the rights of access in this section are not limited to the
required retention period. The rights of access will last as long as the
Date 05/23/2022 Page: 6 of 34
records are retained.
3. Cooperate and provide reasonable assistance to authorized
representatives of ,the Department and others when those individuals
have access to the Grantee's grant records.
G. Audits
1. Single Audit
The Grantee must submit to the Department a Single Audit consistent
with the regulations set'forth in Title 2 Code of Federal Regulations
(CFR) Part 200, Subpart F. The Single Audit reporting package must
include all components described in Title 2 Code of Federal
Regulations, Section 200.512 (c) including a Corrective Action Plan, and
management letter (if one is issued) with a response to the Department.
The Grantee must assure that the Schedule of Expenditures of Federal
Awards includes expenditures for all federally -funded grants.
2. Other Audits
The Department or federal agencies may also conduct or arrange for
agreed upon procedures or additional audits to meet their needs.
3. Due Date and Where to Send
The required audit and any other required submissions (i.e., corrective
action plan, and management letter with a corrective action plan),
and/or Audit Exemption Notice must be submitted to the Department
within nine months after the end of the Grantee's fiscal year by e-mail
at, MDHHS-AuditReports@michigan.gov. Single Audit reports must be
submitted simultaneously to the Department and Federal Audit
Clearinghouse, in accordance with 2 CFR 200.512(a), The required
submission must be assembled as one document in a PDF file and
compatible with Adobe Acrobat (read only). The subject line must
state the agency name and fiscal year end. The Department reserves
the right to request a hard copy of the audit materials if for any reason
the electronic submission process is not successful.
4. Penalty
a. Delinquent Single Audit or Financial Related Audit
If the Grantee does not submit the required Single Audit
reporting package, management letter (if one is issued) with a
response, 'and Corrective Action Plan within nine months after
the end of the Grantee's fiscal year and an extension has not
been approved by the cognizant or oversight agency for audit,
the Department may withhold from the current funding an
amount equal to five percent of the audit year's grant funding
(not to exceed $200,000) until the required filing is received by
the Department. The Department may retain the amount
Date. 05/23/2022 Page: 7 of 34
withheld if the Grantee is more than 120 days delinquent in
meeting the filing requirements and an extension has not been
approved by the' cognizant or oversight agency for audit. The
Department may terminate the current grant if the Grantee is
more than 180 days delinquent in meeting the filing
requirements and an extension has not been approved by the
cognizant or oversight agency for audit.
b. Delinquent Audit, Exemption Notice
Failure to submit the Audit Exemption Notice, when required,
may result in withholding payment from Department to Grantee
an amount equal to one percent of the audit year's grant
funding until the Audit Exemption Notice is received.
H. Subrecipient/Contractor Monitoring
1. When passing federal funds through to a subrecipient (if the Agreement
does not prohibit the passing of federal funds through to a subrecipient),
the Grantee must:
a. Ensure that every subaward is clearly identified to the
subrecipient as a subaward and includes the information
required by 2 CFR 200.332.
b. Ensure the subrecipient complies with all the requirements of
this Agreement.
C. Evaluate each subrecipient's risk for noncompliance as required
by 2 CFR 200.332(b).
d. Monitor the activities of the subrecipient as necessary to ensure
that the subaward is used for authorized purposes, in
compliance with federal statutes, regulations and the terms and
conditions of the subawards; that subaward performance goals
are achieved; and that all monitoring requirements of 2 CFR
200.332(d) are met including reviewing financial and
programmatic reports, following up on corrective actions and
issuing management decisions for audit findings.
e. Verify that every subrecipient is audited as required by 2 CFR
200 Subpart F.
2. Develop a subrecipient monitoring plan that addresses the above
requirements and provides reasonable assurance that the subrecipient
administers federal awards in compliance with laws, regulations and the
provisions of this Agreement, and that performance goals are achieved.
The subrecipient monitoring plan should include a risk -based
assessment to determine the level of oversight and monitoring activities,
such as reviewing financial and performance reports, performing site
visits and maintaining regular contact with subrecipients.
3. Establish requirements to ensure compliance for for -profit subrecipients
Date. 05/23/2022 Page: 8 Of 34
as required by 2 CFR 200.501(h), as applicable.
4. Ensure that transactions with subrecipients/contractors comply with
laws, regulations and provisions of contracts or grant agreements.
I. Notification of Modifications
Provide timely notification to the Department, in writing, of any action by its
governing board or any other funding source that would require or result in
significant modification in the provision of activities, funding or compliance with
operational procedures.
J. Software Compliance
Ensure software compliance and compatibility with the Department's data
systems for activities provided under this Agreement, including but not limited
to stored data, databases and interfaces for the production of work products
and reports. All required data under this Agreement must be provided in an
accurate and timely manner without interruption, failure or errors due to the
inaccuracy of the Grantee's business operations for processing data. All
information systems, electronic or hard copy, that contain state or federal data
must be protected from unauthorized access.
K. Human Subjects
Comply with Federal Policy for the Protection of Human Subjects, 45 CFR 46.
The Grantee agrees that prior to the initiation of the research, the Grantee will
submit Institutional Review Board (IRB) application material for all research
involving human subjects, which is conducted in programs sponsored by the
Department or in programs which receive funding from or through the state of
Michigan, to the Department's IRB for review and approval, or the IRB
application and approval' materials for acceptance of the review of another
IRB. All such research must be approved by a federally assured IRB, but the
Department's IRB can only accept the review and approval of another
institution's IRB under a formally approved interdepartmental agreement. The
manner of the review will be agreed upon between the Department's IRB
Chairperson and the Grantee's authorized official.
L. Mandatory Disclosures
1. Disclose to the Department in writing within 14 days of receiving notice
of any litigation, investigation, arbitration or other proceeding
(collectively, "Proceeding") involving Grantee, a subcontractor or an
officer or director of Grantee or subcontractor that arises during the term
of this Agreement including:
a. All violations of federal and state criminal law involving fraud,
bribery, or gratuity violations potentially affecting the
Agreement.
b. A criminal Proceeding;
C. A parole of probation Proceeding;
d.I A Proceeding under the Sarbanes-Oxley Act;
Data 05/23/2022 Page: 9 of 34
e. A civil Proceeding involving:
1. A claim that might reasonably be expected to
adversely affect Grantee's viability or financial stability;
or
2. A governmental or public entity's claim or written
allegation of fraud; or
3. Any complaint filed in a legal or administrative
proceeding alleging the Grantee or its subcontractors
discriminated against its employees, subcontractors,
vendors, or suppliers during the term of this
Agreement; or
f. A Proceeding involving any license that Grantee is required to
possess in, order to perform under this Agreement.
2. Notify the Department, at least 90 calendar days before the effective
date, of a change in Grantee's ownership or executive management.
M. Minimum Program Requirements
Comply with Minimum Program Requirements established in accordance with
Section 2472.3 of 1978 PA 368 as amended, MCL 333.2472 (3), MSA 14.15
(2472.3), for each applicable program element funded under this Agreement.
N. Annual Budget and Plan Submission
Submit an Annual Budget and Plan request to the Department, in accordance
with instructions established by the Department, to serve as the basis for
completion of specific details for Attachments I, III, and IV of this Agreement
via Grantee/Department, negotiated amendment(s). Failure to submit a
complete Annual Budget and Plan by the due date through MI E-Grants will
result in the deferral of Department payments until these documents are
submitted.
O. Maintenance of Effort
Comply with maintenance of effort requirements for Essential Local Public
Health Services (ELPHS), as defined in the current Department appropriation
act, and Family Planning in accordance with federal requirements, except as
noted in Section 3.C.3 of Part I.
P. Accreditation
1. Comply with the local public health accreditation standards and follow
the accreditation process and schedule established by the Department
to achieve full accreditation status.
a. Failure to meet all accreditation requirements or implement
corrective plans of action within the prescribed time period will
result in the status of "Not Accredited." Grantees designated as
"Not Accredited" may have their Department allocations
reduced for costs incurred in the assurance of service delivery.
Date. 05/23/2022 Page 10 of 34
b. Submit a written request for inquiry to the Department should
the Grantee disagree with on -site review findings or their
accreditation status. The request must identify the
disagreement and resolution sought. The inquiry participants
will be comprised of Grantee staff, Department staff, the
Accreditation Commission Chair, and the Accreditation
Coordinator as needed. Participants will clarify facts, verify
information and seek resolution.
2. Consent Agreements/Administrative Compliance
Orders/Administrative Hearings for "Not Accredited" Grantees:
a. If designated as "Not Accredited", the Grantee will receive a
Consent Agreement Package from the Department. Grantees
and their local governing entities will be given 75 days to review
the package, meet with the Department, and sign and return the
Consent Agreement.
b. Fulfillment of the terms and conditions of the Consent
Agreement will not affect accreditation status, but impacts the
Grantees' ability to fulfill its contractual obligations under the
Local Health Department Grant Agreement. Grantees
designated as "Not Accredited", will retain this designation until
the subsequent accreditation cycle.
C. Failure to fulfill the terms and conditions of the Consent
Agreement within the prescribed time period will result in the
issuance of an Administrative Compliance Order by the
Department.
d. Within 60 working days after receipt of an Administrative
Compliance Order and proposed compliance period, a local
governing entity may petition the Department for an
administrative hearing. If the local governing entity does not
petition the Department for a hearing within 60 days after
receipt of an Administrative Compliance Order, the order and
proposed compliance date will be final. After a hearing, the
Department may reaffirm, modify, or revoke the order or modify
the time permitted for compliance.
e. If the local governing entity fails to correct a deficiency for which
a final order has been issued within the period permitted for
compliance, the Department may petition the appropriate circuit
court for a writ of mandamus to compel correction.
Q. Medicaid Outreach Activities Reimbursement
Report allowable costs and request reimbursement for the Medicaid Outreach
activities it provides in accordance with 2 CFR, Part 200 and the requirements
in Medicaid Bulletin number: MSA 05-29.
Date: 05/23/2022 Page 11 of 34
Submit a Cost Allocation Plan Certification to the Department to bill for the
Medicaid Outreach Activities. The Cost Allocation Plan Certification is valid
until a change is made to the cost allocation plan or the Department
determines it is invalid.
Submit quarterly FSRs for the Medicaid Outreach activities and an annual FSR
for the Children with Special Health Care Services Medicaid Outreach
activities in accordance with the instructions contained in Attachment I.
In accordance with the Medicaid Bulletin, MSA 05-29, agree to target Medicaid
outreach effort toward Department established priorities. For fiscal year 2021,
the Department priorities are: lead testing, outreach and enrollment for the
Family Planning waiver, and outreach for pregnant women, mothers and
infants for the Maternal and Infant Health Program. The Grantee will submit a
report using the MDHHS Local Health Department Medicaid Outreach form
describing their outreach activities targeting the priorities 30 days after the end
of a fiscal year quarter and at the same time as the final FSR is due to the
Department. The Local Health Department Medicaid Outreach reports are to
be sent through MI E-Grants as an attachment report to the Financial Status
Report.
R. Conflict of Interest and Code of Conduct Standards
1. Be subject to the provisions of 1968 PA 317, as amended, 1973 PA
196, as amended, and 2 CFR 200.318 (c)(1) and (2).
2. Uphold high ethical standards and be prohibited from the following:
a. Holding or acquiring an interest that would conflict with this
Agreement;
b. Doing anything that creates an appearance of impropriety with
respect to the award or performance of this Agreement;
C. Attempting to influence or appearing to influence any state
employee by the direct or indirect offer of anything of value; or
d. Paying or agreeing to pay any person, other than employees
and consultants working for Grantee, any consideration
contingent upon the award of this Agreement.
3. Immediately notify the Department of any violation or potential violation
of these standards. This section applies to Grantee, any parent, affiliate
or subsidiary organization of Grantee, and any subcontractor that
performs activities in connection with this Agreement.
S. Travel Costs
1. Be reimbursed for travel costs (including mileage, meals, and lodging)
budgeted and incurred related to services provided under this
Agreement.
a. If the Grantee has a documented policy related to travel
reimbursement for employees and if the Grantee follows that
documented oolicv. the Department will reimburse the Grantee
Date. 06/23/2022 Page: 12 of 34
for travel costs at the Grantee's documented reimbursement
rate for employees. Otherwise, the State of Michigan travel
reimbursement rate applies.
b. State of Michigan travel rates may be found at the following
website: https://www.michigan.gov/dtmb/0,5552,7-358-
82548_ 13132---, 00. htm I .
C. International travel must be preapproved by the Department
and itemized in the budget.
T. Insurance Requirements
Maintain at least a minimum of the insurances or governmental self -
insurances listed below and be responsible for all deductibles. All
required insurance or self-insurance must:
a. Protect the state of Michigan from claims that may arise out of,
are alleged to arise out of, or result from Grantee's or a
subcontractor's performance;
b. Be primary and non-contributing to any comparable liability
insurance (including self-insurance) carried by the state; and
C. Be provided by a company with an A.M. Best rating of "A-" or
better and, a financial size of VII or better.
2. Insurance Types
a. Commercial General Liability Insurance or Governmental Self -
Insurance: Except for Governmental Self -Insurance, policies
must be endorsed to add "the state of Michigan, its
departments, divisions, agencies, offices, commissions,
officers, employees, and agents" as additional insureds using
endorsement CG 20 10 11 85, or both CG 2010 12 19 and CG
20371219.
If the Grantee will interact with children, schools, or the
cognitively impaired, the Grantee must maintain appropriate
insurance coverage related to sexual abuse and molestation
liability.
b. Workers' Compensation Insurance or Governmental Self -
Insurance: Coverage according to applicable laws governing
work activities. Policies must include waiver of subrogation,
except where waiver is prohibited by law.
C. Employers Liability Insurance or Governmental Self -Insurance.
d. Privacy and Security Liability (Cyber Liability) Insurance: cover
information security and privacy liability, privacy notification
costs, regulatory defense and penalties, and website media
content liability.
Date: 05/23/2022 Page: 13 of 34
3. Require that subcontractors maintain the required insurances contained
in this Section.
4, This Section is not intended to and is not to be construed in any manner
as waiving, restricting or limiting the liability of the Grantee from any
obligations under this Agreement.
5. Each Party must promptly notify the other Party of any knowledge
regarding an occurrence which the notifying Party reasonably believes
may result in a claim against either Party. The Parties must cooperate
with each other regarding such claim.
U. Fiscal Questionnaire
1. Complete and upload the yearly fiscal questionnaire to the EGrAMS
agency profile within three months of the start of the Agreement.
2. The fiscal questionnaire template can be found in EGrAMS documents.
V. Criminal Background Check
1. Conduct or cause to be conducted a search that reveals information
similar or substantially similar to information found on an Internet
Criminal History Access Tool (ICHAT) check and a national and state
sex offender registry check for each new employee, employee,
subcontractor, subcontractor employee, or volunteer who under this
Agreement works directly with clients or has access to client
information.
a. ICHAT: http://apps.michigan.gov/ichat
b. Michigan Public Sex Offender Registry:
http://www..mipsor.state.mi.us
C. National Sex Offender Registry: http://www.nsopw.gov
2. Conduct or cause to be conducted a Central Registry (CR) check for
each employee, subcontractor, subcontractor employee, or volunteer
who, under this Agreement works directly with children.
a. Central Registry: https://www.michigan.gov/mdhhs/0,5885,7-
339-73971 _7119_50648_48330-180331--, 00. htm I
3. Require each new employee, employee, subcontractor, subcontractor
employee or volunteer who, under this Agreement, works directly with
clients or who has access to client information to notify the Grantee in
writing of criminal convictions (felony or misdemeanor), pending felony
charges, or placement on the Central Registry as a perpetrator, at hire
or within 10 days of the event after hiring.
4. Determine whether to prohibit any employee, subcontractor,
subcontractor employee, or volunteer from performing work directly with
clients or accessing client information related to clients under this
Agreement, based on the results of a positive ICHAT response or
Date: 05/23/2022 Page. 14 of 34
reported criminal felony conviction or perpetrator identification.
5. Determine whether to prohibit any employee, subcontractor,
subcontractor employee or volunteer from performing work directly with
children under this Agreement, based on the results of a positive CR
response or reported perpetrator identification.
6. Require any employee, subcontractor, subcontractor employee or
volunteer who may have access to any databases of information
maintained by the federal government that contain confidential or
personal information, including but not limited to federal tax information,
to have a fingerprint background check performed by the Michigan State
Police.
II. Responsibilities - Department
The Department in accordance with the general purposes and objectives of this
Agreement will:
A. Reimbursement
Provide reimbursement in accordance with the terms and conditions of this
Agreement based upon appropriate reports, records, and documentation
maintained by the Grantee.
B. Report Forms
Provide any report forms and reporting formats required by the Department at
the start date of this Agreement and provide to the Grantee any new report
forms and reporting formats proposed for issuance thereafter at least 90 days
prior to their required usage in order to afford the Grantee an opportunity to
review.
C. Notification of Modifications
Notify the Grantee in writing of modifications to federal or state laws, rules and
regulations affecting this Agreement.
D. Identification of Laws
Identify for the Grantee relevant laws, rules, regulations, policies, procedures,
guidelines and state and federal manuals, and provide the Grantee with copies
of these documents to the extent they are not otherwise available to the
Grantee.
E. Modification of Funding
Notify the Grantee in writing within 30 calendar days of becoming aware of the
need for any modifications in Agreement funding commitments made
necessary by action of the federal government, the governor, the legislature or
the Department of Technology Management and Budget on behalf of the
governor or the legislature. Implementation of the modifications will be
determined jointly by the Grantee and the Department.
F. Monitor Compliance
Monitor compliance with all applicable provisions contained in federal grant
Date. 05/23/2022 Page: 15 of 34
awards and their attendant rules, regulations and requirements pertaining to
program elements covered by this Agreement.
G. Technical Assistance
Make technical assistance available to the Grantee for the implementation of
this Agreement.
H. Accreditation
Adhere to the accreditation requirements including the process for "Not
Accredited" Grantees. The process includes developing and monitoring
consent agreements, issuing and monitoring administrative compliance orders,
participating in administrative hearings and petitioning appropriate circuit
courts.
I. Medicaid Outreach Activities Reimbursement
Agrees to reimburse the Grantee for all allowable Medicaid Outreach activities
that meet the standards of the Medicaid Bulletin: MSA 05-29 including the cost
allocation plan certification and that are billed in accordance with the
requirements in Attachment I.
In accordance with the Medicaid Bulletin, MSA 05-29, the Department will
identify each fiscal year the Medicaid Outreach priorities and establish a
reporting requirement for the Grantee.
III. Assurances
The following assurances are hereby given to the Department:
A. Compliance with Applicable Laws
The Grantee will comply with applicable federal and state laws, guidelines,
rules and regulations in carrying out the terms of this Agreement. The Grantee
will also comply with all applicable general administrative requirements, such
as 2 CFR 200, covering cost principles, grant/agreement principles and audits,
in carrying out the terms of this Agreement. The Grantee will comply with all
applicable requirements in the original grant awarded to the Department if the
Grantee is a subgrantee. The Department may determine that the Grantee has
not complied with applicable federal or state laws, guidelines, rules and
regulations in carrying out the terms of this Agreement and may then terminate
this Agreement under Part 2, Section V.
B. Anti -Lobbying Act
The Grantee will comply with the Anti -Lobbying Act (31 U.S.C. 1352) as
revised by the Lobbying Disclosure Act of 1995 (2 U.S.C. 1601 et sec.),
Federal Acquisition Regulations 52.203.11 and 52.203.12, and Section 503 of
the Departments of Labor, Health & Human Services, and Education, and
Related Agencies section of the current fiscal year Omnibus Consolidated
Appropriations Act. Further, the Grantee must require that the language of this
assurance be included in the award documents of all subawards at all tiers
(including subcontracts, subgrants, and contracts under grants, loans and
cooperative agreements) and that all subrecioients must certifv and disclose
Date 05/23/2022 Page: 16 of 34
accordingly.
C. Non -Discrimination
1. The Grantee must comply with the Department's non-discrimination
statement: The Michigan Department of Health and Human Services will
not discriminate against any individual or group because of race, sex,
religion, age, national origin, color, height, weight, marital status, gender
identification or expression, sexual orientation, partisan considerations,
or a disability or genetic information that is unrelated to the person's
ability to perform the duties of a particular job or position. The Grantee
further agrees that every subcontract entered into for the performance
of any contract or purchase order resulting therefrom, will contain a
provision requiring non-discrimination in employment, activity delivery
and access, as herein specified, binding upon each subcontractor. This
covenant is required pursuant to the Elliot -Larsen Civil Rights Act (1976
PA 453, as amended; MCL 37.2101 et seq.) and the Persons with
Disabilities Civil Rights Act (1976 PA 220, as amended; MCL 37.1101 et
sec.), and any breach thereof may be regarded as a material breach of
this Agreement.
2. The Grantee will comply with all federal statutes relating to
nondiscrimination. These include but are not limited to:
a. Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which
prohibits discrimination based on race, color or national origin;
b. Title IX of the Education Amendments of 1972, as amended (20
U.S.C, 1681-1683, 1685-1686), which prohibits discrimination
based on sex;
C. Section 504 of the Rehabilitation Act of 1973, as amended (29
U.S.C. 794), which prohibits discrimination based on
disabilities;
d. The Age Discrimination Act of 1975, as amended (42 U.S.C.
6101-6107), which prohibits discrimination based on age;
e. The Drug Abuse Office and Treatment Act of 1972 (P.L. 92-
255), as amended, relating to nondiscrimination based on drug
abuse;
f. The Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment, and Rehabilitation Act of 1970 (P.L. 91-616) as
amended, relating to nondiscrimination based on alcohol abuse
or alcoholism;
g. Sections 523 and 527 of the Public Health Service Act of 1944
(42 U.S.C. 290dd-2), as amended, relating to confidentiality of
alcohol and drug abuse patient records;
h. Any other nondiscrimination provisions in the specific statute(s)
under which application for federal assistance is being made;
Date, 05/23/2022 Page, 17 of 34
and,
i. The requirements of any other nondiscrimination statute(s)
which may apply to the application.
3. Additionally, assurance is given to the Department that proactive efforts
will be made to identify and encourage the participation of minority -
owned and women -owned businesses, and businesses owned by
persons with disabilities in contract solicitations. The Grantee must
include language in all contracts awarded under this Agreement which
(1) prohibits discrimination against minority -owned and women -owned
businesses and businesses owned by persons with disabilities in
subcontracting; and (2) makes discrimination a material breach of
contract.
D. Debarment and Suspension
The Grantee will comply with federal regulation 2 CFR 180 and certifies to the
best of its knowledge and'belief that it, its employees and its subcontractors:
1. Are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transactions by
any federal department or contractor;
2. Have not within a five-year period preceding this Agreement been
convicted of or had a 'civil judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (federal, state, or local) or
private transaction or contract under a public transaction; violation of
federal or state antitrust statutes or commission of embezzlement, theft,
forgery, bribery, falsification or destruction of records, making false
statements, tax evasion, receiving stolen property, making false claims,
or obstruction of justice;
3. Are not presently indicted or otherwise criminally or civilly charged by a
government entity (federal, state or local) with commission of any of the
offenses enumerated in section 2;
4. Have not within a five-year period preceding this Agreement had one or
more public transactions (federal, state or local) terminated for cause or
default; and
5. Have not committed an act of so serious or compelling a nature that it
affects the Grantee's present responsibilities.
E. Federal Requirement: Pro -Children Act
1. The Grantee will comply with the Pro -Children Act of 1994 (P.L. 103-
227; 20 U.S.C. 6081, at seq.), which requires that smoking not be
permitted in any portion of any indoor facility owned or leased or
contracted by and used routinely or regularly for the provision of health,
day care, early childhood development activities, education or library
activities to children under the age of 18, if the activities are funded by
Date. 05/23/2022 Page'. 18 of 34
federal programs either directly or through state or local governments,
by federal grant, contract, loan or loan guarantee. The law also applies
to children's activities that are provided in indoor facilities that are
constructed, operated, or maintained with such federal funds. The law
does not apply to children's activities provided in private residences;
portions of facilities used for inpatient drug or alcohol treatment; activity
providers whose sole source of applicable federal funds is Medicare or
Medicaid; or facilities where Women, Infants, and Children (WIC)
coupons are redeemed. Failure to comply with the provisions of the law
may result in the irhposition of a civil monetary penalty of up to $1,000
for each violation and/or the imposition of an administrative compliance
order on the responsible entity. The Grantee also assures that this
language will be included in any subawards which contain provisions for
children's activities.
2. The Grantee also assures, in addition to compliance with P.L. 103-227,
any activity funded in whole or in part through this Agreement will be
delivered in a smoke -free facility or environment. Smoking must not be
permitted anywhere in the facility, or those parts of the facility under the
control of the Grantee. If activities are delivered in facilities or areas that
are not under the control of the Grantee (e.g., a mall, restaurant or
private work site), 'the activities must be smoke -free.
F. Hatch Act and Intergovernmental Personnel Act
The Grantee will comply with the Hatch Act (5 U.S.C. 1501-1508, 5 U.S.C.
7321-7326), and the Intergovernmental Personnel Act of 1970 (P.L. 91-648)
as amended by Title VI of the Civil Service Reform Act of 1978 (P.L. 95-454).
Federal funds cannot be used for partisan political purposes of any kind by any
person or organization involved in the administration of federally assisted
programs.
G. Employee Whistleblower Protections
The Grantee will comply with 41 U.S.C. 4712 and must insert this clause in all
subcontracts.
H. Clean Air Act and Federal Water Pollution Control Act
The Grantee will comply with the Clean Air Act (42 U.S.C. 7401-7671(q)) and
the Federal Water Pollution Control Act (33 U.S.C. 1251-1388), as amended.
This Agreement and anyone working on this Agreement will be subject to the
Clean Air Act and Federal Water Pollution Control Act and must comply with
all applicable standards, orders or regulations issued pursuant to these Acts.
Violations must be reported to the Department.
I. Victims of Trafficking and Violence Protection Act
The Grantee will comply with the Victims of Trafficking and Violence Protection
Act of 2000 (P.L. 106-386), as amended.
This Agreement and anyone working on this Agreement will be subject to P.L.
Date: 05/23/2022 Page 19 of 34
106-386 and must comply with all applicable standards, orders or regulations
issued pursuant to this Act. Violations must be reported to the Department.
J. Procurement of Recovered Materials
The Grantee will comply with section 6002 of the Solid Waste Disposal Act of
1965 (P.L. 89-272), as amended.
This Agreement and anyone working on this Agreement will be subject to
section 6002 of P.L. 89-272, as amended, and must comply with all applicable
standards, orders or regulations issued pursuant to this act. Violations must be
reported to the Department.
K. Subcontracts
For any subcontracted activity or product, the Grantee will ensure:
1. That a written subcontract is executed by all affected parties prior to the
initiation of any new subcontract activity or delivery of any
subcontracted product. Exceptions to this policy may be granted by the
Department if the Grantee asks the Department in writing within 30 days
of execution of the Agreement.
2. That any executed subcontract to this Agreement must require the
subcontractor to comply with all applicable terms and conditions of this
Agreement. In the event of a conflict between this Agreement and the
provisions of the subcontract, the provisions of this Agreement will
prevail.
A conflict between this Agreement and a subcontract, however, will not
be deemed to exist where the subcontract:
a. Contains additional non -conflicting provisions not set forth in
this Agreement;
b. Restates provisions of this Agreement to afford the Grantee the
same or substantially the same rights and privileges as the
Department; or
C. Requires the subcontractor to perform duties and services in
less time than that afforded the Grantee in this Agreement.
3. That the subcontract does not affect the Grantee's accountability to the
Department for the subcontracted activity.
4. That any billing or request for reimbursement for subcontract costs is
supported by a valid subcontract and adequate source documentation
on costs and services.
5. That the Grantee will submit a copy of the executed subcontract if
requested by the Department.
6. That subcontracts in support of programs or elements utilizing funds
provided by the Department, the State of Michigan or the federal
government in excess of $10,000 must contain provisions or conditions
Date: 05/23/2022 Page: 20 Of 34
that will:
a. Allow the Grantee or Department to seek administrative,
contractual or legal remedies in instances in which the
subcontractor violates or breaches contract terms, and provide
for such remedial action as may be appropriate.
b. Provide for termination by the Grantee, including the manner by
which termination will be effected and the basis for settlement.
7. That all subcontracts in support of programs or elements utilizing funds
provided by the Department, the State of Michigan or the federal
government of amounts in excess of $100,000 must contain a provision
that requires compliance with all applicable standards, orders or
regulations issued pursuant to the Clean Air Act of 1970 (42 USC
1857(h)), Section 508 of the Clean Water Act (33 U.S.C. 1368),
Executive Order 11738 and Environmental Protection Agency
regulations (40 CFR Part 15).
8. That all subcontracts and subgrants in support of programs or elements
utilizing funds provided by the Department, the State of Michigan or the
federal government in excess of $2,000 for construction or repair,
awarded by the Grantee must include a provision:
a. For compliance with the Copeland "Anti -Kickback" Act (18
U.S.C. 874) as supplemented in Department of Labor
regulations (29 CFR, Part 3).
b. For compliance with the Davis -Bacon Act (40 U.S.C. 276a to a-
7) and as supplemented by Department of Labor regulations
(29 CFR, Part 5) (if required by Federal Program Legislation).
c. For compliance with Section 103 and 107 of the Contract Work
Hours and Safety Standards Act (40 U.S.C. 327-330) as
supplemented by Department of Labor regulations (29 CFR,
Part 5). This provision also applies to all other contracts in
excess of $2,500 that involve the employment of mechanics or
laborers.
L. Procurement
1. Grantee will ensure that all purchase transactions, whether negotiated
or advertised, are conducted openly and competitively in accordance
with the principles and requirements of 2 CFR 200.
2. Funding from this Agreement must not be used for the purchase of
foreign goods or services.
3. Preference must be given to goods and services manufactured or
provided by Michigan businesses, if they are competitively priced and of
comparable quality.
4. Preference must be given to goods and services that are manufactured
or provided by Michigan businesses owned and operated by veterans, if
Date. 05/23/2022 Page: 21 of 34
they are competitively priced and of comparable quality.
5. Records must be sufficient to document the significant history of all
purchases and must be maintained for a minimum of four years after the
end of the Agreement period.
M. Health Insurance Portability and Accountability Act
To the extent that the Health Insurance Portability and Accountability Act
(HIPAA) is applicable to the Grantee under this Agreement, the Grantee
assures that it is in compliance with requirements of HIPAA including the
following:
1. The Grantee must not share any protected health information provided
by the Department that is covered by HIPAA except as permitted or
required by applicable law, or to a subcontractor as appropriate under
this Agreement.
2. The Grantee will ensure that any subcontractor will have the same
obligations as the Grantee not to share any protected health data and
information from the Department that falls under HIPAA requirements in
the terms and conditions of the subcontract.
3. The Grantee must only use the protected health data and information
for the purposes of this Agreement.
4. The Grantee must.have written policies and procedures addressing the
use of protected health data and information that falls under the HIPAA
requirements. The policies and procedures must meet all applicable
federal and state requirements including the HIPAA regulations. These
policies and procedures must include restricting access to the protected
health data and information by the Grantee's employees.
5. The Grantee must have a policy and procedure to immediately report to
the Department any suspected or confirmed unauthorized use or
disclosure of protected health information that falls under the HIPAA
requirements of which the Grantee becomes aware. The Grantee will
work with the Department to mitigate the breach and will provide
assurances to the,Department of corrective actions to prevent further
unauthorized uses or disclosures. The Department may demand
specific corrective actions and assurances and the Grantee must
provide the same to the Department.
6. Failure to comply with any of these contractual requirements may result
in the termination of this Agreement in accordance with Part 2, Section
V.
7. In accordance with HIPAA requirements, the Grantee is liable for any
claim, loss or damage relating to unauthorized use or disclosure of
protected health data and information, including without limitation the
Department's costs in responding to a breach, received by the Grantee
from the Department or any other source.
Date: 05/23/2022 Page. 22 of 34
8. The Grantee will enter into a business associate agreement should the
Department determine such an agreement is required under HIPAA.
N. Home Health Services
If the Grantee provides Home Health Services (as defined in Medicare Part B),
the following requirements apply:
1. The Grantee must not use State ELPHS or categorical grant funds
provided under this Agreement to unfairly compete for home health
services available from private providers of the same type of services in
the Grantee's service area.
2. For purposes of this Agreement, the term "unfair competition" will be
defined as offering of home health services at fees substantially less
than those generally charged by private providers of the same type of
services in the Grantee's area, except as allowed under Medicare
customary charge regulations involving sliding fee scale discounts for
low-income clients. based upon their ability to pay.
3. If the Department finds that the Grantee is not in compliance with its
assurance not to use state ELPHS and categorical grant funds to
unfairly compete, the Department will follow the procedure required for
failure by local health departments to adequately provide required
services set forth in Sections 2497 and 2498 of 1978 PA 368 as
amended (Public Health Code), MCL 333.2497 and 2498, MSA 14.15
(2497) and (2498).
O. Website Incorporation
The Department is not bound by any content on Grantee's website or other
internet communication platforms or technologies, unless expressly
incorporated directly into this Agreement. The Department is not bound by any
end user license agreement or terms of use unless specifically incorporated in
this Agreement or any other agreement signed by the Department. The
Grantee must not refer to the Department on the Grantee's website or other
internet communication platforms or technologies without the prior written
approval of the Department.
P. Survival
The provisions of this Agreement that impose continuing obligations will
survive the expiration or termination of this Agreement.
Q. Non -Disclosure of Confidential Information
The Grantee agrees that it will use confidential information solely for the
purpose of this Agreement. The Grantee agrees to hold all confidential
information in strict confidence and not to copy, reproduce, sell, transfer
or otherwise dispose of, give or disclose such confidential information to
third parties other than employees, agents, or subcontractors of a party
who have a need to know in connection with this Agreement or to use
such confidential information for any purpose whatsoever other than the
Date'. 05/23/2022 Page: 23 of 34
performance of this Agreement. The Grantee must take all reasonable
precautions to safeguard the confidential information. These
precautions must be at least as great as the precautions the Grantee
takes to protect its own .confidential or proprietary information.
2. Meaning of Confidential Information
For the purpose of this Agreement the term "confidential information"
means all information and documentation that:
a. Has been marked "confidential" or with words of similar
meaning, at the time of disclosure by such party;
b. If disclosed orally or not marked "confidential" or with words of
similar meaning, was subsequently summarized in writing by
the disclosing party and marked "confidential" or with words of
similar meaning;
C. Should reasonably be recognized as confidential information of
the disclosing party;
d. Is unpublished or not available to the general public; or
e. Is designated by law as confidential.
3. The term "confidential information" does not include any information or
documentation that was:
a. Subject to disclosure under the Michigan Freedom of
Information Act (FOIA);
b. Already in the possession of the receiving party without an
obligation of confidentiality;
C. Developed independently by the receiving party, as
demonstrated by the receiving party, without violating the
disclosing party's proprietary rights;
d. Obtained from a source other than the disclosing party without
an obligation of confidentiality; or
e. Publicly available when received or thereafter became publicly
available (other than through an unauthorized disclosure by,
through or on behalf of, the receiving party).
4. The Grantee must notify the Department within one business day after
discovering any unauthorized use or disclosure of confidential
information. The Grantee will cooperate with the Department in every
way possible to regain possession of the confidential information and
prevent further unauthorized use or disclosure.
R. Cap on Salaries
None of the funds awarded to the Grantee through this Agreement will be used
to pay, either through a grant or other external mechanism, the salary of an
individual at a rate in excess of Executive Level ll. The current rates of pay for
the Executive Schedule are located on the United States Office of Personnel
oaW 05/23/2022 Page: 24 of 34
Management web site, http://www.opm.gov, by navigating to Policy — Pay &
Leave — Salaries & Wages. The salary rate limitation does not restrict the
salary that a Grantee may pay an individual under its employment; rather, it
merely limits the portion of that salary that may be paid with funds from this
Agreement.
IV. Financial Requirements
A. Operating Advance
Under the pre -payment reimbursement method, no additional operating
advances will be issued.
B. Payment Method
1. Prepayments
a. The Department will make monthly prepayments equal to
1/12th of the Agreement amount for each non -fee -for -service
program contained in Attachment IV of this Agreement. One
single payment covering all non -fee -for -service programs will
be made within the first week of each month. The Grantee
can view their monthly prepayment within the MI E-Grants
system.
b. Prepayments for the months of October thru January will be
based upon the initial Agreement amounts in Attachment IV.
Subsequent monthly prepayments may be adjusted based upon
Agreement amendments or Grantee adjustment requests.
C. If the sum of the prepayments does not equal at least 90% of
the Grantee's expenditures for a quarter of the contract period,
the Grantee may submit documentation for an adjustment to the
monthly prepayment amount via the following process:
i. Submit a written request for the adjustment to the
Department's Accounting Expenditure Operations Division.
ii. The adjustment request must be itemized by program and
must list the amount received from the Department, the
expenditure amount reported per the quarterly Financial
Status Report (FSR), and the difference. The amount
received from the Department and the expenditures must
be for the same reporting quarterly FSR period.
iii. The Department will review the requests and if an
adjustment is approved, it will be included in the next
scheduled monthly prepayment.
iv. Adjustment requests will not be accepted prior to
submission of the FSR for the quarter ending December
31. No adjustments will be made prior to the February
monthly prepayment.
Date: 05/23/2022 Page25 of 34
v. The ability of the Department to approve adjustments may
be limited by the quarterly allotments of spending authority
in the Department's appropriation account mandated by
the Office of the State Budget Director. The quarterly
allotment limits the amount of each account (program) that
the Department may expend during each fiscal quarter.
2. Fixed Fee Reimbursement
a. Quarterly reimbursement for fixed fee projects is based on
Attachment IV and approved quarterly Financial Status Reports.
C. Financial Status ReportSubmission
1. The Grantee must electronically prepare and submit FSRs to the
Department via the EGrAMS website (http://egrams-mi.com/mdhhs).
A Financial Status Report (FSR) must be submitted on a quarterly basis
no later than 30 days after the close of the calendar quarter for all
programs listed on Attachment IV and fee for services project budgeted.
Failure to meet financial reporting responsibilities as identified in this
Agreement may result in withholding future payments.
2. FSR's must report total actual program expenditures regardless of the
source of funds. The Department will reimburse the Grantee for
expenditures in accordance with the terms and conditions of this
Agreement. Failure to comply with the reporting due dates will result in
the deferral of the Grantee's monthly prepayment.
3. The Grantee representative who submits the FSR is certifying to the
best of their knowledge and belief that the report is true, complete and
accurate and the expenditures, disbursements, and cash receipts are
for the purposes and objectives set forth in the terms and conditions of
this Agreement. The individual submitting the FSR should be aware
that any false, fictitious, or fraudulent information, or the omission of any
material facts, may subject them to criminal, civil or administrative
penalties for fraud, false statements, false claims or otherwise.
4. The instructions for completing the FSR form are available on the
website http://egrams-mi.com/dch. Send FSR questions to
FSRMDHHS@michigan.gov.
D. Reimbursement Method
The Grantee will be reimbursed in accordance with the reimbursement
methods for applicable program elements described as follows:
1. Performance Reimbursement - A reimbursement method by which
Grantees 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
Date 05/23/2022 Page: 26 of 34
earmarked sources) up to the contracted amount of state funds. Any
local funds used to support program elements operated under such
provisions of this Agreement may be transferred by the Grantee within,
among, to or from the affected elements without Department approval,
subject to applicable provisions of Sections 3.6. and 3.C.3 of Part 1. If
Grantee's performance falls short of the expectation by a factor greater
than the allowed minimum performance percentage, the state
maximum allocation will be reduced equivalent to actual performance
in relation to the minimum performance.
2. Actual Cost Reimbursement - A reimbursement method by which
Grantees are reimbursed based upon the understanding that state
dollars will be paid up to total costs in relation to the state's share of
the total costs and up to the total state allocation as agreed to in the
approved budget. This reimbursement approach is not directly
dependent upon whether a specified level of performance is met by the
local health department. Department funding under this
reimbursement method is allocable as a source before any local
funding requirement unless a specific local match condition exists.
3. Fixed Unit Rate Reimbursement - A reimbursement method by which
Grantee is reimbursed a specific amount for each output actually
delivered and reported.
4. Essential Local Public Health Services (ELPHS) - A reimbursement
method by which Grantees are reimbursed a share of reasonable and
allowable costs incurred for required services, as noted in the current
Appropriations Act.
E. Reimbursement Mechanism
All Grantees must sign up through the on-line vendor registration process to
receive all State of Michigan payments as Electronic Funds Transfers
(EFT)/Direct Deposits. Vendor registration information is available through
the Department of Technology, Management and Budget's web site:
http://www.michigan.gov/sigmayss
F. Unobligated Funds
Any unobligated balance of funds held by the Grantee at the end of the
Agreement period will be returned to the Department or treated in accordance
with instructions provided by the Department.
G. Final Obligation Reporting Requirements
An Obligation Report, based on annual guidelines, must be submitted by the
due date using the format provided by the Department through MI E-Grants,
The Grantee must provide, by program, an estimate of total expenditures for
the entire Agreement period (October 1 through September 30). This report
Date: 05/23/2022 Page27 of 34
must represent the Grantee's best estimate of total program expenditures for
the Agreement period. The information on the report will be used to record the
Department's year-end accounts payables and receivables by program for this
Agreement. The report assists the Department in reserving sufficient funding
to reimburse the final expenditures that will be reported on the Final FSR
without materially overstating or understating the year-end obligations for this
Agreement. The Department compares the total estimated expenditures from
this report to the total amount reimbursed to the Grantee in the monthly
prepayments and quarterly fee -for -service payments to establish accounts
payable and accounts receivable entries at fiscal year-end. The Department
recognizes that based upon payment adjustments and timing of Agreement
amendments, the Grantee may owe the Department funding for overpayment
of a program and may be due funds from the Department for underpayment of
a program at fiscal year-end.
Within 60 days after the Agreement fiscal year-end, the Grantee must liquidate
any unpaid year-end commitments and obligations. Any obligation remaining
unliquidated after 60 days from the end of the Agreement period will revert to
the Department for disposition in accordance with applicable state and/or
federal requirements, except as specifically authorized in writing by the
Department.
H. Final Financial Status Reporting Requirements
Final FSRs are due on the following dates following the Agreement period
end date:
Project Final FSR Due Date
Public Health Emergency Preparedness 11/15/2023
All Remaining Projects 11/30/2023
Upon receipt of the final FSR electronically through MI E-Grants, the
Department will determine by program, if funds are owed to the Grantee or if
the Grantee owes funds to the Department. If funds are owed to the Grantee,
payment will be processed. However, if the Grantee underestimated their
year-end obligations in the Obligation Report as compared to the final FSR
and the total reimbursement requested does not exceed the Agreement
amount that is due to the Grantee, the Department will make every effort to
process full reimbursement to the Grantee per the final FSR. Final payment
may be delayed pending final disposition of the Department's year-end
obligations.
If funds are owed to the Department, it will generally not be necessary for
Grantee to send in a payment. Instead, the Department will make the
necessary entries to offset other payments and as a result the Grantee will
receive a net monthly prepayment. When this does occur, clarifying
documentation will be provided to the Grantee by the Department's Bureau of
Finance and Accounting.
Date. 05/23/2022 Page 28 of 34
I. Penalties for Reporting Noncompliance
For failure to submit the final total Grantee FSR report by November 30,
through MI E-Grants after the Agreement period end date, the Grantee may be
penalized with a one-time reduction in their current ELPHS allocation for
noncompliance with the fiscal year-end reporting deadlines. Any penalty funds
will be reallocated to other Local Health Department Grantees. Reductions will
be one-time only and will not carryforward to the next fiscal year as an ongoing
reduction to a Grantee's ELPHS allocation. Penalties will be assessed based
upon the submitted date in MI E-Grants:
ELPHS Penalties for Noncompliance with Reporting Requirements:
1. 1 % - 1 day to 30 days late;
2. 2% - 31 days to 60 days late;
3. 3% - over 60 days late with a maximum of 3% reduction in the
Grantee's ELPHS allocation.
J. Indirect Costs and Cost Allocations/Distribution Plans
The Grantee is allowed to use approved federal indirect rate, 10% de minims
indirect rate or cost allocation/distribution plans in their budget calculations.
1. Costs must be consistently charged as indirect, direct or cost allocated,
but may not be double charged or inconsistently charged.
2. If the Grantee does not have an existing approved federal indirect rate,
they may use a 10% de minimis rate in accordance with Title 2 Code of
Federal Regulations (CFR) Part 200 to recover their indirect costs.
3. Grantees using the cost allocation/distribution method must develop
certified plan in accordance with the requirements described in Title 2
CFR, Part 200 which includes detailed budget narratives and is retained
by the Grantee and subject to Department review.
4. 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 and subject to Department review.
V. Agreement Termination
This Agreement may be terminated without further liability or penalty to the
Department for any of the following reasons:
A. By either party by giving 30 days written notice to the other party stating the
reasons for termination and the effective date.
B. By either party with 30 days written notice upon the failure of either party to
carry out the terms and conditions of this Agreement, provided the alleged
defaulting party is given notice of the alleged breach and fails to cure the
default within the 30-day period.
C. Immediately if the Grantee or an official of the Grantee or an owner is
convicted of any activity referenced in Part 2 Section III. D. of this Agreement
during the term of this Agreement or any extension thereof.
Date. 05/23/2022 Page29 of 34
Further, this Agreement may be terminated or modified immediately upon a finding by
the Department in accordance with MCL 333.2235 that the Grantee local health
department for the delivery of public health services under this Agreement is unable or
unwilling to provide any or all of the services as provided in this Agreement, and the
Department may redirect funds as necessary to ensure that the public health services
are provided within the Grantee's jurisdiction.
VI. Stop Work Order
The Department may suspend any or all activities under this Agreement at any time.
The Department will provide the Grantee with a written stop work order detailing the
suspension. Grantee must comply with the stop work order upon receipt. The
Department will not pay for activities, Grantee's incurred expenses or financial losses,
or any additional compensation during a stop work period.
VII. Final Reporting upon Termination
Should this Agreement be terminated by either party, within 30 days after the
termination, the Grantee must provide the Department with all financial, performance
and other reports required as a condition of this Agreement. The Department will
make payments to the Grantee for allowable reimbursable costs not covered by
previous payments or other state or federal programs. The Grantee must immediately
refund to the Department any funds not authorized for use and any payments or funds
advanced to the Grantee in excess of allowable reimbursable expenditures.
Vill. Severability
If any part of this Agreement is held invalid or unenforceable by any court of
competent jurisdiction, that part will be deemed deleted from this Agreement and the
severed part will be replaced by agreed upon language that achieves the same or
similar objectives. The remaining parts of the Agreement will continue in full force and
effect.
IX. Amendments
A. Except as otherwise provided, any changes to this Agreement will be valid
only if made in writing and accepted by all parties to this Agreement.
In the event that circumstances occur that are not reasonably foreseeable, or
are beyond the Grantee's or Department's control, which reduce or otherwise
interfere with the Grantee's or Department's ability to provide or maintain
specified services or operational procedures, immediate written notification
must be provided to the other party. Any change proposed by the Grantee
which would affect the state funding of any project, in whole or in part as
provided in Part 1, Section 3.C. of the Agreement, must be submitted in writing
to the Department for approval immediately upon determining the need for
such change. The proposed change may be implemented upon receipt of
written notification from the Department.
B. Except as otherwise provided, amendments to this Agreement will be made
within thirty days after receipt and approval of a change proposed by the
Date 05/23/2022 Page30 of 34
Grantee.
Amendments of a routine nature including applicable changes in budget
categories, modified indirect rates, and similar conditions which do not modify
the Agreement scope, amount of funding to be provided by the Department or,
the total amount of the budget may be submitted by the Grantee, in writing, at
any time prior to June 7. The Department will provide a written response within
30 calendar days.
All amendments must be submitted to the Department within three weeks of
receipt through MI E-Grants to assure the amendment can be executed prior
to the end of the Agreement period.
X. Liability
A. All liability to third parties, loss, or damage as a result of claims, demands,
costs, or judgments arising out of activities, such as direct service delivery, by
the Grantee, Grantee's, subcontractors or anyone directly or indirectly
employed by the Grantee in the performance of this Agreement will be the
responsibility of the Grantee, and not the responsibility of the Department.
Nothing herein will be construed as a waiver of any governmental immunity
that has been provided to the Grantee or its employees by law.
B. In the event that liability to third parties, loss, or damage arises as a result of
activities conducted jointly by the Grantee and the Department in fulfillment of
their responsibilities under this Agreement, such liability, loss, or damage will
be borne by the Grantee and the Department in relation to each party's
responsibilities under these joint activities, provided that nothing herein will be
construed as a waiver of any governmental immunity by the Grantee, the
state, its agencies (the , Department) or their employees, respectively, as
provided by statute or court decisions.
XI. Waiver
Failure to enforce any provision of this Agreement will not constitute a waiver.
Any clause or condition of this Agreement found to be an impediment to the intended
and effective operation of this Agreement may be waived in writing by the Department
or the Grantee, upon presentation of written justification by the requesting party. Such
waiver may be temporary or for the life of the Agreement and may affect any or all
program elements covered by this Agreement.
XII. State of Michigan Agreement
This Agreement is governed, construed, and enforced in accordance with Michigan
law, excluding choice -of -law principles, and all claims relating to or arising out of this
Agreement are governed by Michigan law, excluding choice -of -law principles. Any
dispute arising from this Agreement must be resolved in the Michigan Court of Claims.
Complaints against the State must be initiated in Ingham County, Michigan. Grantee
waives any objections, such as lack of personal jurisdiction or forum non conveniens.
Date: 05/23/2022 Page: 31 of 34
Grantee must appoint an agent in Michigan to receive service of process.
XIII. Funding
A. State funding for this Agreement will be provided from the applicable and
available Department appropriations for the current fiscal year. The
Department provided funds will'be as stated in the approved Annual Budget -
Attachment I Instructions for the Annual Budget, Attachment III, Program
Specific Assurances and Requirements, and as outlined in Attachment IV,
Funding/Reimbursement Matrix.
B. The funding provided through the Department for this Agreement will not
exceed the amount shown for each federal and state categorical program
element except as adjusted by amendment. The Grantee must advise the
Department in writing by May 1, if the amount of Department funding may not
be used in its entirety or appears to be insufficient for any program element.
ELPHS transfer requests between MDHHS, MDARD and MDEQ must also be
requested in writing by May 1. All ELPHS required services must be
maintained throughout the entire period of the Agreement.
C. The Department may periodically redistribute funds between agencies during
the Agreement period in order to ensure that funds are expended to meet the
varying needs for services.
Date 05/23/2022 Page: 32 of 34
AA Attachments
Al Attachment I - Instructions for the Annual Budget
A2 Attachment III - Program Specific Assurances and Requirements
Attachment IV Notes
Date: 05/23/2022 Page: 33 of 34
Summary of Budget
Source of Funds
Date: 05/23/2022 Page 34 Of 34
ATTACHMENT
MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES
Local Health Department Agreement
October 1, 2022- September 30, 2023
Fiscal Year 2023
INSTRUCTIONS
FOR THE
ANNUAL BUDGET
INSTRUCTIONS FOR THE ANNUAL BUDGET FOR LOCAL HEALTH DEPARTMENT SERVICES
TABLE OF CONTENTS
Page
I. INTRODUCTION............................................................................................................ 2
IL MINIMUM BUDGETING REQUIREMENTS................................................................... 2
III. REIMBURSEMENT CHART........................................................................................... 3
IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION
PROCEDURES.............................................................................................................. 3
V. FORM PREPARATION - GENERAL.............................................................................. 4
VI. FORM PREPARATION - EXPENDITURE CATEGORIES ............................................. 4
VII. FORM PREPARATION - SOURCE OF FUNDS............................................................. 6
Vill. SPECIAL BUDGET INSTRUCTIONS
A. Public Health Emergency Preparedness(PHEP).................................................... 9
B. Program Budget Detail- Cost, Detail Schedule Preparation .................................... 10
C. Immunization 317 and VFC Allowable Expenditures... ......................................... 18
1
INSTRUCTIONS FOR THE
ANNUAL BUDGET
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.
Il. MINIMUM BUDGETING REQUIREMENTS
A. Cost Principles - Types or items of cost which will be considered for reimbursement are
generally consistent with definitions contained in Title 2 Code of Federal Regulations
CFR, Part 200 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards.
B. Federal Block Grant Funds - Maternal & Child Health and Preventive Health Block
Grant funds may not be used to: provide inpatient services; make cash payments to
intended recipients of health services; purchase or improve land; purchase, contract or
permanently improve (other than minor remodeling defined as work required to change
the interior arrangements or other physical characteristics of any existing facility or
installed equipment when the cost of the remodeling incident does not exceed $2,000)
any building or other facility; or purchase major medical equipment (any item of medical
equipment having a unit cost of over $10,000 and used in the diagnosis or treatment of
patients, excluding equipment typically used in a laboratory); satisfy any requirement for
the expenditure of non-federal funds as a condition for the receipt of Federal funds; or
provide financial assistance to any entity other than a public or nonprofit private entity.
C. Expenditure and Fundina Source Breakdown - For purposes of development, analysis
and negotiation activities must be budgeted at the individual expenditure and funding
source category level on the Annual Budget for Local Health Services.
D. Special Budaet Reauirements for Certain Cateaorical Proaram Elements - The
Annual Budget for Local Health Services is completed in the MI E-Grants System
through the application budget to include details for all program elements (excluding
Administration and Grantee Support).
III. REIMBURSEMENT CHART
A. Proaram Element/Fundina Source
The Program Element/Funding Source column has been moved to Attachment III and
provides the listing of all currently funded MDHHS programs that are included in the
Comprehensive Local Health Department Agreement.
B. Tvpe of Proiect
The type of project designation is indicated by footnote and is used if the project meets
the Research and Development Project criteria. Research and Development Projects
are defined by Title 2 CFR, Section 200.87, Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards.
Research and development (R&D) means all research activities, both basic and applied,
and all development activities that are performed by non -Federal entities. Research is
defined as a systematic study directed toward fuller scientific knowledge or
understanding of the subject studied. The term research also includes activities involving
the training of individuals in research techniques where such activities utilize the same
facilities as other research and development activities and where such activities are not
included in the instruction function. Development is the systematic use of knowledge and
understanding gained from research directed toward the production of useful materials,
devices, systems, or methods, including design and development of prototypes and
processes.
C. Reimbursement Chart
The Reimbursement Chart 'notes elements/funding sources, applicable payment
methods, target levels, output measures for each program/element having a performance
reimbursement option. In addition, the chart also provides the subrecipient, contractor, or
recipient designations, as in prior years:
IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION
PROCEDURES
As in past years, no additional accounting system detail is being required beyond local uniform
accounting procedures prescribed by the Michigan Department of Treasury, Local Financial
Management System requirements, documentation requirements of categorical program funding
sources and any local requirements. Some agencies may already have separate cost centers in
their accounting system to directly identify costs and related funding of required services, but
such breakdowns are not essential to being able to meet minimum reporting requirements if
proper allocation procedures are used and adequate documentation is maintained. All
allocations must have clearly measurable bases that directly apply to the amounts being
allocated, must be documented with work papers that will provide an adequate audit trail and
must result in a representative reporting of costs and funding for affected programs. More
specific guidance can be found in Title 2 CFR, Part 200 Appendix V State/Local Government
and Indian Tribe -Wide Central Service Cost Allocation Plans and the brochure published by the
Department of Health and Human Services entitled "A Guide for State, Local and Indian Tribal
Governments: Cost Principles and Procedures for Developing Cost Allocation Plans and Indirect
Cost Rates for Agreements with the Federal Government.
V. FORM PREPARATION - GENERAL'
The MI E-Grants System on-line application, including the budget entry forms, are utilized to
develop a budget summary for each program element administered by the local Grantee. The
system is designed to accommodate any number of local program elements including those
unique to a particular local Grantee. Applications, including budget forms, are completed for all
program elements, regardless of. the 'reimbursement mechanism, including Agency
administration(s) fee for service program elements, categorical program elements, performance -
based program elements and Medicaid Outreach associated program elements. Budget entry is
required for each major expenditure and source of fund categories for which costs/funds are
identified.
VI. FORM PREPARATION - EXPENDITURE CATEGORIES
Budaeted expenditures are to be entered for each program element, project or group of
services by applicable major category.
A. Salaries and Waaes- This category includes the compensation budgeted for all permanent
and part-time employees on the payroll of the Grantee and assigned directly to the program.
This does not include contractual'services, professional fees or personnel hired on a private
contract basis. Consulting services, vendor services, professional fees or personnel hired on
a private contracting basis should be included in "Other Expenses." Contracts with
secondary recipient organizations such as cooperating service delivery institutions or
delegate agencies should be included in Contractual (Sub -contract) Expenses.
B. Frinae Benefits - This category is to include, for at least the specified elements, all Grantee
costs for social security, retirement, insurance and other similar benefits for all permanent
and part-time employees assigned to the specified elements.
C. Cap ExD for Eauio & 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 maybe
reported under this category. Small equipment items costing less than $5,000 are properly
classified as Supplies and Materials or Other Expenses. This category also includes capital
outlay for purchase or renovation of facilities.
D. Contractual (Subcontracts/Subrecioient) - 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 11) - These are costs for all other items purchased exclusively for the
operation of the program element and not appropriately included in any of the other
categories including items such as repairs, janitorial services, consultant services, vendor
services, equipment rental, insurance, Automated Data Processing (ADP) systems, etc.
K. Total Direct Expenditures — The MI E-Grants System sums the direct expenditures
budgeted for each program element, project or service grouping and records in the Total
Direct Expenditure line of the Budget Summary.
L. Indirect Cost —These cost categories are used to distribute costs of general administrative
operations that have not been directly charged to individual subrecipient programs. The
Indirect Cost expenditures distribute administrative overhead costs to each program element,
project or service grouping. Two separate local rates may apply to the agreement period
(i.e., one for each local fiscal year). Use Calendar Rate 1 to reflect the rate applicable to the
first part of the agreement period and Calendar Rate 2 for the rate applicable to the latter
part. Indirect costs are not allowed on programs elements designated as vendor relationship.
An indirect rate proposal and related supporting documentation must be retained for audit in
accordance with records retention requirements. In addition, these documents are reviewed
as part of the Single Audit, subrecipient monitoring visit, or other State of Michigan reviews.
Following is further clarification regarding indirect rate and/or cost allocation approval
requirements to distribute administrative overhead costs, in accordance with Title 2 CFR Part
200 (formerly Circular A-87 2 CFR Part 225, Appendix E), for Local Health Departments
budgeting indirect costs: '
1. Local Health Departments receiving more than $35 million in direct Federal awards are
required to have an approved indirect cost rate from a Federal Cognizant Agency. Ifyour
Local Health Department has received an approved indirect rate from a Federal
Cognizant agency, attach the Federal approval letter to your MI E-Grants Grantee Profile.
2. Local Health Departments receiving $35 million or less in direct Federal awards are
required to prepare indirect cost rate proposals in accordance with Title 2 CFR and
maintain the documentation on file subject to review.
3. Local Health Departments that received approved indirect cost rates from another State
of Michigan Department should attach their State approval letter to their MI E-Grants
Grantee Profile.
4. Local Health Departments with cost allocation plans should reflect these allocations in the
Other Cost Distributions budget category. See Section M. Other Cost Distribution for
budgeting guidance.
5. As a Subrecipient of federal funds from MDHHS, a Local Health Department that has
5
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 Budciet
Detail Schedule.
The amount of Indirect Cost should be allocated to all appropriate program elements with the
total equivalent amount reflected as a credit or minus in the Administration projects.
M. Other Cost Distributions — Use to distribute various contributing activity costs to
appropriate program areas based upon activity counts, time study supporting data or other
reasonable and equitable means. An example of Other Cost Distributions is nursing
supervision. The distribution process permits costs reflected in a single program element to
be subsequently distributed, perhaps only in part, to other programs or projects as
appropriate. If an allocation is made, the charges must be reflected in the appropriate
program element and the offsetting credit reflected in the program element being distributed.
There must be a documented', well-defined rationale and audit trail for anv cost
distribution or allocation based upon Title 2 CFR. Part 200 Cost Principles Local Health
Departments using the cost distribution or cost allocation must develop the plan in
accordance with the requirements described in Title 2 CFR, Part 200. Local Health
Departments should maintain supporting documentation for audit in accordance with record
retention requirements. The plan should include a Certification of Cost Allocation plan in
accordance with Title 2 CFR, Part,200 Appendix V. The cost allocation plan documentation
is not required to be submitted unless specifically requested.
Cost associated with the Essential Local Public Health Services (ELPHS), Maternal and
Child Health (MCH) Block Grant and Fixed Fee may be budgeted in the associated program
element and distributed to the associated projects.
Federal Provided Vaccine Value should be reported on a separate line and clearly identified.
N. Total Direct & Admin. Expenditures — The MI E-Grants System sums the indirect
expenditures program element and records in the Total Indirect Expenditure line of the
Budget Summary.
O. Total Expenditures — The MI E-Grants System sums the direct and indirect expenditures
and records in the Total Expenditure line of the Budget Summary.
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 Party—
i. 15t party funds projected to be received from private payers, including patients, source
users and any member of the general population receiving services.
ii. 2nd party funds received from organizations, private or public, who might reimburse
services for a group or under a special plan.
iii. Any Other Collections
B. Fees & Collections - 31d Partv — 3rd Party Fees - Funds projected to be received from
private insurance, Medicaid, Medicare or other applicable titles of the Social Security Act
directly related to the cost of providing patient care or other services (e.g., includes Early
Periodic Screening, Detection and Treatment [EPSDT] Screening, Family Planning.)
C. Federal/State Fundina (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. Reauired Match - Local — Funds projected to be local contribution for programs that have a
match contribution requirement (Please note: for Medicaid Outreach, CSHCS Medicaid
Outreach, or Nurse Family Partnership Medicaid Outreach, this amount represents the 50%
matching local contribution for allocable Medicaid Outreach Activities. Federal Medicaid
Outreach and Required Local match amounts should equal each other.)
H. Local Non-ELPHS - Local funds budgeted for the following expenditures:
Expenditures for services not designated as required and allowable for ELPHS funding
(e.g., medical examiner and inpatient maternity services); expenditures determined not to
be reasonable; and, expenditures in excess of the maximum state share of funds
available.
2. Any losses arising from uncollectible accounts and other related claims. Under -recovery
of reimbursable expenditures from, or failure to bill, available funding sources that would
otherwise result in exclusions from ELPHS funding, if recovered.
However, no exclusion is required where the local jurisdiction has made and documented
a decision to have local funds underwrite:
a. The cost of uncollectible accounts or bad debts incurred in support of providing
required or allowable health services. An example of this condition would be for
services provided to indigents who are billed as a matter of procedure with little
chance for receipt of payment.
b. Potential recoveries or under -recoveries from other sources for the principal purpose
of providing required and allowable health services at free or reduced cost to the
public served by the Grantee. An example would be keeping fees for services at a
reduced level for the benefit of the people served by the Grantee while recognizing
that to do so limits recovery from third parties for the same types of services.
3. Contributions to a contingency reserve or any similar provisions for unforeseen events.
4. Charitable contributions and donations.
5. Salaries and other incidental expenditures of the chief executive of a political subdivision
(i.e., county executive and mayor).
6. Legislative expenditures, such as, salaries and other incidental expenditures of local
governing bodies (i.e., county commissioners and city councils). Do not enter board of
health expenses.
7. Expenditures for amusements; social activities and other incidental expenditures related
to, such as, meals, beverages, lodging, rentals, transportation and gratuities.
8. Fines, penalties and interest on borrowings.
9. Capital Expenditures - Local capital 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 Hearina — This section includes all funding projected to be due under
Comprehensive Agreement specific to the ELPHS MDHHS Hearing program and has to
equal the MDHHS ELPHS Hearing allocation. Additional ELPHS to be budgeted for the
Hearing Program must be entered into ELPHS — MDHHS Other. Hearing allocations may
only be spent on the Hearing Program.
M. ELPHS - MDHHS Vision — This section includes all funding projected to be due under
Comprehensive Agreement specific to the ELPHS MDHHS Vision program and has to equal
the ELPHS MDHHS Vision allocation. Additional ELPHS to be budgeted for the Vision
Program must be entered into ELPHS.— MDHHS Other. Vision allocations may only be
spent on the Vision Program. '
N. ELPHS — MDHHS Other — This section includes all funding projected to be due under
Comprehensive Agreement specific to the ELPHS MDHHS Other program for eligible
program elements. Please note: The MI E-Grants System validates the ELPHS MDHHS
Other budgeted funds across the applicable program elements to assure the agreement
does exceed the ELPHS — MDHHS Other allocation.
O. ELPHS — Food -This section includes all funding projected to be due under Comprehensive
Agreement specific to the ELPHS Food program and has to equal the ELPHS Food
allocation.
P. ELPHS — Drinkina Water - This section includes all funding projected to be due under
G
Comprehensive Agreement specific to the ELPHS Drinking Water program and has to equal
the ELPHS Drinking Water allocation.
Q. ELPHS — On -site Sewaae - This section includes all funding projected to be due under
Comprehensive Agreement specific to the ELPHS On -site Sewage program and has to equal
the ELPHS On -site Sewage allocation.
R. MCH 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.
Vill. 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 Fundina Contractor
Public Health Emergency U.S. Department of Health & Human Services, Centers for Disease Control
Preparedness
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 Emeraencv Preparedness (PHEP) Special Budget Reauirements
Local Health Departments will receive the initial FY 21/22 allocation of the CDC Public
Health Emergency Preparedness (PREP) funds in nine equal prepayments forthe 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)
Costs Allowable Only With Prior ADDroval - The following costs are allowable only
withprior 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 3186). Prior approval is
accomplished by providing appropriate detail in the budget request approved by MDHHS
or subsequently in a written request approved in writing by MDHHS.
A. Automated Information Svstems -which are required by a local Grantees except
for those used in general management and payroll, including acquisition of
automated data processing hardware or software whether by outright purchase
or rental -purchase agreement or other method of acquisition.
B. 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. Accountina and Auditina 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 apart
of the local Grantee, such as:
Contractual private physician providing certification data.
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. Buildino 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-Frinae 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.
B. Proaram Budaet -Online Detail Budaet Application Entry
Complete the appropriate budget forms contained within the MI E-Grants System for each
program element. An example of this form is attached (see Attachment 1 for reference).
Salary and Waaes -
a. Position Description -Select from the expenditure row look -up all position titles
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 Reauired - Enter the number of positions required for the program
corresponding to the specific position title or description. This entry may be
expressed as a decimal (e.g., Full -Time Equivalent — FTE) when necessary. If
other than a full-time position is budgeted, it is necessary to have a basis in terms
10
of time reports to support time charged to the program.
c. Amount —The MI E-Grants System calculates the salary for the position required
and records it on the Budget Detail. Enter this amount in the Amount column.
d. Total Salary —The MI E-Grants System totals the amount of all positions required
and records it on the Budget Summary.
e. Notes, - Enter any explanatory information that is necessary for the position
description. Include an explanation of the computation of Total Salary in those
instances when the computation is not straightforward (i.e., if the employee is
limited term and/or does not receive fringe benefits).
2. Frinae Benefits — Select from the expenditure row look -up applicable fringe benefits
for staff working in this program. Enter the percentage for each. The MI E-Grants
system updates the total amount for salary and wages in the unit field and calculates
the fringe benefit amount. If the "Composite Rate" fringe benefit item is selected from
the expenditure row look up, record the applicable fringe benefit items (i.e. FICA, Life
insurance, etc.) in the "Notes" tab.
3. Equipment - Enter a description of the equipment being purchased (including
number of units and the unit value), the total by type of equipment and total of all
equipment 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.
Program Budget -Cost Detail Schedule Preparation
11
B1 Attachment B1-Proaram Budaet Summary
Fmoehevt Ceryficetiona "j auag t M14acerleneou4 � intlex
r't t� <I bYe Ldate, (.l'�� =J �PUF Q�COPY
j x cloco-j
Sh Tree fv��l
Budget summary
_
DIRECT EXPENSES
Program Expenses
Salary&SNages
83,419.00E i
83,41900,•
00011
OOoij M
Fnnga Benefit,
34,20200i j
34,20200
000j1
0O0j1, [S]
Cap E p for Equip & Fac
ii
®•
COntradusl
I
',' I
�
j d
SUPPIl2s and Matenals
232750011
23275.00,1
0001
000,
Travel
1 3,3400011111
-- 53400Pi
000jj
OOq b
Commumcabon
_ T,28200i
i,262001
OAO'
OADj; Q.
CountyCry Cenhal Ssmces
,
[J
-
Space Costs
10,1310o;
10, 131.00
000�
00'II,
n,l
All Othars(ALP Can Employees, Niisc)
3,8040O
3,89400:
000'lI
000!1, L�
Total P(agrem Expenses
18552300"'
LOOM 00i
0,doi
0001, ^
TOTAL DIRECT
165,52300,
16552300,•
000'•
000:i
11401RECTEXHNSES
Indirect COsis
1 j
Ind..ct C.O.
29,40500:1 1
29 405.001i 1,
Od%J
Othsr Coat, Oiatnbu0ons
1,69500
169500�I
0.001
0.00 r`ei
Total lrr6revY Cpsia
t 31,09000
31,09000,,
0,00•
000;
TOTAL INDIRECTEXPENSES
3109000,
31.09000y
000�
0DR,
TOTALEXPENOITURES _i
196,6130014
196,613AO,i
000
ODOR
12
Source of Funds
Facesheat ' certiheenonz aadget 1 60scoftnneees I Index
®have IOU Sareo @-9 Valldele PUP °Copy
Source of Ponds
'TOTAL EXPENOf(URES 196,613.ac
Das: I
%CIOAn
k Snow Tree (�) (�j
source of Faves
' i
I
I
'
Fees said Collectors -dd and gnd Pall
000
0,00'
0,00
OOOI
[]
Fees and C011ec0ona Old Paoty
000
66,000001.
ego
MOOD oo
Federal or State)Non I=H)
000
000E
00011
1
Peel
h ,,Federal Cost Based Relmbursement
0.00 �
19,0c0001�
0.00
19,00000�1
Federally PmVlded Vaccines
0.00'
00o'
0.00
0DO
Federal holdlcald OWRVW
000i
0001
Ono
000I
M
Required Match - Local
000
0001',
000
cool
b
Local Non-ELPHS
000
a0o�
0.00'
0001
_
Local Non-ELPHS
0.0
0001
Ono
0so
Sonar Non-ELPH6
0,00
coal„
0.00,
end
LIDCH Non Comprenansrve
000
0OU!
Ono,
rod
�I
X ll CoMprehed lve
66,813A0•i
OOO,i
0001
66,813,0O�i
(ELPHS -MDCH Heading
000i
o001;
0.09
0.00�
ELFH3-MDCH Vision
0Do!
OM,
0.00'—
" iELPHS-LOCH Other
O.OP;
0.00
OAO
ISO
Q
ELPHS-Food
RM
000
000,
0001
0
ELPHS - Drilling Ntalef
0ooi
000
uol
COO,
ELPHS- OtI-Se.emaga
000
Coo;
ODD,
0.001�
NCH Rmding
OR
OAO',
000
40Ol
Y Local FUnda-Other
Oo0'i
44.800,00
'
0,00
d4800.001
,InF;lnd Match
000
0Do
OOO�,
0.00�
Ci
IMOCH Flxad Wuf Rate
i
',
d
U
0oo;
coo
000
Poo,;
13
62 Attachment 82-Proaram Budaet Cost Detail
Agency ABC Health Depaament Program Compre hensire Agr.....I-FY20M
Appllcallon: Family Planning Services SAMPLE
I Facoaheet CedlfiraUpne Budget MIsI.IIaneous We.
vlSava It,Sarv' a Vupu.u; jw P,P Qdj Cap}
apph't Detail
�Category I Program Eipanse.-Sthw&wag.. Type Expaed@xe
Claaalfcallon Seq' It Sub Type' Chad
tnswdons [select the posurn aescnpWn vrnvytneyvanhrY,a Ms menay ins rek es eeerege cmt oer FTf,
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tlattalive
❑ XNur.e Pfagltlonef IJ], 019 910000001ETE 'i(J
17,290,001 17,29000
1Do 000, 7V
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❑ Y, Public H.a3b Nutt. IUI 046 349324301FTE �J-
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16,009 GOt 16106900
0.00 000 ?.1
❑>10oordinator IS! 0.4151036 DOUi FTE I8
GUMBO 20,925,00'
0,001 000 ?1
❑ Y'Clcrk_ IL.J! 1.001 26729240I FTE :U
29,13500, 29,1350011
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1a61Nd10ne' Aema tbetitat L ee Poe S5,e00
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Cles.111 1hon si It Level: (tl Llnt Item lr Category' sub Type: Need
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❑ % Liner 7,26200 7,26200 000 am C.1
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15
Budaet Preparation
A. Sources of Local Fund Tv Des
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.
B. 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.
C. 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 Resort (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.
1. Reauired Match - Local
Should be used to report the local match for Medicaid Outreach, both the federal
and local amounts must match.
2. 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
16
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.
III. Comprehensive Local Health Deaartment Aareement Obliaation Reoort — 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
Partnership Outreach. This should reflect the local contribution multiplied by the
Medicaid enrollment participation rate x 50% federal match rate.
17
object Class Category/l speuses . _
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# (pens, paper, paper claps, etc.). ink
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.erection 1—'Me Basics p-23
1POM 2017
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staff'}: Attorney General, Officeservices
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VI
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✓
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policies that, prohibit local -traycl
✓
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directly related to hnnmili-rutton activities lire outside the secTpc of th9s coops alive,
ap,reelrient ptogrsm and will not be, fiinetcd.
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ai161203 6
Section 1—The Basics p.26
1POM 2017
22
ATTACHMENT III
LOCAL
October 122 — September 3f 2023
Fiscal Year 2023
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.
Special requirements are applicable for the program elements listed in the attached pages.
Attachment IV Reimbursement Chart
Program Element:
The Program Element indicates currently funded Department programs that are included in
the Comprehensive Local Health Department Agreement.
Reimbursement Methods
The Reimbursement Methods specifies the type of method used for each of the program
element/funding sources. Funding under the Comprehensive Local Health Department
Agreement can generally be grouped under four (4) different methods of reimbursement.
These methods are defined as follows:
Performance Reimbursement
A reimbursement method by which local agencies are reimbursed based upon the
understanding that a certain level of performance (measured by outputs) must be met in order
to receive full reimbursement of costs (net of program income and other earmarked sources)
up to the contracted amount of state funds prior to any utilization of local funds. Performance
targets are negotiated starting from the last year's negotiated target and the most recent year's
actual numbers except for programs in which caseload targets are directly tied to funding
formulas/annual allocations. Other considerations in setting performance targets include
changes in state allocations from past years, local fiscal and programmatic factors requiring
adjustment of caseloads, etc. Once total,performance targets are negotiated, a minimum state
funded performance target percentage is applied (typically 90% unless otherwise specified). If
local Grantee actual performance falls short of the expectation by a factor greater than the
allowed minimum performance percentage, the state maximum allocation for cost
reimbursement will be reduced equivalent to actual performance in relation to the minimum
performance.
Fixed Unit Rate Reimbursement
A reimbursement method by which local health departments are reimbursed a specific amount
for each output actually delivered and reported.
ELPHS
A reimbursement method by which local health departments are reimbursed a share of
reasonable and allowable costs incurred for required Essential Local Public Health Services
(ELPHS), as noted in the current Appropriations Act.
Grant Reimbursement
A reimbursement method by which local health departments are reimbursed based upon the
understanding that State dollars will be paid up to total costs in relation to the State's share of
the total costs and up to the total state allocation as agreed to in the approved budget. This
reimbursement approach is not directly dependent upon whether a specified level of
performance is met by the local health department. Department funding under this
reimbursement method is allocable and a source before any local funding requirements unless
a special local match condition exists.
Performance Level If Applicable
The Performance Level column specifies the minimum state funded performance target
percentage for all program elements/funding sources utilizing the performance reimbursement
method (see above). If the program elements/funding source utilizes a reimbursement method
other than performance or if a target is not specified, N/A (not available) appears in the space
provided.
Performance Target Output Measures
Performance Target Output Measure column specifies the output indicator that is applicable for
the program elements/ funding source utilizing the performance reimbursement method. Output
measures are based upon counts of services delivered.
Relationship Designation
The Subrecipient, Contractor, or Recipient Designation column identifies the type of relationship
that exists between the Department and grantee on a program -by -program basis. Federal
awards expended as a subrecipient are subject to audit or other requirements of Title 2 Code of
Federal Regulations (CFR). Payments made to or received as a Contractor are not considered
Federal awards and are, therefore, not subject to such requirements.
Subrecipient
A subrecipient is a non -Federal entity that expends Federal awards received from a pass -
through entity to carry out a Federal program, but does not include an individual that is a
beneficiary of such a program; or is a recipient of other Federal awards directly from a
Federal Awarding agency. Therefore, a pass -through entity must make case -by -case
determinations whether each agreement it makes for the disbursement of Federal program
funds casts the party receiving the funds in the role of a subrecipient or a contractor.
Subrecipient characteristics include:
• Determines who is eligible to receive. what Federal assistance;
• Has its performance measured in relation to whether the objectives of a Federal
program were met;
• Has responsibility for programmatic decision making;
• Is responsibility for adherence to applicable Federal program requirements specified
in the Federal award; and
• In accordance with its agreements uses the Federal funds to carry out a program for
a public purpose specified in authorizing status as opposed to providing goods or
services for the benefit of the pass -through entity.
Contractor
A Contractor is for the purpose of obtaining goods and services for the non -Federal entity's
own user and creates a procurement relationship with the Grantee. Contractor
characteristics include:
• Provides the goods and services within normal business operations;
• Provides similar goods or services to many different purchasers.
• Normally operates in a competitive environment.
• Provides goods or services that are ancillary to the operation of the Federal program;
and
• Is not subject to compliance requirements of the Federal program as a result of the
agreement, though similar requirements may apply for other reasons.
In determining whether an agreement between a pass -through entity and another non -Federal
entity casts the latter as a subrecipient or a contractor, the substance of the relationship is more
important than the form of the agreement. All of the characteristics listed above may not be
present in all cases, and the pass -through .entity must use 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
Amendment Schedule will be added in first amendment.
Key Terms
• 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 ProjectStart/Effective Date, — The date new projects are expected to start, unless
otherwise communicated by the program office.
PROJECT TITLE: American Rescue Plan
American Rescue Plan — HFA
American Rescue Plan — NFP
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The American Rescue Plan (ARP) funding is federal funding issued to assist Home
Visiting programs and associated families with the means to respond to immediate needs
resulting from the impacts of COVID-19. This funding will assist Home Visiting programs
with addressing the impacts of COVID-19 by providing services and supplies to families
while also supporting the programmatic costs and training needs of Home Visiting
agencies.
Reporting Requirements (if different than agreement language):
The Local Implementing Agency (LIA) shall submit all required reports in accordance with
the Department reporting requirements. See the Michigan Department of Health and
Human Services' (MDHHS) Home Visiting Guidance Manual for details about what must
be included in each report.
Staffing Changes: Within 10 day's of a staffing change, notify the appropriate Model
Consultant via e-mail and incorporate the change(s) into the budget and facesheet
during the next amendment cycle as appropriate. The facesheet identifies the
agency contacts and their assigned permissions related to the tasks they can
perform in E-GrAMS. The assigned Project Director in E-GrAMS can make the
facesheet changes once the agreement is available to be amended.
b. ARP Work Plan: By June 30, 2022, the LIA must submit a Work Plan to the MDHHS
Home Visiting mailbox (MDHHS-HVlnitiativena.michiaan.aov) for preapproval. An ARP
Work Plan template will be provided. See the MDHHS Home Visiting Guidance Manual
for requirements related to Work Plan development and reporting.
c. Work Plan Reports: Must be submitted to the MDHHS Home Visiting mailbox
(MDHHS-HVlnitiativena michioan.00v) within 30 days of the end of each quarter
(January 30, April 30, July 30 and October 30). The template mentioned in section
b. above can also be used for Work Plan Report submissions.
ARP Quarterly Report: This report is unique to ARP funding asking for specific
information relating to the allowable uses of ARP funds. These reports will assist the
MDHHS Home Visiting Unit in complying with HRSA requirements and are due on the 15t'
of the month following each calendar quarter. The report template is available in EGrAMS.
All ARP Quarterly Reports should be submitted to the MDHHS Home Visiting mailbox
(MDHHS-HVlnitiative(E).michican.00v).
All reports and/or information (a-d), unless stated otherwise, shall be submitted
electronically to the MDHHS Home Visiting mailbox at MDHHS-
HVlnitiativen,michioan.aov.
PROJECT: COVID Immunization
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
This grant should be directed to increase COVID vaccination within Michigan. will be
used to support awardee and local Health Department (HD) staffing, communications
campaigns, pandemic preparedness, mass vaccination and all COVID-19 vaccine
response work.
Reporting Requirements (if different than contract language)
Completion of the Vaccination Situation Report.
Any additional requirements (if applicable)
Allowable expenses include staffing, communications, and supplies to support COVID-19
vaccination events, including PPE, vaccine refrigerators, data loggers, vaccine coolers,
and indirect costs for COVID-19 related work.
Are not allowable expenses: Vehicles purchasing, Food, Alcoholic beverages, Building
purchases, construction, capital improvements, Entertainment Cost, Goods and services
for personal use and Promotional and/or Incentive Material such as: Mugs/Cups, Pens, or
Bags.
PROJECT: COVID Workforce Development
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
Funding for COVID Workforce Development to establish, expand, and sustain a public
health workforce, including school nurses.
Reporting Requirements (if differentthan'contract language)
Reporting requirements will be provided at a later date.
Any additional requirements (if applicable)
Eligible purchases include:
Hiring personnel (including wages and benefits) for roles that may range from senior
leadership positions to early career or entry-level positions (including, but not limited
to permanent full-time and part-time staff, temporary or term -limited staff, fellows,
interns, and contractors or contracted employees). Examples of personnel include
professional or clinical staff, disease investigation staff, school nurses and school -
based health services personnel, program staff, administrative staff, and any other
positions that may be required to prevent, prepare for, and respond to COVID-19.
• Purchase of equipment and supplies necessary to support the expanded workforce
including personal protective equipment, equipment needed to perform the duties
of the position, computers, cell phones, internet costs, cybersecurity software, and
other costs associated with support of the expanded workforce (to the extent these
are not included in recipient indirect costs).
• Administrative support services necessary to implement activities funded under this
section, including travel and training (to the extent these are not included in recipient
indirect costs).
PROJECT: COVID-19 Mobile Testing
Start Date: 10/1/2022
End Date: 10/1/2023
Project Synopsis
Mobile testing deployment to high -risk areas of need. Walk or drive up testing.
Partnerships with community organizations. Eliminate barriers by offering no
appointments or prescription. Testing and include vaccinations and health screening.
Services include social determinant assessments and linkage to services and care.
Reporting Requirements (if different than contract language)
Monthly Project Updates
Please submit monthly project updates via email to Shronda Grigsby
Griasbvs1 e-michiaan.aov and Nina Talarico TalaricoNa.michician.ciov no later than the
151h of each calendar month.
Quarterly Narrative Progress Reports
Submit quarterly narrative progress reports utilizing the template provided via email to
Shronda Grigsby at Griosbvs1(a),Michiaan.00v and Nina Talarico
TalaricoN(a)michioan.00v in accordance with the following schedule:
Reporting Period Report Due Date
October 1- December 31 January 31
January -March 31 April 30
April 1-June 30 July 31
October 1- Septmeber 30 (entire FY) October 31
Any additional requirements (if applicable)
A. Ensure that activities implemented under this grant award are in accordance
with established MDHHS program standards, as well as State and Federal
policy and statutes, including HIPAA.
B. Adhere to timelines and work plans, budgets, and staffing plans submitted and
approved by MDHHS. Deviations from approved timelines, work plans, budgets
and staffing plans must receive advance authorization from MDHHS. Failure to
make reasonable progress in program development may result in revocation or
reduction of the grant award:
C. Collaborate with and build on other MDHHS COVID-19 response programs
wherever possible, rather than duplicating or rebuilding efforts.
D. Ensure that services and materials are culturally and linguistically appropriate
to meet the needs of the respective client populations.
E. Utilize results from the Social Vulnerability Index/mortality analysis from the
State of Michigan at the census tract level for Southeast Michigan to help
identify priority areas for the mobile testing program within high priority census
tracts, and share data maps of COVID-19 "hot spots" with MDHHS.
Assess insurance status of each individual being tested. Bill relevant insurers,
including private insurers, Medicaid health plans, and the Health Resources
and Services Administration for COVID-19 testing costs when possible.
G. Store, refuel, and maintain vehicles to ensure optimum vehicle performance.
Take all reasonable precautions to keep vehicles safe against fire, water, and
traffic damage, and maintain. cleanliness of the vehicles. Submit documentation
and billing for storage, fuel, and maintenance reimbursement.
H. As part of any vaccination activities, follow all relevant MDHHS protocols,
including record and account of all doses of vaccine administered in the
Michigan Care Improvement Registry (MCIR) and assuring vaccines are stored
at recommended temperatures at all times.
Reports from temperature data logger showing temperatures within
recommended range may be requested at any time by MDHHS.
The terms below are in addition to the standard terms in the County Health Department
Agreement, and apply only to this specific project:
Insurance Requirements. Grantee, at its sole expense, must maintain the insurance
coverage identified below.
All required insurance must:
(i) Protect the State from claims that arise out of, are alleged to arise out of, or
otherwise result from Grantee's performance;
(d) Be primary and non-contributing to any comparable liability insurance
(including self-insurance) carried by the State; and
(iii) Be provided by a company with an A.M. Best rating of "A-" or better, and a
financial size of VII or better.
Required Limits I Additional Requirements
Commercial General Liability Insurance
Minimum Limits:
$1,000,000 Each Occurrence
$1,000,000 Personal & Advertising
Injury
$2,000,000 Products/Completed
Operations
$2,000,000 General Aggregate
Automobile Liability Insurance
Minimum Limits:
$1,000,000 Per Accident
Workers' Compensation Insurance
Minimum Limits:
Coverage according to applicable
laws governing work activities
Employers Liability Insurance
Minimum Limits:
$500,000 Each Accident
$500,000 Each Employee by Disease
$500,000 Aggregate Disease
Coverage must not have
exclusions or limitations related
to sexual abuse and molestation
liability.
Policy must include Hired and
Non -Owned Automobile
coverage.
Waiver of subrogation, except
where waiver is prohibited by
law.
Privacy and Security Liability (Cyber Liability) Insurance
Minimum Limits:
$1,000,000 Each Occurrence
$1,000,000 Annual Aggregate
I Medical Malpractice Insurance
Minimum Limits:
$1,000,000 Each Occurrence
$3,000,000 Annual Aggregate
Policy must cover information
security and privacy liability,
privacy notification costs,
regulatory defense and penalties,
and website media content
liability.
If any required policies provide claims -made coverage, the Grantee must:
1. Provide coverage with a retroactive date before the Effective Date of the Grant
or the beginning of Grant Activities;
2. Maintain coverage and provide evidence of coverage for at least three (3)
years after completion of the Grant Activities; and
3. If coverage is cancelled or not renewed, and not replaced with another claims-
made policy form with a retroactive date prior to the Effective Date of this
Grant, Grantee must purchase extended reporting coverage for a minimum of
three (3) years after completion of work.
Grantee must:
Provide insurance certificates to the Grant Administrator, containing the
agreement or delivery order number, at Grant formation and within twenty (20)
calendar days of the expiration date of the applicable policies;
2. Require that subgrantees maintain the required insurances contained in this
Section;
3. Notify the Grant Administrator within five (5) business days if any policy is
cancelled; and (iv) waive all rights against the State for damages covered by
insurance. Failure to maintain the required insurance does not limit this waiver.
This Section is not intended to and is not to be construed in any manner as waiving,
restricting or limiting the liability of either party for any obligations under this Grant
(including any provisions hereof requiring Grantee to indemnify, defend and hold
harmless the State).
PROJECT: ELC (Epi Lab Capacity) Contact Tracing, Case Investigation,
Testing Coordination, and Infection Prevention
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
For COVID-19 funding from ELC Supplemental for Case Investigations and Contact
Tracing and Infection Prevention. The inability to meet quality standards will elicit the
following response from MDHHS related to this funding:
• Technical assistance
Corrective action/performance improvement plans with MDHHS
Required support from MDHHS
Any single procurement of over $4,000 should be vetted with MDHHS prior to purchase
Reporting Requirements (if differentthan'contract language)
Related to Case Investigation Quality:
LHD's will continue to perform high quality case investigation and contact tracing for
Department -recommended priorities. Local health departments should focus on interview
completion, timeliness, and race and ethnicity completion, as well as effective
communication with providers, individuals, the general public, and businesses related to
isolation and quarantine. LHD's shall focus work on outbreak investigations in
populations of interest. LHD's can procure tools to increase case investigation quality
(people finding software, communications, printed materials for testing events, EMR
access, etc.).
Case investigation data will be reported in MDSS. Allowable expenses include staffing,
IT, communications, computers and or,phones or other office needs, access to people
finding software or EMR, supports to cases for isolation and quarantine (not including
wraparound services). Funding cannot be used for clinical care or research.
Related to Contact Tracing:
Dependent on MDHHS guidance, LHDs will collaborate with MDHHS to assure timely
contact notification and education of close contacts of a COVID-19 case.
Related to testing:
LHDs will provide staffing and support for testing activities related to outbreak response.
This funding can be used to staff testing events or assure testing strategies are
completed.
Related to Infection Prevention: ,
MDHHS SHARP/IPRAT will serve as a statewide technical assistance provider to LHD
Infection Prevention personnel, including but not limited to train -the -trainer models, job
shadowing, assistance with onsite and virtual facility assessments, pre -and post -visit
consultation and follow-up, cluster/outbreak reporting, response and containment.
1. The LHD will designate a staff member or members responsible for leading virtual
and onsite infection prevention assessments:
a. Proactive IP assessments (preparedness)
b. Assessments in response to an outbreak/cluster
2. A list of LHD IP team members and contact information will be available to
MDHHS
3. Team members will participate in a Project kickoff meeting and routinely
4. scheduled coordination calls with MDHHS
5. Dedicated LHD staff will complete Project FirstLine Training provided by CDC
and/or MDHHS
6. Dedicated LHD staff will participate in an APIC training sponsored by MDHHS
7. LHDs will conduct ongoing outreach to high -risk settings to assess communicable
disease reporting and existing infection prevention resources, policies, practices,
processes and provide facilities with best practice recommendations for infection
prevention.
a. High risk settings include but are not limited to healthcare settings
(hospitals, nursing homes, other long term care facilities), jails, prisons, and
shelters.
8. LHDs shall submit ICARs to MDHHS at
httvs://dhhshivstd.ladl.aualtrics.com/ife/form/SV OdNux7Oo256K6B7
This data will be reported to MDHHS in a quarterly survey (Qualtrics/SurveyMonkey):
1. # of LHD staff completing Project FirstLine Training
2. # of LHD staff completing APIC training
3. # of proactive virtual site visits conducted
4. # of proactive onsite visits conducted
5. # of outbreak/cluster site visits conducted
6. # of trainings coordinated by LHD personnel
7. # of infection prevention consultations conducted
8. # of IP meetings coordinated by the LHD
Allowable expenses include staffing, IT, communications, computers and/or phones or
other office needs, travel, PPE, professional development/trainings/conferences for staff,
expenses related to hosting events/trainings.
Funding cannot be used for clinical care or research.
For local health departments:
Use staffing to collaborate to conduct contact tracing, contact notification, and mitigation
for high -priority settings like schools, jails, dorms, congregate settings, etc.
1. LHDs will report to MDHHS the number of clusters/outbreaks investigated with
supported staff
LHD's will provide education to Contacts on public health recommendations for
COVID-19 to other emerging communicable disease threats.
3. LHD will provide information to close contacts such as websites, printed materials,
social media, or hotlines.
Staffing can be used to support:.
connecting people with supportive services and treatments when indicated
assisting with expanding public education and outreach
promoting vaccination — including scheduling and booster reminders
Staff can be cross trained to support other communicable disease investigation
activities such as:
• sexually transmitted infection and
• HIV partner services,
• Hepatitis C infection,
• foodborne outbreak response,
• tuberculosis investigation's,
• healthcare associated and antibiotic resistant organisms,
• other programs that can benefit from the skills of this hiohly-trained
workforce.
LHDs should report to MDHHS, on a quarterly basis, which non-COVID-19
conditions were investigated by staff supported under this award
5. LHDs will support local public health staff impacted by COVID-19 by providing
development and training opportunities, including addressing the physical and
behavioral health impact of COVID-19 on the public health workforce.
6. LHDs will support staff workforce development and training, including conference
fees and associated travel.
Allowable expenses include staffing, IT, communications, computers and or phones or
other office needs, access to people finding software or EMR, supports to cases and
contacts for isolation and quarantine for COVID-19 and/or other infectious disease
threats.
Any additional requirements (if applicable)
PROJECT: ELC Regional Lab
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
ELC Regional Lab funds are dedicated to developing lab, epi, and other public health
efforts to modernize and expand testing and response capabilities of pandemics with
special emphasis on the responses to COVID-19. The Regional laboratory system is
intended to serve as a "hub -and -spoke" model in conjunction with the state public health
laboratory to rapidly respond to commdnity needs. Funding is expected in personnel,
equipment, overhead (discreationary of county or district needs if in support of public
health), and lab supplies/consumables or materials that directly support sampling for
return to the lab.
Reporting Requirements (if different than contract language)
None, but sites may be asked to provide tally counts of testing if not directly available
from StarLIMS or to answer occasional question from CDC on capabilities.
Any additional requirements (if applicable)
PROJECT: ELC SEWER Network
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The State of Michigan SARS-CoV-2 Epidemiology - Wastewater Evaluation and
Reporting Network, also known as the SEWER Network, is a wastewater monitoring
project that utilizes locally coordinated projects to conduct surveillance for SARS-CoV-2
virus shed into Michigan public sewer systems. The overarching goal of the Michigan
SEWER Network is to rapidly detect circulation of SARS-CoV-2 virus within specific
communities via wastewater testing. The SEWER Network is designed to support local
project participation through the collection, transportation, and testing of wastewater
samples, analysis and reporting of results, coordination and communications within local
projects and with state agencies, and submission of results to MDHHS and EGLE. The
emphasis for this funding is that the funded activities provide useful, timely, and
consistent wastewater data to support local COVID-19 public health responses.
Reporting Requirements (if different than contract language)
All local projects may be required to submit a weekly summary of project activities to
MDHHS via email or uploading to the existing Microsoft Teams site for the project. This
could include information on sample collection, testing, data reporting and utility, and
partner communication. A template for,this report will be provided by MDHHS. MDHHS
will communicate any changes in reporting requirements to project participants.
Quarterly workplan updates will be required from all local projects. Lead agencies who
are not local health departments will be required to complete a quarterly workplan report
in EGrAMS that details the activities and objectives during that time period. LHD leads for
local projects will submit quarterly workplan reports directly to MDHHS project staff.
Failure to implement project requirements or submit required financial and performance
reports in accordance with this agreement may result in reduction of funds or non -
renewal of future contracts.
Any additional requirements (if applicable)
This agreement reflects the sampling commitments written in the proposal. Any changes
in the sampling plan need to be discussed with SEWER Network project staff.
PROJECT TITLE: Lead Response
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
Lead Action Level Exceedance (ALE) response capacity encompasses public outreach,
including education on water testing and results, water filter usage, flushing
recommendations, and the interim provision of water filtration systems.
The Michigan Department of Health and Human Services (MDHHS), through a legislative
funding allocation, can provide lead -reducing water filter systems and replacement
cartridges if the local water supply cannot provide them, and if the LHD or local unit of
government doesn't have the resources to provide them.
Filters from MDHHS can be offered at no cost to low-income households that meet these
criteria:
Requirement 1: To qualify for a filter, both requirements must be met:
o Household receives water from the ALE Community Water Supply
o Household has NOT received a water filter from ALE Community Water Supply, the
Local Health Department, or the Michigan Department of Health and Human
Services.
Requirement 2: To qualify for a filter, one requirement must be met:
o A child under age 18 lives at the applicant's address.
o A child under age 18 spends a few hours a day and several days a week at the
applicant's address for at least 3 months of the year.
o A pregnant woman lives at the applicant's address.
Requirement 3: To qualify for a filter, one requirement must be met:
o Household includes a person who receives WIC benefits or Medicaid insurance.
o Household attests they can't afford a filter and replacement cartridges (filters cost
about $35 and replacement cartridges cost about $15.)
If an eligible household's water test result is above the action level (AL = 15 ppb) for lead,
or the resident's home is on the public water system experiencing an ALE for lead, a
faucet mount filter and 2 replacement cartridges will be offered. A pitcher filter and 3
replacement cartridges may be offered, when necessary (e.g., faucet mount does not fit
their faucet).
These measures will be provided until a permanent solution can be identified and
implemented, as resources allow, or a determination is made by MDHHS Division of
Environmental Health that filtration is no longer recommended or advised.
Reporting Requirements
By Wednesday at noon each week, grantees are required to enter all data collected on
the Water Filter Request Forms in the attached Excel file. The file will be submitted to
Gabriella Dionise, atdioniseaI(@rnichiaan.aov.
Additional Requirements:
Requesting Funding
Local Health Departments requesting funds for Lead ALE response will provide an
estimated budget, as well as a description of expenses on Form DCH-0385(E) and DCH-
0386(E).
Lead ALE response funds are not capacity building funds but are limited -term funding to
achieve a critical public health response on behalf of the MDHHS for environmental
public health needs related to lead in drinking water.
Eligible Expenses Include:
a) Staff time and fringe dedicated to Lead ALE response in association with the
interim response.
• Eligible staff activities for Lead ALE response include filtration system
distribution, home visits, organizing and hosting town hall meetings or other
public education, phone banks, water sample collection or other activities
approved by and conducted in collaboration with MDHHS Division of
Environmental Health.
b) Printing materials associated with ALE response;
c) Mileage associated with lead ALE response and MDHHS-provided training;
d) Lead and copper analysis fees for health departments with certified drinking water
laboratories when costs are in alignment with the Michigan Department of
Environment, Great Lakes, and Energy's (EGLE) Drinking Water Laboratory fees
($26/sample).
e) Other items as need is determined, such as public meeting venue rental or phone
bank expenses.
Other expenses that are not on this list must receive prior approval by DEH before
submission to Division of Local Health Services. Any deviation or amendment to existing
Lead ALE response projects requires DEH approval. Local Health Departments submit
all budget requests to DEH Community Engagement Unit.
Ineligible Expenses Include:
• Training
• Association membership fees; and
• Travel not associated with direct Lead ALE service delivery.
Providing Interim Filtration Systems
When distributing water filters to residents, health departments will obtain a signed Water
Filter Request Form from each resident. A site -specific form will be provided as a tillable
PDF. Health Departments may choose to type resident's information into the fillable PDF
or print off the form. Residents will complete Page 1 of the form, and health department
staff (or their designees) will complete Page 2 of the form. Grantees are requested to
maintain hard copies of the Water Filter Request Forms for audit purposes. Completion of
the Water Filter Request Form is NOT intended to be a barrier to the provision of filtration
systems for households with pregnant women and children under age 18.
- A note here: sometimes the filter distributions happen at CE events that are not
run by LHDs, in that case, Lakecia holds onto the PDF forms.
PROJECT: Local Public Health Nurse Case Management
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The purpose of this project is to fund nursing case management support for children 6-16
years of age with elevated lead levels in Berrien County, as well as children under 6
years of age with an elevated blood lead level who are not enrolled in a Medicaid Health
Plan in Berrien County. This project also supports funding to InterCare FQHC, as
needed, for reimbursement blood lead sample analysis at $7.00 each. Finally, this
project supports efforts to increase blood lead testing within Berrien County, with high
priority to Benton Harbor. This funding can support Berrien County in identifying barriers
to blood lead testing, reduction strategies for these identified barriers and methods to
increase access to blood lead testing, focusing messaging on blood lead testing for
children and pregnant persons.
Reporting Requirements (if different than contract language)
N/A
Any additional requirements (if applicable)
N/A
PROJECT: PFAS Response (All Locations)
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The Michigan Department of Health and Human Services (MDHHS) Division of Environmental
Health (DEH), in consultation and collaboration with local health departments, provides
drinking water recommendations to residents with private residential wells contaminated with
PFAS. Local health departments are eligible for PFAS Response funding when filtration or
another source of drinking water is recommended as a health protective measure.
PFAS Response encompasses the components below:
• Educational outreach such as, but not limited to, education regarding drinking water
testing and results.
• Interim provision of water filtration systems or an alternate source(s) of water until a
determination is made by MDHHS DEH that filtration or alternate water is no longer
recommended.
• Follow-up with residents who have received a water filter to offer free replacement filter
cartridges every six months.
Local health departments requesting funds for PFAS response will provide an estimated
budget as well as a description of expenses on forms DCH-0385E and-0386E.
PFAS Response funds are not capacity building funds but are limited -term funding to achieve
a critical public health response on behalf of MDHHS DEH for environmental public health
needs related to PFAS.
Eligible expenses Include:
• Water filters certified for PFAS reduction.
• Installation of certified water filters by a plumber licensed in the State of Michigan.
• Replacement water filter cartridges provided approximately every 6 months or after 800
gallons of water has been filtered, depending on residents' water usage.
• Alternate water such as water coolers/dispensers or bottled water, as need is
determined and approved by MDHHS DEH.
• Mileage.
• Supplies.
• Staff time and fringe dedicated to PFAS response. Required staff activities for PFAS
response include:
a. Distribution of certified water filtration systems and replacement cartridges.
b. Coordination of water filter installation by a licensed plumber when requested by
the resident.
c. Provision of semi-annual filter replacement cartridge offers and reminders. These
offers and reminders are made to residents previously provided with water filters
until:
• a determination is made by MDHHS DEH that water filtration is no longer
recommended.
d. Documentation of water filter and replacement cartridge distribution.
e. Data entry and submission to MDHHS DEH.
• When necessary, staff activities may include:
a. Bottled water distribution.
b. Home visits.
c. Organizing and hosting town hall meetings or other public education.
d. Phone banks.
e. Water sample collection support when requested by MDHHS DEH.
• Other items as need is determined such as public meeting venue rental or phone bank
expenses.
• Indirect costs.
Expenses not on this list must receive prior approval by MDHHS DEH before submission. Any
deviation from or amendment to existing PFAS response projects requires MDHHS DEH
approval.
Ineligible expenses include:
• Training.
• Association membership fees.
• Travel not associated with direct PFAS service delivery.
• The cost to remove filters unless the water filter is found to be defective and requires
replacement.
Reporting Requirements (if different than contract language):
By the first Wednesday of each month, grantees are required to submit:
• Site -specific, updated tracking forms including:
a. Site name.
b. Resident's name, address, contact information.
c. Water filter or alternate water type provided.
d. Water filter or alternate water quantity distributed.
e. Filter replacement cartridges distributed.
f. Date of each distribution.
g. Permission to contact resident.
h. Filter declination.
i. Staff name.
• Site -specific updated information on number of bottles of water distributed.
Submit tracking forms to MDHHS DEH via email to MDHHS-DEHresoonse -michiaan.aov with
the subject line PFAS Alternate Water Tracker — (add reported month).
Any additional requirements (if applicable)
Local health departments submit all budget requests to MDHHS DEH for approval.
• Application for funds in subsequent fiscal years is expected where there is an ongoing
recommendation for water filtration or an alternate water source.
• Local health department are to maintain number of staff hours expended on the grant.
Acknowledgement of Receiving or Declining Water Filter Form
When providing a water filter to a resident, grantees will complete the Acknowledgement of
Water Filter Receipt form, or similar acknowledgment form based on the grantee's legal
review, including the resident's signature. The forms will be retained by the grantees.
• Please note that an acknowledgement form is NOT intended to be a barrier to provision
of water assistance.
PROJECT: Reopening Schools HRA
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The Michigan Department of Health and Human Services (MDHHS) is offering a
voluntary program to provide rapid antigen testing to educators, staff, and students at
public and private schools. In addition, MDHHS is providing funds to school districts that
have indicated the need for additional technical support with the intent to participate in
testing programs, among other factors. Funding provided will support hiring health
resource advocates (HRAs). Individuals serving in the role as an HRA will provide front-
line support for COVID-19 testing and reporting, help districts identify emerging COVID-
19 related health concerns, and amplify best health practices.
Any additional requirements (if applicable)
Reporting Requirements (if different than contract language)
Bi-Monthly reports by school district to include the following (additional information may
be requested):
1. Total enrollment
2. PCR tests conducted
3. Antigen tests conducted
4. Total positive cases
5. # HRAs hired
6. Qualitative feedback on:
• barriers
•successes
• lessons learned
• verification of funding use for HRA positions
Reports should be submitted via email to MDHHS-HRAreoortinq(a-)-michigan.gov. For any,
additional questions or concerns can be submitted to MDHHS-
COVI DTestinaSu000rtemichiaan.aov.
Funding may only be used for hiring an, HRA(s). The funding shall not be used for any
other purpose beyond hiring and/or funding an HRA(s), which may include supporting
existing positions. These funds must also be accompanied by a plan to conduct COVID-
19 testing in school settings.
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ATTACHMENT B.3
MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES
BUREAU OF GRANTS AND PURCHASING
EQUIPMENT INVENTORY SCHEDULE
Please list equipment items that were purchased during the grant agreement period as specified in the grant
agreement budget's cost detail schedule - Attachment B.2. Provide as much information about each piece as
possible, including quantity, item name, item specifications: make, model, etc. Equipment is defined to be an
article of non -expendable tangible personal property having a useful life of more than one (1) year and an
acquisition cost of $5,000 or more per unit. Please complete and forward this form to the MDHHS contract
manager with the final progress report.
Grantee Name: Contract #: Date:
Grantee's Signature:
Date:
$ 0
DCH-0665 FY2023
Version: Comprehensive
MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
FY 22/23 AGREEMENT ADDENDUM A
This addendum adds the following section to Part I and Renumbers existing 11
Special Certification to 12 and existing 12 Signature Section to 13:
Part I
11. Agreement Exceptions and Limitations
Notwithstanding any other term or condition in this Agreement including, but
not limited to, any provisions related to any services as described in the
Annual Action Plan, any Contractor (Oakland County) services provided
pursuant to this Agreement, or any limitations upon any Department funding
obligations herein, the Parties specifically intend and agree that the
Contractor may discontinue, without any penalty or liability whatsoever, any
Contractor services or performance obligations under this Agreement when
and if it becomes apparent that State or Department funds for any such
services will be no longer available. Notwithstanding any other term or
condition in this Agreement, the Parties specifically understand and agree
that no provision in this Agreement shall operate as a waiver, bar or limitation
of any kind, on any legal claim or right the Contractor may have at any time
under any Michigan constitutional provision or other legal basis (e.g., any
Headlee Amendment limitations) to challenge any State or Department
program funding obligations; and, the parties further agree that no term or
condition in this Agreement is intended and no such provision shall be
argued to state or imply that the Contractor voluntarily assumed or undertook
to provide any services as described in the Annual Action Plan, and thereby,
waived any rights the Contractor may have had under any legal theory, in law
or equity, without regard to whether or not the Contractor continued to
perform any services herein after any State or Department funding ends.
This addendum modifies the following sections of Part 11 General Provisions:
Part II
Responsibilities -Grantee
J. Software Compliance: This section will be deleted in its entirety and
replaced with the following language:
Version: Comprehensive
The Michigan Department of Health and Human Services and the
County of Oakland will work together to identify and overcome
potential data incompatibility problems.
Assurances
A. Compliance with Applicable Laws. This first sentence of this
paragraph will be stricken in its entirety and replace with the following
language:
The Contractor will comply with applicable Federal and State laws,
and lawfully enacted administrative rules or regulations, in carrying out
the terms of this agreement.
M. Health Insurance Portabilitv and Accountabilitv Act. The
provisions in this section shall be deleted in their entirety and replaced
with the following language:
The Grantee agrees that it will comply with the Health Insurance
Portability and Accountability Act of 1996, and the lawfully enacted
and applicable Regulations promulgated there under.
X. Liability. Paragraph A. will be deleted in its entirety and replaced with the
following language.
A. Except as otherwise provided by law neither Party shall be
obligated to the other, or indemnify the other for any third party
claims, demands, costs, or judgments arising out of activities to be
carried out pursuant to the obligations of either party under this
Contract, nothing herein shall be construed as a waiver of any
governmental immunity for either party or its agencies, or officers
and employees as provided by statute or modified by court
decisions.
ATTACHMENT BA
Updated March 2022
MICHIGAN DEPARTMENTOF HEALTH AND HUMAN SERVICES
De Mmlmis 10%Incilfect Rate Calculator
HaWI Year 2023 Gra n r Agreements
NOTE: The Grantee will complete the blue shared cells,
The yell., Gelb will be automatically calculated.
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IGRANT PROJECT Id applosiblen
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1 211
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T.1.fa Reduced Expan sea
C. TOTAL BUDGETED MODIFIED DIRECT COSTS
D. CALCULATED BUDGETED DEMINIMIS EXPENSES
EXCLUDED EXPENSES (See Darnitl.n, Too)
Title 2 CFR 200 starts the Modlned Hear Direct Costs (MUTC) radudes.
Rental Cents
Copltai Expenditures
Equipment
TuMon Remisslon
Scholarships and Fellowships
Participant Support Conte
Charges for Patient Care
Portion of Subawmd In Excess of $ ED"B"
FY 22/23 COMPREHENSIVE AGREEMENT
APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES, AND MANUALS
Program/Element Laws/Administrative Rules
Federal Regulations/Circulars
Policies
General - (Law) Annual State
- 2CFR Part 200 Uniform Administrative Requirements,
- Waiver Policy BCS-
Administration Appropriation Bills*
Cost Principles, and Audit Requirements for Federal
2007*
- (Law) Public Health
Awards; Final Rule
- MDCH Funding
Code P.A. 368 of 1978
- 2CFR Part 225 (OMB CircularA-87) (Revised) Cost
Allocation Policy*
(as amended)*
Principles for State, Local and Indian Tribal
- Minimum Program
- (Law) Single AudltAct-
Governments
Requirements -
Amended*1996
- Federal OMB Circular A-102 (Revised) Implemented
Department Policy
- (Law) Federal MCH
through "Common Rules -Grants Management*
8000*
Block Grants-P.L. 97-35
- PHS Grants Management Handbook*
- Capital Outlay Prior
of 1981 (as
Part 96 Block Grant Regulations (1)
Approval Policy -BCS-
amended)(1)
_ 45 CFR
014*
- (Law) Subcontract
- 45 CFR Part 74 Administration of Grants (3) or;
Requirements, Civil
45 CFR Part 92, Uniform Administrative
Rights Laws/Special
Requirements for Grants and Cooperative
Assurances as specified
Agreements to State and Local Governments, as
in the agreements*
applicable'
- (Law) Local Uniform
- Federal OMB CircularA-133Audfls of States, Local
Budgeting Act PA 621
Governments and Non -Profit Organization*
of 1978 (as amended)*
_ Federal OMB Circular A-133 Compliance
_ - (Law) Local Uniform
- Supplement - -
Accounting Act P.A. 71
_ 2 CFR Part 180 Guidelines to Agencies on
of 1919 (as amended)*
Government wide Debarment and Suspension
_ - (Law) Section 1352 of
_ 45 CFR Part 93 Lobbying' -
-
P.L. 101-121 (re:
Lobbying) (�)
- 45 CFR Part 6, Inventions and Patents*
- (Law) Management and
- 42 CFR Parts 432 and 433 (Title XIX Funded
Budget Act*
Programs)
- (Law) OBRA 89 P.L.
- 45 CFR, Part 46, Protection of Human Subjects
101-239(amendmentto
- Catalog of Federal DomesticAssistance(CFDA)*
Ttle V)*
FOR SUBGRANTEES.
- (Law) and
- 2 C.F.R. Part 220 (OMB Circular A-21) Cost
96
P.A- 196 as
PA 1973
Principles for Educational Institutions"
amended regarding
conflict of interest*
- 2CFR Part 215 (OMB Circular A-110) Uniform
- (Law)P.L. 103-227
Administrative Requirements for Grants and Other
Agreements with Institutions of Higher Education,
Part C Environmental
Hospitals and Other Non-profit Organizations*
Tobacco Smoke*
_ 2C.F.R. Part 230(OMB CircularA-122)Cost
- (Law) PA 533 of 2004
Principles for Non-proftOrganizations*
- (Rules) 325.13053
- Federal OMB CircularA-133Audit Requirements for
States, Local Govemments and Non -Profit
Organizations*
- Federal OMB CircularA-133 Compliance
Supplement
- Americans With Disabilities Act of 1990*
Procedures
Waiver Procedure BCS-2007.1
Capital Outlay PnorApproval
Procedure BCS-014.1*
State/Federal Manuals
- (State) Local FM IS Manual*
- (State) Treasury LHD
Accounting Procedures
Manual*
- (State) MDCH Reporting
Requirements Notebook
(H-284)*
- (State) Minimum Program
Requirements
- (Fed) PHS Grants Policy
Statement*
- (Fed) PHS Grants
Administration Manual`
- (Fed) HHS Grants
Administration Manual*
- (State)Annual Budget, FSR
& Indirect Instructions*
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Agency Name: Click or tap here to enter text.
Fiscal Year: Click or tap here to enter text.
NOTE. Any question answered N/A must have an explanation in the comments column.
A.1.
Are grant funds only used on allowable activities and
❑ Yes
not on items prohibited by the laws, regulations, and
❑ No
provisions of each MDHHS contract and proqram?
A. 2.
Are staff aware of the applicable cost principles in Title
❑ Yes
2 CFR 200, Subpart E?
❑ No
A.3.
Are staff aware of unallowable charges (e.g., alcoholic
❑ Yes
beverages, bad debts, contingency reserves,
❑ No
contributions and donations, fund raising, use
allowances, etc.)?
A.A.
If costs are allocated to multiple funding sources, are
❑ Yes
they allocated in accordance with the benefits received
❑ No
in accordance with the cost principles and a
documented process?
A.S.
Does the Agency have written accounting policies and
❑ Yes
procedures for the receipt and disbursement of funds,
❑ No
purchasinq, and payment of expenses?
A.6.
Does the Agency have a financial management system
❑ Yes
that provides for the identification of all Federal awards
❑ No
received and expended, and the Federal programs
under which they were received? [Title 2 CFR
200.302(b)(1)1
A.7
Does the financial management system provide a clear
❑ Yes
and accurate record of the receipt and disbursement of
❑ No
grant funds with a separate revenue and expense
accounts for each separate program and aqreement?
A.8
Is the financial management system capable of tracking
❑ Yes
revenues and expenses by the MDHHS grant period
❑ No
when it differs from the AgencV's fiscal year?
A.9
Does the Agency have written procedures for
❑ Yes
determining the reasonableness, allocability, and
❑ No
allowability of costs in accordance with Title,2 CFR Part
2 and the conditions of the Federal award? [Title 2 CFR
200.302(b)(7)1
A.10
Does the Agency have an effective internal control
❑ Yes
system over Federal awards that provides reasonable
❑ No
assurance that the Agency manages Federal awards in
compliance with Federal statutes, regulations, and the
terms and conditions of the Federal awards; and the
internal controls are in compliance with guidance issued
by the Comptroller General of the United States and the
Committee of Sponsoring Organization (COSO) of the
Treadway Commission? [Title 2 CFR 200.303(a)l
A.11
Does the Agency evaluate and monitor its compliance
❑ Yes
with statutes, regulations, and the terms and conditions
❑ No
of Federal awards? [Title 2 CFR 200.303(c)]
A.12
Does the automated accounting system have controls in
❑ Yes
place to limit access to authorized personne'I only (e.g.,
❑ No
Agency Name: Click or tap here to enter text.
Fiscal Year: Click or tap here to enter text.
NOTE: Any question answered N/A must have an explanation in the comments column.
access is limited by secure user ID and password, are
roles based on least privilege?
A.13
Does the Agency maintain a complete set of books that
❑ Yes
include a cash receipts journal, a cash disbursements
❑ No
journal or transaction/voucher listing, and general
ledger?
A.14
Does the general ledger include account titles, posting
❑ Yes
dates, descriptions of transactions, posting references,
❑ No
debit and credit amounts and balances?
A 15
Does the Agency have a chart of accounts that is used
❑ Yes
by all programs/activities of the Agency?
❑ No
A.16
Does the accounting line detail enable reporting
❑ Yes
MDHHS grant expenditures comparable to the MDHHS
❑ No
qrant budqet line items?
A.17
Do the general ledger revenue and expense accounts
❑ Yes
for the MDHHS grants agree with the reports (e.g.,
❑ No
Financial Status Report or Statement of Expenditures,
etc.)?
A.18
Does the Agency follow Generally Accepted Accounting
❑ Yes
Principles (GAAP) to record financial information?
❑ No
A.19
Is the modified accrual (government) or accrual
❑ Yes
(nonprofit) basis if accounting used to record revenues
❑ No
and expenses?
A.20
Are there clearly defined responsibilities for the
❑ Yes
following duties, including consideration for access and
❑ No
use within the automated accounting system? Indicate
all that apply and identify the position title(s)
responsible.
a Reconciliation of bank accounts
b. Approving invoices for payment
c. Approving time records
d. Payroll preparation
e. Approving payroll for payment
f. Mailing or delivering payroll checks
g. Opening mail
h. Preparing bank deposit slips
i. Making bank deposit
j. Posting receipts to the accounting system
k. Posting expenses to the accounting system
A.21 Is the person that approves invoices for payment (a)
❑ Yes
other than someone that requesting payment, and (b)
❑ No
knowledqeable about allowable and unallowable costs?
A.22 Does that person authorizing invoices for payment
❑ Yes
review original invoices and other supporting
❑ No
documentation?
A.23 Are all expenditure payments supported by
❑ Yes
documentation include (a) type of purpose of expense,
❑ No
a. Click or tap here to enter text.
b. Click or tap here to enter text.
c. Click or tap here to enter text.
d. Click or tap here to enter text.
e. Click or tap here to enter text.
f. Click or tap here to enter text.
g. Click or tap here to enter text.
h. Click or tap here to enter text.
Click or tap here to enter text
j. Click or tap here to enter text.
k. Click or tap here to enter text.
Agency Name: Click or tap here to enter text.
Fiscal Year: Click or tap here to enter text.
NOTE: Any question answered N/A must have an explanation in the comments column.
(b) amount, (c) date service was provided, (e) date of
invoice, and (f) programs to be charged?
A.24
Are original invoices marked paid to prevent a duplicate
❑ Yes
payment?
❑ No
A.25
Do only persons authorized to prepare or supervise the
❑ Yes
preparation of checks has access to blank checks?
❑ No
A.26
Are all checks pre -numbered?
❑ Yes
❑ No
A.27
Are all voided checks retained?
❑ Yes
❑ No
A.28
Are all voided checks clearly marked as void?
❑ Yes
❑ No
A.29
Do all checks require two signatures?
❑ Yes
❑ No
A.30
Are there dollar threshold limitations when checks
❑ Yes
require only one signature? 1
❑ No
A.31
Do the Agency's policies and procedures prohibit
❑ Yes
signing blank checks?
❑ No
A.32
Do the Agency's policies and procedures prohibit
❑ Yes
checks to be made out to Cash?
❑ No
A.33
Are individuals (a) who sign checks, (b) have
❑ Yes
disbursement responsibilities, or (c) receipting
❑ No
responsibilities, properly bonded?
A.34
Do the Agency's policies and procedures describe when
❑ Yes
petty cash may be used, the dollar threshold, and
❑ No
documentation required, and a process to account for
❑ N/A
the petty cash fund?
A.35
Are the accounting records current and balanced
❑ Yes
regularly?
❑ No
A.36
Are the Agency's bank accounts reconciled on a
❑ Yes
monthly basis by someone who does not authorize
❑ No
transactions and/or are the reconciliations reviewed by
management?
A.37
Is the Agency current with filing payroll, unemployment,
❑ Yes
and filings with the Internal Revenue Service?
❑ No
A.38
Are the accounting records and confidential client
❑ Yes
records adequately protected in accordance with laws
❑ No
regarding privacy and confidentiality, and protected from
fire and damage? [Title 2 CFR 200.303(e)]
A.39
Is source documentation (e.g., vouchers and original
❑ Yes
invoices, etc.) readily available to support amounts
❑ No
entered into IT systems and charged to MDHHS grants?
A.40
When the accrual basis if accounting is used, are all
❑ Yes
costs reported to MDHHS actually incurred during the
❑ No
funding period and paid within the time period specified
Re., reported in the proper grant year)?
Click or tap here to enter text.
3
Agency Name: Click or tap here to enter text.
Fiscal Year: Click or tap here to enter text.
NOTE: Any question answered N/A must have an explanation in the comments column.
A 41 Do the record retention policies comply with the contract ❑ Yes
provisions and Title 2 CFR 200.334? 1
❑ No
A.42
Does the Agency have back up policies and procedures
❑ Yes
to ensure that data can be retrieved in the event of
❑ No
system failure?
A.43
Does the accounting system have budgetary controls,
❑ Yes
by line item and total, to prevent excess expenses from
❑ No
being charged to funding sources?
A.44
Does the Agency have written policies and procedures
❑ Yes
for management and the governing board to document
❑ No
its review of a functional budget compared to actual
expenses by funding source and program?
[Title 2 CFR 200.302(b)(5)j
A.45
Does the Agency have policies and procedures for
❑ Yes
management and the governing board to follow-up on
❑ No
budget variances when they occur?
A.46
Does the governing board have an Audit and/or Finance
❑ Yes
Committee that convenes and communicates regularly
❑ No
with the governing board to assist in understanding and
responding to adverse financial developments?
A.47
Does the Agency have adequate controls over the
❑ Yes
financial management system to ensure complete and
❑ No
accurate data processing (e.g., sequence checks,
referential integrity checks, control/hash totals, range
checks, run totals, reconciliations, etc.)?
A.48
Does the Agency have procedures to identify and
❑ Yes
correct processing errors?
❑ No
A.49
Does the financial management system produce logs or
❑ Yes
audit trails for all user activity, including system
❑ No
administrators and transaction processing?
A.50
Can users modify the financial management system
❑ Yes
logs or audit trails?
❑ No
A.51
Are third party contractors used to provide accounting
❑ Yes
systems, processing, or functions?
❑ No
A.52
Are third party contracts or service level agreements In
❑ Yes
place?
❑ No
❑ N/A
A.53
Are external audits performed of third party contractors
❑ Yes
that provide accounting systems, processing, or
❑ No
functions?
❑ N/A
A.54
Are SSAE 18 reports of the third party contractors
❑ Yes
required and reviewed?
❑ No
1
❑ N/A
A.55
Does the Agency have policies and procedures
❑ Yes
regarding updating or changing the automated financial
❑ No
management system?
Agency Name: Click or tap hereto enter text.
Fiscal Year: Click or tap hereto enter text.
NOTE Any question answered N/A must have an explanation in the comments column.
FWA
M]
M
6M
W
Does the Agency have a formal change management
process in place to ensure data integrity?
Does the Agency have a documented process for
allocating staff time among all programs and activities to
ensure personnel costs are reported for each benefitting
qrant?
Are personnel records supported by a system of internal
control which provides reasonable assurance that
personnel expenses are accurate, allowable, and
properly allocated? [Title 2 CFR, 200.430(i)(1)(viii)j
Do personnel expense records reasonably reflect the
TOTAL activity (i.e., time worked and paid time off) for
which the employee is compensated by the Agency, not
exceed 100% of compensated activities?
(Title 2 CFR 200.430(i)(1)(iii)j
Do personnel expense records support the distribution
of the employee's salary and wages among'specific
activities or cost objectives if the employee works on
more than one Federal award; a Federal award and a
non -Federal award; an indirect cost activity and a direct
cost activity; two or more indirect cost categories which
are allocated using different allocation bases; or an
unallowable activity and a direct or indirect cost activity?
[Title 2 CFR 200.430(i)(1)(vii)[
If budget estimates (determined before services are
performed) are used for interim accounting purposes for
allocating and reporting personnel costs, are the
following in place:
a. A system for establishing the estimates produces
reasonable approximations of the activity actually
performed?
b. Significant changes in the corresponding work
activity are identified and entered into the records in
a timely manner?
c The system of internal controls includes processes
to review after -the -fact activity in comparison to the
budget estimates, with adjustments to ensure the
final amount charged to the Federal award is
accurate, allowable, and properly allocated?
[Title 2 CFR 200.4300)(1)(viii)[
For local governments and Indian Tribes using
substitute processes or systems (other than those
described in Title 2 CFR 200.430(i)(1) for allocating
salaries and wages to Federal awards, such as but not
limited to, random moment sampling, rolling time
studies, case counts, or other quantifiable measures of
work performed, is the substitute system approved by
the cognizant agency for indirect costs? [Tit'le 2 CFR
200.430(i)(5)j
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ N/A
❑ Yes
❑ No
Click or tap here to enter text.
Agency Name: Click or tap here to enter text.
Fiscal Year: Click or tap here to enter text.
NOTE: Any question answered N/A must have an explanation in the comments column.
B.7
Do the personnel positions charged to the grant
❑ Yes
generally conform to the positions in the MDHHS
❑ No
budqet?
B.8
Are attendance records maintained to monitor leave
❑ Yes
usage?
❑ No
B.9
Do supervisors approve leave time taken?
❑ Yes
❑ No
B.10
Does the Agency have a written Personnel Policy?
❑ Yes
❑ No
B 11
Are fringe benefits, in the form of employer expenses for
❑ Yes
employee health, life, unemployment, and workers
p No
compensation insurance, charged based on actual
costs incurred, and supported by invoices?
B.12
Are fringe benefits, in the form of regular compensation
❑ Yes
paid to employees during periods of authorized
❑ No
absences from the job, and employer contributions for
social security, insurance, and pension costs, allocated
equitably to all related activities?
B 13
Are fringe benefit costs allocated on a per person basis
❑ Yes
based on hours worked in the program?
❑ No
❑ N/A Click or tap here to enter text.
B.14
Are total fringe benefit costs allocated based on the
❑ Yes
percentage of total salaries and wages attributable to
❑ No
the program?
❑ N/A Click or tap here to enter text.
B.15
Does the Agency have a documented fringe benefit
❑ Yes
policy which includes all fringe benefits? [Title 2 CFR
❑ No
200.430(c)
C.1
Does the Agency have written travel policies and
❑ Yes
procedures defining reasonable limits for hotel and meal
❑ No
reimbursements, mileage rates, unallowable costs, and
documentation requirements? '
C.2
Is travel charged to MDHHS grants supported by
❑ Yes
employee travel vouchers that include the purpose of
❑ No
travel, the period covered, destination, departure and
arrival times, with appropriate documentation? (Title 2
CFR 200,475(b)(1) requires documentation that justifies
that participation of the individual is necessary to the
Federal award
DA
Agency Owned Buildings — Is space based on
❑ Yes
depreciation plus actual operating and maintenance
❑ No
costs with NO use allowance?
D.2
Agency Rented Buildings — Is the space cost supported
❑ Yes
by a current signed lease agreement?
❑ No
D.3
Is space cost allocated to all benefitting programs by
❑ Yes
square footage used by each program or another
❑ No
consistently applied allocation base?
Agency Name: Click or tap here to enter text.
Fiscal Year: Click or tap here to enter text.
NOTE: Any question answered N/A must have an explanation in the comments column.
DA Does the Agency have a documented written space ❑ Yes
cost policy and procedure? ❑ No
E.1 Does the Agency have a current executed contract for
❑ Yes
each contractor?
❑ No
E 2 Do the contracts contain the applicable provisions
❑ Yes
described in Title 2 CFR Appendix II?
❑ No
E.3 Are contractor charges supported by detailed billings as
❑ Yes
to the type and amount of services/goods provided.
❑ No
rather than only statinq For Services Rendered?
EA Are contract billings reviewed prior to payment to
❑ Yes
ensure consistency with the contract terms and
❑ No
F.1 Are indirect costs charged to MDHHS programs (e g„
❑ Yes
agency -wide administration, division level
❑ No
administration, county/city central services, nursing'
supervision, general nursinq, etc.)?
F.2 If charging indirect costs to the MDHHS, is the
❑ Yes
methodology being consistently used for all grant
❑ No
awards (MDHHS and other funding sources) in
accordance with Title 2 CFR Part 200?
F.3 Select the indirect methodology used:
a. A DeMinimis rate of 10% of modified total direct
❑
costs.
b. A Federally approved indirect cost rate
❑
negotiated between the Agency and the Federal
government.
C. A rate negotiated between MDHHS and the
❑
Agency.
d. A rate approved by another Department of the
❑
State of Michigan and accepted via contract by
MDHHS.
e. Actual indirect costs allocated in accordance
❑
with the Agency's documented cost allocation
plan which complies with the provisions of 2
CFR Part 200 (e.g., based on a pro rate share
of personnel costs, total direct costs of the
benefitting programs, etc.).
f. Indirect costs not consistently applied to all
❑ Click or tap here to enter text.
awards and benefitting activities using one
methodology. Explain in the comments column.
FA Does the Agency comply with the indirect cost rate/cost
❑ Yes
allocation plan documentation that provides a fair and
❑ No
equitable distribution of indirect costs to all Agency
programs and activities that benefit from the indirect
expenses in accordance with 2 CFR Part 200 (e.q.;
7
Agency Name: Click or tap here to enter text.
Fiscal Year: Click or tap here to enter text.
NOTE: Any question answered N/A must have an explanation in the comments column.
Answer
Comments
based on a pro rate share of personnel costs, total
direct costs of the benefittinq programs, etc )?
F.5
Does the Agency comply with the indirect cost rate/cost
❑ Yes
allocation plan documentation and certification
❑ No
requirements in accordance with the appropriate
appendix of 2 CFR Part 200?
• Appendix III — Institutions of Higher Education
® Appendix IV — Nonprofit Organizations
Appendix V — Local Governments and Indian Tribe -
Wide Central Services Cost Allocation Plan
® Appendix VI —Local Government and Indian Tribe
Indirect Cost Proposals
F,6
Which of the costs are included in the Agency -wide
administration cost pool and allocated as indirect costs.
a. Salaries/Wages/Fringe Benefit of Adm Staff
❑
b. Data Management
❑
c. Space Costs
❑
d. Communication Costs
❑
e. Equipment Depreciation
❑
f. Central Service Cost Allocation Plan (County/City)
❑
g. Other(describe)
❑
Click or tap here to enter text.
F.7
Describe the indirect rate computation and methodology
❑ N/A
Click or tap here to enter text.
for allocatinq Agency -wide costs.
F.6
Are any other indirect costs (e.g., nursing supervision,
❑ Yes
Click or tap here to enter text.
general nursing, other) charged to MDHHS grants. If
❑ No
yes, please describe the cost and the how they are
allocated to the benefitting MDHHS grants and other
benefittin A ency rograms and activities.
G 1
For programs funded by MDHHS on a reimbursement
❑ Yes
basis, are the costs paid for by the Agency before
❑ No
reimbursements are requested from MDHHS?
❑ N/A
Click or tap here to enter text.
G 2
For programs funded by MDHHS on a reimbursement
❑ Yes
basis, does the Agency have provisions in place for
❑ No
timely submission of requests for reimbursement?
❑ N/A
Click or tap here to enter text.
G 3
If MDHHS advances funds to the Agency for any
❑ Yes
programs, does the Agency have procedures to ensure
❑ No
that the time elapsed between the pre -payment
❑ N/A
Click or tap here to enter text.
(advance) and disbursements are minimized?
(2 CFR 200.305(b)]
0
0 6 tl1
H.1
If MDHHS grant funds were used to purchase
❑ Yes
equipment, were the items purchased specifically
❑ No
approved in the MDHHS oriqinal or amended budqet?
H 2
Are the equipment purchases supported by approved
❑ Yes
invoices?
❑ No
Agency Name: Click or tap here to enter text.
Fiscal Year: Click or tap here to enter text.
NOTE: Any question answered N/A must have an explanation in the comments column.
H.3
Do the Agency's procedures designate the person(s)
❑ Yes Click or tap here to enter text,
authorized to approve equipment purchases?
❑ No
Identify the position title(s) in the comments column.
HA
Does the Agency maintain inventory records (for
❑ Yes
equipment costing over $5,000), as well as adequate
❑ No
safeguards over government -financed property and
equipment including an inventory every two years?
12 CFR 200.313(d)(1),(2),(3)1
H.5
Does the Agency maintain equipment inventory records
❑ Yes
that provide the following detail in accordance with 2
❑ No
CFR 200.313(d)(1)(3) requirements? Check all that
apply to your Agency.
a. Item Description
❑
b. Serial Number
❑
C. Cost
❑
d. Acquisition and Disposal Dates
❑
e. Location/Responsible Program
❑
f. Funding Source
❑
g. Tag Number
❑
H.6
Are MDHHS grant -funded supplies maintained in a
❑ Yes
secure location with access limited to applicable
❑ No
program staff?
H.7
Are there controls in place to prevent unauthorized
❑ Yes
consumption of MDHHS grant -funded supplies?
❑ No
H.8
Does the Agency maintain a perpetual inventory of
❑ Yes
MDHHS grant -funded supplies, and perform periodic
❑ No
physical inventories of qrant supplies?
H,9
If yes, how often are the physical inventories
Click or tap here to enter text.
1.1 Do the Agency's financial report to MDHHS include the ❑ Yes
required match?
❑
No
Click or tap here to enter text.
❑
N/A
Click or tap here to enter text.
1,2 Is the reported match from allowable sources and
❑
Yes
comply with the requirements specified In 2 CFR
❑
No
200 306(b)?
❑
N/A
Click or tap here to enter text.
1.3 Does the Agency have procedures in place to ensure
❑
Yes
required levels of effort are maintained?
❑
No
❑
N/A
Click or tap here to enter text.
1.4 Were required levels of effort maintained?
❑
Yes
If no, explain in the comments column.
❑
No
Click or tap here to enter text.
❑
N/A
Click or tap here to enter text.
1.5 Has the Agency adhered to all earmarks established by
❑
Yes
MDHHS grants? (e g. Women's Specialty Services
❑
No
Click or tap here to enter text.
target; maximum amount or percentage for program
❑
N/A
Click or tap here to enter text.
development and coordination activities; a minimum
9
Agency Name: Click or tap hereto enter text.
Fiscal Year: Click or tap hereto enter text.
NOTE: Any question answered N/A must have an explanation in the comments column.
amount or percentage for services related to access,
home services, and legal assistance; etc.)
If no, explain in the comments column.
J.1 Does the Agency comply with the General Procurement
Standards contained in 2 CFR 200,318, which include,
but are not limited to the following?
a. The non -Federal entity must have and use
documented procurement procedures,
consistent with State, local, and tribal laws.and
regulations and the standards of this section, for
the acquisition of property or services required
under a Federal award or subaward. The non -
Federal entity's documented procedures must
conform to the procurement standards identified
in 2 CFR 200.317 through 200.327.
b. Maintaining oversight to ensure that contractors
perform in accordance with the terms,
conditions, and specifications of their contracts
or purchase orders?
C. Maintaining written standards of conduct
covering conflicts of interest and governing the
performance of its employees engaged in the
selection, award and administration of
contracts?
d. Awarding contracts only to responsible
contractors possessing the ability to perform
successfully under the terms and conditions of
a proposed procurement?
e. Maintaining records sufficient to detail the
history of procurement including the rationale
for the method of procurement, selection of
contract type, contractor selection or rejection,
and the basis for the contract price?
J.2 Does the Agency conduct all procurement transactions
in a manner providing full and open competition
consistent with the standards of 2 CFR 200.319?
J.3 Does the Agency have written procedures for
procurement transactions ensuring that all solicitations
incorporate a clear and accurate description of the
technical requirements for the material, product, or.
service to be procured; all requirements which the
offerors must fulfill; and all other factors to be used in
evaluatinq bids or proposals? t2 CFR 200.319(d)j
J,4 Does the Agency comply with the following allowed
methods of procurement and the requirements for each
(including establishing appropriate thresholds) as
specified in 2 CFR 200.320?
a. Micro -purchases (generally less than or equal to
$10,000 without quotes if price is reasonable)
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
10
Agency Name: Click or tap here to enter text
Fiscal Year: Click or tap here to enter text.
NOTE: Any question answered N/A must have an explanation in the comments column.
b. Small purchase procedures (generally less than
$250,000 with quotes from adequate sources)
C. Sealed bids
d. Competitive proposals
e. Non-competitive Drocurement
K.1 Did the Agency verify that subcontractors and ❑ Yes
subrecipients under covered transactions (procurement ❑ No
contracts for goods and services under a grant or ❑ N/A
cooperative agreement that are expected to equal or
exceed $25,000, and all subawards to subrecipients
irrespective of award amount) are not suspended or
debarred or otherwise excluded?
Note: Verification may be accomplished by checking
the System for Award Management for excluded parties
maintained by the General Services Administration at
www,sam.00v collecting a certification from the entity,
or adding a clause or condition to the covered
transaction with that entitv per 2 CFR 180.300,
L.1
Does the Agency have program income (fees and
❑ Yes
collections)?
❑ No
L.2
Is program income (fees and collections) billed on a
❑ Yes
sliding fee scale?
❑ No
L.3
Does the fee scale conform to applicable poverty
❑ Yes
guidelines? 1❑
No
L.4
Are duplicate receipt slips prepared for every receipt,
❑ Yes
and a copy given to the client?
❑ No
L.5
Are all receipts recorded promptly and deposited daily
❑ Yes
or at appropriate intervals?
❑ No
L.6
If receipts must be kept overnight, are they adequately
❑ Yes
safeguarded?
❑ No
L.7
Is all MDHHS grant program income revenue posted to
❑ Yes
separate program revenue accounts?
❑ No
L.7
Are duplicate deposit slips prepared?
❑ Yes
❑ No
L.8
Are deposit slips stamped by the bank or treasurer's
❑ Yes
office and checked against records of receipt?
❑ No
L.9
Does the Agency use program income for current costs,
❑ Yes
and deduct program income from total allowable costs
❑ No
to determine the net allowable costs [2 CFR
200.307(e)l?
Are financial reports (e.g. Financial Status Reports, ❑ Yes
Statement of Expenditures) submitted timely to ❑ No
MDHHS?
Click or tap here to enter text
Click or tap here to enter text,
If no, proceed to Section M, Reporting
11
Agency Name: Click or tap here to enter text.
Fiscal Year: Click or tap here to enter text.
NOTE: Any question answered NIA must have an explanation in the comments column.
M.2 Do financial reports to MDHHS include actual costs, and ❑ Yes
not budgeted amounts? ❑ No
M.3 Do financial reports to MDHHS include costs in the' ❑ Yes
appropriate line item categories? ❑ No
N 1
Does the Agency act as a pass -through entity and enter
❑ Yes
into subaward agreements related to the subawards
❑ No
passed through from MDHHS to the Agency?
N.2
Does the Agency identify every subaward to
subrecipients as a subaward and include the following
required information [2 CFR 200.332(a)(1)]?
Check those that the Agency includes in its subaward
agreement(s).
a. Subreclpient's unique identifier
❑
b. Federal award identification number
❑
c. Federal award date
❑
d. Subaward period of performance start and end
❑
dates
e. Subaward budget period start and end dates
❑
f. Total amount of Federal award
❑
g. Federal award project description
❑
h. Name of Federal awarding agency, pass-
❑
through entity, and contract information for
awarding official
i. Assistance Listing number and name
❑
j. Whether the award is research and
❑
development
k. Indirect cost rate
❑
N.3
Does the Agency communicate all requirements
❑ Yes
imposed on the subrecipient, including requirements
❑ No
imposed by MDHHS, so that the Federal award is used
in accordance with Federal statutes, regulations and the
terms and conditions of the Federal award? [2 CFR
200.332(a)(2)]
NA
Do the Agency subawards with subrecipients include a
❑ Yes
requirement that the subrecipient permit the pass-
❑ No
through entity and auditors to have access to the
subrecipient's records and financial statements as
necessary? [2 CFR 200.332(a)(5)]
N.5
Does the Agency evaluate each subrecipient's risk of
❑ Yes
noncompliance with Federal statutes, regulations, and
❑ No
the terms and conditions of the subaward for purposes
of determining the appropriate subrecipient monitoring?
[2 CFR 200,332(b)]
N.6
Does the Agency monitor the activities of subrecipients
❑ Yes
to ensure that the subawards are used for authorized
❑ No
purposes, in compliance with Federal statutes,
requlations, and the terms and conditions of the
If no, proceed to Section O, Policies and
Procedures.
12
Agency Name: Click or tap here to enter text,
Fiscal Year: Click or tap here to enter text.
NOTE: Any question answered N/A must have an explanation in the comments column
subawards; and that subaward performance goals are
achieved? 12 CFR 200.332(d)l
N.7 Does the Agency monitor the subrecipients with on.site
reviews?
N.8 Does the Agency monitor the subrecipients with a
financial review checklist?
N.9 Does the Agency monitor the subrecipients with any
other checklists or procedures?
NA 0 Does the Agency review financial and programmatic
reports of the subrecipients? [2 CFR 200 332(d)(1)1
N 11 Are subrecipient's financial reports or billing reports
reviewed by the Agency for budgetary compliance and
allowable costs before reimbursinq the subrecipients?
N.12 Does the Agency verify that each subrecipient's
financial reports or billings report actual expenses and
revenues, and not budqeted amounts?
N.13 Does the Agency verify that each subrecipient's time
documentation for volunteer services used to match
requirements.
N.14 Does the Agency test program income reported by
subrecipients for accuracy and completeness?
N.15 Does the Agency verify that its subrecipients are
audited as required by Title 2 CFR 200, Subpart F,
when it is expected that the subrecipient's Federal
awards from all funding sources during the
subrecipient's fiscal year exceed the $750,000 threshold
that requires a Single Audit?
[Title 2 CFR, 200.332(d)(2)1
NA Does the Agency receive and review its subrecipients'
Single Audit reports, if applicable?
N.17 Does the Agency follow-up to ensure its subrecipients
take timely and appropriate action on all deficiencies
pertaining to the Federal awards provided by the
Agency that are detected through audits, on -site
reviews, and receive written confirmation from the
subrecipient, highlighting the status of corrective actions
to address the deficiencies?
[2 CFR 200.332(d)(3)1
NA 8 Does the Agency issue management decisions
pertaining to the deficiencies provided by the Agency to
the subrecipient?
[2 CFR 200.332(d)(3)1
N.19 Does the Agency issue its management decisions within
six months of receiving the subrecipient's audit report?
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ N/A No volunteer time used for match.
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ N/A
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Subrecipients do not meet the threshold
for a single audit. Proceed to Section 0,
Policies and Procedures.
13
Agency Name: Click or tap here to enter text,
Fiscal Year: Click or tap here to enter text.
NOTE: Any question answered N/A must have an explanation in the comments column.
0.2 Does the Agency maintain written standards of conduct
covering conflicts of interest for the action of its
employees engaged in the selection, award, and
administration of contracts if there is a real or apparent
conflict of interest? [Title 2 CFR, 200.318(c)(1) and (2)1
03 Does the Agency have a written procedure to disclose,
in writing, any potential conflict of interest to MDHHS?
[Title 2 CFR 200,1121
0.4. Does the Agency have written procedures for
determining the allowability of costs in accordance with
Title 2 CFR Subpart E and the terms and conditions of
the Federal award? [Title 2 CFR 200.302(b)(7)]
0.5 Does the Agency have written procedures for managing
equipment (including replacement), whether acquired in
whole or in part under a Federal award, until disposition
takes place? [Title 2 CFR 200.313(d)l
0.6 Does the Agency have written policies which include
fringe benefits offered to employees to ensure expenses
are allowed? (Title 2 CFR 200 431(a)l
0.7 Does the Agency have a written travel policy that
includes all types of expenses (e.g., lodging, meals,
mileage, modes of transportation, etc.) that are
reimbursable by the Agency when an employee is
traveling for the benefit of the Federal program?
[Title 2 CFR 200,474(a)l
0,8 Does the Agency have a written Whistleblower policy
and procedure? (41 U.S.C. 4712]
0.9 Does the Agency have a written procedure to notify
MDHHS within one business day after discovering any
unauthorized use or disclosure of confidential
information? [MDHHS Aqreement, Section II, PA]
0.10 Does the Agency have a written HIPAA policy and
procedure? [MDHHS Agreement, Section Il, VIA]
0.11 Does the Agency have a written policy and procedure to
immediately report breaches of protected health data to
MDHHS? [MDHHS Agreement, Section II, M.5]
Name and Title of Authorized Representative
Click or tap here to enter text.
Email Address
Click or tap here to enter text.
❑ Yes
❑ No
❑ Yes
❑ No
❑_Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ N/A
❑ Yes
❑ No
❑ N/A
14
Date
Click or tap here to enter text.
Signature
FOR MDHHS USE ONLY
Evaluator Name Click or tap here to enter text
Evaluator Title Click or tap here to enter text.
Date Click or tap here to enter text.
15