HomeMy WebLinkAboutResolutions - 2022.09.29 - 37625
AGENDA ITEM: Grant Acceptance with Michigan Department of Health and Human Services for
the FY 2023 LHD Comprehensive Agreement 22-327
COMMITTEE MEETING: Board of Commissioners
DATE: Thursday, September 29, 2022 12:58 PM - Click to View Agenda
ITEM SUMMARY SHEET
DEPARTMENT SPONSORED BY
Health & Human Services - Health Division Penny Luebs
INTRODUCTION AND BACKGROUND
The Michigan Department of Health and Human Services (MDHHS) has awarded Oakland County
Health Division funding through the Fiscal Year (FY) 2023 Local Health Department
(Comprehensive) Agreement for the period October 1, 2022 through September 30, 2023 to
support the delivery of public health services to the citizens of Oakland County.
POLICY ANALYSIS
BUDGET AMENDMENT REQUIRED: Yes
Committee members can contact Michael Andrews, Policy and Fiscal Analysis Supervisor at
248.858.5115 (office) or andrewsmb@oakgov.com, or the department contact persons listed for
additional information.
CONTACT
Leigh-Anne Stafford, Director Health &
Human Services-APP
staffordl@oakgov.com
ITEM REVIEW TRACKING
Penny Luebs, Created/Initiated - 9/29/2022
David Woodward, Board of Commissioners Approved - 9/29/2022
Hilarie Chambers, Executive's Office Approved - 10/3/2022
Lisa Brown, Clerk/Register of Deeds Final Approval - 10/4/2022
AGENDA DEADLINE: 10/09/2022 12:58 PM
COMMITTEE TRACKING
2022-09-13 Public Health & Safety - Recommend and forward to Finance
2022-09-14 Finance - Recommend to Board
2022-09-29 Full Board - Adopt
ATTACHMENTS
1. PH&S - Health FY2023 LHD Schedule A
2. Health - FY2023 LHD Agreement Schedule B - Continuations Draft 7-15-22
3. Health - FY2023 LHD Agreement Schedule D - Deletions Draft 8-8-2022
4. FY2023 LHD Agreement Schedule E - Creation 8-8-22
5. Grant Acceptance Sign-Off FY23
6. Health - FY23 LHD Grant Acceptance WriteUp
7. Contract
8. Att I
9. ATT III
10. ATT IV
11. ATT V Addenum
September 29, 2022
MISCELLANEOUS RESOLUTION #22-327
Sponsored By: Penny Luebs
Health & Human Services - Health Division - Grant Acceptance with Michigan Department of
Health and Human Services for the FY 2023 LHD Comprehensive Agreement
Chairperson and Members of the Board:
WHEREAS the Michigan Department of Health and Human Services (MDHHS) has awarded
Oakland County Health Division funding through the Fiscal Year (FY) 2023 Local Health Department
(Comprehensive) Agreement (formerly the Comprehensive Planning, Budgeting, and Contracting
agreement - CPBC) for the period October 1, 2022 through September 30, 2023 in the amount of
$11,782,611; and
WHEREAS funding will be used to support the delivery of public health services to the citizens of
Oakland County; and
WHEREAS the FY2023 grant award in the amount of $11,782,611 is an increase of $352,201 from
the FY2022 grant award totaling $11,430,410; and
WHEREAS the FY 2023 award includes funding in the amount of $639,867 to continue the
subrecipient agreement for reimbursement of services provided to Woman, Infants and Children
(WIC) program participants for the period October 1, 2022 through September 30, 2023; and
WHEREAS it is requested to continue fifty-four (54) Special Revenue (SR) positions as identified in
Schedule B; and
WHEREAS it is requested to delete seven (7) SR positions as identified in Schedule D – Deletions;
and
WHEREAS it is requested to create one (1) SR position as identified in Schedule E – Creation; and
WHEREAS the Local Health Department (Comprehensive) Agreement has completed the Grant
Review Process in accordance with the Grants Policy approved by the Board at their January 21,
2021 meeting.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners hereby
approves the FY 2023 Local Health Department (Comprehensive) Agreement for funding in the
amount of $11,782,611 for the period of October 1, 2022 through September 30, 2023.
BE IT FURTHER RESOLVED to continue fifty-four (54) Special Revenue (SR) positions as identified
in Schedule B – Continuations.
BE IT FURTHER RESOLVED to delete seven (7) SR positions as identified in Schedule D –
Deletions.
BE IT FURTHER RESOLVED to create one (1) SR position as identified in Schedule E – Creation.
BE IT FURTHER RESOLVED that acceptance 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 the FY 2023 – FY 2025 budgets are amended as reflected in the
attached Schedule A budget amendment.
Chairperson, the following Commissioners are sponsoring the foregoing Resolution: Penny Luebs.
Date: September 29, 2022
David Woodward, Commissioner
Date: October 03, 2022
Hilarie Chambers, Deputy County Executive II
Date: October 04, 2022
Lisa Brown, County Clerk / Register of Deeds
COMMITTEE TRACKING
2022-09-13 Public Health & Safety - Recommend and forward to Finance
2022-09-14 Finance - Recommend to Board
2022-09-29 Full Board - Adopt
VOTE TRACKING
Motioned by Commissioner Michael Gingell seconded by Commissioner Gary McGillivray to adopt the
attached Grant Acceptance: with Michigan Department of Health and Human Services for the FY 2023 LHD
Comprehensive 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 (20)
No: None (0)
Abstain: None (0)
Absent: (0)
Passed
ATTACHMENTS
1. PH&S - Health FY2023 LHD Schedule A
2. Health - FY2023 LHD Agreement Schedule B - Continuations Draft 7-15-22
3. Health - FY2023 LHD Agreement Schedule D - Deletions Draft 8-8-2022
4. FY2023 LHD Agreement Schedule E - Creation 8-8-22
5. Grant Acceptance Sign-Off FY23
6. Health - FY23 LHD Grant Acceptance WriteUp
7. Contract
8. Att I
9. ATT III
10. ATT IV
11. ATT V Addenum
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 September 29, 2022,
with the original record thereof now remaining in my office.
In Testimony Whereof, I have hereunto set my hand and affixed the seal of the Circuit Court at Pontiac,
Michigan on Thursday, September 29, 2022.
Lisa Brown, Oakland County Clerk / Register of Deeds
Oakland County, Michigan
HEALTH AND HUMAN SERVICES DEPARTMENT/HEALTH DIVISION - FY 2023 LOCAL HEALTH DEPARTMENT (COMPREHENSIVE) AGREEMENT
Schedule "A" DETAIL
R/E Fund Name Division Name
Fund #
(FND)Cost Center (CCN) #
Account #
(RC/SC)
Program #
(PRG)Grant ID (GRN) #
Project ID #
(PROJ)
Region
(REG)
Budget
Fund
Affiliate
(BFA)
Ledger
Account
Summary Account Title
FY 2023
Amendment
FY 2024
Amendment
FY 2025
Amendment
R Greenall Fund - Grants Health FND10101 CCN1060212 RC610313 PRG133930 GRN-1003939 610000 Federal Operating Grants 33,418 33,418 33,418
R Greenall Fund - Grants Health FND10101 CCN1060220 RC615571 PRG134000 GRN-1003944 615000 State Operating Grants 1,176,612 1,176,612 1,176,612
R Greenall Fund - Grants Health FND10101 CCN1060220 RC615571 PRG134080 GRN-1003943 615000 State Operating Grants 413,718 413,718 413,718
R Greenall Fund - Grants Health FND10101 CCN1060220 RC615571 PRG134200 GRN-1003943 615000 State Operating Grants 571,324 571,324 571,324
R Greenall Fund - Grants Health FND10101 CCN1060237 RC615571 PRG133300 GRN-1003945 615000 State Operating Grants 253,969 253,969 253,969
R Greenall Fund - Grants Health FND10101 CCN1060237 RC615571 PRG133310 GRN-1003946 615000 State Operating Grants 253,968 253,968 253,968
R Greenall Fund - Grants Health FND10101 CCN1060283 RC615571 PRG133930 GRN-1003939 615000 State Operating Grants 36,847 36,847 36,847
R Greenall Fund - Grants Health FND10101 CCN1060201 RC615675 PRG133150 GRN-1003903 615000 Health State Subsidy 2,557,216 2,557,216 2,557,216
Total Revenues $5,297,072 $5,297,072 $5,297,072
R Human Services Grants Health FND11007 CCN1060234 RC610313 PRG133120 GRN-1003921 610000 Federal Operating Grants 15,750 15,750 15,750
R Human Services Grants Health FND11007 CCN1060234 RC615571 PRG133120 GRN-1003921 615000 State Operating Grants 47,250 47,250 47,250
Total Revenues $63,000 $63,000 $63,000
E Human Services Grants Health FND11007 CCN1060234 SC702010 PRG133120 GRN-1003921 702000 Salaries Regular 32,258 32,258 32,258
E Human Services Grants Health FND11007 CCN1060234 SC722740 PRG133120 GRN-1003921 722000 Fringe Benefits 18,356 18,356 18,356
E Human Services Grants Health FND11007 CCN1060234 SC730926 PRG133120 GRN-1003921 730000 Indirect Costs 4,458 4,458 4,458
E Human Services Grants Health FND11007 CCN1060234 SC732018 PRG133120 GRN-1003921 730000 Travel and Conference 4,015 4,015 4,015
E Human Services Grants Health FND11007 CCN1060234 SC750280 PRG133120 GRN-1003921 750000 Laboratory Supplies 3,829 3,829 3,829
E Human Services Grants Health FND11007 CCN1060234 SC774677 PRG133120 GRN-1003921 770000 Insurance Fund 84 84 84
Total Expenditures $63,000 $63,000 $63,000
FY23 Special Revenue Grant
Schedule B - Continuations
Dept. #FY23
Pos. #Budgeted Class FT/PT Hour
s Filled As Grant
1060291 05129 Office Support Clerk - Senior FTE 2080 Children's Special Health Care Services
1060291 05130 Supervisor PH Nursing FTE 2080 Children's Special Health Care Services
1060291 05163 Public Health Nurse III FTE 2080 Public Health Nurse II - PTNE Children's Special Health Care Services
1060291 06824 Auxiliary Health Clerk FTE 2080 Office Support Clerk - Senior - FTE Children's Special Health Care Services
1060291 07839 Auxiliary Health Clerk PTNE 1000 Children's Special Health Care Services
1060291 12442 Office Suppprt Clerk PTNE 1000 Children's Special Health Care Services
1060290 06747 Public Health Nurse III FTE 2080 Public Health Educator II - FTE Cities Readiness Initiative, PHEP
1060290 07416 Public Health Emergency Preparedness Specialist FTE 2080 Cities Readiness Initiative, PHEP
1060290 09999 Public Health Emergency Preparedness Specialist FTE 2080 Cities Readiness Initiative, PHEP
1060234 07565 Public Health Nurse III FTE 2080 Hep C
1060294 06100 Public Health Nurse III FTE 2080 Auxiliary Health Clerk - FTE HIV PrEP Clinic
1060294 12443 Clincal Health Specialist PTNE 1000 HIV PrEP Clinic
1060294 06426 Health Program Coordinator FTE 2080 HIV Prevention
1060294 07557 Public Health Nurse III FTE 2080 Public Health Nurse III - PTNE HIV Prevention
1060294 09668 Public Health Nurse III FTE 2080 HIV Prevention
1060294 06538 Office Support Clerk - Senior FTE 2080 HIV Prevention/Adolescent Screening Prevention
1060218 02070 Immunizatin Program Supervisor FTE 2080 IAP
1060218 07413 Public Health Nurse III FTE 2080 Public Health Nurse II - PTNE IAP
1060218 07414 Office Leader FTE 2080 IAP
1060218 07415 Office Support Clerk - Senior FTE 2080 IAP
1060291 05401 Public Health Nutritionist III FTE 2080 Maternal Children Health - All Other
1060291 15530 Public Health Nutritionist III PTNE 1000 Maternal Children Health - All Other
1060230 00752 Public Health Nurse III FTE 2080 Nurse-Family Partnership
1060291 04736 NFP Program Supervisor FTE 2080 Nurse-Family Partnership
1060230 00906 Public Health Nurse III FTE 2080 Nurse-Family Partnership
1060230 03107 Public Health Nurse III FTE 2080 Nurse-Family Partnership
1060230 03183 Public Health Nurse III FTE 2080 Maternal Children Health - All Other, NFP
1060230 03427 Public Health Nurse III FTE 2080 Maternal Children Health - All Other, NFP
1060290 03094 PH Emergency Preparedness Supervisor FTE 2080 PHEP
1060234 02436 Vaccine Supply Coordinator FTE 2080 Vaccine Quality Assurance, IAP
1060234 07559 Vaccine Supply Coordinator FTE 2080 Vaccine Quality Assurance, IAP
1060284 00674 Auxiliary Health Clerk FTE 2080 WIC
1060284 00958 Office Supervisor II FTE 2080 WIC
1060284 01328 Auxiliary Health Clerk FTE 2080 WIC
1060284 01865 Public Health Nutrition Supervisor FTE 2080 WIC
1060284 02074 Public Health Nutritionist II FTE 2080 WIC
1060284 02509 Nutrition Technician - WIC FTE 2080 WIC
1060284 03073 Office Supervisor II FTE 2080 WIC
1060284 04771 Auxiliary Health Clerk FTE 2080 WIC
1060284 05233 Public Health Nutritionist II FTE 2080 Nutrition Technician - WIC - FTE WIC
1060284 05234 Public Health Nutritionist I FTE 2080 Nutrition Technician - WIC - FTE WIC
1060284 05235 Public Health Nutritionist II FTE 2080 Nutrition Technician - WIC - FTE WIC
1060284 05693 Public Health Nutritionist II FTE 2080
1060291 07360 Public Health Nutritionist III FTE 2080 Public Health Educator II - FTE
WIC (740 hours); 495 hours SNAP ED grant and 845 hours on
non-LHD grant
1060284 07381 Public Health Nutritionist III FTE 2080 WIC 2072 hours; WIC BF 8 hours
1060284 07382 Nutrition Technician - WIC FTE 2080 WIC
1060284 07384 Auxiliary Health Clerk FTE 2080 WIC
1060284 07562 Nutrition Technician - WIC FTE 2080 WIC
1060284 07563 Auxiliary Health Clerk FTE 2080 WIC
1060284 11579 Lactation Specialist FTE 2080 WIC Breastfeeding
Yes
No
FY23 Special Revenue Grant Positions
Schedule D - Deletions
Dept. #FY23
Pos. #Budgeted Classification FT/P
T Hours Job Code Salary Plan Grant
1060294 06099 Public Health Nurse III FTE 2080 J000771 048/F Data to Care
FY23 Special Revenue Grant Positions
Schedule E - Creation
Dept. #FY23
Pos. #Requested Classification FT/P
T Hours Current Job
Code
Current Salary
Plan Grant
1060232 NEW Dental Hygentist PT 1000 Oral Health- Kindergarten Assessment
GRANT REVIEW SIGN-OFF – Health & Human Services/Health Division
GRANT NAME: FY 2023 Local Health Department (Comprehensive) Agreement
FUNDING AGENCY: Michigan Department of Health & Human Services
DEPARTMENT CONTACT PERSON: Stacey Smith / (248) 452-2151
STATUS: Acceptance (Greater than $10,000)
DATE: 08/29/2022
Please be advised the captioned grant materials have completed internal grant review. Below are the returned comments.
The Board of Commissioners’ liaison committee resolution and grant acceptance package (which should include this sign-
off email and the grant agreement/contract with related documentation) may be requested to be placed on the agenda(s) of
the appropriate Board of Commissioners’ committee(s) for grant acceptance by Board resolution.
DEPARTMENT REVIEW
Management and Budget:
Approved – Sheryl Johnson 08/23/2022
Human Resources:
Approved. – Heather Mason 08/25/2022
Risk Management:
Approved – Robert Erlenbeck 08/29/2022
Corporation Counsel:
Approved – Sharon Kessler 08/25/2022
REQUEST:
1. To accept the FY23 Local Health Department (Comprehensive) Grant Agreement effective October
1, 2022, through September 30, 2023.
2. To continue fifty-four (54) SR positions included in Schedule B.
3. To delete seven (7) SR positions included in Schedule D
4. To create one (1) SR positions included in Schedule E.
PROPOSED FUNDING:
Michigan Department of Health and Human Services Local Health Department FY22 Grant (Formerly
Comprehensive Planning, Budget and Contracting – CPBC)
OVERVIEW:
The Michigan Department of Health and Human Services LHD Grant funds several programs administered
by the Health Division. The amount of this grant is $11,782,611 which is an increase of $352,201 from the
previous year grant agreement. This agreement begins October 1, 2022, through September 30, 2023. the
FY 2023 award includes funding in the amount of $639,867 to continue the subrecipient agreement for
reimbursement of services provided to Woman, Infants and Children (WIC) program participants
The grant agreement and anticipated fiscal year 2023 contract amendments include sufficient funding for
fifty-four (54) positions listed in Schedule B. Additionally, the following one (1) special revenue (SR) position
is requested to be created:
SPECIAL REVENUE POSITIONS TO BE CREATED
Unit #Status (FTE or PTNE)Classification
1060232 Part-Time Non-Eligible
1,000 hours/year Dental Hygienist
This grant agreement has been submitted through the County Executive's Contract Review Process and is
recommended for approval. Acceptance of this grant does not obligate the County to any future
commitment and continuation of the special revenue position in the grant is contingent upon continued
future levels of grant funding.
COUNTY EXECUTIVE RECOMMENDATION:Recommended as Requested
PROJECTED PERTINENT SALARIES 2020
SALARY AND FRINGE BENEFIT COST:
**Note: FY23 Fringe benefit rates displayed are County averages. Annual costs are shown for illustrative
purposes only. Actual costs are reflected in the fiscal note.
Class Period Base 1 Year 2 Year 3 Year 4 Year 5 Year
Dental
Hygienist
Annual
Bi-wkly
Hourly
25,707
2,005.52
25.07
26,290
2,102.89
26.29
27,500
2,200.25
27.50
28,720
2297.60
28.72
2394.97
29.94
2492.33
31.15
Create one (1) SR Funded PTNE 1,000 hrs/yr. Dental Hygienist position (#1060232).
Hourly Rate at 1-year step x 1000 hours $26,290
Fringes at 5.49% $ 1,443
Total Cost of position $27,733
Delete one (1) SR Funded FTE Public Health Nurse (048/F) (#1060294-06099)
Salary at 1 year step $ (62,724)
Fringes @ 35.48% $ (22,254)
Direct Contract Charge $ (13,574)
Total worth of position $ (98,552)
Delete one (1) SR Funded 1,000 hrs/yr. PTNE Lactation Specialist (HRL/107) (#1060284-
12441)
Salary at 1 year step $ (16,010)
Fringes @ 5.49% $ (878.95)
Total worth of position $ (16,889)
Delete one (1) SR Funded FTE Auxiliary Health Clerk (087/111) (#1060284-04773)
Salary at 1 year step $ (40,799)
Fringes @ 35.48% $ (14,475)
Direct Contract Charge $ (13,574)
Total worth of position $ (68,848)
Delete one (1) SR Funded FTE Office Leader (UNI/110) (#1060290-05246)
Salary at 1 year step $ (38,856)
Fringes @ 35.48% $ (13,786)
Direct Contract Charge $ (13,574)
Total worth of position $ (66,216)
Delete one (1) SR Funded 1,000 hrs/yr. PTNE Public Health Nurse III (087/111)
(#1060284-04773)
Salary at 1 year step $ (30,160)
Fringes @ 5.49% $ ( 1656)
Total worth of position $ (31,816)
Delete two (2) SR Funded FTE Office Support Clerk – Senior (UNI/109) (#1060284-0866,
1060291-05526)
Salary at 1 year step $ (74,012)
Fringes @ 35.48% $ (26,259)
Direct Contract Charge $ (27,148)
Total worth of position $ (127,419)
Total Savings $ (382,007)
DRAFT08/15/2022
Agreement #:
Agreement Between
Michigan Department of Health and Human 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 1032
Federal I.D.#: 38-6004876, Unique Entity Identifier: {uei_no}
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
covered by this Agreement is $11,782,611.00.
Local Health Department - 2023, Date: 08/15/2022
__________________________________________________________________________
Page: 1 of 206
DRAFT08/15/2022
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 C.1 and C.2 provisions authorizing transfers or changes in local
funds apply also to the Family Planning program, provided statewide
local maintenance of effort is not diminished in total.
Any statewide diminishing of total local effort for family planning and/or
any related funding penalty experienced by the Department 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
Local Health Department - 2023, Date: 08/15/2022
__________________________________________________________________________
Page: 2 of 206
DRAFT08/15/2022
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:
TIFANNY KEYES-BOWIE Accountant
___________________________________________________________________
Name Title
KEYESBOWIET@OAKGOV.COM (248) 858-0943
___________________________________________________________________
E-Mail Address Telephone No.
Local Health Department - 2023, Date: 08/15/2022
__________________________________________________________________________
Page: 3 of 206
DRAFT08/15/2022
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 Oakland County Department of Health and Human Services/ Health Division
Andrea Powers Administrator
___________________________________________________________________
Name Title
For the Michigan Department of Health and Human Services
Christine H. Sanches 08/15/2022
___________________________________________________________________
Christine H. Sanches, Director Date
Bureau of Grants and Purchasing
Local Health Department - 2023, Date: 08/15/2022
__________________________________________________________________________
Page: 4 of 206
DRAFT08/15/2022
Part 2
General Provisions
I.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 not be financed by any sources other than the
Local Health Department - 2023, Date: 08/15/2022
__________________________________________________________________________
Page: 5 of 206
DRAFT08/15/2022
Department under the terms of this Agreement. If funding is received
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.
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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
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
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(not to exceed $200,000) until the required filing is received by
the Department. The Department may retain the amount
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,
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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
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
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Agreement.
b.A criminal Proceeding;
c.A parole or probation Proceeding;
d.A Proceeding under the Sarbanes-Oxley Act;
e.A civil Proceeding involving:
A claim that might reasonably be expected to
adversely affect Grantee’s viability or financial stability;
or
1.
A governmental or public entity’s claim or written
allegation of fraud; or
2.
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
3.
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.
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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.
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
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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.
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
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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 policy, the Department will reimburse the Grantee
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.html.
c.International travel must be preapproved by the Department
and itemized in the budget.
T.Insurance Requirements
1.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
20 37 12 19.
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,
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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.
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.html
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
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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
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
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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
awards and their attendant rules, regulations and requirements pertaining to
program elements covered by this Agreement.
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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 seq.),
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 subrecipients must certify and disclose
accordingly.
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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
seq.), 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;
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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, et seq.), which requires that smoking not be
permitted in any portion of any indoor facility owned or leased or
contracted by and used routinely or regularly for the provision of health,
day care, early childhood development activities, education or library
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activities to children under the age of 18, if the activities are funded by
federal programs either directly or through state or local governments,
by federal grant, contract, loan or loan guarantee. The law also applies
to children’s 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 imposition of a civil monetary penalty of up to $1,000
for each violation and/or the imposition of an administrative compliance
order on the responsible entity. The 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
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Act of 2000 (P.L. 106-386), as amended.
This Agreement and anyone working on this Agreement will be subject to P.L.
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
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provided by the Department, the State of Michigan or the federal
government in excess of $10,000 must contain provisions or conditions
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
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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
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
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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.
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
1.The Grantee agrees that it will use confidential information solely for the
purpose of this Agreement. The Grantee agrees to hold all confidential
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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
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
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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 II. The current rates of pay for
the Executive Schedule are located on the United States Office of Personnel
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.
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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.
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
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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 Report Submission
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
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.B. and 3.C.3 of Part 1. If
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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/sigmavss
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
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
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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.
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
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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 minimis
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.
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
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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.
VIII.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
Grantee.
Amendments of a routine nature including applicable changes in budget
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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.
Grantee must appoint an agent in Michigan to receive service of process.
XIII.Funding
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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.
Local Health Department - 2023, Date: 08/15/2022
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DRAFT08/15/2022
AA Attachments
A1 Attachment I - Instructions for the Annual Budget
Attachment I - Instructions for the Annual Budget
A2 Attachment III - Program Specific Assurances and Requirements
Attachment III - Program Specific Assurances and Requirements
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICESATTACHMENT IV - Local Health Department - 2023CONTRACT MANAGEMENT SECTIONOakland County Department of Health and Human Services/ Health Division Program Element/Funding Source(a)MDHHSSourceFed/StFundingAmountReimbursementMethod(b)PerformanceTargetOutputMeasurementTotal (c)PerformExpectState (d)FundedTargetPerformState Funded MinimumPerformancePercentNumber (e)Contractor /Subrecepient(f)Adolescent STI ScreeningReg. Alloc.F73,000Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientBody Art Fixed FeeCalc. Amt.250.00/NumbersFixed Unit Rate (2)N/AN/AN/AN/AN/ARecepientChildren's Special Hlth CareServices (CSHCS) CareCoordinationCalc. Amt.150.00/VariousFixed Unit Rate (1),(7)N/AN/AN/AN/AN/ASubrecepientChildren's Special Hlth CareServices (CSHCS) Outreach &AdvocacyReg. Alloc.F147,201Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientReg. Alloc.S147,201CSHCS Medicaid Elevated BloodLead Case MgmtCalc. Amt.201.58/VariousFixed Unit Rate (2)N/AN/AN/AN/AN/ASubrecepientCSHCS Vaccine InitiativeReg. Alloc.F35,329Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientEGLE Drinking Water and OnsiteWastewater ManagementReg. Alloc.S985,042ELPHS (3), (6)N/AN/AN/AN/AN/ARecepientEmerging Threats - Hepatitis CReg. Alloc.S76,221Actual CostReimbursementN/AN/AN/AN/AN/ARecepientFetal Infant Mortality Review(FIMR) Case AbstractionCalc. Amt.270.00/VariousFixed Unit Rate (2)N/AN/AN/AN/AN/ASubrecepientFIMR InterviewsCalc. Amt.85.00/NumbersFixed Unit Rate (2),(11)N/AN/AN/AN/AN/ASubrecepientFood ELPHSReg. Alloc.S1,176,612ELPHS (3), (4)N/AN/AN/AN/AN/ARecepientGonococcal Isolate SurveillanceProjectReg. Alloc.F15,750Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientReg. Alloc.S47,250Harm Reduction Support ServicesReg. Alloc.F150,000Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientHearing ELPHSReg. Alloc.L253,969ELPHS (3), (6)N/AN/AN/AN/AN/ARecepientHIV PrEP ClinicReg. Alloc.F168,560Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientLocal Health Department - 2023, Date: 08/15/2022________________________________________________________________________________________________________________Page: 36 of 206
DRAFTContract # Date: 08/15/2022MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICESATTACHMENT IV - Local Health Department - 2023CONTRACT MANAGEMENT SECTIONOakland County Department of Health and Human Services/ Health Division Program Element/Funding Source(a)MDHHSSourceFed/StFundingAmountReimbursementMethod(b)PerformanceTargetOutputMeasurementTotal (c)PerformExpectState (d)FundedTargetPerformState Funded MinimumPerformancePercentNumber (e)Contractor /Subrecepient(f)Reg. Alloc.P1,720Reg. Alloc.S1,720HIV PreventionReg. Alloc.F22,612Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientReg. Alloc.P22,612Reg. Alloc.S407,021Immunization Action Plan (IAP)Reg. Alloc.F501,895Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientImmunization Fixed FeesCalc. Amt.300.00/NumbersFixed Unit Rate (2),(7)N/AN/AN/AN/AN/ASubrecepientImmunization Vaccine QualityAssuranceReg. Alloc.S105,347Actual CostReimbursementN/AN/AN/AN/AN/ARecepientInfant Safe SleepReg. Alloc.F7,000Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientReg. Alloc.S63,000Laboratory Services BioReg. Alloc.F500Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientMCH - All OtherReg. Alloc.F0Local MCH (3), (6)N/AN/AN/AN/AN/ASubrecepientMCH - All OtherLocal MCHS321,457Local MCH (3), (6)N/AN/AN/AN/AN/ASubrecepientMDHHS-Essential Local PublicHealth Services (ELPHS)Reg. Alloc.S2,557,216ELPHS (3),(6)N/AN/AN/AN/AN/ARecepientNurse Family PartnershipServicesReg. Alloc.F405,324Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientReg. Alloc.S270,216Oral Health- KindergartenAssessmentReg. Alloc.S110,597Actual CostReimbursementN/AN/AN/AN/AN/ARecepientPublic Health EmergencyPreparedness (PHEP) 10/1 - 6/30Reg. Alloc.F222,449Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientPublic Health EmergencyPreparedness (PHEP) CRI 10/1 -6/30Reg. Alloc.F167,007Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientLocal Health Department - 2023, Date: 08/15/2022________________________________________________________________________________________________________________Page: 37 of 206
DRAFTContract # Date: 08/15/2022MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICESATTACHMENT IV - Local Health Department - 2023CONTRACT MANAGEMENT SECTIONOakland County Department of Health and Human Services/ Health Division Program Element/Funding Source(a)MDHHSSourceFed/StFundingAmountReimbursementMethod(b)PerformanceTargetOutputMeasurementTotal (c)PerformExpectState (d)FundedTargetPerformState Funded MinimumPerformancePercentNumber (e)Contractor /Subrecepient(f)Sexually Transmitted Infection(STI) ControlReg. Alloc.F33,418Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientReg. Alloc.S703Reg. Alloc.S36,144Southeast Michigan Infant VitalityReg. Alloc.P25,000Actual CostReimbursementN/AN/AN/AN/AN/ARecepientReg. Alloc.S0Transforming Youth SuicidePreventionReg. Alloc.F60,000Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientTuberculosis (TB) ControlReg. Alloc.F13,061Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientVector-Borne Surveillance &PreventionReg. Alloc.S9,000Actual CostReimbursementN/AN/AN/AN/AN/ARecepientVision ELPHSReg. Alloc.L253,968ELPHS (3), (6)N/AN/AN/AN/AN/ARecepientWest Nile Virus CommunitySurveillanceReg. Alloc.F10,000Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientWIC BreastfeedingReg. Alloc.F261,619Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientWIC Resident ServicesReg. Alloc.F2,615,870Actual CostReimbursementN/AN/AN/AN/AN/ASubrecepientTOTAL MDHHS FUNDING11,782,611*SPECIFIC OUTPUT PERFORMANCE MEASURES WILL BE INCORPORATED VIA AMENDMENTAttachment IV NotesAttachment IV NotesLocal Health Department - 2023, Date: 08/15/2022________________________________________________________________________________________________________________Page: 38 of 206
DRAFTContract # Date: 08/15/2022
Attachment V
Oakland County FY Agreement Addendum A
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Administration
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 6,885,267.00 6,885,267.00
2 Fringe Benefits 3,593,334.00 3,593,334.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 146,794.00 146,794.00
5 Supplies and Materials 515,395.00 515,395.00
6 Travel 62,737.00 62,737.00
7 Communication 38,975.00 38,975.00
8 County-City Central Services 0.00 0.00
9 Space Costs 759,921.00 759,921.00
10 All Others (ADP, Con. Employees, Misc.)2,363,051.00 2,363,051.00
Total Program Expenses 14,365,474.00 14,365,474.00
TOTAL DIRECT EXPENSES 14,365,474.00 14,365,474.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 951,544.00 951,544.00
2 Cost Allocation Plan / Other -9,673,413.00 -9,673,413.00
Total Indirect Costs -8,721,869.00 -8,721,869.00
TOTAL INDIRECT EXPENSES -8,721,869.00 -8,721,869.00
TOTAL EXPENDITURES 5,643,605.00 5,643,605.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
523,950.00 0.00 523,950.00 0.00
Fees and Collections - 3rd Party 278,058.00 0.00 278,058.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHSComprehensive 0.00 0.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 4,841,597.00 0.00 4,841,597.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate 0.00 0.00 0.00 0.00
Total Source of Funds 5,643,605.00 0.00 5,643,605.00 0.00
Totals 5,643,605.00 0.00 5,643,605.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 6,885,267.00
2 Fringe Benefits 3,593,334.00
3 Cap. Exp. for Equip & Fac.0.00
4 Contractual 146,794.00
5 Supplies and Materials 515,395.00
6 Travel 62,737.00
7 Communication 38,975.00
8 County-City Central Services 0.00
9 Space Costs 759,921.00
10 All Others (ADP, Con. Employees, Misc.)2,363,051.00
Total Program Expenses 14,365,474.00
TOTAL DIRECT EXPENSES 14,365,474.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 951,544.00
2 Cost Allocation Plan / Other
Other Cost Distributions-Other Inf Disease/CD -1,619,159.00
Other Cost Distributions-Misc Distribution -1,910,925.00
Other Cost Distributions-SIDS fee -2,000.00
Health Adm Distribution -8,494,849.00
Other Cost Distributions-Education 2,353,520.00
Total for Cost Allocation Plan / Other -9,673,413.00
Total Indirect Costs -8,721,869.00
TOTAL INDIRECT EXPENSES -8,721,869.00
TOTAL EXPENDITURES 5,643,605.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Administration -
Environmental
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 6,348,054.00 6,348,054.00
2 Fringe Benefits 3,174,196.00 3,174,196.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 60,300.00 60,300.00
6 Travel 257,390.00 257,390.00
7 Communication 75,525.00 75,525.00
8 County-City Central Services 0.00 0.00
9 Space Costs 169,876.00 169,876.00
10 All Others (ADP, Con. Employees, Misc.)737,205.00 737,205.00
Total Program Expenses 10,822,546.00 10,822,546.00
TOTAL DIRECT EXPENSES 10,822,546.00 10,822,546.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 877,301.00 877,301.00
2 Cost Allocation Plan / Other -2,256,086.00 -2,256,086.00
Total Indirect Costs -1,378,785.00 -1,378,785.00
TOTAL INDIRECT EXPENSES -1,378,785.00 -1,378,785.00
TOTAL EXPENDITURES 9,443,761.00 9,443,761.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
1,161,687.00 0.00 1,161,687.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)2,471,296.00 0.00 2,471,296.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 0.00 0.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 5,810,778.00 0.00 5,810,778.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate 0.00 0.00 0.00 0.00
Total Source of Funds 9,443,761.00 0.00 9,443,761.00 0.00
Totals 9,443,761.00 0.00 9,443,761.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 6,348,054.00
2 Fringe Benefits 3,174,196.00
3 Cap. Exp. for Equip & Fac.0.00
4 Contractual 0.00
5 Supplies and Materials 60,300.00
6 Travel 257,390.00
7 Communication 75,525.00
8 County-City Central Services 0.00
9 Space Costs 169,876.00
10 All Others (ADP, Con. Employees, Misc.)737,205.00
Total Program Expenses 10,822,546.00
TOTAL DIRECT EXPENSES 10,822,546.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 877,301.00
2 Cost Allocation Plan / Other
EH Adm Distribtions -5,708,886.00
Other Cost Distributions-Body Art Fees -50,000.00
Health Adm Distribution 3,476,266.00
Other Cost Distributions-Misc 26,534.00
Total for Cost Allocation Plan / Other -2,256,086.00
Total Indirect Costs -1,378,785.00
TOTAL INDIRECT EXPENSES -1,378,785.00
TOTAL EXPENDITURES 9,443,761.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Adolescent STI Screening
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 35,639.00 35,639.00
2 Fringe Benefits 18,937.00 18,937.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 9,059.00 9,059.00
6 Travel 781.00 781.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)3,659.00 3,659.00
Total Program Expenses 68,075.00 68,075.00
TOTAL DIRECT EXPENSES 68,075.00 68,075.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 18,081.00 18,081.00
Total Indirect Costs 18,081.00 18,081.00
TOTAL INDIRECT EXPENSES 18,081.00 18,081.00
TOTAL EXPENDITURES 86,156.00 86,156.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 73,000.00 73,000.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 13,156.00 0.00 13,156.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 86,156.00 73,000.00 13,156.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Public Health Nurse
Notes : PH Nurse 3 R. Ross
Position P00000755
GFGP position - overtime only
Notes: This position is
responsible for testing clients in
OCJ, treatment of clients as
needed, and educational
support.
0.1087 80809.000 0.000 FTE 8,784.00
Public Health Nurse
Notes : PH Nurse 3 D. Vines
Position P00002616
GFGP Position-overtime only
Notes: This position is
responsible for testing clients in
OCJ, treatment of clients as
needed, and educational
support.
0.1082 80822.000 0.000 FTE 8,745.00
Medical Technologist
Notes : Z. Zelmanov Position
P00012305
Notes: This position is
responsible for running lab work
in OC labs from client testing.
0.1231 34656.000 0.000 FTE 4,265.00
Clerk
Notes : Office Support Clerk
Senior S. Cloutier Position
P00006538
Notes: This position is
responsible for intake paperwork,
scheduling of clients, follow-up
with nurses and clients.
0.2789 49641.000 0.000 FTE 13,845.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Total for Salary & Wages 35,639.00
2 Fringe Benefits
Composite Rate
Notes : FICA
Unemployment Insurance
Retirement Insurance
Hospital Insurance
Life Insurance
Vision Insurance
Dental Insurance
Workers Comp
Short and Long Term Disability
Insurance
0.0000 53.136 35639.000 18,937.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies
Notes : Notes: Supplies and
materials needed for general
office use such as paper, pes,
envelopes, folders, etc.
0.0000 0.000 0.000 2,110.00
Medical Supplies
Notes : Notes: lancets, blood
tubes, specimen cups, gauze,
band aids, etc for speciman
collecting and handling $167/mo
*12 months
0.0000 0.000 0.000 2,004.00
Printing
Notes : Notes: Printing costs of
service for client charts,
treatment sheets, etc
0.0000 0.000 0.000 1,300.00
Educational Supplies
Notes : Notes: Pamphlets for
client education
0.0000 0.000 0.000 3,645.00
Total for Supplies and Materials 9,059.00
6 Travel
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Mileage
Notes : 1,250 miles @ 0.625
Notes: Mileage for the two PHN
III. 0.625/mi *52mi/mo *12mos
*2PHN = appx $781.00
0.0000 0.000 0.000 781.00
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Insurance 0.0000 0.000 0.000 97.00
Advertising
Notes : Notes: Social media
postings and bilboard rental fees
0.0000 0.000 0.000 3,562.00
Total for All Others (ADP, Con. Employees, Misc.)3,659.00
Total Program Expenses 68,075.00
TOTAL DIRECT EXPENSES 68,075.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 4,925.00
Health Adm Distribution 0.0000 0.000 0.000 8,502.00
Nursing Adm Distribution 0.0000 0.000 0.000 4,654.00
Total for Cost Allocation Plan / Other 18,081.00
Total Indirect Costs 18,081.00
TOTAL INDIRECT EXPENSES 18,081.00
TOTAL EXPENDITURES 86,156.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Public Health Emergency
Preparedness (PHEP) 10/1 - 6/30
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 6/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 129,851.00 129,851.00
2 Fringe Benefits 74,897.00 74,897.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 139.00 139.00
7 Communication 2,259.00 2,259.00
8 County-City Central Services 0.00 0.00
9 Space Costs 11,671.00 11,671.00
10 All Others (ADP, Con. Employees, Misc.)8,890.00 8,890.00
Total Program Expenses 227,707.00 227,707.00
TOTAL DIRECT EXPENSES 227,707.00 227,707.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 45,486.00 45,486.00
Total Indirect Costs 45,486.00 45,486.00
TOTAL INDIRECT EXPENSES 45,486.00 45,486.00
TOTAL EXPENDITURES 273,193.00 273,193.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 22,245.00 0.00 22,245.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 222,449.00 222,449.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 28,499.00 0.00 28,499.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 273,193.00 222,449.00 50,744.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Coordinator
Notes : Vacant Position
P00003094
0.7500 73270.000 0.000 FTE 54,953.00
Public Health Educator II
Notes : Chiasson, Lyndsey
Position P00006747
0.0962 61715.000 0.000 FTE 5,937.00
Specialist
Notes : Montney, Samantha
Position P00007416
0.7500 82703.000 0.000 FTE 62,027.00
Administrator
Notes : Match $6,937
Stoddard, Sara Position
P00000936
0.0553 125463.000 0.000 FTE 6,937.00
Rounding Public Health Educator
II
1.0000 -3.000 0.000 FTE -3.00
Total for Salary & Wages 129,851.00
2 Fringe Benefits
Composite Rate
Notes : MATCH $3,637
FICA
Unemp Ins
Retirement
Hospital Ins
Life Ins
Vision Ins
Short/Long Term Disability
Dental Ins
Work Comp
0.0000 57.679 129851.000 74,897.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Mileage
Notes : 222 miles @ 0.625
0.0000 0.000 0.000 139.00
7 Communication
Telephone Communications 0.0000 0.000 0.000 2,259.00
8 County-City Central Services
9 Space Costs
Building Space Rental
Notes : MATCH $11,671
0.0000 0.000 0.000 11,671.00
10 All Others (ADP, Con. Employees, Misc.)
Insurance 0.0000 0.000 0.000 270.00
IT Operations 0.0000 0.000 0.000 8,620.00
Total for All Others (ADP, Con. Employees, Misc.)8,890.00
Total Program Expenses 227,707.00
TOTAL DIRECT EXPENSES 227,707.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 16,987.00
Health Adm Distribution 0.0000 0.000 0.000 28,499.00
Total for Cost Allocation Plan / Other 45,486.00
Total Indirect Costs 45,486.00
TOTAL INDIRECT EXPENSES 45,486.00
TOTAL EXPENDITURES 273,193.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Body Art Fixed Fee
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 0.00 0.00
2 Fringe Benefits 0.00 0.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 50,000.00 50,000.00
Total Indirect Costs 50,000.00 50,000.00
TOTAL INDIRECT EXPENSES 50,000.00 50,000.00
TOTAL EXPENDITURES 50,000.00 50,000.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 0.00 0.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 0.00 0.00 0.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Body Art Fee 50,000.00 50,000.00 0.00 0.00
Totals 50,000.00 50,000.00 0.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Distributions for Fees-from
Environmental Administration
0.0000 0.000 0.000 50,000.00
Total Indirect Costs 50,000.00
TOTAL INDIRECT EXPENSES 50,000.00
TOTAL EXPENDITURES 50,000.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Children's Special Hlth
Care Services (CSHCS) Care Coordination
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 0.00 0.00
2 Fringe Benefits 0.00 0.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 222,558.00 222,558.00
Total Indirect Costs 222,558.00 222,558.00
TOTAL INDIRECT EXPENSES 222,558.00 222,558.00
TOTAL EXPENDITURES 222,558.00 222,558.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 0.00 0.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 0.00 0.00 0.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
CSHCS Care Coordination 222,558.00 222,558.00 0.00 0.00
Totals 222,558.00 222,558.00 0.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Distributions for Fees-from
CSHCS Outreach & Advoc
0.0000 0.000 0.000 222,558.00
Total Indirect Costs 222,558.00
TOTAL INDIRECT EXPENSES 222,558.00
TOTAL EXPENDITURES 222,558.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / CSHCS Medicaid
Outreach
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 0.00 0.00
2 Fringe Benefits 0.00 0.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 270,317.00 270,317.00
Total Indirect Costs 270,317.00 270,317.00
TOTAL INDIRECT EXPENSES 270,317.00 270,317.00
TOTAL EXPENDITURES 270,317.00 270,317.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 102,301.00 102,301.00 0.00 0.00
Required Match - Local 102,301.00 0.00 102,301.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 0.00 0.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 65,715.00 0.00 65,715.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 270,317.00 102,301.00 168,016.00 0.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Distributions for Medicaid 0.0000 0.000 0.000 270,317.00
Total Indirect Costs 270,317.00
TOTAL INDIRECT EXPENSES 270,317.00
TOTAL EXPENDITURES 270,317.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / CSHCS Medicaid Elevated
Blood Lead Case Mgmt
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 0.00 0.00
2 Fringe Benefits 0.00 0.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 75,000.00 75,000.00
Total Indirect Costs 75,000.00 75,000.00
TOTAL INDIRECT EXPENSES 75,000.00 75,000.00
TOTAL EXPENDITURES 75,000.00 75,000.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 0.00 0.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 0.00 0.00 0.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
CSHCS Medicaid Elevated Blood Lead
Case
75,000.00 75,000.00 0.00 0.00
Totals 75,000.00 75,000.00 0.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Distributions for Fees-Fees
for Lead Case Mgt
Notes : $40,000 non-Medicaid
home visits
$20,000 Medicaid home visits
$15,000 CHW visits
0.0000 0.000 0.000 75,000.00
Total Indirect Costs 75,000.00
TOTAL INDIRECT EXPENSES 75,000.00
TOTAL EXPENDITURES 75,000.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Public Health Emergency
Preparedness (PHEP) CRI 10/1 - 6/30
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 6/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 103,121.00 103,121.00
2 Fringe Benefits 54,576.00 54,576.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 491.00 491.00
7 Communication 1,665.00 1,665.00
8 County-City Central Services 0.00 0.00
9 Space Costs 7,715.00 7,715.00
10 All Others (ADP, Con. Employees, Misc.)2,722.00 2,722.00
Total Program Expenses 170,290.00 170,290.00
TOTAL DIRECT EXPENSES 170,290.00 170,290.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 34,814.00 34,814.00
Total Indirect Costs 34,814.00 34,814.00
TOTAL INDIRECT EXPENSES 34,814.00 34,814.00
TOTAL EXPENDITURES 205,104.00 205,104.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 16,701.00 0.00 16,701.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 167,007.00 167,007.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 21,396.00 0.00 21,396.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 205,104.00 167,007.00 38,097.00 0.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Specialist
Notes : Emergency
Preparedness Specialist
T. Bravender Position
P00009999
0.7500 85934.000 0.000 FTE 64,451.00
Chief Admin Services - MATCH
Notes : S.Stoddard Position
P00000936
0.0481 125405.000 0.000 FTE 6,032.00
Health Educator
Notes : Public Heatlh Educator II
L. Chiasson Position P00006747
0.5289 61709.000 0.000 FTE 32,638.00
Total for Salary & Wages 103,121.00
2 Fringe Benefits
Composite Rate
Notes : MATCH $2,954
FICA
Unemp Ins
Retirement
Hospital Insurance
Life Insurance
Vision Ins.
Short/Long Term Disability
Dental Insurance
Work Comp
0.0000 52.924 103121.000 54,576.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
Mileage
Notes : 785 x 0..625 per mile
0.0000 0.000 0.000 491.00
7 Communication
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Telephone 0.0000 0.000 0.000 1,665.00
8 County-City Central Services
9 Space Costs
Space/Rental Costs
Notes : MATCH $7,715
0.0000 0.000 0.000 7,715.00
10 All Others (ADP, Con. Employees, Misc.)
Insurance 0.0000 0.000 0.000 207.00
IT Operations 0.0000 0.000 0.000 2,515.00
Total for All Others (ADP, Con. Employees, Misc.)2,722.00
Total Program Expenses 170,290.00
TOTAL DIRECT EXPENSES 170,290.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 13,418.00
Health Adm Distribution 0.0000 0.000 0.000 21,396.00
Total for Cost Allocation Plan / Other 34,814.00
Total Indirect Costs 34,814.00
TOTAL INDIRECT EXPENSES 34,814.00
TOTAL EXPENDITURES 205,104.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Children's Special Hlth
Care Services (CSHCS) Outreach & Advocacy
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 272,756.00 272,756.00
2 Fringe Benefits 113,445.00 113,445.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 6,441.00 6,441.00
6 Travel 2,563.00 2,563.00
7 Communication 4,608.00 4,608.00
8 County-City Central Services 0.00 0.00
9 Space Costs 27,088.00 27,088.00
10 All Others (ADP, Con. Employees, Misc.)52,364.00 52,364.00
Total Program Expenses 479,265.00 479,265.00
TOTAL DIRECT EXPENSES 479,265.00 479,265.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other -184,863.00 -184,863.00
Total Indirect Costs -184,863.00 -184,863.00
TOTAL INDIRECT EXPENSES -184,863.00 -184,863.00
TOTAL EXPENDITURES 294,402.00 294,402.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 294,402.00 294,402.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 0.00 0.00 0.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 294,402.00 294,402.00 0.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Public Health Nurse
Notes : PHN 3
A. Troostwijik Position
P00005163
0.4808 73995.000 0.000 FTE 35,577.00
Auxillary Health Clerk
Notes : P. Lewis-Jones Position
P00007839
0.4808 49648.000 0.000 FTE 23,871.00
Clerk
Notes : PH Clerk 2
V. Arrowsmith Position
P00006824
1.0000 46052.000 0.000 FTE 46,052.00
Clerk
Notes : PH Clerk 2
B. Smith Position P00005129
1.0000 47851.000 0.000 FTE 47,851.00
Clerk
Notes : Office Support Clerk
S. Doll Position P00012442
0.4808 45034.000 0.000 FTE 21,651.00
Supervisor
Notes : PHN Supervisor
E. Bauer Position P00005130
1.0000 95740.000 0.000 FTE 95,740.00
OCHD Staff - Overtime Various
positions
1.0000 2014.000 0.000 2,014.00
Total for Salary & Wages 272,756.00
2 Fringe Benefits
Composite Rate
Notes : FICA
Unemployment Insurance
Retirement Insurance
Hospital Insurance
Life Insurance
Vision Insurance
Dental Insurance
Workers Comp
0.0000 41.592 272756.000 113,445.00
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Line Item Qty Rate Units UOM Total
Short and Long Term Disability
Insurance
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 2,000.00
Postage 0.0000 0.000 0.000 3,441.00
Printing 0.0000 0.000 0.000 1,000.00
Total for Supplies and Materials 6,441.00
6 Travel
Mileage
Notes : 2,500 miles @.0.625
0.0000 0.000 0.000 1,563.00
Conferences 0.0000 0.000 0.000 1,000.00
Total for Travel 2,563.00
7 Communication
Telephone 0.0000 0.000 0.000 4,608.00
8 County-City Central Services
9 Space Costs
Building Space Rental 0.0000 0.000 0.000 27,088.00
10 All Others (ADP, Con. Employees, Misc.)
IT Print Services 0.0000 0.000 0.000 5,728.00
Insurance 0.0000 0.000 0.000 800.00
IT Operations 0.0000 0.000 0.000 45,836.00
Total for All Others (ADP, Con. Employees, Misc.)52,364.00
Total Program Expenses 479,265.00
TOTAL DIRECT EXPENSES 479,265.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
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Line Item Qty Rate Units UOM Total
2 Cost Allocation Plan / Other
Other Cost Distributions-CSHCS
Care Coor Fees
0.0000 0.000 0.000 -222,558.00
Health Adm Distribution 0.0000 0.000 0.000 60,294.00
Other Cost Distributions-Nursing
Staff
0.0000 0.000 0.000 177,057.00
Nursing Adm Distribution 0.0000 0.000 0.000 32,966.00
Other Cost Distributions-CSHCS
- Medicaid Outreach
0.0000 0.000 0.000 -270,317.00
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 37,695.00
Total for Cost Allocation Plan / Other -184,863.00
Total Indirect Costs -184,863.00
TOTAL INDIRECT EXPENSES -184,863.00
TOTAL EXPENDITURES 294,402.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / CSHCS Vaccine Initiative
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 17,491.00 17,491.00
2 Fringe Benefits 8,410.00 8,410.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 4,000.00 4,000.00
6 Travel 2,261.00 2,261.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)750.00 750.00
Total Program Expenses 32,912.00 32,912.00
TOTAL DIRECT EXPENSES 32,912.00 32,912.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 6,532.00 6,532.00
Total Indirect Costs 6,532.00 6,532.00
TOTAL INDIRECT EXPENSES 6,532.00 6,532.00
TOTAL EXPENDITURES 39,444.00 39,444.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 35,329.00 35,329.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 4,115.00 0.00 4,115.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 39,444.00 35,329.00 4,115.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Supervisor
Notes : TBD
0.0264 84205.000 0.000 FTE 2,223.00
Case Manager
Notes : TBD
0.0313 76869.000 0.000 FTE 2,406.00
Case Manager
Notes : TBD
0.0313 76869.000 0.000 FTE 2,406.00
Case Manager
Notes : TBD
0.0313 76869.000 0.000 FTE 2,406.00
Case Manager
Notes : TBD
0.0313 76869.000 0.000 FTE 2,406.00
Case Manager
Notes : TBD
0.0313 76869.000 0.000 FTE 2,406.00
Office Support Clerk Senior
Notes : TBD
0.0385 42890.000 0.000 FTE 1,650.00
Office Support Clerk Senior
Notes : TBD
0.0385 41247.000 0.000 FTE 1,588.00
Total for Salary & Wages 17,491.00
2 Fringe Benefits
Composite Rate
Notes : FICA
UNEMPLOYMENT INS
RETIREMENT
HOSPITAL INS
LIFE INS
VISION INS
DENTAL INS
WORK COMP
SHORT AND LONG TERM
DISABILITY
0.0000 48.080 17491.000 8,410.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Office Supplies 0.0000 0.000 0.000 1,500.00
Materials and Supplies 0.0000 0.000 0.000 500.00
Postage 0.0000 0.000 0.000 500.00
Printing 0.0000 0.000 0.000 300.00
Educational Supplies 0.0000 0.000 0.000 500.00
Outreach (Incentives)0.0000 0.000 0.000 500.00
Medical Supplies 0.0000 0.000 0.000 200.00
Total for Supplies and Materials 4,000.00
6 Travel
Mileage
Notes : 0.625 per mile x 2,600
miles
0.0000 0.000 0.000 1,625.00
Conferences 0.0000 0.000 0.000 636.00
Total for Travel 2,261.00
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Interpretation Fees 0.0000 0.000 0.000 250.00
Advertising 0.0000 0.000 0.000 500.00
Total for All Others (ADP, Con. Employees, Misc.)750.00
Total Program Expenses 32,912.00
TOTAL DIRECT EXPENSES 32,912.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 2,417.00
Health Adm Distribution 0.0000 0.000 0.000 4,115.00
Total for Cost Allocation Plan / Other 6,532.00
Total Indirect Costs 6,532.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
TOTAL INDIRECT EXPENSES 6,532.00
TOTAL EXPENDITURES 39,444.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Emerging Threats -
Hepatitis C
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 31,663.00 31,663.00
2 Fringe Benefits 17,848.00 17,848.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 9,205.00 9,205.00
6 Travel 2,000.00 2,000.00
7 Communication 336.00 336.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)10,793.00 10,793.00
Total Program Expenses 71,845.00 71,845.00
TOTAL DIRECT EXPENSES 71,845.00 71,845.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 13,253.00 13,253.00
Total Indirect Costs 13,253.00 13,253.00
TOTAL INDIRECT EXPENSES 13,253.00 13,253.00
TOTAL EXPENDITURES 85,098.00 85,098.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 76,221.00 76,221.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 8,877.00 0.00 8,877.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 85,098.00 76,221.00 8,877.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Public Health Nurse
Notes : Vacant Position
P00007565
0.4800 65964.000 0.000 FTE 31,663.00
2 Fringe Benefits
Composite Rate
Notes : Fica
Unemp Ins
Retirement
Hosp Ins
Life Ins
Vision Ins
Dental Ins
Work Comp
Short/Long Term Disability
0.0000 56.369 31663.000 17,848.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Postage 0.0000 0.000 0.000 830.00
Office Supplies 0.0000 0.000 0.000 1,475.00
Printing 0.0000 0.000 0.000 1,200.00
Educational Supplies 0.0000 0.000 0.000 1,200.00
Incentives 0.0000 0.000 0.000 2,500.00
Computer Supplies 0.0000 0.000 0.000 500.00
Medical Supplies 0.0000 0.000 0.000 1,500.00
Total for Supplies and Materials 9,205.00
6 Travel
Mileage
Notes : 1,600 miles @ 0.625 per
mile
0.0000 0.000 0.000 1,000.00
Conferences 0.0000 0.000 0.000 1,000.00
Total for Travel 2,000.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
7 Communication
Telephone Communications 0.0000 0.000 0.000 336.00
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
IT Operations 0.0000 0.000 0.000 6,520.00
Insurance 0.0000 0.000 0.000 101.00
Interpretation Fees 0.0000 0.000 0.000 250.00
Advertising 0.0000 0.000 0.000 2,922.00
Lab Fees 0.0000 0.000 0.000 1,000.00
Total for All Others (ADP, Con. Employees, Misc.)10,793.00
Total Program Expenses 71,845.00
TOTAL DIRECT EXPENSES 71,845.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 4,376.00
Health Adm Distribution 0.0000 0.000 0.000 8,877.00
Total for Cost Allocation Plan / Other 13,253.00
Total Indirect Costs 13,253.00
TOTAL INDIRECT EXPENSES 13,253.00
TOTAL EXPENDITURES 85,098.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Fetal Infant Mortality
Review (FIMR) Case Abstraction
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 0.00 0.00
2 Fringe Benefits 0.00 0.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 6,480.00 6,480.00
Total Indirect Costs 6,480.00 6,480.00
TOTAL INDIRECT EXPENSES 6,480.00 6,480.00
TOTAL EXPENDITURES 6,480.00 6,480.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 0.00 0.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 0.00 0.00 0.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Fetal Infant Mortality Review 6,480.00 6,480.00 0.00 0.00
Totals 6,480.00 6,480.00 0.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Distributions for Fees-FIMR
Cases
Notes : Cost Distribution for
FIMR fees from Community
Nursing
0.0000 0.000 0.000 6,480.00
Total Indirect Costs 6,480.00
TOTAL INDIRECT EXPENSES 6,480.00
TOTAL EXPENDITURES 6,480.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Food ELPHS
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 0.00 0.00
2 Fringe Benefits 0.00 0.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 4,759,872.00 4,759,872.00
Total Indirect Costs 4,759,872.00 4,759,872.00
TOTAL INDIRECT EXPENSES 4,759,872.00 4,759,872.00
TOTAL EXPENDITURES 4,759,872.00 4,759,872.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
1,595,710.00 0.00 1,595,710.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 1,176,612.00 1,176,612.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 1,987,550.00 0.00 1,987,550.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 4,759,872.00 1,176,612.00 3,583,260.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Environmental Hlth Adm
Distribution
0.0000 0.000 0.000 3,494,106.00
Health Adm Distribution 0.0000 0.000 0.000 1,265,766.00
Total for Cost Allocation Plan / Other 4,759,872.00
Total Indirect Costs 4,759,872.00
TOTAL INDIRECT EXPENSES 4,759,872.00
TOTAL EXPENDITURES 4,759,872.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Gonococcal Isolate
Surveillance Project
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 32,258.00 32,258.00
2 Fringe Benefits 18,356.00 18,356.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 3,829.00 3,829.00
6 Travel 4,015.00 4,015.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)84.00 84.00
Total Program Expenses 58,542.00 58,542.00
TOTAL DIRECT EXPENSES 58,542.00 58,542.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 15,813.00 15,813.00
Total Indirect Costs 15,813.00 15,813.00
TOTAL INDIRECT EXPENSES 15,813.00 15,813.00
TOTAL EXPENDITURES 74,355.00 74,355.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 63,000.00 63,000.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 11,355.00 0.00 11,355.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 74,355.00 63,000.00 11,355.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Public Health Nurse
Notes : PH Nurse 3 F. McClish
Position P00002147
This position is responsible for
the preparation & collection of
GISP, N. gonorrhoeae
specimens and result reporting of
specimens collected in Oakland
County Health Division's STI
clinics.
0.1995 80841.000 0.000 16,129.00
Public Health Nurse
Notes : PH Nurse 3 M. McCarthy
Position P00001122
This position is responsible for
the preparation & collection of
GISP, N. gonorrhoeae
specimens and result reporting of
specimens collected in Oakland
County Health Division's STI
clinics.
0.1995 80841.000 0.000 16,129.00
Total for Salary & Wages 32,258.00
2 Fringe Benefits
Composite Rate
Notes : FICA
Unemployment Insurance
Retirement Insurance
Hospital Insurance
Life Insurance
Vision Insurance
Dental Insurance
Workers Comp
Short and Long Term Disability
0.0000 56.903 32258.000 18,356.00
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Line Item Qty Rate Units UOM Total
Insurance
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Lab Supplies
Notes : Purchase of supplies
necessary for all services related
directly to the GISP: MTM
plates, chocolate plates,
disposable transfer pipets, KWIK
sticks for QC organisms, culture
loops, 2 ml tubes for freezing
broth, Tsoy broth, cryo pens,
NAAT urine and swab collection
kits
0.0000 0.000 0.000 3,829.00
6 Travel
Conferences
Notes : Education
seminars/webinars for clinic and
lab staff related to GISP, N.
gonorrhoeae specimen
collection, treatment & clinical
updates.
0.0000 0.000 0.000 4,015.00
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Insurance 0.0000 0.000 0.000 84.00
Total Program Expenses 58,542.00
TOTAL DIRECT EXPENSES 58,542.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 4,458.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Health Adm Distribution 0.0000 0.000 0.000 7,338.00
Nursing Adm Distribution 0.0000 0.000 0.000 4,017.00
Total for Cost Allocation Plan / Other 15,813.00
Total Indirect Costs 15,813.00
TOTAL INDIRECT EXPENSES 15,813.00
TOTAL EXPENDITURES 74,355.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Hearing ELPHS
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 373,696.00 373,696.00
2 Fringe Benefits 111,152.00 111,152.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 10,114.00 10,114.00
6 Travel 7,058.00 7,058.00
7 Communication 1,033.00 1,033.00
8 County-City Central Services 0.00 0.00
9 Space Costs 16,695.00 16,695.00
10 All Others (ADP, Con. Employees, Misc.)9,124.00 9,124.00
Total Program Expenses 528,872.00 528,872.00
TOTAL DIRECT EXPENSES 528,872.00 528,872.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 515,869.00 515,869.00
Total Indirect Costs 515,869.00 515,869.00
TOTAL INDIRECT EXPENSES 515,869.00 515,869.00
TOTAL EXPENDITURES 1,044,741.00 1,044,741.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 253,969.00 253,969.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 790,772.00 0.00 790,772.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 1,044,741.00 253,969.00 790,772.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Supervisor
Notes : L. Covarubbias Postion
P00001402
1.0000 68041.000 0.000 FTE 68,041.00
Technician
Notes : C. Sinacola Position
P00000631
0.4808 44249.000 0.000 FTE 21,275.00
Technician
Notes : C. Whitt Postion
P00012314
0.2404 40655.000 0.000 FTE 9,773.00
Technician
Notes : T. Spedding Position
P00012320
0.3365 40660.000 0.000 FTE 13,682.00
Technician
Notes : Vacant Poistion
P00012321
0.3966 37058.000 0.000 FTE 14,698.00
Technician
Notes : Vacant Poistioin
P00012322
0.3365 37058.000 0.000 FTE 12,471.00
Technician
Notes : C. Vieregge Position
P00012323
0.4808 40655.000 0.000 FTE 19,546.00
Technician
Notes : A.Lynch Position
P000000642
0.4808 44249.000 0.000 FTE 21,275.00
Technician
Notes : D. Roeder Position
P00010837
0.4808 47847.000 0.000 FTE 23,005.00
Technician
Notes : K. McPherson Position
P00010838
0.4808 38856.000 0.000 FTE 18,681.00
Technician
Notes : Vacant Position
P00010841
0.4808 37058.000 0.000 FTE 17,816.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Technician
Notes : A. Moellenhoff Position
P00010842
0.4808 38856.000 0.000 FTE 18,681.00
Coordinator
Notes : D. Ferber Position
P00001917
0.5000 103219.000 0.000 FTE 51,610.00
Auxillary Health Clerk
Notes : BJ. Wright Position
P00006736
0.7000 54739.000 0.000 FTE 38,317.00
Office Support Clerk Senior
Notes : K. Dabrowski Position
P00002891
0.5000 49650.000 0.000 FTE 24,825.00
Total for Salary & Wages 373,696.00
2 Fringe Benefits
Composite Rate
Notes : FICA
UNEMPLOYMENT INS
RETIREMENT
HOSPITAL INS
LIFE INS
VISION INS
DENTAL INS
WORK COMP
SHORT/LONG TERM
DISABILITY
0.0000 29.744 373696.000 111,152.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 941.00
Printing 0.0000 0.000 0.000 2,353.00
Postage 0.0000 0.000 0.000 6,820.00
Total for Supplies and Materials 10,114.00
6 Travel
Personal Mileage
Notes : 0.625 PER MILE
0.0000 0.000 0.000 7,058.00
7 Communication
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Telephone 0.0000 0.000 0.000 1,033.00
8 County-City Central Services
9 Space Costs
Space/Rental Costs 0.0000 0.000 0.000 16,695.00
10 All Others (ADP, Con. Employees, Misc.)
IT Print Services 0.0000 0.000 0.000 300.00
Insurance 0.0000 0.000 0.000 1,130.00
Equipment Repair 0.0000 0.000 0.000 2,635.00
Staff Training 0.0000 0.000 0.000 2,588.00
Interpreter Fees 0.0000 0.000 0.000 118.00
Expendable Equipment 0.0000 0.000 0.000 2,353.00
Total for All Others (ADP, Con. Employees, Misc.)9,124.00
Total Program Expenses 528,872.00
TOTAL DIRECT EXPENSES 528,872.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 51,645.00
Health Adm Distribution 0.0000 0.000 0.000 67,612.00
Other Cost Distributions-Misc
Distributions
0.0000 0.000 0.000 396,612.00
Total for Cost Allocation Plan / Other 515,869.00
Total Indirect Costs 515,869.00
TOTAL INDIRECT EXPENSES 515,869.00
TOTAL EXPENDITURES 1,044,741.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / HIV PrEP Clinic
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 63,983.00 63,983.00
2 Fringe Benefits 26,234.00 26,234.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 29,801.00 29,801.00
6 Travel 7,000.00 7,000.00
7 Communication 1,920.00 1,920.00
8 County-City Central Services 0.00 0.00
9 Space Costs 10,000.00 10,000.00
10 All Others (ADP, Con. Employees, Misc.)24,220.00 24,220.00
Total Program Expenses 163,158.00 163,158.00
TOTAL DIRECT EXPENSES 163,158.00 163,158.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 39,842.00 39,842.00
Total Indirect Costs 39,842.00 39,842.00
TOTAL INDIRECT EXPENSES 39,842.00 39,842.00
TOTAL EXPENDITURES 203,000.00 203,000.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 172,000.00 172,000.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 31,000.00 0.00 31,000.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 203,000.00 172,000.00 31,000.00 0.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Specialist
Notes : Clinical Health Specialist
R. Nzoma Position P00012443
0.1154 97306.000 0.000 FTE 11,228.00
Nurse
Notes : PH Nurse III E. Swank-
Schreffler Position P00006100
1.0000 52755.000 0.000 FTE 52,755.00
Total for Salary & Wages 63,983.00
2 Fringe Benefits
Composite Rate
Notes : Fica, Unemp Ins,
Retirement, Hospital Ins, Life Ins,
Vision Ins, Dental Ins,
Workcomp, Short/Long Term
Disability
0.0000 41.002 63983.000 26,234.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 3,500.00
Printing 0.0000 0.000 0.000 6,500.00
Drugs 0.0000 0.000 0.000 5,000.00
Medical Supplies 0.0000 0.000 0.000 6,605.00
Incentives - Gas cards 0.0000 0.000 0.000 2,500.00
Lab Supplies 0.0000 0.000 0.000 1,290.00
Educational Supplies 0.0000 0.000 0.000 3,500.00
Postage 0.0000 0.000 0.000 906.00
Total for Supplies and Materials 29,801.00
6 Travel
Mileage
Notes : 0.625 per mile x 3,200
miles
0.0000 0.000 0.000 2,000.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Client Transportation 0.0000 0.000 0.000 2,500.00
Conferences 0.0000 0.000 0.000 2,500.00
Total for Travel 7,000.00
7 Communication
Telephone Communications 0.0000 0.000 0.000 1,920.00
8 County-City Central Services
9 Space Costs
Space/Rental Costs 0.0000 0.000 0.000 10,000.00
10 All Others (ADP, Con. Employees, Misc.)
Insurance 0.0000 0.000 0.000 164.00
IT Operations 0.0000 0.000 0.000 13,056.00
Managed Print Services 0.0000 0.000 0.000 500.00
Interpretation 0.0000 0.000 0.000 500.00
Professional Services 0.0000 0.000 0.000 10,000.00
Total for All Others (ADP, Con. Employees, Misc.)24,220.00
Total Program Expenses 163,158.00
TOTAL DIRECT EXPENSES 163,158.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 8,842.00
Health Adm Distribution 0.0000 0.000 0.000 20,033.00
Nursing Adm Distribution 0.0000 0.000 0.000 10,967.00
Total for Cost Allocation Plan / Other 39,842.00
Total Indirect Costs 39,842.00
TOTAL INDIRECT EXPENSES 39,842.00
TOTAL EXPENDITURES 203,000.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / HIV Prevention
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 247,192.00 247,192.00
2 Fringe Benefits 115,884.00 115,884.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 7,085.00 7,085.00
6 Travel 8,200.00 8,200.00
7 Communication 3,108.00 3,108.00
8 County-City Central Services 0.00 0.00
9 Space Costs 10,276.00 10,276.00
10 All Others (ADP, Con. Employees, Misc.)26,338.00 26,338.00
Total Program Expenses 418,083.00 418,083.00
TOTAL DIRECT EXPENSES 418,083.00 418,083.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 87,297.00 87,297.00
Total Indirect Costs 87,297.00 87,297.00
TOTAL INDIRECT EXPENSES 87,297.00 87,297.00
TOTAL EXPENDITURES 505,380.00 505,380.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 452,245.00 452,245.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 53,135.00 0.00 53,135.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 505,380.00 452,245.00 53,135.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Coordinator
Notes : Health Program
Coordinator
E. Trepkowski Position
P00006426
1.0000 90231.000 0.000 FTE 90,231.00
Clerk
Notes : Office Support Clerk
Senior
S. Cloutier Position P00006538
0.7211 49653.000 0.000 FTE 35,805.00
Public Health Nurse
Notes : Public Health Nurse III
J. Lombardi-Perwerton Position
P00007557
0.3750 80841.000 0.000 FTE 30,315.00
Public Health Nurse
Notes : Public Heath Nurse III
L. Drouillard Position P00009668
1.0000 80841.000 0.000 FTE 80,841.00
OCHD Staff Overtime - various
positions
1.0000 10000.000 0.000 FTE 10,000.00
Total for Salary & Wages 247,192.00
2 Fringe Benefits
Composite Rate
Notes : FICA
Unemployment Insurance
Retirement Insurance
Hospital Insurance
Life Insurance
Vision Insurance
Dental Insurance
Workers Comp
Short and Long Term Disability
0.0000 46.880 247192.000 115,884.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Insurance
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 2,459.00
Medical Supplies 0.0000 0.000 0.000 1,125.00
Postage 0.0000 0.000 0.000 1,000.00
Printing 0.0000 0.000 0.000 500.00
Incentives 0.0000 0.000 0.000 500.00
Training-Ed Supplies 0.0000 0.000 0.000 1,501.00
Total for Supplies and Materials 7,085.00
6 Travel
Mileage
Notes : 4,800 miles @ 0.625
0.0000 0.000 0.000 3,000.00
Client Transportation 0.0000 0.000 0.000 3,000.00
Conferences 0.0000 0.000 0.000 2,200.00
Total for Travel 8,200.00
7 Communication
Telephone 0.0000 0.000 0.000 3,108.00
8 County-City Central Services
9 Space Costs
Space/Rental Costs 0.0000 0.000 0.000 10,276.00
10 All Others (ADP, Con. Employees, Misc.)
IT Operations 0.0000 0.000 0.000 19,131.00
IT Mangaged Print Svcs 0.0000 0.000 0.000 4,152.00
Insurance 0.0000 0.000 0.000 1,055.00
Interpretation 0.0000 0.000 0.000 200.00
Professional Services - TLO 0.0000 0.000 0.000 1,800.00
Total for All Others (ADP, Con. Employees, Misc.)26,338.00
Total Program Expenses 418,083.00
TOTAL DIRECT EXPENSES 418,083.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 34,162.00
Health Adm Distribution 0.0000 0.000 0.000 53,135.00
Total for Cost Allocation Plan / Other 87,297.00
Total Indirect Costs 87,297.00
TOTAL INDIRECT EXPENSES 87,297.00
TOTAL EXPENDITURES 505,380.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Harm Reduction Support
Services
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 0.00 0.00
2 Fringe Benefits 0.00 0.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 12,071.00 12,071.00
6 Travel 1,000.00 1,000.00
7 Communication 4,157.00 4,157.00
8 County-City Central Services 0.00 0.00
9 Space Costs 36,000.00 36,000.00
10 All Others (ADP, Con. Employees, Misc.)96,772.00 96,772.00
Total Program Expenses 150,000.00 150,000.00
TOTAL DIRECT EXPENSES 150,000.00 150,000.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 17,470.00 17,470.00
Total Indirect Costs 17,470.00 17,470.00
TOTAL INDIRECT EXPENSES 17,470.00 17,470.00
TOTAL EXPENDITURES 167,470.00 167,470.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 150,000.00 150,000.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 17,470.00 0.00 17,470.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 167,470.00 150,000.00 17,470.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 2,500.00
Computer Supplies 0.0000 0.000 0.000 500.00
Materials and Supplies 0.0000 0.000 0.000 3,000.00
Postage 0.0000 0.000 0.000 71.00
Printing 0.0000 0.000 0.000 1,500.00
Medical Supplies 0.0000 0.000 0.000 3,500.00
Educational Supplies 0.0000 0.000 0.000 500.00
Gas Cards 0.0000 0.000 0.000 500.00
Total for Supplies and Materials 12,071.00
6 Travel
Transportation of Clients 0.0000 0.000 0.000 1,000.00
7 Communication
Telephone Communications 0.0000 0.000 0.000 1,416.00
WiFi 0.0000 0.000 0.000 2,741.00
Total for Communication 4,157.00
8 County-City Central Services
9 Space Costs
Rent 0.0000 0.000 0.000 33,600.00
Building Space Rental
(Electrical)
0.0000 0.000 0.000 2,400.00
Total for Space Costs 36,000.00
10 All Others (ADP, Con. Employees, Misc.)
Professional Services 0.0000 0.000 0.000 86,600.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
IT Operations 0.0000 0.000 0.000 5,112.00
Interpretation Fees 0.0000 0.000 0.000 500.00
IT Print Managed Services 0.0000 0.000 0.000 1,200.00
Laundry and Cleaning 0.0000 0.000 0.000 3,360.00
Total for All Others (ADP, Con. Employees, Misc.)96,772.00
Total Program Expenses 150,000.00
TOTAL DIRECT EXPENSES 150,000.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Health Adm Distribution 0.0000 0.000 0.000 17,470.00
Total Indirect Costs 17,470.00
TOTAL INDIRECT EXPENSES 17,470.00
TOTAL EXPENDITURES 167,470.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Immunization Action Plan
(IAP)
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 291,569.00 291,569.00
2 Fringe Benefits 154,234.00 154,234.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 9,086.00 9,086.00
6 Travel 6,125.00 6,125.00
7 Communication 3,432.00 3,432.00
8 County-City Central Services 0.00 0.00
9 Space Costs 7,914.00 7,914.00
10 All Others (ADP, Con. Employees, Misc.)19,240.00 19,240.00
Total Program Expenses 491,600.00 491,600.00
TOTAL DIRECT EXPENSES 491,600.00 491,600.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 106,157.00 106,157.00
Total Indirect Costs 106,157.00 106,157.00
TOTAL INDIRECT EXPENSES 106,157.00 106,157.00
TOTAL EXPENDITURES 597,757.00 597,757.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)30,000.00 0.00 30,000.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 501,895.00 501,895.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 65,862.00 0.00 65,862.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 597,757.00 501,895.00 95,862.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Coordinator
Notes : Health Program
Coodinator
L. Martin Position P00002070
1.0000 93623.000 0.000 FTE 93,623.00
Coordinator
Notes : Vaccine Supply
Coordinator
S. Crottie Position P00007559
1.0000 60350.000 0.000 FTE 60,350.00
Public Health Nurse
Notes : C. NDukwe Position
P00007413
0.4808 68211.000 0.000 FTE 32,796.00
Office Leader
Notes : J. Vermilya Position
P00007414
1.0000 52132.000 0.000 FTE 52,132.00
Clerk
Notes : Office Support Clerk
Senior
M. Rompa Position P00007415
1.0000 49650.000 0.000 FTE 49,650.00
Coordinator
Notes : Vaccine Supply
Coordinator
I. Highfield Position P00002436
0.0500 60350.000 0.000 FTE 3,018.00
Total for Salary & Wages 291,569.00
2 Fringe Benefits
Composite Rate
Notes : FICA
Unemployment Insurance
Retirement Insurance
Hospital Insurance
Life Insurance
Vision Insurance
Dental Insurance
Workers Comp
Short and Long Term Disability
0.0000 52.898 291569.000 154,234.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Insurance
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 3,126.00
Postage 0.0000 0.000 0.000 2,000.00
Printing 0.0000 0.000 0.000 2,000.00
Educational Supplies 0.0000 0.000 0.000 1,960.00
Total for Supplies and Materials 9,086.00
6 Travel
Mileage
Notes : 5,000 miles @ 0.625
0.0000 0.000 0.000 3,125.00
Conferences 0.0000 0.000 0.000 3,000.00
Total for Travel 6,125.00
7 Communication
Telephone 0.0000 0.000 0.000 3,432.00
8 County-City Central Services
9 Space Costs
Building Space Rental 0.0000 0.000 0.000 7,914.00
10 All Others (ADP, Con. Employees, Misc.)
Convenience Copier 0.0000 0.000 0.000 3,860.00
IT Operations 0.0000 0.000 0.000 13,132.00
Insurance 0.0000 0.000 0.000 1,248.00
Professional Services - Econtrol 0.0000 0.000 0.000 1,000.00
Total for All Others (ADP, Con. Employees, Misc.)19,240.00
Total Program Expenses 491,600.00
TOTAL DIRECT EXPENSES 491,600.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Other Cost Distributions-Nurse
Train/VFC/AFIX
0.0000 0.000 0.000 -30,000.00
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 40,295.00
Health Adm Distribution 0.0000 0.000 0.000 61,949.00
Nursing Adm Distribution 0.0000 0.000 0.000 33,913.00
Total for Cost Allocation Plan / Other 106,157.00
Total Indirect Costs 106,157.00
TOTAL INDIRECT EXPENSES 106,157.00
TOTAL EXPENDITURES 597,757.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Infant Safe Sleep
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 11,314.00 11,314.00
2 Fringe Benefits 4,962.00 4,962.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 35,825.00 35,825.00
6 Travel 3,700.00 3,700.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)12,635.00 12,635.00
Total Program Expenses 68,436.00 68,436.00
TOTAL DIRECT EXPENSES 68,436.00 68,436.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 14,180.00 14,180.00
Total Indirect Costs 14,180.00 14,180.00
TOTAL INDIRECT EXPENSES 14,180.00 14,180.00
TOTAL EXPENDITURES 82,616.00 82,616.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 70,000.00 70,000.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 12,616.00 0.00 12,616.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 82,616.00 70,000.00 12,616.00 0.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Health Educator
Notes : PH Educator III M.
McClain Position P00006735
Step 4 GFGP
0.0769 69168.000 0.000 FTE 5,319.00
PH Chief
Notes : L. Hahn Position
P00000733
Step 5 GFGP
0.0077 108380.000 0.000 FTE 834.00
Supervisor
Notes : PH Nursing Supervisor
D. Roth Position P00006865
0.0500 103219.000 0.000 FTE 5,161.00
Total for Salary & Wages 11,314.00
2 Fringe Benefits
Composite Rate
Notes : FICA
Unemployment Ins
Retirement Ins
Hospital Ins
Life Ins
Vision Ins
Dental Ins
Workers Comp
Short/Long Terms Disability Ins
0.0000 43.857 11314.000 4,962.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Printing
Notes : “We print a significant
quantity of locally developed
client education materials and
distribute them to 15,000+ WIC
0.0000 0.000 0.000 16,000.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
clients annually, as well as our
other community outreach.”
Materials and Supplies 0.0000 0.000 0.000 500.00
Office Supplies 0.0000 0.000 0.000 225.00
Educational Supplies
Notes : hand sanitizer, pens,
stress balls, and water bottles
0.0000 0.000 0.000 14,200.00
Incentives
Notes : Pack n plays and sleep
sacks/onesies
0.0000 0.000 0.000 4,900.00
Total for Supplies and Materials 35,825.00
6 Travel
Conferences
Notes : May include safe sleep,
breastfeeding or smoking
cessation
0.0000 0.000 0.000 3,700.00
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Advertising 0.0000 0.000 0.000 3,500.00
Insurance 0.0000 0.000 0.000 200.00
Training
Notes : CLC, IBCLC or other
breastfeeding, or smoking
cessation
0.0000 0.000 0.000 5,000.00
Interpretation Fees 0.0000 0.000 0.000 583.00
IT Operations 0.0000 0.000 0.000 3,352.00
Total for All Others (ADP, Con. Employees, Misc.)12,635.00
Total Program Expenses 68,436.00
TOTAL DIRECT EXPENSES 68,436.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 1,564.00
Health Adm Distribution 0.0000 0.000 0.000 8,153.00
Nursing Adm Distribution 0.0000 0.000 0.000 4,463.00
Total for Cost Allocation Plan / Other 14,180.00
Total Indirect Costs 14,180.00
TOTAL INDIRECT EXPENSES 14,180.00
TOTAL EXPENDITURES 82,616.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Laboratory Services Bio
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 0.00 0.00
2 Fringe Benefits 0.00 0.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 500.00 500.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
Total Program Expenses 500.00 500.00
TOTAL DIRECT EXPENSES 500.00 500.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 58.00 58.00
Total Indirect Costs 58.00 58.00
TOTAL INDIRECT EXPENSES 58.00 58.00
TOTAL EXPENDITURES 558.00 558.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 500.00 500.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 58.00 0.00 58.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 558.00 500.00 58.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Lab supplies 0.0000 0.000 0.000 500.00
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Total Program Expenses 500.00
TOTAL DIRECT EXPENSES 500.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 58.00
Total Indirect Costs 58.00
TOTAL INDIRECT EXPENSES 58.00
TOTAL EXPENDITURES 558.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Nurse Family Partnership
Services
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 379,334.00 379,334.00
2 Fringe Benefits 198,505.00 198,505.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 24,000.00 24,000.00
5 Supplies and Materials 6,750.00 6,750.00
6 Travel 5,512.00 5,512.00
7 Communication 3,000.00 3,000.00
8 County-City Central Services 0.00 0.00
9 Space Costs 18,941.00 18,941.00
10 All Others (ADP, Con. Employees, Misc.)29,110.00 29,110.00
Total Program Expenses 665,152.00 665,152.00
TOTAL DIRECT EXPENSES 665,152.00 665,152.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 132,139.00 132,139.00
Total Indirect Costs 132,139.00 132,139.00
TOTAL INDIRECT EXPENSES 132,139.00 132,139.00
TOTAL EXPENDITURES 797,291.00 797,291.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 675,540.00 675,540.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 121,751.00 0.00 121,751.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 797,291.00 675,540.00 121,751.00 0.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Public Health Nurse
Notes : A. Varela Position
P00003427
0.2500 80841.000 0.000 FTE 20,210.00
Public Health Nurse
Notes : S. Martinez Position
P00000906
1.0000 80841.000 0.000 FTE 80,841.00
Public Health Nurse
Notes : T, Gordon Position
P00003107
1.0000 80841.000 0.000 FTE 80,841.00
Public Health Nurse
Notes : M. Reader Position
P00003183
0.5000 80841.000 0.000 FTE 40,421.00
Public Health Nurse
Notes : K. Smedley Positon
P00000752
1.0000 80841.000 0.000 FTE 80,841.00
OVERTIME PHN
Notes : Overtime (PHNs)
1.0000 1012.000 0.000 FTE 1,012.00
Coordinator
Notes : M. Maloff Position
P00004736
0.8029 93623.000 0.000 FTE 75,170.00
Rounding Coordinator 1.0000 -2.000 0.000 FTE -2.00
Total for Salary & Wages 379,334.00
2 Fringe Benefits
Composite Rate
Notes : Fica
Unemp Ins
Retirement
Hosp Ins
Life Ins
Vision Ins
Dental Ins
Work Comp
Short/Long Term Disability
0.0000 52.330 379334.000 198,505.00
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Line Item Qty Rate Units UOM Total
3 Cap. Exp. for Equip & Fac.
4 Contractual
NFP Nurse Consultation 0.0000 0.000 0.000 24,000.00
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 2,200.00
Client Support Materials
(Incentives)
0.0000 0.000 0.000 1,750.00
Educational Supplies 0.0000 0.000 0.000 1,500.00
Printing 0.0000 0.000 0.000 250.00
Postage 0.0000 0.000 0.000 1,050.00
Total for Supplies and Materials 6,750.00
6 Travel
Mileage
Notes : 8,000 miles @ .625
0.0000 0.000 0.000 5,000.00
Conferences 0.0000 0.000 0.000 512.00
Total for Travel 5,512.00
7 Communication
Telephone Communications 0.0000 0.000 0.000 3,000.00
8 County-City Central Services
9 Space Costs
Building Space Rental 0.0000 0.000 0.000 18,941.00
10 All Others (ADP, Con. Employees, Misc.)
Insurance 0.0000 0.000 0.000 1,600.00
IT Managed Print Services 0.0000 0.000 0.000 7,860.00
IT Operations-laptops 0.0000 0.000 0.000 18,400.00
Staff Training 0.0000 0.000 0.000 750.00
Translation and Interpretation 0.0000 0.000 0.000 500.00
Total for All Others (ADP, Con. Employees, Misc.)29,110.00
Total Program Expenses 665,152.00
TOTAL DIRECT EXPENSES 665,152.00
INDIRECT EXPENSES
Indirect Costs
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
1 Indirect Costs
2 Cost Allocation Plan / Other
Health Adm Distribution 0.0000 0.000 0.000 78,679.00
Nursing Adm Distribution 0.0000 0.000 0.000 43,072.00
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 10,388.00
Total for Cost Allocation Plan / Other 132,139.00
Total Indirect Costs 132,139.00
TOTAL INDIRECT EXPENSES 132,139.00
TOTAL EXPENDITURES 797,291.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Oral Health- Kindergarten
Assessment
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 52,453.00 52,453.00
2 Fringe Benefits 15,680.00 15,680.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 18,000.00 18,000.00
6 Travel 1,582.00 1,582.00
7 Communication 1,300.00 1,300.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)14,333.00 14,333.00
Total Program Expenses 103,348.00 103,348.00
TOTAL DIRECT EXPENSES 103,348.00 103,348.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 20,130.00 20,130.00
Total Indirect Costs 20,130.00 20,130.00
TOTAL INDIRECT EXPENSES 20,130.00 20,130.00
TOTAL EXPENDITURES 123,478.00 123,478.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 110,597.00 110,597.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 12,881.00 0.00 12,881.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 123,478.00 110,597.00 12,881.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Dental Hygenienist
Notes : TBD-Vacant
0.4808 60062.000 0.000 28,878.00
Dental Hygenienist
Notes : L.Dobias
0.3606 65377.000 0.000 23,575.00
Total for Salary & Wages 52,453.00
2 Fringe Benefits
Composite Rate
Notes : FICA
UNEMPLOYMENT INS
RETIREMENT
HOSPITAL INS
LIFE INS
VISION INS
DENTAL INS
WORK COMP
SHORT AND LONG TERM
DISABILITY
0.0000 29.893 52453.000 15,680.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 1,000.00
Postage 0.0000 0.000 0.000 2,000.00
Printing 0.0000 0.000 0.000 5,000.00
Medical Supplies 0.0000 0.000 0.000 10,000.00
Total for Supplies and Materials 18,000.00
6 Travel
Mileage
Notes : 2,531 miles * 0.625 per
mile
0.0000 0.000 0.000 1,582.00
7 Communication
Telephone Communications 0.0000 0.000 0.000 1,300.00
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Line Item Qty Rate Units UOM Total
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Insurance 0.0000 0.000 0.000 457.00
Interpretation Fees 0.0000 0.000 0.000 2,000.00
Advertising 0.0000 0.000 0.000 3,500.00
IT Operations 0.0000 0.000 0.000 3,376.00
Staff Training 0.0000 0.000 0.000 5,000.00
Total for All Others (ADP, Con. Employees, Misc.)14,333.00
Total Program Expenses 103,348.00
TOTAL DIRECT EXPENSES 103,348.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 7,249.00
Health Adm Distribution 0.0000 0.000 0.000 12,881.00
Total for Cost Allocation Plan / Other 20,130.00
Total Indirect Costs 20,130.00
TOTAL INDIRECT EXPENSES 20,130.00
TOTAL EXPENDITURES 123,478.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Medicaid Outreach
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 494,900.00 494,900.00
2 Fringe Benefits 277,144.00 277,144.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 28,401.00 28,401.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
Total Program Expenses 800,445.00 800,445.00
TOTAL DIRECT EXPENSES 800,445.00 800,445.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 169,588.00 169,588.00
Total Indirect Costs 169,588.00 169,588.00
TOTAL INDIRECT EXPENSES 169,588.00 169,588.00
TOTAL EXPENDITURES 970,033.00 970,033.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 434,420.00 434,420.00 0.00 0.00
Required Match - Local 434,420.00 0.00 434,420.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 0.00 0.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 101,193.00 0.00 101,193.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 970,033.00 434,420.00 535,613.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Multiple positons
Notes : Amount determined
based on time studies.
1.0000 494900.000 0.000 FTE 494,900.00
2 Fringe Benefits
Composite Rate
Notes : FICA
UNEMPLOY
RETIREMENT
HOSPITAL
LIFE INSURANCE
VISION
DENTAL
WORKERS COMP
SHORT/LONG TERM
DISABILITY
0.0000 56.000 494900.000 277,144.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
Office Space Rental 0.0000 0.000 0.000 28,401.00
10 All Others (ADP, Con. Employees, Misc.)
Total Program Expenses 800,445.00
TOTAL DIRECT EXPENSES 800,445.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 68,395.00
Health Adm Distribution 0.0000 0.000 0.000 101,193.00
Total for Cost Allocation Plan / Other 169,588.00
Total Indirect Costs 169,588.00
TOTAL INDIRECT EXPENSES 169,588.00
TOTAL EXPENDITURES 970,033.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / MCH - All Other
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 178,137.00 178,137.00
2 Fringe Benefits 101,419.00 101,419.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 9,934.00 9,934.00
6 Travel 3,875.00 3,875.00
7 Communication 1,500.00 1,500.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)7,560.00 7,560.00
Total Program Expenses 302,425.00 302,425.00
TOTAL DIRECT EXPENSES 302,425.00 302,425.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 4,358,427.00 4,358,427.00
Total Indirect Costs 4,358,427.00 4,358,427.00
TOTAL INDIRECT EXPENSES 4,358,427.00 4,358,427.00
TOTAL EXPENDITURES 4,660,852.00 4,660,852.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 0.00 0.00 0.00 0.00
MCH Funding 321,457.00 321,457.00 0.00 0.00
Local Funds - Other 4,339,395.00 0.00 4,339,395.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 4,660,852.00 321,457.00 4,339,395.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Nutritionist/Dietician
Notes : M. Blesch Position
P00005401
1.0000 80874.000 0.000 FTE 80,874.00
Public Health Nurse
Notes : A. Varela Position
P00003427
0.6400 80841.000 0.000 FTE 51,738.00
Public Health Nurse
Notes : M. Reader Position
P00003183
0.5000 80841.000 0.000 FTE 40,421.00
OVERTIME 1.0000 5106.000 0.000 FTE 5,106.00
Rounding - PHN 1.0000 -2.000 0.000 FTE -2.00
Total for Salary & Wages 178,137.00
2 Fringe Benefits
Composite Rate
Notes : FICA, LIFE INS,
DENTAL, UNEMPLOYMENT,
VISION, WORK COMP,
RETIREMENT,
HOSPITALIZATION,
SHORT/LONG TERM
DISABILITY
0.0000 56.933 178137.000 101,419.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 234.00
Printing 0.0000 0.000 0.000 200.00
Educational Supplies 0.0000 0.000 0.000 2,622.00
Breast feeding Supplies 0.0000 0.000 0.000 6,878.00
Total for Supplies and Materials 9,934.00
6 Travel
Mileage 0.0000 0.000 0.000 3,875.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Notes : 6,200 miles * 0.625 per
mile
7 Communication
Telephone 0.0000 0.000 0.000 1,500.00
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Info Tech Operations 0.0000 0.000 0.000 3,260.00
Interpretation Fees 0.0000 0.000 0.000 3,500.00
Insurance 0.0000 0.000 0.000 800.00
Total for All Others (ADP, Con. Employees, Misc.)7,560.00
Total Program Expenses 302,425.00
TOTAL DIRECT EXPENSES 302,425.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 19,032.00
Health Adm Distribution 0.0000 0.000 0.000 39,036.00
Other Cost Distributions-Nursing
Notes : This distribution takes
total costs of Field Nursing and
allocates them back to various
cost centers by a time study.
The % back to MCH is 50.644%
0.0000 0.000 0.000 4,229,656.00
Nursing Adm Distribution 0.0000 0.000 0.000 20,587.00
Other Cost Distributions-
Education
Notes : this distribution takes
total costs of Education and
allocates them back to various
cost centers by a time study.
The % back to MCH is 1.545%
0.0000 0.000 0.000 50,116.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Total for Cost Allocation Plan / Other 4,358,427.00
Total Indirect Costs 4,358,427.00
TOTAL INDIRECT EXPENSES 4,358,427.00
TOTAL EXPENDITURES 4,660,852.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / MDHHS-Essential Local
Public Health Services (ELPHS)
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 0.00 0.00
2 Fringe Benefits 0.00 0.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 8,176,518.00 8,176,518.00
Total Indirect Costs 8,176,518.00 8,176,518.00
TOTAL INDIRECT EXPENSES 8,176,518.00 8,176,518.00
TOTAL EXPENDITURES 8,176,518.00 8,176,518.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 698,350.00 0.00 698,350.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 2,557,216.00 2,557,216.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 4,920,952.00 0.00 4,920,952.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 8,176,518.00 2,557,216.00 5,619,302.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Health Adm Distribution 0.0000 0.000 0.000 198,288.00
Nursing Adm Distribution 0.0000 0.000 0.000 170,003.00
Other Cost Distributions-MISC
Distributions
0.0000 0.000 0.000 5,490,718.00
Federally Provided Vaccines 0.0000 0.000 0.000 698,350.00
Other Cost Distributions-Non
Community Water & Std
0.0000 0.000 0.000 1,619,159.00
Total for Cost Allocation Plan / Other 8,176,518.00
Total Indirect Costs 8,176,518.00
TOTAL INDIRECT EXPENSES 8,176,518.00
TOTAL EXPENDITURES 8,176,518.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Southeast Michigan Infant
Vitality
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 14,954.00 14,954.00
2 Fringe Benefits 3,278.00 3,278.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 4,201.00 4,201.00
6 Travel 500.00 500.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
Total Program Expenses 22,933.00 22,933.00
TOTAL DIRECT EXPENSES 22,933.00 22,933.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 4,979.00 4,979.00
Total Indirect Costs 4,979.00 4,979.00
TOTAL INDIRECT EXPENSES 4,979.00 4,979.00
TOTAL EXPENDITURES 27,912.00 27,912.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 25,000.00 25,000.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 2,912.00 0.00 2,912.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 27,912.00 25,000.00 2,912.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Epidemiologist
Notes : L. Fink Position
P00014522
0.0500 99479.000 0.000 4,974.00
Health Educator
Notes : PH Educator 2 D.
McCree Position P00012437
0.1500 66536.000 0.000 9,980.00
Total for Salary & Wages 14,954.00
2 Fringe Benefits
Composite Rate
Notes : FICA
UNEMPLOYMENT INS
RETIREMENT
HOSPITAL INS
LIFE INS
VISION INS
DENTAL INS
WORK COMP
SHORT AND LONG TERM
DISABILITY
0.0000 21.921 14954.000 3,278.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 250.00
Postage 0.0000 0.000 0.000 250.00
Printing 0.0000 0.000 0.000 500.00
Educational Supplies 0.0000 0.000 0.000 2,201.00
Materials and Supplies 0.0000 0.000 0.000 1,000.00
Total for Supplies and Materials 4,201.00
6 Travel
Mileage
Notes : 800 miles @ 0.625 per
0.0000 0.000 0.000 500.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
mile
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Total Program Expenses 22,933.00
TOTAL DIRECT EXPENSES 22,933.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 2,067.00
Health Adm Distribution 0.0000 0.000 0.000 2,912.00
Total for Cost Allocation Plan / Other 4,979.00
Total Indirect Costs 4,979.00
TOTAL INDIRECT EXPENSES 4,979.00
TOTAL EXPENDITURES 27,912.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / FIMR Interviews
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 0.00 0.00
2 Fringe Benefits 0.00 0.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 2,000.00 2,000.00
Total Indirect Costs 2,000.00 2,000.00
TOTAL INDIRECT EXPENSES 2,000.00 2,000.00
TOTAL EXPENDITURES 2,000.00 2,000.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 0.00 0.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 0.00 0.00 0.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Sudden Infant Death Syndrome Fees 2,000.00 2,000.00 0.00 0.00
Totals 2,000.00 2,000.00 0.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Health Adm Distribution
Notes : Cost Distributions for
FIMR Interviews (SIDS) Fees
from Health Adminstration
0.0000 0.000 0.000 2,000.00
Total Indirect Costs 2,000.00
TOTAL INDIRECT EXPENSES 2,000.00
TOTAL EXPENDITURES 2,000.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Sexually Transmitted
Infection (STI) Control
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 41,002.00 41,002.00
2 Fringe Benefits 23,597.00 23,597.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
Total Program Expenses 64,599.00 64,599.00
TOTAL DIRECT EXPENSES 64,599.00 64,599.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 17,968.00 17,968.00
Total Indirect Costs 17,968.00 17,968.00
TOTAL INDIRECT EXPENSES 17,968.00 17,968.00
TOTAL EXPENDITURES 82,567.00 82,567.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 70,265.00 70,265.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 12,302.00 0.00 12,302.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 82,567.00 70,265.00 12,302.00 0.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Medical Technologist
Notes : P. Lafroy-Wolff Position
P00002106
Medical Technologist: This
position is responsible for the
preparation, analysis and result
reporting of specimens collected
in Oakland County Health
Division's STI clinics.
0.5070 80874.000 0.000 FTE 41,002.00
2 Fringe Benefits
Composite Rate
Notes : FICA
Unemployment Insurance
Retirement Insurance
Hospital Insurance
Life Insurance
Vision Insurance
Dental Insurance
Workers Comp
Short and Long Term Disability
Insurance
0.0000 57.551 41002.000 23,597.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Total Program Expenses 64,599.00
TOTAL DIRECT EXPENSES 64,599.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Health Adm Distribution 0.0000 0.000 0.000 12,302.00
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 5,666.00
Total for Cost Allocation Plan / Other 17,968.00
Total Indirect Costs 17,968.00
TOTAL INDIRECT EXPENSES 17,968.00
TOTAL EXPENDITURES 82,567.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Tuberculosis (TB) Control
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 0.00 0.00
2 Fringe Benefits 0.00 0.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 81,600.00 81,600.00
6 Travel 950.00 950.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)39,592.00 39,592.00
Total Program Expenses 122,142.00 122,142.00
TOTAL DIRECT EXPENSES 122,142.00 122,142.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 177,162.00 177,162.00
Total Indirect Costs 177,162.00 177,162.00
TOTAL INDIRECT EXPENSES 177,162.00 177,162.00
TOTAL EXPENDITURES 299,304.00 299,304.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 13,061.00 13,061.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 286,243.00 0.00 286,243.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 299,304.00 13,061.00 286,243.00 0.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Client Supp Material/Incentives
Enablers
Notes : TB GRANT
0.0000 0.000 0.000 1,000.00
Postage
Notes : TB GRANT
0.0000 0.000 0.000 200.00
Medical Supplies
Notes : TB GRANT
0.0000 0.000 0.000 100.00
Office Supplies
Notes : TB GRANT
0.0000 0.000 0.000 300.00
Drugs
Notes : COUNTY BUDGET
0.0000 0.000 0.000 80,000.00
Total for Supplies and Materials 81,600.00
6 Travel
Client Transportation
Notes : TB GRANT
0.0000 0.000 0.000 200.00
Conferences
Notes : TB GRANT
0.0000 0.000 0.000 750.00
Total for Travel 950.00
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Lab Fees
Notes : TB GRANT $3,251.00
COUNTY BUDGET $8,000.00
0.0000 0.000 0.000 11,251.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
IT Print Services
Notes : COUNTY BUDGET
0.0000 0.000 0.000 71.00
Memberships & Dues
Notes : COUNTY BUDGET
0.0000 0.000 0.000 760.00
Professional Services
Notes : COUNTY BUDGET
0.0000 0.000 0.000 10,250.00
TB Cases/Outside
Notes : COUNTY BUDGET
0.0000 0.000 0.000 10,000.00
Translation & Interpretation
Notes : TB GRANT
0.0000 0.000 0.000 300.00
Software Support Maintenance
Notes : TB GRANT
0.0000 0.000 0.000 6,960.00
Total for All Others (ADP, Con. Employees, Misc.)39,592.00
Total Program Expenses 122,142.00
TOTAL DIRECT EXPENSES 122,142.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Health Adm Distribution 0.0000 0.000 0.000 17,125.00
Nursing Adm Distribution 0.0000 0.000 0.000 16,169.00
Other Cost Distributions-Misc
Distribution
0.0000 0.000 0.000 143,868.00
Total for Cost Allocation Plan / Other 177,162.00
Total Indirect Costs 177,162.00
TOTAL INDIRECT EXPENSES 177,162.00
TOTAL EXPENDITURES 299,304.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Transforming Youth
Suicide Prevention
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 37,473.00 37,473.00
2 Fringe Benefits 2,057.00 2,057.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 6,860.00 6,860.00
6 Travel 506.00 506.00
7 Communication 540.00 540.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)7,385.00 7,385.00
Total Program Expenses 54,821.00 54,821.00
TOTAL DIRECT EXPENSES 54,821.00 54,821.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 12,167.00 12,167.00
Total Indirect Costs 12,167.00 12,167.00
TOTAL INDIRECT EXPENSES 12,167.00 12,167.00
TOTAL EXPENDITURES 66,988.00 66,988.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 60,000.00 60,000.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 6,988.00 0.00 6,988.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 66,988.00 60,000.00 6,988.00 0.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Health Educator
Notes : PH Educator III K.
Polmear Position P00015437
1.0000 37473.000 0.000 37,473.00
2 Fringe Benefits
Composite Rate
Notes : FICA
UNEMPLOYMENT INS
RETIREMENT
HOSPITAL INS
LIFE INS
VISION INS
DENTAL INS
WORK COMP
SHORT AND LONG TERM
DISABILITY
0.0000 5.490 37473.000 2,057.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 10.00
Printing 0.0000 0.000 0.000 1,250.00
Materials and Supplies 0.0000 0.000 0.000 1,550.00
Educational Supplies 0.0000 0.000 0.000 3,650.00
Incentives 0.0000 0.000 0.000 400.00
Total for Supplies and Materials 6,860.00
6 Travel
Mileage
Notes : 250 miles @ 0.625 per
mile
0.0000 0.000 0.000 156.00
Conferences 0.0000 0.000 0.000 350.00
Total for Travel 506.00
7 Communication
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Telephone Communications 0.0000 0.000 0.000 540.00
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
IT Operations 0.0000 0.000 0.000 3,352.00
Insurance 0.0000 0.000 0.000 250.00
Advertising 0.0000 0.000 0.000 1,733.00
Workshops and Meetings 0.0000 0.000 0.000 50.00
Staff Training 0.0000 0.000 0.000 2,000.00
Total for All Others (ADP, Con. Employees, Misc.)7,385.00
Total Program Expenses 54,821.00
TOTAL DIRECT EXPENSES 54,821.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 5,179.00
Health Adm Distribution 0.0000 0.000 0.000 6,988.00
Total for Cost Allocation Plan / Other 12,167.00
Total Indirect Costs 12,167.00
TOTAL INDIRECT EXPENSES 12,167.00
TOTAL EXPENDITURES 66,988.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Vector-Borne Surveillance
& Prevention
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 4/1/2023 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 5,155.00 5,155.00
2 Fringe Benefits 2,169.00 2,169.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 150.00 150.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)814.00 814.00
Total Program Expenses 8,288.00 8,288.00
TOTAL DIRECT EXPENSES 8,288.00 8,288.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 1,760.00 1,760.00
Total Indirect Costs 1,760.00 1,760.00
TOTAL INDIRECT EXPENSES 1,760.00 1,760.00
TOTAL EXPENDITURES 10,048.00 10,048.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 9,000.00 9,000.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 1,048.00 0.00 1,048.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 10,048.00 9,000.00 1,048.00 0.00
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3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Sanitarian
Notes : Senior PH Sanitarian J.
Jacobs Position P00006721
0.0207 90096.000 0.000 FTE 1,865.00
Sanitarian
Notes : PH Sanitarian C. Dunaj
Position P00002965
0.0288 66319.000 0.000 FTE 1,910.00
Supervisor
Notes : Program Supervisor D.
McArthur/J. McCloskey Position
P000123006/P00012307
0.0200 49624.000 0.000 FTE 992.00
Epidemiologist
Notes : M. Swain Position
P00007258
0.0048 80780.000 0.000 FTE 388.00
Total for Salary & Wages 5,155.00
2 Fringe Benefits
Composite Rate
Notes : FICA
Unemp Ins
Retirement
Hospital Insurance
Life Insurance
Vision Ins.
Short/Long Term Disability
Dental Insurance
Work Comp
0.0000 42.076 5155.000 2,169.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 150.00
6 Travel
7 Communication
8 County-City Central Services
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Line Item Qty Rate Units UOM Total
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Insurance 0.0000 0.000 0.000 14.00
Percentage of Motor Pool
Charges
0.0000 0.000 0.000 800.00
Total for All Others (ADP, Con. Employees, Misc.)814.00
Total Program Expenses 8,288.00
TOTAL DIRECT EXPENSES 8,288.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 712.00
Health Adm Distribution 0.0000 0.000 0.000 1,048.00
Total for Cost Allocation Plan / Other 1,760.00
Total Indirect Costs 1,760.00
TOTAL INDIRECT EXPENSES 1,760.00
TOTAL EXPENDITURES 10,048.00
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1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Immunization Fixed Fees
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 0.00 0.00
2 Fringe Benefits 0.00 0.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 30,000.00 30,000.00
Total Indirect Costs 30,000.00 30,000.00
TOTAL INDIRECT EXPENSES 30,000.00 30,000.00
TOTAL EXPENDITURES 30,000.00 30,000.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 0.00 0.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 0.00 0.00 0.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
IMM: VFC - AFIX Visits 30,000.00 30,000.00 0.00 0.00
Totals 30,000.00 30,000.00 0.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Distributions for Fees-from
IAP
0.0000 0.000 0.000 30,000.00
Total Indirect Costs 30,000.00
TOTAL INDIRECT EXPENSES 30,000.00
TOTAL EXPENDITURES 30,000.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Vision ELPHS
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 432,252.00 432,252.00
2 Fringe Benefits 113,393.00 113,393.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 11,381.00 11,381.00
6 Travel 7,942.00 7,942.00
7 Communication 1,163.00 1,163.00
8 County-City Central Services 0.00 0.00
9 Space Costs 18,789.00 18,789.00
10 All Others (ADP, Con. Employees, Misc.)10,265.00 10,265.00
Total Program Expenses 595,185.00 595,185.00
TOTAL DIRECT EXPENSES 595,185.00 595,185.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 532,627.00 532,627.00
Total Indirect Costs 532,627.00 532,627.00
TOTAL INDIRECT EXPENSES 532,627.00 532,627.00
TOTAL EXPENDITURES 1,127,812.00 1,127,812.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 253,968.00 253,968.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 873,844.00 0.00 873,844.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 1,127,812.00 253,968.00 873,844.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Supervisor
Notes : S. Jodway Position
P00011503
1.0000 65382.000 0.000 FTE 65,382.00
Technician
Notes : E. James Position
P00000632
0.4808 44254.000 0.000 FTE 21,276.00
Technician
Notes : T. Alcocer Position
P00000633
0.4808 49646.000 0.000 FTE 23,870.00
Technician
Notes : Vacant Position
P00000634
0.4808 37058.000 0.000 FTE 17,816.00
Technician
Notes : K. Ferrell Position
P00000636
0.4808 38856.000 0.000 FTE 18,681.00
Technician
Notes : T. Pechy Position
P0012316
0.4086 46057.000 0.000 FTE 18,819.00
Technician
Notes : N. Hall Position
P00012317
0.4087 44247.000 0.000 FTE 18,084.00
Technician
Notes : L. Arden Position
P00012318
0.4087 44247.000 0.000 FTE 18,084.00
Technician
Notes : M. O'Connell Position
P00012319
0.3606 40655.000 0.000 FTE 14,659.00
Technician
Notes : K. Peterson Position
P00000639
0.4808 40655.000 0.000 FTE 19,546.00
Technician
Notes : Vacant Position
P00000644
0.4808 37058.000 0.000 FTE 17,816.00
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Line Item Qty Rate Units UOM Total
Technician
Notes : Vacant Position
P00012315
0.2404 37058.000 0.000 FTE 8,908.00
Technician
Notes : K. Shepard Position
P00003672
0.4808 44254.000 0.000 FTE 21,276.00
Technician
Notes : Vacant Position
P00010836
0.4808 37058.000 0.000 FTE 17,816.00
Technician
Notes : Vacant Position
P00010839
0.4808 37058.000 0.000 FTE 17,816.00
Technician
Notes : K. Buchler Position
P00010840
0.4808 40655.000 0.000 FTE 19,546.00
Coordinator
Notes : D. Ferber Position
P00001917
0.5000 103219.000 0.000 FTE 51,610.00
Auxillary Health Clerk
Notes : BJ Wright Position
P00006736
0.3000 54739.000 0.000 FTE 16,422.00
Office Support Senior
Notes : K. Dabrowski Position
P00002891
0.5000 49650.000 0.000 FTE 24,825.00
Total for Salary & Wages 432,252.00
2 Fringe Benefits
Composite Rate
Notes : FICA
UNEMPLOYMENT INS
RETIREMENT
HOSPITAL INS
LIFE INS
VISION INS
HEARING INS
DENTAL INS
WORK COMP
SHORT/LONG TERM
DISABILITY
0.0000 26.233 432252.000 113,393.00
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Line Item Qty Rate Units UOM Total
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 1,059.00
Printing 0.0000 0.000 0.000 2,647.00
Postage 0.0000 0.000 0.000 7,675.00
Total for Supplies and Materials 11,381.00
6 Travel
Personal Mileage
Notes : 12,707 miles @ .625
0.0000 0.000 0.000 7,942.00
7 Communication
Telephone 0.0000 0.000 0.000 1,163.00
8 County-City Central Services
9 Space Costs
Space/Rental Costs 0.0000 0.000 0.000 18,789.00
10 All Others (ADP, Con. Employees, Misc.)
Staff Training 0.0000 0.000 0.000 2,912.00
Equipment Repair 0.0000 0.000 0.000 2,965.00
IT Print Services 0.0000 0.000 0.000 338.00
Insurance 0.0000 0.000 0.000 1,271.00
Interpreter Fees 0.0000 0.000 0.000 132.00
Expendable Equipment 0.0000 0.000 0.000 2,647.00
Total for All Others (ADP, Con. Employees, Misc.)10,265.00
Total Program Expenses 595,185.00
TOTAL DIRECT EXPENSES 595,185.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 59,737.00
Health Adm Distribution 0.0000 0.000 0.000 76,278.00
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Line Item Qty Rate Units UOM Total
Other Cost Distributions-Misc
Distribution
0.0000 0.000 0.000 396,612.00
Total for Cost Allocation Plan / Other 532,627.00
Total Indirect Costs 532,627.00
TOTAL INDIRECT EXPENSES 532,627.00
TOTAL EXPENDITURES 1,127,812.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / Immunization Vaccine
Quality Assurance
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 2,413,509.00 2,413,509.00
2 Fringe Benefits 1,208,198.00 1,208,198.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 1,324,246.00 1,324,246.00
6 Travel 8,000.00 8,000.00
7 Communication 28,289.00 28,289.00
8 County-City Central Services 0.00 0.00
9 Space Costs 245,706.00 245,706.00
10 All Others (ADP, Con. Employees, Misc.)310,374.00 310,374.00
Total Program Expenses 5,538,322.00 5,538,322.00
TOTAL DIRECT EXPENSES 5,538,322.00 5,538,322.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other -4,202,475.00 -4,202,475.00
Total Indirect Costs -4,202,475.00 -4,202,475.00
TOTAL INDIRECT EXPENSES -4,202,475.00 -4,202,475.00
TOTAL EXPENDITURES 1,335,847.00 1,335,847.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
1,145,500.00 0.00 1,145,500.00 0.00
Fees and Collections - 3rd Party 85,000.00 0.00 85,000.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 105,347.00 105,347.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 0.00 0.00 0.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 1,335,847.00 105,347.00 1,230,500.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Coordinator
Notes : VQA GRANT
Vaccine Supply Coordinator
L. HIghfield Position P00002436
0.9500 60350.000 0.000 FTE 57,333.00
PH Clinic Nurses-COUNTY
BUDGET
1.0000 2356176.000 0.000 FTE 2,356,176.00
Total for Salary & Wages 2,413,509.00
2 Fringe Benefits
Composite Rate
Notes : FICA
Unemployment Insurance
Retirement Insurance
Hospital Insurance
Life Insurance
Vision Insurance
Dental Insurance
Workers Comp
Short and Long Term Disability
Insurance
VQA GRANT
0.0000 68.340 57333.000 39,181.00
Composite Rate - COUNTY
BUDGET
Notes : FICA
Unemployment Insurance
Retirement Insurance
Hospital Insurance
Life Insurance
Vision Insurance
Dental Insurance
Workers Comp
Short and Long Term Disability
Insurance
0.0000 49.615 2356176.00
0
1,169,017.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Total for Fringe Benefits 1,208,198.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Drugs/Vaccines-COUNTY
BUDGET
0.0000 0.000 0.000 1,239,285.00
Medical Supply-COUNTY
BUDGET
0.0000 0.000 0.000 70,200.00
Office Supplies-COUNTY
BUDGET
0.0000 0.000 0.000 10,000.00
Postage-COUNTY BUDGET 0.0000 0.000 0.000 100.00
Printing-COUNTY BUDGET 0.0000 0.000 0.000 3,900.00
Materials & Supplies
Notes : VQA GRANT
0.0000 0.000 0.000 761.00
Total for Supplies and Materials 1,324,246.00
6 Travel
Mileage
Notes : COUNTY BUDGET
0.625 per mile
0.0000 0.000 0.000 7,000.00
Conferences
Notes : COUNTY BUDGET
0.0000 0.000 0.000 1,000.00
Total for Travel 8,000.00
7 Communication
Telephone-COUNTY BUDGET 0.0000 0.000 0.000 28,289.00
8 County-City Central Services
9 Space Costs
Space/Rental Costs
Notes : COUNTY BUDGET
0.0000 0.000 0.000 245,706.00
10 All Others (ADP, Con. Employees, Misc.)
Insurance
Notes : VQA GRANT
0.0000 0.000 0.000 149.00
Insurance
Notes : COUNTY BUDGET
0.0000 0.000 0.000 9,536.00
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Line Item Qty Rate Units UOM Total
Professional Services-COUNTY
BUDGET
0.0000 0.000 0.000 1,500.00
IT Oper-COUNTY BUDGET 0.0000 0.000 0.000 207,968.00
Staff Training
Notes : COUNTY BUDGET
0.0000 0.000 0.000 200.00
Laundry-COUNTY BUDGET 0.0000 0.000 0.000 1,500.00
Uniforms-COUNTY BUDGET
Notes : COUNTY BUDGET
0.0000 0.000 0.000 81,359.00
Interpreter Fees - COUNTY
BUDGET
Notes : COUNTY BUDGET
0.0000 0.000 0.000 5,000.00
Equipment Rental - COUNTY
BUDGET
0.0000 0.000 0.000 840.00
IT Managed Print Svs - COUNTY
BUDGET
0.0000 0.000 0.000 2,322.00
Total for All Others (ADP, Con. Employees, Misc.)310,374.00
Total Program Expenses 5,538,322.00
TOTAL DIRECT EXPENSES 5,538,322.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : VQA GRANT 13.82%
0.0000 0.000 0.000 7,923.00
Cost Allocation Plan
Notes : 13.82% COUNTY
BUDGET
0.0000 0.000 0.000 325,624.00
Health Adm Distribution 0.0000 0.000 0.000 683,888.00
Nursing Adm Distribution 0.0000 0.000 0.000 374,388.00
Other Cost Distributions-Misc
Distributions
0.0000 0.000 0.000 -5,594,298.00
Total for Cost Allocation Plan / Other -4,202,475.00
Total Indirect Costs -4,202,475.00
TOTAL INDIRECT EXPENSES -4,202,475.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
TOTAL EXPENDITURES 1,335,847.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / WIC Breastfeeding
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 94,851.00 94,851.00
2 Fringe Benefits 66,458.00 66,458.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 84,867.00 84,867.00
5 Supplies and Materials 98.00 98.00
6 Travel 125.00 125.00
7 Communication 1,300.00 1,300.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)812.00 812.00
Total Program Expenses 248,511.00 248,511.00
TOTAL DIRECT EXPENSES 248,511.00 248,511.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 43,578.00 43,578.00
Total Indirect Costs 43,578.00 43,578.00
TOTAL INDIRECT EXPENSES 43,578.00 43,578.00
TOTAL EXPENDITURES 292,089.00 292,089.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 261,619.00 261,619.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 30,470.00 0.00 30,470.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 292,089.00 261,619.00 30,470.00 0.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Lactation Specialist
Notes : T. Brickey Position
P00011579
1.0000 39994.000 0.000 FTE 39,994.00
Lactation Specialist
Notes : S. Palanjian Position
P00015436
1.0000 39994.000 0.000 FTE 39,994.00
Nutritionist/Dietician
Notes : PH Nutritionist III A.
Vagts Position P00000912
Mentoring & IBCLC Services
0.0841 80903.000 0.000 FTE 6,804.00
Nutritionist/Dietician
Notes : PH Nutritionist III J.
Vedua-Cardenas Position
P00007381
0.0038 78947.000 0.000 FTE 300.00
Lactation Specialist
Notes : Vacant Position
P00005204
0.2332 33276.000 0.000 FTE 7,759.00
Total for Salary & Wages 94,851.00
2 Fringe Benefits
Composite Rate
Notes : FICA
UNEMP INS
RETIREMENT
HOSPITAL INS
LIFE INS
VISION INS
DENTAL INS
WORK COMP
SHORT/LONG TERM
DISABILITY
0.0000 70.066 94851.000 66,458.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
Subcontracting Agency-OLSHA 0.0000 0.000 0.000 84,867.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Notes : OLSHA
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 20.00
Printing 0.0000 0.000 0.000 33.00
Postage 0.0000 0.000 0.000 45.00
Total for Supplies and Materials 98.00
6 Travel
Mileage
Notes : 200 miles * 0.625 per
mile
0.0000 0.000 0.000 125.00
7 Communication
Telephone Communications 0.0000 0.000 0.000 1,300.00
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Insurance 0.0000 0.000 0.000 497.00
Advertising 0.0000 0.000 0.000 25.00
Staff Training 0.0000 0.000 0.000 90.00
Interpretation 0.0000 0.000 0.000 200.00
Total for All Others (ADP, Con. Employees, Misc.)812.00
Total Program Expenses 248,511.00
TOTAL DIRECT EXPENSES 248,511.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 13,108.00
Health Adm Distribution 0.0000 0.000 0.000 30,470.00
Total for Cost Allocation Plan / Other 43,578.00
Total Indirect Costs 43,578.00
TOTAL INDIRECT EXPENSES 43,578.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
TOTAL EXPENDITURES 292,089.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / WIC Resident Services
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 1,096,279.00 1,096,279.00
2 Fringe Benefits 642,825.00 642,825.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 522,000.00 522,000.00
5 Supplies and Materials 12,256.00 12,256.00
6 Travel 988.00 988.00
7 Communication 9,099.00 9,099.00
8 County-City Central Services 0.00 0.00
9 Space Costs 106,143.00 106,143.00
10 All Others (ADP, Con. Employees, Misc.)74,774.00 74,774.00
Total Program Expenses 2,464,364.00 2,464,364.00
TOTAL DIRECT EXPENSES 2,464,364.00 2,464,364.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 543,170.00 543,170.00
Total Indirect Costs 543,170.00 543,170.00
TOTAL INDIRECT EXPENSES 543,170.00 543,170.00
TOTAL EXPENDITURES 3,007,534.00 3,007,534.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 2,615,870.00 2,615,870.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 391,664.00 0.00 391,664.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 3,007,534.00 2,615,870.00 391,664.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Supervisor
Notes : L. Banks Position
P00001865
1.0000 93623.000 0.000 FTE 93,623.00
Supervisor
Notes : K.Scott Position
P00000958
1.0000 57409.000 0.000 FTE 57,409.00
Supervisor
Notes : K. Beszka Position
P00003073
1.0000 73356.000 0.000 FTE 73,356.00
Clerk
Notes : L. Anderson Position
P00001328
1.0000 54738.000 0.000 FTE 54,738.00
Clerk
Notes : N. Case Position
P00000674
1.0000 54738.000 0.000 FTE 54,738.00
Clerk
Notes : L. Crowder Position
P00004771
1.0000 42839.000 0.000 FTE 42,839.00
Clerk
Notes : J. Heenan Position
P00007563
1.0000 54738.000 0.000 FTE 54,738.00
Clerk
Notes : J. Hutson Position
P00007384
1.0000 54738.000 0.000 FTE 54,738.00
Technician
Notes : C. Bacon Position
P00002509
1.0000 52132.000 0.000 FTE 52,132.00
Technician
Notes : J. Cook Position
P00007382
1.0000 40799.000 0.000 FTE 40,799.00
Technician
Notes : O. SchuelkePosition
P00007562
1.0000 52132.000 0.000 FTE 52,132.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Technician
Notes : T. Shaffer Position
P00005234
1.0000 52132.000 0.000 FTE 52,132.00
Technician
Notes : L. Williams Position
P00005233
1.0000 50244.000 0.000 FTE 50,244.00
Nutritionist/Dietician
Notes : A. Vagts Position
P00000912
0.8942 80877.000 0.000 FTE 72,320.00
Nutritionist/Dietician
Notes : K. Takeshita Position
P00002074
1.0000 73356.000 0.000 FTE 73,356.00
Nutritionist/Dietician
Notes : M. Seefelt Position
P00005693
1.0000 73356.000 0.000 FTE 73,356.00
Nutritionist/Dietician
Notes : J. Vedua-Cardenas
Position P00007381
1.0000 77634.000 0.000 FTE 77,634.00
Health Educator
Notes : K. Merz Position
P00007360
0.3558 61709.000 0.000 FTE 21,956.00
Nutritionist/Dietician
Notes : T. Saputo Position
P00005235
1.0000 42689.000 0.000 FTE 42,689.00
OCHD Staff Overtime - Various
positions
1.0000 1350.000 0.000 FTE 1,350.00
Total for Salary & Wages 1,096,279.00
2 Fringe Benefits
Composite Rate
Notes : FICA
UNEMPLOYMENT INS
RETIREMENT
HOSPITAL INS
LIFE INS
VISION INS
DENTAL INS
WORK COMP
SHORT AND LONG TERM
0.0000 58.637 1096279.00
0
642,825.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
DISABILITY
3 Cap. Exp. for Equip & Fac.
4 Contractual
Subcontracting Agency-OLSHA-
WIC svcs in Oakland Co.
Notes : Average caseload 3065
@ $180/client
0.0000 0.000 0.000 522,000.00
5 Supplies and Materials
Office Supplies 0.0000 0.000 0.000 2,475.00
Medical Supplies 0.0000 0.000 0.000 4,000.00
Educational Supplies 0.0000 0.000 0.000 2,000.00
Postage 0.0000 0.000 0.000 791.00
Printing 0.0000 0.000 0.000 1,990.00
Materials & Supplies 0.0000 0.000 0.000 300.00
Computer Supplies 0.0000 0.000 0.000 700.00
Total for Supplies and Materials 12,256.00
6 Travel
Mileage
Notes : 1,100 Miles * 0.625 per
mile
0.0000 0.000 0.000 688.00
Conferences 0.0000 0.000 0.000 300.00
Total for Travel 988.00
7 Communication
Telephone 0.0000 0.000 0.000 9,099.00
8 County-City Central Services
9 Space Costs
Space/Rental Costs 0.0000 0.000 0.000 86,858.00
Rent 0.0000 0.000 0.000 19,285.00
Total for Space Costs 106,143.00
10 All Others (ADP, Con. Employees, Misc.)
Insurance 0.0000 0.000 0.000 6,500.00
Equipment Maintenance 0.0000 0.000 0.000 850.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Info Tech Print Managed Svcs 0.0000 0.000 0.000 3,500.00
IT Operatons 0.0000 0.000 0.000 61,724.00
Advertising 0.0000 0.000 0.000 25.00
Staff Training 0.0000 0.000 0.000 675.00
Interpretation 0.0000 0.000 0.000 850.00
Laundry & Cleaning 0.0000 0.000 0.000 600.00
Expendable Equipment 0.0000 0.000 0.000 50.00
Total for All Others (ADP, Con. Employees, Misc.)74,774.00
Total Program Expenses 2,464,364.00
TOTAL DIRECT EXPENSES 2,464,364.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 151,506.00
Health Adm Distribution 0.0000 0.000 0.000 304,667.00
Other Cost Distributions-Misc
Distributions
0.0000 0.000 0.000 86,997.00
Total for Cost Allocation Plan / Other 543,170.00
Total Indirect Costs 543,170.00
TOTAL INDIRECT EXPENSES 543,170.00
TOTAL EXPENDITURES 3,007,534.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / West Nile Virus
Community Surveillance
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 5/1/2023 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 5,226.00 5,226.00
2 Fringe Benefits 2,552.00 2,552.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 686.00 686.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)814.00 814.00
Total Program Expenses 9,278.00 9,278.00
TOTAL DIRECT EXPENSES 9,278.00 9,278.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 1,887.00 1,887.00
Total Indirect Costs 1,887.00 1,887.00
TOTAL INDIRECT EXPENSES 1,887.00 1,887.00
TOTAL EXPENDITURES 11,165.00 11,165.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 10,000.00 10,000.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 1,165.00 0.00 1,165.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 11,165.00 10,000.00 1,165.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
Sanitarian
Notes : Senior PH Sanitarian J.
Jacobs Position P00006721
0.0250 90231.000 0.000 FTE 2,256.00
Sanitarian
Notes : PH Sanitarian C. Dunaj
Position P00002965
0.0365 66301.000 0.000 FTE 2,420.00
Epidemiologist
Notes : M. Swain Position
P00007258
0.0039 79743.000 0.000 FTE 311.00
Supervisor
Notes : Program Supervisor D.
McArthur/J. McCloskey Position
P000123006/P00012307
0.0048 49624.000 0.000 FTE 239.00
Total for Salary & Wages 5,226.00
2 Fringe Benefits
Composite Rate
Notes : FICA, UNEMP INS,
RETIREMENT, HOSP INS, LIFE
INS, VISION INS, DENTAL INS,
WORK COMP, SHORT/LONG
TERM DISABILITY
0.0000 48.833 5226.000 2,552.00
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
Testing Materials 0.0000 0.000 0.000 686.00
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
Insurance 0.0000 0.000 0.000 14.00
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DRAFTContract # Date: 08/15/2022
Line Item Qty Rate Units UOM Total
Percentage of Motor Pool
Charges
0.0000 0.000 0.000 800.00
Total for All Others (ADP, Con. Employees, Misc.)814.00
Total Program Expenses 9,278.00
TOTAL DIRECT EXPENSES 9,278.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Cost Allocation Plan
Notes : 13.82%
0.0000 0.000 0.000 722.00
Health Adm Distribution 0.0000 0.000 0.000 1,165.00
Total for Cost Allocation Plan / Other 1,887.00
Total Indirect Costs 1,887.00
TOTAL INDIRECT EXPENSES 1,887.00
TOTAL EXPENDITURES 11,165.00
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DRAFTContract # Date: 08/15/2022
1 Program Budget Summary
PROGRAM / PROJECT
Local Health Department - 2023 / EGLE Drinking Water and
Onsite Wastewater Management
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and Human Services/
Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 0.00 0.00
2 Fringe Benefits 0.00 0.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 0.00 0.00
5 Supplies and Materials 0.00 0.00
6 Travel 0.00 0.00
7 Communication 0.00 0.00
8 County-City Central Services 0.00 0.00
9 Space Costs 0.00 0.00
10 All Others (ADP, Con. Employees, Misc.)0.00 0.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 0.00 0.00
2 Cost Allocation Plan / Other 2,995,154.00 2,995,154.00
Total Indirect Costs 2,995,154.00 2,995,154.00
TOTAL INDIRECT EXPENSES 2,995,154.00 2,995,154.00
TOTAL EXPENDITURES 2,995,154.00 2,995,154.00
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DRAFTContract # Date: 08/15/2022
2 Program Budget - Source of Funds
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Source of Funds
Fees and Collections - 1st and 2nd
Party
0.00 0.00 0.00 0.00
Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00
Federal or State (Non MDHHS)0.00 0.00 0.00 0.00
Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00
Federally Provided Vaccines 0.00 0.00 0.00 0.00
Federal Medicaid Outreach 0.00 0.00 0.00 0.00
Required Match - Local 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Local Non-ELPHS 0.00 0.00 0.00 0.00
Other Non-ELPHS 0.00 0.00 0.00 0.00
MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
MDHHS Comprehensive 985,042.00 985,042.00 0.00 0.00
MCH Funding 0.00 0.00 0.00 0.00
Local Funds - Other 2,010,112.00 0.00 2,010,112.00 0.00
Inkind Match 0.00 0.00 0.00 0.00
MDHHS Fixed Unit Rate
Totals 2,995,154.00 985,042.00 2,010,112.00 0.00
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DRAFTContract # Date: 08/15/2022
3 Program Budget - Cost Detail
Line Item Qty Rate Units UOM Total
DIRECT EXPENSES
Program Expenses
1 Salary & Wages
2 Fringe Benefits
3 Cap. Exp. for Equip & Fac.
4 Contractual
5 Supplies and Materials
6 Travel
7 Communication
8 County-City Central Services
9 Space Costs
10 All Others (ADP, Con. Employees, Misc.)
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs
2 Cost Allocation Plan / Other
Environmental Hlth Adm
Distribution
0.0000 0.000 0.000 2,017,970.00
Health Adm Distribution 0.0000 0.000 0.000 731,021.00
Other Cost Distributions-Misc
Distribution
0.0000 0.000 0.000 246,163.00
Total for Cost Allocation Plan / Other 2,995,154.00
Total Indirect Costs 2,995,154.00
TOTAL INDIRECT EXPENSES 2,995,154.00
TOTAL EXPENDITURES 2,995,154.00
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DRAFTContract # Date: 08/15/2022
Summary of Budget
PROGRAM / PROJECT
Local Health Department - 2023 / Local
Health Department - 2023
DATE PREPARED
8/15/2022
CONTRACTOR NAME
Oakland County Department of Health and
Human Services/ Health Division
BUDGET PERIOD
From : 10/1/2022 To : 9/30/2023
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Rd.
34 East
BUDGET AGREEMENT
Original Amendment
AMENDMENT #
0
CITY
Pontiac
STATE
MI
ZIP CODE
48341-
1032
FEDERAL ID NUMBER
38-6004876
Category Total Amount
DIRECT EXPENSES
Program Expenses
1 Salary & Wages 20,089,379.00 20,089,379.00
2 Fringe Benefits 10,143,740.00 10,143,740.00
3 Cap. Exp. for Equip & Fac.0.00 0.00
4 Contractual 777,661.00 777,661.00
5 Supplies and Materials 2,188,873.00 2,188,873.00
6 Travel 395,440.00 395,440.00
7 Communication 183,209.00 183,209.00
8 County-City Central Services 0.00 0.00
9 Space Costs 1,475,136.00 1,475,136.00
10 All Others (ADP, Con. Employees, Misc.)3,863,680.00 3,863,680.00
Total Program Expenses 39,117,118.00 39,117,118.00
TOTAL DIRECT EXPENSES 39,117,118.00 39,117,118.00
INDIRECT EXPENSES
Indirect Costs
1 Indirect Costs 1,828,845.00 1,828,845.00
2 Cost Allocation Plan / Other 7,201,496.00 7,201,496.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
Total Indirect Costs 9,030,341.00 9,030,341.00
TOTAL INDIRECT EXPENSES 9,030,341.00 9,030,341.00
TOTAL EXPENDITURES 48,147,459.00 48,147,459.00
SOURCE OF FUNDS
Category Total Amount Cash Inkind
1 Fees and Collections - 1st
and 2nd Party
4,426,847.00 0.00 4,426,847.00 0.00
2 Fees and Collections - 3rd
Party
363,058.00 0.00 363,058.00 0.00
3 Federal or State (Non
MDHHS)
2,501,296.00 0.00 2,501,296.00 0.00
4 Federal Cost Based
Reimbursement
0.00 0.00 0.00 0.00
5 Federally Provided Vaccines 698,350.00 0.00 698,350.00 0.00
6 Federal Medicaid Outreach 536,721.00 536,721.00 0.00 0.00
7 Required Match - Local 575,667.00 0.00 575,667.00 0.00
8 Local Non-ELPHS 0.00 0.00 0.00 0.00
9 Local Non-ELPHS 0.00 0.00 0.00 0.00
10 Local Non-ELPHS 0.00 0.00 0.00 0.00
11 Other Non-ELPHS 0.00 0.00 0.00 0.00
12 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00
13 MDHHS Comprehensive 11,461,154.0
0
11,461,154.
00
0.00 0.00
14 MCH Funding 321,457.00 321,457.00 0.00 0.00
15 Local Funds - Other 26,876,871.0
0
0.00 26,876,871.0
0
0.00
16 Inkind Match 0.00 0.00 0.00 0.00
17 MDHHS Fixed Unit Rate 386,038.00 386,038.00 0.00 0.00
Local Health Department - 2023, Date: 08/15/2022
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DRAFTContract # Date: 08/15/2022
TOTAL 48,147,459.0
0
12,705,370.
00
35,442,089.0
0
0.00
Local Health Department - 2023, Date: 08/15/2022
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Page: 206 of 206
ATTACHMENT I
MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES
Local Health Department Agreement
October 1, 202- September 30, 2023
Fiscal Year 2023
INSTRUCTIONS
FOR THE
ANNUAL BUDGET
1
INSTRUCTIONS FOR THE ANNUAL BUDGET FOR LOCAL HEALTH DEPARTMENT SERVICES
TABLE OF CONTENTS
Page
I. INTRODUCTION ............................................................................................................ 2
II. MINIMUM BUDGETING REQUIREMENTS ................................................................... 2
III. REIMBURSEMENT CHART ........................................................................................... 3
IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION
PROCEDURES .............................................................................................................. 4
V. FORM PREPARATION - GENERAL .............................................................................. 4
VI. FORM PREPARATION - EXPENDITURE CATEGORIES ............................................. 4
VII. FORM PREPARATION - SOURCE OF FUNDS ............................................................. 7
VIII. SPECIAL BUDGET INSTRUCTIONS
A. Public Health Emergency Preparedness (PHEP) .................................................. 10
B. WIC ........................................................................................................................ 10
C. Family Planning ..................................................................................................... 12
D. Breast and Cervical Cancer .................................................................................. 13
E. CSHCS Outreach and Advocacy ........................................................................... 15
F. Program Budget Detail- Cost Detail Schedule Preparation .................................... 16
G. Medicaid Outreach Activities Reimbursement Procedures .................................... 21
I. Immunization 317 and VFC Allowable Expenditures ............................................. 26
2
INSTRUCTIONS FOR THE
ANNUAL BUDGET
FOR LOCAL HEALTH SERVICES
I. INTRODUCTION
The Annual Budget for Local Health Services is completed on a state fiscal year basis and is
used to establish budgets for many Department programs. In the Annual Budget, the
Department consolidates many of its categorical programs’ funding and Essential Local Public
Health Services (ELPHS) (formerly known as the local public health operation’s funding) into a
single, Comprehensive Agreement for local health departments. The Department's Plan and
Budget Framework serves as a principal reference point for budget development.
The Annual Budget for Local Health Services must be completed in accordance with and adhere
to the established requirements as specified in these instructions and submitted to the
Department as required by the agreement.
II. MINIMUM BUDGETING REQUIREMENTS
A. Cost Principles - Types or items of cost which will be considered for reimbursement are
generally consistent with definitions contained in Title 2 Code of Federal Regulations
CFR, Part 200 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards.
B. Federal Block Grant Funds - Maternal & Child Health and Preventive Health Block
Grant funds may not be used to: provide inpatient services; make cash payments to
intended recipients of health services; purchase or improve land; purchase, contract or
permanently improve (other than minor remodeling defined as work required to change
the interior arrangements or other physical characteristics of any existing facility or
installed equipment when the cost of the remodeling incident does not exceed $2,000)
any building or other facility; or purchase major medical equipment (any item of medical
equipment having a unit cost of over $10,000 and used in the diagnosis or treatment of
patients, excluding equipment typically used in a laboratory); satisfy any requirement for
the expenditure of non-federal funds as a condition for the receipt of Federal funds; or
provide financial assistance to any entity other than a public or nonprofit private entity.
C. Expenditure and Funding Source Breakdown - For purposes of development, analysis
and negotiation activities must be budgeted at the individual expenditure and funding
source category level on the Annual Budget for Local Health Services.
D. Special Budget Requirements for Certain Categorical Program Elements - The
Annual Budget for Local Health Services is completed in the MI E-Grants System
through the application budget to include details for all program elements (excluding
Administration and Grantee Support).
E. Local MCH - Local MCH funds can be used to support the health of women, children,
and families in communities across Michigan. Funding addresses one or more Title V
Maternal and Child Health Block Grant national and state priority areas and/or a local
3
MCH priority need identified through a needs assessment process. Priority areas are
developed into Local MCH Work Plans which are described in the Annual Local MCH
Plan. These funds are to be budgeted as a funding source in two project categories.
The Local MCH projects need to be budgeted separately. Please note only two LMCH
project titles can be used:
• MCH – Children
• MCH – All Other
These funding sources cannot be used under the WIC element except in extreme
circumstances where a waiver is requested in advance of expenditures, and evidence
is provided that the expenditures satisfy all funding requirements. Local health
departments are encouraged to select only one to two performance measures and
delve deeper into the strategies in an effort to “move the needle.”
III. REIMBURSEMENT CHART
A. Program Element/Funding 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. Type of Project
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:
4
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
Budgeted expenditures are to be entered for each program element, project or group of
services by applicable major category.
A. Salaries and Wages- This category includes the compensation budgeted for all permanent
and part-time employees on the payroll of the Grantee and assigned directly to the program.
This does not include contractual services, professional fees or personnel hired on a private
contract basis. Consulting services, vendor services, professional fees or personnel hired on
a private contracting basis should be included in “Other Expenses.” Contracts with
secondary recipient organizations such as cooperating service delivery institutions or
delegate agencies should be included in Contractual (Sub-contract) Expenses.
B. Fringe Benefits - This category is to include, for at least the specified elements, all Grantee
costs for social security, retirement, insurance, and other similar benefits for all permanent
and part-time employees assigned to the specified elements.
C. Cap Exp for Equip & 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
5
purchase of the equipment. Only budgeted equipment items costing $5,000 or more may be
reported under this category. Small equipment items costing less than $5,000 are properly
classified as Supplies and Materials or Other Expenses. This category also includes capital
outlay for purchase or renovation of facilities.
D. Contractual (Subcontracts/Subrecipient) - Use for expenditures applicable to written
contracts or agreements with secondary recipient organizations such as cooperating service
delivery institutions or delegate agencies. Payments to individuals for consulting or
contractual services, or for vendor services are to be included under Other Expenses.
Specify subcontractor(s) address, amount by subcontractor and total of all subcontractors.
E. Supplies and Materials - Use for all consumable items and materials including equipment-
type items costing less than $5,000 each. This includes office, printing, janitorial, postage
and educational supplies; medical supplies; contraceptives and vaccines; tape and gauze;
prescriptions and other appropriate drugs and chemicals. Federal Provided Vaccine Value
should be reported and identified on in Other Cost Distributions category. Do not combine
with supplies.
F. Travel - Travel costs of permanent and part-time employees assigned to each program
element. This includes costs of mileage, per diem, lodging, meals, registration fees and
other approved travel costs incurred by the employee. Travel of private, non-employee
consultants should be reported under Other Expenses.
G. Communication Costs - These are costs for telephone, Internet, telegraph, data lines,
websites, fax, email, etc., when related directly to the operation of the program element.
H. County/City Central Services - These are costs associated with central support activities of
the local governing unit allocated to the local health department in accordance with Title 2
CFR, part 200.
I. Space Costs - These are costs of building space necessary for the operation of the
program.
J. All Others (Line 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
6
budgeting indirect costs:
1. Local Health Departments receiving more than $35 million in direct Federal awards are
required to have an approved indirect cost rate from a Federal Cognizant Agency. If your
Local Health Department has received an approved indirect rate from a Federal
Cognizant agency, attach the Federal approval letter to your MI E-Grants Grantee Profile.
2. Local Health Departments receiving $35 million or less in direct Federal awards are
required to prepare indirect cost rate proposals in accordance with Title 2 CFR and
maintain the documentation on file subject to review.
3. Local Health Departments that received approved indirect cost rates from another State
of Michigan Department should attach their State approval letter to their MI E-Grants
Grantee Profile.
4. Local Health Departments with cost allocation plans should reflect these allocations in the
Other Cost Distributions budget category. See Section M. Other Cost Distribution for
budgeting guidance.
5. As a Subrecipient of federal funds from MDHHS, a Local Health Department that has
never received a negotiated indirect cost rate, your Local Health Department may 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 Budget
Detail Schedule.
The amount of Indirect Cost should be allocated to all appropriate program elements with the
total equivalent amount reflected as a credit or minus in the Administration projects.
M. Other Cost Distributions – Use to distribute various contributing activity costs to
appropriate program areas based upon activity counts, time study supporting data or other
reasonable and equitable means. An example of Other Cost Distributions is nursing
supervision. The distribution process permits costs reflected in a single program element to
be subsequently distributed, perhaps only in part, to other programs or projects as
appropriate. If an allocation is made, the charges must be reflected in the appropriate
program element and the offsetting credit reflected in the program element being distributed.
There must be a documented, well-defined rationale and audit trail for any cost
distribution or allocation based upon Title 2 CFR, Part 200 Cost Principles Local Health
Departments using the cost distribution or cost allocation must develop the plan in
accordance with the requirements described in Title 2 CFR, Part 200. Local Health
Departments should maintain supporting documentation for audit in accordance with record
retention requirements. The plan should include a Certification of Cost Allocation plan in
accordance with Title 2 CFR, Part 200 Appendix V. The cost allocation plan documentation
7
is not required to be submitted unless specifically requested.
Cost associated with the Essential Local Public Health Services (ELPHS), Maternal and
Child Health (MCH) Block Grant and Fixed Fee may be budgeted in the associated program
element and distributed to the associated projects.
Federal Provided Vaccine Value should be reported on a separate line and clearly identified.
N. Total Direct & Admin. Expenditures – The MI E-Grants System sums the indirect
expenditures program element and records in the Total Indirect Expenditure line of the
Budget Summary.
O. Total Expenditures – The MI E-Grants System sums the direct and indirect expenditures
and records in the Total Expenditure line of the Budget Summary.
VII. FORM PREPARATION - SOURCE OF FUNDS
Source of Funds are to be entered for each program element, project or group of services by
applicable major category as follows:
A. Fees & Collections - Fees 1st & 2nd Party–
i. 1st party funds projected to be received from private payers, including patients, source
users and any member of the general population receiving services.
ii. 2nd party funds received from organizations, private or public, who might reimburse
services for a group or under a special plan.
iii. Any Other Collections
B. Fees & Collections - 3rd Party – 3rd Party Fees - Funds projected to be received from
private insurance, Medicaid, Medicare or other applicable titles of the Social Security Act
directly related to the cost of providing patient care or other services (e.g., includes Early
Periodic Screening, Detection and Treatment [EPSDT] Screening, Family Planning.)
C. Federal/State Funding (Non-MDHHS) - Funds received directly from the federal
government and from any state Contractor other than MDHHS, such as the Department of
Natural Resources and Environment (MDNRE). This line should also be used to exclude
state aid funds such as those provided through the Michigan Department of Treasury under
P.A. 264 of 1987 (cigarette tax).
D. Federal Cost Based Reimbursement – Funds received for Federal Cost Based
Reimbursement which should be budgeted in the program in which they were earned.
E. Federally Provided Vaccines – The projected value of federally provided vaccine.
F. Federal Medicaid Outreach – (Please note: to be used only for Medicaid Outreach,
CSHCS Medicaid Outreach or Nurse Family Partnership Medicaid Outreach program
elements.) Funds projected to be received from the federal government for allowable
Medicaid Outreach activities. This amount represents the anticipated 50% federal
administrative match of local contributions.
G. Required Match - Local – Funds projected to be local contribution for programs that have a
match contribution requirement (Please note: for Medicaid Outreach, CSHCS Medicaid
8
Outreach, or Nurse Family Partnership Medicaid Outreach, this amount represents the 50%
matching local contribution for allocable Medicaid Outreach Activities. Federal Medicaid
Outreach and Required Local match amounts should equal each other.)
H. Local Non-ELPHS - Local funds budgeted for the following expenditures:
1. Expenditures for services not designated as required and allowable for ELPHS funding
(e.g., medical examiner and inpatient maternity services); expenditures determined 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.
9
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 Hearing – 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 must equal the ELPHS Food allocation.
P. ELPHS – Drinking Water - This section includes all funding projected to be due under
Comprehensive Agreement specific to the ELPHS Drinking Water program and must equal
the ELPHS Drinking Water allocation.
Q. ELPHS – On-site Sewage - This section includes all funding projected to be due under
Comprehensive Agreement specific to the ELPHS On-site Sewage program and must 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.
10
VIII. SPECIAL BUDGET INSTRUCTIONS
Certain elements are supported by federal or other categorical program funds for which special
budgeting requirements are placed upon grantees and subgrantees. These include:
Element Federal or Other Funding Contractor
Public Health Emergency
Preparedness
U.S. Department of Health & Human Services, Centers for Disease Control
WIC U.S. Department of Agriculture, Food & Nutrition Service
Family Planning U.S. Department of Health & Human Services, Public Health Service
Breast and Cervical Cancer U.S. Department of Health & Human Services, Centers for Disease Control
CSHCS Outreach & Advocacy Michigan Department of Health & Human Services
Medicaid Outreach Activities Centers for Medicare and Medicaid Services
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 Emergency Preparedness (PHEP) Special Budget Requirements
Local Health Departments will receive the initial FY 22/23 allocation of the CDC Public
Health Emergency Preparedness (PHEP) funds in nine equal prepayments for the period
October 1, 2022 through June 30, 2023. LHDs must submit a nine-month budget and a
quarterly Financial Status Report (FSR) for each of the following COMPREHENSIVE
Local Health Department program elements:
1. Public Health Emergency Preparedness (PHEP) (October 1 – June 30)
2. Public Health Emergency Preparedness (PHEP)– Cities of Readiness (October 1 –
June 30)
3. Laboratory Services - Bioterrorism (October 1 – September 30)
B. WIC Special Budget Requirements
1. Cost/Funding Categories - The following local budget breakdowns are required
to fulfill WIC grant application budget requirements each fiscal year:
Salaries & Fringe Benefits
Automated Management Systems
Space Utilization Costs
Equipment
11
Supplies
Communications & Travel
All Other Direct Costs
Indirect Costs
All Funding Sources by Type
The WIC cost/funding categories and supporting budget detail requirements are
satisfied by completion of an application budget form in the MI E-Grants System.
General instructions for these forms are contained at the end of this section.
Agencies receiving WIC-USDA Infrastructure grants must budget these funds as a
separate element. Agencies must track and report expenditures separately on the
FSR.
Agencies receiving WIC-USDA Breastfeeding Peer Counselor funds must budget
these funds as a separate element. Agencies must track and report expenditures
separately on the FSR. And comply with special reporting requirements.
2. Costs Allowable Only With Prior Approval - The following costs are allowable only
with prior review/approval of the Michigan Department of Health & Human Services
as specified by the U.S. Department of Agriculture, Food and Nutrition Service (Ref.:
7 CFR Part 246, and USDA-WIC Administrative Cost Handbook 3/86). Prior approval
is accomplished by providing appropriate detail in the budget request approved by
MDHHS or subsequently in a written request approved in writing by MDHHS.
A. Automated Information Systems - which are required by a local Grantees except
for those used in general management and payroll, including acquisition of
automated data processing hardware or software whether by outright purchase
or rental-purchase agreement or other method of acquisition.
B. Capital Expenditures of $2,500 or More - such as the cost of facilities,
equipment, including medical equipment, other capital assets and any repairs
that materially increase the value or useful life of capital assets.
C. Management Studies - performed by agencies or departments other than the
local Grantee or those performed by outside consultants under contract with the
local Grantee.
D. Accounting and Auditing Services - performed by private sector firms under
professional service contracts for purposes of preparation or audit of program
and financial records/reports.
E. Other Professional Services - rendered by individuals or organizations, not a part
of the local Grantee, such as:
1. Contractual private physician providing certification data.
2. Contractual organization providing laboratory data.
3. Contractual translators and interpreters at the local Grantee level.
F. Training 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. Building Space and Related Facilities - the cost to buy, lease or rent space in
privately or publicly owned buildings for the benefit of the program.
12
H. Non-Fringe Insurance and Indemnification Costs
All charges to WIC must be necessary, reasonable, allowable and allocable for
the proper and efficient administration of the program. Further information and
cost standards are provided in federal instructions including Title 2 CFR, Part
200 and 7 CFR Part 3015.
C. Family Planning Special Budget Requirements
1. Cost/Funding Categories - The following local budget breakdowns are required to
fulfill Family Planning grant application budget requirements each fiscal year:
Salaries & Wages
Fringe Benefits
Travel
Equipment
Supplies
Contractual
Construction
All Other Direct Costs
Indirect Costs
All Funding Sources by Type
The Family Planning cost/funding categories and supporting budget detail
requirements are satisfied by completion of an application budget in the MI E-Grants
System. General instructions for these forms are contained at the end of this section.
2. Costs Allowable Only With Prior Approval - The following costs are allowable only
with prior review/approval of MDHHS. Prior approval is accomplished by providing
appropriate detail in the budget request approved by MDHHS or subsequently in a
written request approved in writing by MDHHS.
A. Alterations and Renovations - to change the interior arrangements or other
physical characteristics of existing facilities or installed equipment, to the extent
that such changes cost more than $1,000 each.
B. Audiovisual Materials and Activities - acquired, produced, presented, or
disseminated to the general public.
C. Consultant Contracts for General Support Services - including equipment and
supplies, that will cost in excess of $25,000 or 10% of the total direct cost budget
(whichever is greater).
D. Equipment - including general purpose and special equipment (e.g., air
conditioning) costing $5,000 or more per unit.
E. Insurance - contributions to a reserve for a self-insurance program.
F. Public Information Service Costs – for the cost of providing public information
services.
G. Publication and Printing Costs - for the cost of publications.
H. Capital Expenditures - for land or buildings.
I. Indemnification Against Third Parties Costs - insurance against potential
liabilities.
J. Mass Severance Pay - involving grant-supported personnel.
13
K. Organization/Reorganization Costs - allocable to the program.
L. Overtime Premium - involving grant-supported personnel.
M. Patient Care Costs – re-budgeting out of or reduction in patient care costs
(considered a change in scope).
N. Professional Services - in connection with Patent/Copyright Infringement
Litigation.
O. Trailers or Modular Units – for costs of trailers and modular units.
P. Transfers Between Construction and Non-construction - for approved
construction funds.
Q. Transfers Between Indirect and Direct Costs - for amounts awarded for indirect
costs to absorb increases in direct costs.
R. Transfers for Substantive Programmatic Work - to a third party, by contracting, or
any other means used for the actual performance of substantive programmatic
work.
All charges to Family Planning must be necessary, reasonable, allowable, and
allocable, for the proper and efficient administration of the program. Further
information and cost standards are provided in federal instructions including 2 CFR,
Part 225 (OMB Circular A-87), A-102 Common Rule and 2 CFR, Part 215 (OMB
Circular A-110)
D. Breast and Cervical Cancer Control Coordination Program Special Budget
Requirements
1. The Breast and Cervical Cancer Control Navigation Program (BC3NP) budget is to be
developed based on specific responsibilities of Local Health Departments (LHDs)
participating in the Breast and Cervical Cancer Control Navigation Program. LHDs
agreeing to participate in the program fall into two categories: LHDs agreeing to
participate as Local Coordinating Agencies (LCAs) and LHDs agreeing to participate
as Local Community Partners (LCPs).
a. LHDs agreeing to participate as Local Coordinating Agencies (LCAs) – LCAs
are responsible in assuring implementation of all program requirements and
policies and procedures. This includes client outreach and recruitment into
BC3NP to achieve yearly targeted caseload allocations, financial monitoring of
program expenses and claims for provision of client clinical services, obtaining
results of client services and entry of client data into the program’s secure
statewide database to monitor timeliness and completeness of care delivery
and authorize payment for services, and assuring appropriate providers are
contracted with the program to provide screening and diagnostic services to
enrolled clients. Only coordination expenses will be reimbursed through the
Comprehensive Agreement. No clinical services will be reimbursed
through the Comprehensive Agreement. All clinical service claims must be
billed to the MDHHS Cancer Prevention and Control Section for claim
processing. The LCA and/or direct service providers with contracts or letters of
agreement with the LCA will be responsible for billing clinical services claims to
the MDHHS Cancer Prevention and Control Section. The Coordination amount
14
of $205-$210 per woman is based on achievement of a target caseload
established for each LCA by MDHHS. Requirements. Each LCAs target
caseload is evaluated yearly based on the BC3NP Tiered Program
Performance requirements. There is no longer a match requirement. Match is
recorded by the program and reported to MDHHS in EGrAMS.
b. LHDs agreeing to participate as Community Partners (LCPs) – LCPs are
responsible for implementing strategies to identify and recruit clients eligible for
the BC3NP, enroll clients into the program, and arrange for provision of
screening and diagnostic clinical services through contracted providers. LCPs
will obtain results of all clinical services provided to BC3NP clients and send
this information to MDHHS for data entry into the secure program’s statewide
database. Information entered into the database will be reviewed by MDHHS
staff to evaluate timeliness and completeness of care delivery and authorize
payment for services. MDHHS staff will oversee financial monitoring of
program expenses and claims for provision of client clinical services. LCPs will
be awarded a base award (to be determined yearly by MDHHS) that is to be
used to implement strategies to recruit a minimum target caseload of BC3NP
women established for these agencies by MDHHS. No clinical services will
be reimbursed through the Comprehensive Agreement. All clinical service
claims must be billed to the MDHHS Cancer Prevention and Control Section
for claim processing. The LCP and/or direct service providers with contracts or
letters of agreement with the LCP will be responsible for billing clinical service
claims to the MDHHS Cancer Prevention and Control Section. There is no
longer a match requirement. Match is recorded by the program and reported to
MDHHS in EGrAMS.
For specific billing requirements refer to the most recent BC3NP Participation
Manual. For specific program requirements, including current fiscal year Direct
Service Reimbursement Rates refer to the current fiscal year Unit Cost
Reimbursement Rate Schedule for the BC3NP issued in August of each fiscal
year. The above referenced documents are available at https://michigan.gov/BC3NP
E. The Well-Integrated Screening and Evaluation for Women Across the Nation
(WISEWOMAN) budget is to be developed in the following way:
1. WISEWOMAN Coordination and Screening should be used to budget costs
associated with coordination of the program and delivery of the initial screening and
risk reduction counseling to WISEWOMAN participants. This includes collecting
answers to health intake questions, WISEWOMAN screening services (height, weight,
body mass index, 2 blood pressure readings, total cholesterol, HDL cholesterol, and
fasting glucose or A1C), and delivery of risk reduction counseling.
2. All Direct Service claims must be billed to the MDHHS Cancer Prevention and Control
Section for claim processing. The Local Coordinating Agency (LCA) and/or direct
service providers with contracts or letters of agreements with the LCA will be
responsible for billing Direct Service claims to the MDHHS Cancer Prevention and
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Control Section. This includes follow-up fasting lipid panel, fasting glucose, A1c, and
one diagnostic exam. No Direct Services expenses will be reimbursed through the
Comprehensive Agreement. The Coordination and Screening amount is $150 per
woman based on a target caseload established by MDHHS.
3. Performance reimbursement will be based upon the understanding that a certain level
of performance (measured by outputs) must be met. There is a 95% caseload
performance requirement for this project.
For specific billing requirements refer to the most recent Billing Manual. For
specific program requirements, including current fiscal year Direct Service
Reimbursement rates and documentation related to the match requirement,
refer to the current fiscal year Special Budgeting and other Program
instructions for the WISEWOMAN Program issued in August of each fiscal
year. The above referenced documents are available at www.michigan.gov/
wisewoman.
F. Children’s Special Health Care Services (CSHCS) Outreach and Advocacy - The
program element, titled CSHCS Outreach and Advocacy should be used to budget costs
associated with this program.
I. Program Budget - Online Detail Budget Application 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).
1. Salary and Wages -
a. Position Description - Select from the expenditure row look-up all position titles
or job descriptions required to staff the program. If the position is missing from the
list, please use Other and type in the position in the drop-down field provided.
b. Positions Required - Enter the number of positions required for the program
corresponding to the specific position title or description. This entry may be
expressed as a decimal (e.g., Full-Time Equivalent – FTE) when necessary. If
other than a full-time position is budgeted, it is necessary to have a basis in terms
of time reports to support time charged to the program.
c. Amount – The MI E-Grants System calculates the salary for the position required
and records it on the Budget Detail. Enter this amount in the Amount column.
d. Total Salary –The MI E-Grants System totals the amount of all positions required
and records it on the Budget Summary.
e. Notes - Enter any explanatory information that is necessary for the position
description. Include an explanation of the computation of Total Salary in those
instances when the computation is not straightforward (i.e., if the employee is
limited term and/or does not receive fringe benefits).
2. Fringe Benefits – Select from the expenditure row look-up applicable fringe benefits
for staff working in this program. Enter the percentage for each. The MI E-Grants
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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.
G. Program Budget-Cost Detail Schedule Preparation
B1 Attachment B1-Program Budget Summary
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Source of Funds
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B2 Attachment B2-Program Budget Cost Detail
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H. Medicaid Outreach Activities Reimbursement Procedures
Medicaid Outreach Activities that are funded by local dollars and meet federal requirements
are eligible for reimbursement at a 50% federal administrative match rate. Local Health
Departments must maintain proper documentation of the activities performed and those
activities must conform with the activities outlined in MSA Bulletin 05-29. Medicaid Outreach
Activities funding is a subrecipient relationship.
I. Budget Preparation
A. Medicaid Outreach Activities
Complete the MI E-Grants application and budget forms for the application Medicaid
Outreach Activities that occur during the fiscal year: 10/1/xx-09/30/xx. Reimbursable
activities included in the budget must conform to the requirements as specified in the MSA
Bulletin 05-29. Complete the MI E-Grants application and budget forms for this program.
1. Expenditure Category Tab
Enter the expenditures budgeted for the fiscal year: 10/01/xx-09/30/xx. Expenses
budgeted for each of the listed expenditure categories are allowable and must be
specific to the Medicaid program as described in MSA Bulletin 05-29. Outreach
activities must not be part of direct service. Expenditures must be reflected in the cost
allocation plan.
2. Source of Funds Tab
Budget the amount expected from the federal government for allowable Medicaid
Outreach Activities. Federal Medicaid Outreach represents the anticipated 50%
federal administrative match of local contributions. Budget the local contribution.
Required Match - Local represents the 50% matching local contribution for Medicaid
Outreach activities. These two amounts must match.
3. Sources of Local Funds Types
Local Health Departments may utilize their county appropriation, any earned income,
funds received from local or private foundations, local contributors or donators, and
from other non-state/non-federal grant agreements that are specific to Medicaid
outreach or are to be used at the discretion of the Health Department as a source for
matching funds. Other state and/or federal grant awards for Medicaid Outreach must
be recorded on the appropriate line as indicated in the Comprehensive Budget
Instructions - Attachment I.
B. Nurse-Family Partnership Outreach (applicable only for Berrien, Calhoun, Ingham,
Kalamazoo, Kent, Oakland, and Saginaw)
Complete the MI E-Grants application and budget forms for the application titled Nurse-Family
Partnership Medicaid Outreach for the timeframe: 10/01/xx-09/30/xx. Complete the MI E-
Grants application and budget forms for this program.
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Expenditures related to Nurse-Family Partnership Medicaid Outreach should be reflected
under one program element and adhere to Section VIII, Special Budget Instructions section
found in the Comprehensive Budget Instructions - Attachment I. The budget should reflect
the entire fiscal year period: 10/1/xx-09/30/xx.
1. Federal Medicaid Outreach
Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the
LHD Nurse-Family Partnership program has been applied. The formula for calculating
the federal funding is as follows:
Federal funding = (Local funds x % of Medicaid Participation Rate) x 50% Federal
Administrative Match rate)
2. Required Match - Local
Represents the 50% match of local contributions. Budget the local match contribution in
Required Match – Local. Federal Medicaid Outreach and Required Match – Local must
equal each other. Additional local contribution related to service provision for non-
Medicaid eligible participants which are not eligible for the 50% federal match should
be reported in Local Funds – Other.
3. Sources of Local Fund Types
Local Health Departments may utilize their county appropriation, funds received from
local or private foundations, local contributors or donators, and from other non-
state/non-federal grant agreements that are specific to Medicaid Outreach or are to be
used at the discretion of the Health Department as a source for matching funds.
C. CSHCS Medicaid Outreach
Complete the MI E-Grants application and budget forms for the application titled CSHCS
Medicaid Outreach for the timeframe: 10/01/xx-09/30/xx.
Expenditures related to CSHCS Medicaid Outreach should be reflected under one program
element and adhere to Section IV, Special Instruction Section found in the Comprehensive
Budget Instructions - Attachment I. The budget should reflect the entire fiscal year period:
10/1/xx-09/30/xx.
1. Federal Medicaid Outreach
Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the
LHD CSHCS program has been applied. A table containing each health jurisdiction
Medicaid Participation Rate is located in the MI E-Grants site. The formula for
calculating the federal funding is as follows:
Federal funding = (Local funds x % of Medicaid Participation Rate) x 50% Federal
Administrative Match rate)
2. Required Match - Local
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Represents the 50% match of local contributions. Budget the local match contribution.
Federal Medicaid Outreach and Required Match – Local must equal each other.
Additional local contribution that is not eligible for the 50% federal match should
be reported on the Local Funds – Other line.
3. Sources of Local Fund Types
Local Health Departments may utilize their county appropriation, funds received from
local or private foundations, local contributors or donators, and from other non-state/non-
federal grant agreements that are specific to Medicaid Outreach or are to be used at the
discretion of the health department as a source for matching funds to be used at the
discretion of the health department as a source for matching funds.
4. Comprehensive CSHCS Outreach and Advocacy and Case Management/Care
Coordination Funds
Should be reported in a separate program element.
D. Indirect Costs
There are three (3) options for indirect costs. They are:
1. an approved federal or state indirect rate;
2. a 10% de minimis rate; or
3. a cost allocation/distribution plan
Most Health Departments will use the cost allocation plan for indirect costs. For further
detail, go to VI. Form Preparation, L. Indirect Cost, on page 5 of this document.
E. Cost Allocation Certification
The Cost Allocation Certification remains on file with the Department until there is a change in
the Cost Allocation Plan. When the cost allocation plan on file with the program (MDHHS-
Medicaid-Outreach), the local health department must: 1) submit a copy of the revised cost
allocation plan with the budget request; and 2) complete a revised cost allocation methodology
certification. Both documents are to be attached to a Detailed Budget line in EGrAMS.
II. Financial Status Report (FSR) – LHDs seeking 50% federal administrative match must
request reimbursement by submitting their actual expenses for allowable Medicaid Outreach
activities on their quarterly FSRs through MI E-Grants.
A. Quarterly and Final FSR
LHDs must reflect the actual Medicaid Outreach expenses incurred on the quarterly and
final FSR. Actual expenses incurred must be specific to Medicaid Outreach as defined by
the MSA Bulletin 05-29 and not part of a direct service. All expenses should be supported
by an approved methodology and appropriate support documentation.
1. Federal Medicaid Outreach
Should be used to request the 50% federal administrative match for Medicaid
Outreach.
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2. Required Match - Local
Should be used to report the local match for Medicaid Outreach. Both the federal
and local amounts must match.
3. Source of Funds Category
Other source of funds that are non-reimbursable for Medicaid Outreach (i.e.,
other federal grants, other MDHHS grants, etc.) should be reported on the
appropriate line has indicated in the Comprehensive Budget Instructions -
Attachment I (e.g., Local non-ELPHS or Local Funds – Other).
Total Source of Funds must equal Total Expenditures.
B. Nurse-Family Partnership Medicaid Outreach – Quarterly and Final FSRs
For Quarters 1-3, LHDs must reflect the actual Medicaid Outreach expenses incurred in a
separate program element titled Medicaid Outreach. Actual expenses incurred for each of
the listed expenditure categories are allowable but must be specific to Medicaid Outreach as
defined by MSA Bulletin 05-29 and not part of a direct service. Expenses should be
supported by a time study or other federally approved methodology.
1. Federal Medicaid Outreach
Should be used to request the 50% federal administrative match. Match is
determined by multiplying local contribution for the program by the percentage of
Medicaid enrollees. This product is then multiplied by 50% in order to determine the
eligible federal administrative match.
2. Required Match - Local
Should be used to report the remaining portion of the local contribution for the
Medicaid Outreach Match. Both lines should equal. Additional local contribution
related to service provision for non-Medicaid eligible participants which are
not eligible for the 50% federal match should be reported in Local Funds -
Other.
3. Source of Funds Category
Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other
federal grants, other MDHHS grants, etc.) should be reported on the appropriate
line has indicated in the Comprehensive Budget Instructions - Attachment I (e.g.,
Local non-ELPHS or Local Funds – Other).
C. CSHCS Medicaid Outreach – Final FSR
CSHCS Medicaid Outreach billing may occur before the final FSR through the MI E-Grants
system after Comprehensive Agreement CSHCS Outreach and Advocacy funds have been
25
fully expended. Local contributions eligible for the Medicaid Outreach match should
be cost distributed to the CSHCS Medicaid Outreach program element from the
CSHCS Outreach and Advocacy program element and reported as indicated below.
1. Federal Medicaid Outreach
Should be used to request the 50% federal administrative match. Match is
determined by multiplying local contribution for the program by the percentage of
Medicaid enrollees. This product is then multiplied by 50% in order to determine
the eligible federal administrative match.
2. Required Match - Local
Should be used to report the remaining portion of the local contribution for the
Medicaid Outreach Match. Additional local contribution that is not eligible for
the 50% federal match should be reported in Local Funds - Other.
3. Source of Funds Category
Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other
federal grants, other MDHHS grants, etc.) should be reported on the appropriate
line has indicated in the Comprehensive Budget Instructions - Attachment I.
4. Comprehensive CSHCS Outreach and Advocacy and Care Coordination
Should be billed as separate program element.
III. Comprehensive Local Health Department Agreement Obligation Report – filed in
September.
The Obligation report is used to estimate the payable amount due to Local Health
Departments from MDHHS for each program element.
A. In the Estimate Column, enter the maximum projected federal administrative match
earnings for allowable Medicaid Outreach Activities to be earned from Medicaid
Outreach on the Federal Medicaid Outreach row.
B. In the Estimate Column, enter the maximum projected federal administrative match
earnings for allowable Medicaid Outreach activities to be earned from CSHSC –
Medicaid Outreach. This should reflect the local contribution multiplied by the Medicaid
enrollment participation rate x 50% federal match rate.
C. In the Estimate Column, enter the maximum projected federal administrative match
earnings for allowable Medicaid Outreach activities to be earned from Nurse Family
Partnership Outreach. This should reflect the local contribution multiplied by the
Medicaid enrollment participation rate x 50% federal match rate.
Note: CSHCS Outreach and Advocacy and CSHCS Care Coordination activities funded through the
Comprehensive Agreement are recorded as separate program element.
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ATTACHMENT III
MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES
LOCAL HEALTH DEPARTMENT AGREEMENT
October 1, 2022 – September 30, 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.
Many program specific assurances and other requirements are defined within the referenced
documents including Minimum Program Requirements established for the following program
elements as of October 1, 2006:
1. Breast and Cervical Cancer Control
2. Clinical Laboratory
3. CSHCS
4. EGLE Drinking Water and Onsite Wastewater Management
5. Family Planning
6. Food ELPHS
7. Hearing ELPHS
8. HIV/STD Prevention Treatment
9. MDHHS Essential Local Public Health Services (ELPHS)
10. Michigan Care Improvement Registry
11. Vision ELPHS
12. WIC
For Fiscal Year 2023, special requirements are applicable for the remaining program
elements listed in the attached pages.
Attachment IV Reimbursement Chart
Program Element:
The Program Element indicates currently funded Department programs that are included in
the Comprehensive Local Health Department Agreement.
Reimbursement Methods
The Reimbursement Methods specifies the type of method used for each of the program
element/funding sources. Funding under the Comprehensive Local Health Department
Agreement can generally be grouped under four (4) different methods of reimbursement.
These methods are defined as follows:
Performance Reimbursement
A reimbursement method by which local agencies are reimbursed based upon the
understanding that a certain level of performance (measured by outputs) must be met in order
to receive full reimbursement of costs (net of program income and other earmarked sources)
up to the contracted amount of state funds prior to any utilization of local funds. Performance
targets are negotiated 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 provided in amendment #1.
Project Title Name EMAIL
Administration Projects Laura de la Rambelje delarambeljel@michigan.gov
Adolescent STI Screening Christopher Stickney stickneyc@michigan.gov
Asthma Demonstration Project Laura de la Rambelje delarambeljel@michigan.gov
Body Art Fixed Fee Seth Eckel eckels1@michigan.gov
Breast & Cervical Cancer Control (BCCCP) Coordination Polly Hager hagerp@michigan.gov
CAHC MI Kids Now Kim Kovalchick kovalchickk@michigan.gov
Child and Adolescent Health Center Program Expansion Kim Kovalchick kovalchickk@michigan.gov
Childhood Lead Poisoning Prevention Michelle Twichell twichellm@michigan.gov
Children's Special Hlth Care Services (CSHCS) Care Coordination Kelly Schoenherr-Gram Gramk2@michigan.gov
Children's Special Hlth Care Services (CSHCS) Outreach & Advocacy Kelly Schoenherr-Gram Gramk2@michigan.gov
CLPP Lead Expansion Carin Speidel speidelc@michigan.gov
Community Blood Lead Testing Carin Speidel speidelc@michigan.gov
CSHCS Medicaid Elevated Blood Lead Case Mgmt Thomas Largo largot@michigan.gov
CSHCS Medicaid Outreach Kelly Schoenherr-Gram Gramk2@michigan.gov
CSHCS Vaccine Initiative Kelly Schoenherr-Gram Gramk2@michigan.gov
Eastern Equine Encephalitis Virus Surveillance Project Mary Grace Stobierski stobierskim@michigan.gov
Eat Safe Fish Christopher Finch finchc2@michigan.gov
EEEH-All Locations Taggert Doll dollt@michigan.gov
EGLE Drinking Water and Onsite Wastewater Management Jeremy Hoeh hoehj@michigan.gov
Emergency Response Planning Gerald Tiernan tiernang@michigan.govg g p @ gg
Ending the HIV Epidemic Implementation Christopher Stickney stickneyc@michigan.gov
Enviromental Health Data in Michigan Thomas Largo largot@michigan.gov
Fetal Alcohol Spectrum Disorders Community Projects Aurea Booncharoen booncharoena@michigan.gov
Fetal Infant Mortality Review (FIMR) Case Abstraction Nicholas Drzal drzaln@michigan.gov
FFPSA HV Expansion Charisse Sanders sandersc2@michigan.gov
FIMR Interviews Nicholas Drzal drzaln@michigan.gov
Food ELPHS Adam Christenson christensona@michigan.gov
Gonococcal Isolate Surveillance Project Christopher Stickney stickneyc@michigan.gov
Harm Reduction Support Services Seth Eckel eckels1@michigan.gov
Hearing ELPHS Jennifer Dakers dakersj@michigan.gov
HIV & STI Testing and Prevention Christopher Stickney stickneyc@michigan.gov
HIV / STI Partner Services Christopher Stickney stickneyc@michigan.gov
HIV Care Coordination Christopher Stickney stickneyc@michigan.gov
HIV Data to Care Christopher Stickney stickneyc@michigan.gov
HIV Housing Assistance Christopher Stickney stickneyc@michigan.gov
HIV Linkage to Care Christopher Stickney stickneyc@michigan.gov
HIV PrEP Clinic Christopher Stickney stickneyc@michigan.gov
HIV Prevention Christopher Stickney stickneyc@michigan.gov
HOPWA Plus Lynn Hendges HendgesL2@michigan.gov
Housing Opportunities for People Living with HIV/AIDS Jessica Altenbernt altenberntj@michigan.gov
Immunization Action Plan (IAP)Terri Adams adamst2@michigan.gov
Immunization Action Plan-Pilot Terri Adams adamst2@michigan.gov
Immunization Field Services Rep Terri Adams adamst2@michigan.gov
Immunization Fixed Fees Terri Adams adamst2@michigan.gov
Immunization Michigan Care Improvement Registry (MCIR) Regions Ryan de la Rambelje delarambeljer@michigan.gov
Immunization Vaccine Quality Assurance Terri Adams adamst2@michigan.gov
Infant Safe Sleep Nicholas Drzal drzaln@michigan.gov
Informed Consent Laura de la Rambelje delarambeljel@michigan.gov
Laboratory Services Bio Marty Soehnlen soehnlenm@michigan.gov
Lactation Consultant Deanna Charest charestd@michigan.gov
Lead Hazard Control Courtney Wisinski wisinskic@michigan.gov
Local Health Department (LHD) Sharing Support Laura de la Rambelje delarambeljel@michigan.gov
Maternal Infant Erly Chd Home Visiting Initiative Rural Local Home Visiting Grp3 Charisse Sanders sandersc2@michigan.gov
Maternal Infant Erly Childhood Home Visiting Initiative Local Home Visiting Grp Charisse Sanders sandersc2@michigan.gov
MCH - All Other Trudy Esch EschT@michigan.gov
MCH - Children Trudy Esch EschT@michigan.gov
MDHHS-Essential Local Public Health Services (ELPHS)Laura de la Rambelje delarambeljel@michigan.gov
Medicaid Outreach Carrie Tarry tarryc@michigan.gov
MI Adolescent Pregnancy & Parenting Program Hillary Brandon brandonh@michigan.gov
MI Health and Wellness 4x4 Plan - Implementation Scott Bell bells1@michigan.gov
MI Home Visiting Initiative Rural Expansion Grant Charisse Sanders sandersc2@michigan.gov
MIECHVP Healthy Families America Expansion Charisse Sanders sandersc2@michigan.gov
Minority Health Community Capacity Building Initiatve Brenda Jegede jegedeb@michigan.gov
Nurse Family Partnership Medicaid Outreach Charisse Sanders sandersc2@michigan.gov
Nurse Family Partnership Services Charisse Sanders sandersc2@michigan.gov
Oral Health - Kindergarten Assessment Carrie Tarry tarryc@michigan.gov
Public Health Emergency Preparedness (PHEP) 10/1 - 6/30 Mary Macqueen macqueenm@michigan.gov
Public Health Emergency Preparedness (PHEP) 7/1- 9/30 Mary Macqueen macqueenm@michigan.gov
Public Health Emergency Preparedness (PHEP) CRI 10/1 - 6/30 Mary Macqueen macqueenm@michigan.gov
Public Health Emergency Preparedness (PHEP) CRI 7/1 - 9/30 Mary Macqueen macqueenm@michigan.gov
Regional Perinatal Care System Deanna Charest charestd@michigan.gov
SEAL! Michigan Dental Sealant Christine Farrell farrellc@michigan.gov
Sexual Violence Prevention Jennifer DeLaCruz delacruzj@michigan.gov
Sexually Transmitted Infection (STI) Control Christopher Stickney stickneyc@michigan.gov
Statewide Lead Case Managment - Fixed Fee Carin Speidel speidelc@michigan.gov
STI Specialty Services Christopher Stickney stickneyc@michigan.gov
Taking Pride in Prevention Kara Anderson andersonk10@michigan.gov
Tobacco Control Grant Program Julia Hitchingham hitchinghamj@michigan.gov
Transforming Youth Suicide Prevention Jennifer DeLaCruz delacruzj@michigan.gov
Tuberculosis (TB) Control Peter Davidson davidsonp@michigan.gov
Vector-Borne Surveillance & Prevention Mary Grace Stobierski stobierskim@michigan.gov
Vision ELPHS Rachel Schumann schumannr@michigan.gov
West Nile Virus Community Surveillance Mary Grace Stobierski stobierskim@michigan.gov
WIC Breastfeeding Cecilia Hutson hutsonc1@michigan.gov
WIC Migrant Cecilia Hutson hutsonc1@michigan.gov
WIC Resident Services Cecilia Hutson hutsonc1@michigan.gov
Wisewoman Polly Hager hagerp@michigan.gov
PROJECT TITLE: Adolescent Sexually Transmitted Infection (STI) Screening
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
Sexually Transmitted Infections (STIs) result in excessive morbidity, mortality, and
health care cost. Adolescents and young adults experience elevated rates of infection
in Michigan and across the country. Individuals 15-24 years of age will be screened for
chlamydia and gonorrhea at the following Oakland County sites:
1. Oakland County Main Jail
2. Oakland County Work Release
3. Oakland County Community Sites where Priority Population Gathers
Reporting Requirements (if different than agreement language):
Report Period Due Date(s)
How to
Submit
Report
Quarterly report of screening
and treatment activity Quarterly 15 days after the end
of the quarter
Email to
MDHHS
contract liaison
GRANTEE SPECIFIC REQUIREMENTS
Utilizing the identified project sites:
1. Test at least 100 adolescents and young adults per month, using NAAT tests for
gonorrhea and chlamydia.
2. Collect race, gender, age, test result, and treatment date for all tests.
3. Refer clients for further health evaluation if indicated.
4. Provide client centered risk reduction plan, promoting abstinence.
5. Treat all positives on site if possible.
6. Contact positive clients that are released prior to treatment with treatment options
in community.
7. Promote self-notification of partners.
8. Develop one annual slide set highlighting year end data by demographic variable
including trend data.
9. Continue to promote awareness of prevalence of STIs within adolescent and
young adult populations.
Participate in MDHHS convened meetings regarding chlamydia and gonorrhea
screening as requested.
Technical Assistance
1. Technical assistance (TA) requests must be submitted via the MDHHS SHOARS
system. In addition, if your contract is to be amended, the request will have to be
logged into SHOARS. Registration instructions and further information can be
found at: https://bit.ly/3HS7xdG
2. Recipient agency must register an Authorized Official and Program Manager in
the DHSP SHOARS system. These roles must match what the agency has listed
for these roles in the EGrAMS system. If you have access related questions,
contact MDHHS-SHOARS-SUPPORT MDHHS-SHOARS-
SUPPORT@michigan.gov
PROJECT: Asthma Demonstration
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
Provide evidence-based asthma management education to families and providers in an
attempt to decrease hospitalizations and emergency room utilization for individuals with
asthma.
Reporting Requirements (if different than contract language)
Progress report updates are required twice per year per CDC reporting requirements.
Any additional requirements (if applicable)
PROJECT: Body Art Fixed Fee
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
This agreement is intended to establish a payment schedule to the Grantee, following
notification of a completed inspection and recommendation for issuance of license.
The intent is to help offset costs related to the licensing of a body art facility, when
fees are collected from the respective Grantee’s jurisdiction in accordance with
Section 13101-13111 of the Public Health Code, Public Act 149 of 2007, which was
updated on December 22, 2010 and is now Public Act 375.
Reporting Requirements (if different than contract language)
The Department will reimburse the Grantee on a quarterly basis according to the
following criteria:
1. Initial annual license for a Body Art Facility prior to July 1
• $288.98 (50% of state fee)
2. Initial annual license for a Body Art Facility after to July 1
• $144.49 (50% of state fee)
3. Issue a temporary license for a Body Art Facility
• $130.03 (75% of state fee)
4. License renewal prior to December 1
• $288.98 (50% of state fee)
5. License renewal after to December 1
• $433.47 (50% of state fee + 50% late fee penalty)
6. Duplicate license
• $28.89
Payment will be made for those body art facilities that have applied and paid in full to the
Department, following notification of a completed inspection and recommendation for
issuance of license. Please note that the fees in the list above are based on FY2022
reimbursement rates and are subject to change with the Consumer Price Index.
Any additional requirements (if applicable)
The Grantee is authorized to enforce PA 375 and conduct an inspection of all body art
facilities under its jurisdiction, investigate complaints, and enforce licensing regulations
and requirements. The Grantee must complete a Body Art Facility Inspection Report
[DCH-1468 (07-09)], as provided by the Department, or other report form approved by
the Department that meets, at minimum, all standards of the state inspection report.
Only body art facilities that have applied for licensure should be inspected. All body art
facilities must be inspected annually. Licenses will only be released from the
Department following notification of a completed inspection and upon recommendation
by the Grantee.
Completed inspection reports should be signed by the facility owner and
recommendation for licensure should be forwarded to the Department within two to four
weeks following the inspection. Reports should be entered via the online interface or
can be sent to:
HIV/STD and Body Art Section
Division of Communicable Diseases
333 S. Grand Ave, 3rd Floor
Lansing, Michigan 48933
PROJECT: Breast and Cervical Cancer Control Navigation Program
Beginning Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The BC3NP (Breast and Cervical Cancer Control Navigation Program) provides
individualized assistance to low-income women, < 250% FPL, in overcoming barriers
that may impede their access to receiving breast and cervical cancer services.
Services are provided to uninsured, underinsured, and insured women both within and
outside the program. Women identified for priority enrollment in the program are those
women in hard-to-reach populations, such as minorities, particularly African American,
Hispanic, Asian American, Arab American, and Native American women as well as
women who have insurance but do not know how to access the healthcare system to
receive breast or cervical cancer services.
Breast and/or cervical screening and diagnostic services are reimbursed for uninsured
and underinsured low-income women enrolled through the program that meet the
following criteria:
• Age 21-64; self-referred, referred from a BC3NP provider or a non-BC3NP
provider and requires cervical cancer screening and/or diagnostic services for
an identified cervical screening abnormality.
• Age 40-64; self-referred, referred from a BC3NP provider or a non-BC3NP
provider and requires breast cancer screening and/or diagnostic services for an
identified abnormality.
• Age 21-39; referred from either a BC3NP or non-BC3NP provider with an l
breast finding requiring diagnostic follow-up to rule out or confirm a breast
cancer diagnosis.
The BC3NP provides navigation services to low-income insured women, not enrolled
in the program, to assist them in accessing the healthcare system so they can
receive breast and/or cervical cancer screening, diagnostic, and/or treatment services
through their insurance provider.
Reporting Requirements (if different than contract language)
Instructions for use of MBCIS, a statewide database, will be provided to agencies that
contribute data to this database. The CPCS will exchange relevant program reports with
appropriate contractors through encrypted email or a secure file transfer system.
Any additional requirements (if applicable)
For specific BC3NP requirements, refer to the most current BC3NP Policies and
Procedures or visit www.michigan.gov/BC3NP.
PROJECT: CAHC MI Kids Now (All Locations)
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
A major role of the CAHC program is to provide a safe and caring place for children and
adolescents to receive needed medical care and support, learn positive health behaviors,
and prevent diseases, resulting in healthy youth who are ready and able to learn and
become educated, productive adults. CAHCs assist eligible children and adolescents with
enrollment in Medicaid and provide access to Medicaid preventive
services.
Reporting Requirements (if different than contract language)
A. The Grantee shall submit the following reports on the following dates:
• Quarterly Program Data Report: Due 30 days after the end of the reported quarter
• Annual Program Narrative: Due 30 days after the end of the grant period
B. Any such other information as specified in the Statement of Work, Attachment A shall
be developed and submitted by the Grantee as required by the Contract Manager.
C. Reports and information shall be submitted to the Contract Manager as follows:
• Quarterly Program Data Report: via the Child and Adolescent Health Center
Clinical Reporting Tool located at Clinical Reporting Tool (knack.com)
• Annual Program Narrative: email
D. The Contract Manager shall evaluate the reports submitted as described in
Attachment C, Items A. and B. for their completeness and adequacy.
E. The Grantee shall permit the Department or its designee to visit and to make an
evaluation of the project as determined by Contract Manager.
Any additional requirements (if applicable)
Funding Eligibility
To be eligible for funding, all applicants must provide signed assurance that referrals for
abortion services or assistance in obtaining an abortion will not be provided as part of the
services (MCL §388.1766). For programs providing services on school property, signed
assurance is required that family planning drugs and/or devices will not be prescribed,
dispensed or otherwise distributed on school property as mandated in the Michigan School
Code (MCL §380.1507). Applicants must assure compliance with all federal and state laws
and regulations prohibiting discrimination and with all requirements and regulations of MDE
and MDHHS.
Target Populations to be Served
Proposals should focus on the delivery of health services to ages 5-21 years at school-
based sites, and 10-21 years at school-linked sites, in geographic areas where it can be
documented that health care services that are accessible and acceptable to children and
adolescents require enhancement or do not currently exist. The children (birth and up) of
the adolescent target population may also be served where appropriate. Funding may be
used to provide clinical services to students receiving special education services up to 26
years of age.
Technology
Successful applicants are required to have an accessible electronic mail account (email)
to facilitate ongoing communication. All successful applicants will be added to a CAHC
program list serve, which is the primary vehicle for communication from the State.
Successful applicants must have the necessary technology and equipment to support
billing and reimbursement from third party payers. Refer to Reference A, Minimum Program
Requirements which describes the billing and reimbursement requirements for all
grantees.
Training
At least one staff member is required to attend a yearly Michigan Department of Health
and Human Services CAHC Annual Meeting in the fall, as announced by the MDHHS team.
Unallowable Expenses
The following costs are not allowed with this funding:
• The purchase or improvement of land
• Fundraising activities
• Political education or lobbying, including membership costs for advocacy or
lobbying organizations
• Indirect costs
The following restrictions are in effect for this funding:
• Funds may not be used to refer a student for an abortion or assist a student in
obtaining an abortion (MCL §388.1766).
• Funds may not be used to prescribe, dispense or otherwise distribute a family
planning drug or device in a public school or on public school property (MCL
§380.1507).
• Funding may not be used to serve the adult population (ages 22 years and older),
with the exception of students up to 26 years of age who are receiving special
education services.
• Funds may not be used to supplant or replace an existing program supported with
another source of funds or for ongoing or usual activities of any organization
involved in the project.
Minimum Program Requirements
The Minimum Program Requirements document is considered to be part of Attachment
III.
PROJECT: Child and Adolescent Health Center Program Expansion
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
A major role of the CAHC program is to provide a safe and caring place for children
and adolescents to receive needed medical care and support, learn positive health
behaviors, and prevent diseases, resulting in healthy youth who are ready and able to
learn and become educated, productive adults. CAHCs assist eligible children and
adolescents with enrollment in Medicaid and provide access to Medicaid preventive
services.
Reporting Requirements (if different than contract language)
A. The Grantee shall submit the following reports on the following dates:
• Quarterly Program Data Report: Due 30 days after the end of the reported quarter
• Annual Program Narrative: Due 30 days after the end of the grant period
B. Any such other information as specified in the Statement of Work, Attachment A shall
be developed and submitted by the Grantee as required by the Contract Manager.
C. Reports and information shall be submitted to the Contract Manager as follows:
• Quarterly Program Data Report: via the Child and Adolescent Health Center
Clinical Reporting Tool located at Clinical Reporting Tool (knack.com)
• Annual Program Narrative: email
D. The Contract Manager shall evaluate the reports submitted as described in
Attachment C, Items A. and B. for their completeness and adequacy.
E. The Grantee shall permit the Department or its designee to visit and to make an
evaluation of the project as determined by Contract Manager.
Any additional requirements (if applicable)
Funding Eligibility
To be eligible for funding, all applicants must provide signed assurance that referrals for
abortion services or assistance in obtaining an abortion will not be provided as part of the
services (MCL §388.1766). For programs providing services on school property, signed
assurance is required that family planning drugs and/or devices will not be prescribed,
dispensed or otherwise distributed on school property as mandated in the Michigan School
Code (MCL §380.1507). Applicants must assure compliance with all federal and state laws
and regulations prohibiting discrimination and with all requirements and regulations of MDE
and MDHHS.
Target Populations to be Served
Proposals should focus on the delivery of health services to ages 5-21 years at school-
based sites, and 10-21 years at school-linked sites, in geographic areas where it can be
documented that health care services that are accessible and acceptable to children and
adolescents require enhancement or do not currently exist. The children (birth and up) of
the adolescent target population may also be served where appropriate. Funding may be
used to provide clinical services to students receiving special education services up to 26
years of age.
Technology
Successful applicants are required to have an accessible electronic mail account (email)
to facilitate ongoing communication. All successful applicants will be added to a CAHC
program list serve, which is the primary vehicle for communication from the State.
Successful applicants must have the necessary technology and equipment to support
billing and reimbursement from third party payers. Refer to Reference A, Minimum Program
Requirements which describes the billing and reimbursement requirements for all
grantees.
Training
At least one staff member is required to attend a yearly Michigan Department of Health
and Human Services CAHC Annual Meeting in the fall, as announced by the MDHHS team.
Unallowable Expenses
The following costs are not allowed with this funding:
• The purchase or improvement of land
• Fundraising activities
• Political education or lobbying, including membership costs for advocacy or
lobbying organizations
• Indirect costs
The following restrictions are in effect for this funding:
• Funds may not be used to refer a student for an abortion or assist a student in
obtaining an abortion (MCL §388.1766).
• Funds may not be used to prescribe, dispense or otherwise distribute a family
planning drug or device in a public school or on public school property (MCL
§380.1507).
• Funding may not be used to serve the adult population (ages 22 years and older),
with the exception of students up to 26 years of age who are receiving special
education services.
• Funds may not be used to supplant or replace an existing program supported with
another source of funds or for ongoing or usual activities of any organization
involved in the project.
Minimum Program Requirements
The Minimum Program Requirements document is considered to be part of Attachment
III.
PROJECT: Childhood Lead Poisoning Prevention
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
MDHHS CLPPP’s mission is “to prevent childhood lead poisoning across the state
through surveillance, outreach and health services”. This grant provides local health
departments the opportunity to prevent and address lead poisoning within their
communities, with support of CLPPP. The overall goal of the grant is to increase testing
for children under the age of 6, specifically capillary to venous testing rates.
Reporting Requirements (if different than contract language)
1. Workplan – submitted according to due dates set by CLPPP
2. Quarterly Reports – submitted no later than thirty (30) days after the close of the
quarter.
Grantee Specific Requirements
Grantees shall:
• Identify target areas with lower testing rates, with the assistance of CLPPP and
quarterly data reports provided to the LHDs.
• Provide a workplan with a detailed overview of how your LHD plans to increase
testing rates within the grantee focus area, and explanation of target
audience/locations. Metrics for success should be strategic, measurable,
ambitious, realistic, time-bound, inclusive, and equitable. Planning for the
workplan should be done in coordination with CLPPP. CLPPP will provide
recommended activities to the grantees.
• Conduct a quarterly review of the workplan and grant activity progress. Submit a
quarterly report to CLPPP with progress made, as well as revisions needed for
the workplan.
• Attend meetings with CLPPP and other grantees as scheduled.
• Ensure all communication materials that are developed and distributed by the
grantee are approved by CLPPP if MDHHS funds are used.
PROJECT: CLPP Lead Expansion
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
MDHHS CLPPP’s mission is “to prevent childhood lead poisoning across the state
through surveillance, outreach and health services”. The goal of this pilot is to maximize
the number of children less than six years of age protected from lead poisoning and the
number of City of Detroit childcare facilities where lead hazards are controlled. This
goal should be accomplished through targeted lead testing and hazard controls efforts,
expanded education and outreach, and enhancing nursing and environmental services
to children with an EBLL 3.5-19 mcg/dL, residing in the 6 high risk zip codes in the City
of Detroit.
Grantees could achieve this goal through:
1) Targeted lead testing and hazard controls efforts, this can include:
• Lead education in early childhood care centers (daycares, Early Head Start,
Head Start)
• Lead inspection risk assessments in licensed childcare centers
2) Expanded education and outreach, this can include:
• Providing lead testing on site at early childcare centers
• Providing referrals to other essential health services (WIC, IMMS, Vision/Hearing
screening)
3) Enhancing nursing and environmental services to children with an EBLL 3.5-
19mcg/dL, residing in the 6 high risk zip codes in the City of Detroit, this can include:
• Non-Medicaid children – providing nursing case management home visits
• Coordinate lead inspection risk assessments for children with an EBLL, residing
in this zip code
Reporting Requirements (if different than contract language)
• Provide a workplan with a detailed overview of how your LHD plans to expand
education, NCM and linkage to care within the grantee focus area, and explanation
of target audience/locations
• Submit quarterly reports
Any additional requirements (if applicable)
• Attend quarterly call/in-person meetings
• Ensure all communication materials that are developed and distributed by the
grantee are approved by CLPPP if MDHHS funds are used.
PROJECT: Community Blood Lead Testing
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
In response to the decrease in blood lead testing due to COVID-19 and the impact on
pediatric visits and WIC agency closure, there is a necessity to support local health
departments to facilitate innovative strategies in their jurisdictions to ensure access to
and completion of blood lead testing for children to identify lead exposure. It is
imperative that there is a community-based approach to blood lead testing. This pilot
funding is to support local health departments in planning for implementation of
strategies to increased blood lead testing of children <6 years old within their
jurisdiction. This planning will follow the ABC Building Blocks for Community Blood Lead
Testing, comprised of assessing, bolstering, and coordinating.
Grantees could achieve this goal through:
1) Assess current state of blood lead testing in the jurisdiction, this can include:
• Survey community partners and local health department to determine where
blood lead testing is taking place
• Identify gaps in blood lead testing availability
• Identify barriers to accessing blood lead testing
• Identify Medicaid Health Plans (MHPs) serving the community
• Identify Partners for promotion of lead testing
2) Bolster current testing efforts, this can include:
• Conduct provider education regarding recommendations for blood lead testing at
existing access points
• Conduct public education about existing testing options, targeting children less
than 6 years old
• Enhance access to existing local access points for blood lead testing by reducing
identified barriers to testing
3) Coordinate a testing plan, this can include:
• Work with Medicaid Health Plans to identify children due for screening and
perform targeted outreach
• Identify a plan for a “safety net” option for free testing for uninsured, those whose
insurance will not cover testing, those falling outside our target groups, or
communities needing timely access to testing
• Reporting Requirements (if different than contract language)
• Provide a workplan with a detailed overview of how your LHD will demonstrate
functional “safety net” option and ability to increase access to testing as needed
• Submit quarterly reports
Any additional requirements (if applicable)
• Attend quarterly call/in-person meetings
• Ensure all communication materials that are developed and distributed by the
grantee are approved by CLPPP if MDHHS funds are used.
PROJECT: CSHCS Care Coordination
Start Date: 10/01/2022
End Date: 09/30/2023
Project Synopsis
Beneficiaries enrolled in CSHCS with identified needs may be eligible to receive Care
Coordination Services as provided by the local health department. In addition,
beneficiaries with either CSHCS, CSHCS and Medicaid, or Medicaid only (no CSHCS)
may be eligible to receive Case Management services if they have a CSHCS medically
eligible diagnosis, complex medical care needs and/or complex psychosocial situations
which require that intervention and direction be provided by the local health department.
LHD staff includes registered nurses (RNs), social workers, or paraprofessionals under
the direction and supervision of RNs. Services are reimbursed on a fee for services
basis, as specified in Attachment IV Notes.
Reporting Requirements (if different than contract language)
See Attachment I for specific budget and financial requirements.
Case Management and Care Coordination services within a specific Case Management
role cannot be billed during the same LHD billing period, which is usually a fiscal quarter.
Care Coordination and Case Management Logs are submitted electronically via the
Children’s Healthcare Automated Support Services (CHASS) Billing Module to the
Contract Manager. Quarterly logs must be submitted with the financial status report.
Annual Narrative Progress Report
A brief annual narrative report is due by November 15 following the end of the fiscal year.
The reporting period is October 1 – September 30. The annual report will be submitted to
the Department and shall include:
•Summary of successes and challenges
•Technical assistance needs the Grantee is requesting the Department to address
•Brief description of how any local MCH funds allocated to CSHCS were used (e.g.
CSHCS salaries, outreach materials, mailing costs, etc.), if applicable
•The unduplicated number of CSHCS eligible clients assisted with CSHCS
enrollment.
• The unduplicated number of CSHCS clients assisted in the CSHCS renewal
process.
Definitions
Unduplicated Number of CSHCS Eligible Clients Assisted with CSHCS Enrollment
is defined as:
Number of CSHCS eligible clients the Grantee provided one-on-one (in person or via
telephone) substantial assistance to complete the CSHCS enrollment process during the
fiscal year. This assistance includes, but is not limited to, helping the family obtain
necessary medical reports to determine clinical eligibility, completing the CSHCS
Application for Services, completing the CSHCS financial assessment forms, etc.
Assistance does not include mailed letters to the family.
Unduplicated Number of CSHCS Clients Assisted in the CSHCS Renewal Process
is defined as:
Number of CSHCS enrollees the Grantee provided one-on-one (in person or via
telephone) substantial assistance to complete and/or submit documents required for the
Department to make a determination whether to continue/renew CSHCS coverage during
the fiscal year. “Assisted” may also include collaboration with the client’s Medicaid Health
Plan. Assistance does not include mailed letters to the family.
Any additional requirements (if applicable)
Case Management services address complex needs and services and include an initial
face-to-face encounter with the beneficiary/family. Case Management requires that
services be provided in the home setting or other non-office setting based on family
preference. Beneficiaries are eligible for a maximum of six billing units per eligibility year.
Services above the maximum of six require prior approval by MDHHS. To request
approval, the LHD must submit an exception request, including the rationale for additional
services, to MDHHS. Limitations on the need for and number of Case Management
service units are set by MDHHS and must be provided by a specific Case Management
role, in accordance with training and certification requirements.
Staff must be trained in the service needs of the CSHCS population and demonstrate skill
and sensitivity in communicating with children with special needs and their families.
Care Coordination is not reimbursable for beneficiaries also receiving Case Management
services during the same LHD billing period, which is usually a calendar quarter. In the
event Care Coordination services are no longer appropriate and Case Management
services are needed, the change in services may only be made at the beginning of the
next billing period.
PROJECT: CSHCS Medicaid Elevated Blood Lead Case Management
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The local health department will complete in-home elevated blood lead (EBL) case
management (CM) services, with parental consent, for children less than age 6 in their
jurisdiction enrolled in Medicaid with a blood lead level equal to or greater than 3.5
µg/dL as determined by a venous test. EBL CM will be conducted according to the
“Case Management Guide for Children with Elevated Blood Lead Levels” that is
provided by the Childhood Lead Poisoning Prevention Program (CLPPP), Michigan
Department of Health and Human Services (MDHHS). For each child eligible for EBL
CM, efforts to contact the family to provide CM services and specific services provided
must be documented in the child’s electronic record in the Healthy Homes and Lead
Poisoning Prevention Surveillance System (HHLPSS) database.
Reporting Requirements (if different than contract language)
Quarterly FSR and FSR Supplemental Attachment
Submit request for reimbursement through EGrAMS based on the “fixed unit rate”
method. The fixed rate for case management services is $201.58 per home visit, for up
to 6 home visits. Additionally, a FSR supplemental attachment form is required to be
uploaded in EGrAMS that specifies the number of children and home visits for which
reimbursement is being requested on. The FSR and the FSR supplemental attachment
form must be submitted no later than thirty (30) days after the close of the quarter.
Quarterly Case Management Logs
A complete spreadsheet of CM activities is due quarterly, submitted electronically
through the CLPPP’s secure DCH-File Transfer Site available through MiLogin, using a
template provided by CLPPP. The quarterly spreadsheet must be submitted no later
than thirty (30) days after the close of the quarter.
Annual Report
An annual report is required covering the reporting period for FY23 is October 1 –
September 30. The format and due date for the submission will be determined by
CLPPP, and communicated to the local health departments.
Reporting Time Period Due dates for quarterly spreadsheet, FSR,
and supplemental form
October 1 – December 31 January 31
January 1 – March 31 April 30
April 1 – June 30 July 30
July 1 – September 30 October 20
Any additional requirements (if applicable)
The local health department shall:
• Have CM conducted by a registered nurse trained by MDHHS CLPPP. To be
reimbursed for a home visit, the visit must be completed by a registered nurse.
• Sign up for the DCH-File Transfer Site available through MiLogin. This site will be
used for data sharing of confidential information.
• Have an agreement with all Medicaid Health Plans in their jurisdiction that allows
for sharing of Personal Health Information.
• Identify and initiate contact with families of all Medicaid-enrolled children with
EBLLs.
• Complete case management activities according to the MDHHS CLPPP Case
Management Guide.
• Document all required case management activities in the child’s electronic file in
the HHLPPS database. Required documentation includes an initial home visit
form, follow-up visit forms, dates of chelation therapy, and plan of care.
PROJECT: CSHCS Medicaid Outreach
Start Date: 10/01/2022
End Date: 09/30/2023
Project Synopsis
Local Health Departments may perform Medicaid Outreach activities for
CSHCS/Medicaid dually enrolled clients and receive reimbursement at a 50% federal
administrative match rate based upon their CSHCS Medicaid dually enrolled caseload
percentage and local matching funds.
Reporting Requirements (if different than contract language)
See Attachment I for specific budget and financial requirements.
Annual Narrative Progress Report
N/A
Any additional requirements (if applicable)
N/A
PROJECT TITLE: CSHCS Outreach and Advocacy
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
Local Health Departments (LHDs) throughout the state serve children with special health
care needs in the community. The LHD acts as an agent of the CSHCS program at the
community level. It is through the LHD that CSHCS succeeds in achieving its charge to
be community-based. The LHD serves as a vital link between the CSHCS program, the
family, the local community and the Medicaid Health Plan (as applicable) to assure that
children with special health care needs receive the services they require covering every
county in Michigan.
LHD is required to provide the following specific outreach and advocacy services:
• Program representation and advocacy
• Application and renewal assistance
• Link families to support services (e.g. The Family Center, CSHCS Family Phone Line,
the CSHCS Family Support Network (FSN), transportation assistance, etc.)
• Implement any additional MPR requirements
• Care coordination
• Budget and Agreement Requirement and Grantee
• Submission of all documents via the document management portal, as required
Reporting Requirements (if different than agreement language):
Annual Narrative Progress Report
A brief annual narrative report is due by November 15 following the end of the fiscal year.
The reporting period is October 1 – September 30. The annual report will be submitted to
the Department and shall include:
• Summary of successes and challenges
• Technical assistance needs the Grantee is requesting the Department to address
• Brief description of how any local MCH funds allocated to CSHCS were used (e.g.
CSHCS salaries, outreach materials, mailing costs, etc.), if applicable
• The unduplicated number of CSHCS eligible clients assisted with CSHCS
enrollment.
• The unduplicated number of CSHCS clients assisted in the CSHCS renewal
process.
Definitions
Unduplicated Number of CSHCS Eligible Clients Assisted with CSHCS Enrollment
is defined as:
Number of CSHCS eligible clients the Grantee provided one-on-one (in person or via
telephone) substantial assistance to complete the CSHCS enrollment process during the
fiscal year. This assistance includes, but is not limited to, helping the family obtain
necessary medical reports to determine clinical eligibility, completing the CSHCS
Application for Services, completing the CSHCS financial assessment forms, etc.
Assistance does not include mailed letters to the family.
Unduplicated Number of CSHCS Clients Assisted in the CSHCS Renewal Process
is defined as:
Number of CSHCS enrollees the Grantee provided one-on-one (in person or via
telephone) substantial assistance to complete and/or submit documents required for the
Department to make a determination whether to continue/renew CSHCS coverage during
the fiscal year. “Assisted” may also include collaboration with the client’s Medicaid Health
Plan. Assistance does not include mailed letters to the family.
Any additional requirements (if applicable):
Relationship between Grantees and Medicaid Health Plans:
The Grantee must establish and maintain care coordination agreements with all Medicaid
Health Plans for CSHCS enrollees in the Grantees service area. Grantees and the
Medicaid Health Plans may share enrollee information to facilitate coordination of care
without specific, signed authorization from the enrollee. The enrollee has given consent
to share information for purposes of payment, treatment and operations as part of the
Medicaid Beneficiary Application.
Care coordination agreements between Grantees and the Medicaid Health Plans will be
available for review upon request from the Department.
The agreement must address all the following topics:
• Data sharing
• Communication on development of Care Coordination Plan
• Reporting requirements
• Quality assurance coordination
• Grievance and appeal resolution
• Dispute resolution
• Transition planning for youth
PROJECT: CSHCS Vaccine Initiative
Start Date: 10/01/2022
End Date: 09/30/2023
Project Synopsis
Local Health Departments are eligible to receive funding to support efforts to increase
vaccination rates among children with disabilities and special health care needs, along
with parents and family members of children with special health care needs. Eligible
activities include incorporating the promotion of adherence to MDHHS vaccination
guidelines into existing interactions and communications with CSHCS families,
accommodations for serving children with special needs into existing or established
community vaccination efforts, and additional vaccination outreach and promotion efforts
focused on child populations with special needs. Eligible activities should include a focus
on vaccinations for COVID-19 but can also include a broader focus on adherence to
recommended pediatric vaccination schedules. Children with disabilities and special
health care needs includes children enrolled in CSHCS but can also include children with
special health care needs that are not enrolled in or medically eligible for CSHCS.
Reporting Requirements (if different than contract language)
Annual Narrative Progress Report
With Final FSR, please submit a brief narrative with the following information:
1. Describe how these funds have been used to promote vaccinations among
children with special needs and their family members. When feasible, include a
list of events or activities that have been supported with these funds, a total for the
number of events or activities, and an estimate of the number of families reached
through these activities.
2. Describe any local partnerships or collaborations used to reach families for
vaccinations, including partnerships with health care providers and/or provider
organizations. Please note any challenges or successes.
3. Describe any innovative or unique methods used to reach families with a child with
special health care needs to promote or encourage adherence to recommended
vaccination guidelines.
Any additional requirements (if applicable)
N/A
PROJECT: Eat Safe Fish
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The Grantee will collaborate with the Department and the EPA Region V Saginaw
Community Information Office to deliver a uniform message for the Saginaw River and
connected waters regarding the fish and wild game consumption advisories within the tri-
county area (Midland, Saginaw, and Bay).
Reporting Requirements (if different than contract language)
Track and report output measures.
Write and Submit quarterly reports and an annual report to the Department.
• Submit draft quarterly reports within 15 days after the end of each
quarter.
• Annual reports upon request.
Any additional requirements (if applicable)
1. The grantee will develop a plan to distribute that message using existing health
department programs, the medical community, special events, and community
service providers to communicate with the at-risk population.
2. The grantee will get approval from the Department program manager and for any
changes to the Saginaw and Bay County Cooperative Agreement Scope of Work
including budget and budget narratives.
3. The grantee will provide appropriate staff to fulfill the following objectives and
outputs as detailed:
• Comply with the Saginaw and Bay County Cooperative Agreement
budget and budget narratives as describe in the scopes of work
provided to the BCHD program manager as applicable from October 1
to September 30.
• Provide 30 hours of health education and community outreach per
week.
• Conduct health education and community outreach in Saginaw, Midland, and
Bay Counties. Activities will include, but not be limited to, internal BCHD
distribution, health care provider outreach, and key event participation.
• Track hours to comply with cost recovery requirements.
• Development, Printing, and Distribution of Outreach Materials and
implementation of Display Booth.
• Identify, track, and record of materials distributed at additional locations within
Midland, Bay, and Saginaw Counties.
• Make payment for the replacement of signage on the Tittabawasse and
Saginaw Rivers.
• Conduct Capacity Building in Saginaw, Midland and Bay Counties
• Actively seek out new community partners in Saginaw, Midland and Bay
Counties.
• Participate in monthly SBCA teleconference.
• Provide Presentation of display booth at select community events in coordination
with EPA Region V Saginaw Community Information Office.
• Conduct Outreach though existing BCHD Programs such as WIC,
Immunizations, programs for young mothers, or other programs reaching the
target population.
• Assist the EPA Region V Saginaw Community Information Office with
community outreach.
• Outreach to Health Care Providers.
PROJECT: EGLE Drinking Water and Onsite Wastewater Management
Start Date: 10/1/2022
End Date: 09/30/2023
Project Synopsis
State funding for ELPHS shall support, and the Grantee shall provide for, all of the following
required services in accordance with P.A. 368, of 1978 and P.A. 92 of 2000, as amended,
Part 24 and Act No. 336, of 1998 Section 909:
Infectious/Communicable Disease Control
Sexually Transmitted Disease
Immunization
On-Site Wastewater Treatment Management
Drinking Water Supply
Food Service Sanitation
Hearing
Vision
• State funding for ELPHS can support administrative cost for the eight required
services including allowable indirect cost, or a Grantee’s cost allocation plan.
• ELPHS funding can also be used to fund other core health functions including:
Community Health Assessment and Improvement, Public Policy Development,
Health Services Administration, Quality Assurance, Creating and Maintaining a
Competent Work Force and Local Public Health Accreditation. These services may
be budgeted separately as part of the Administrative Budget element.
• Net allowable expenditures are the authorized actual/allowable expenditures
(total costs less specified exclusions). Available funding is also limited by state
appropriations.
• First and second party fees earned in each required service program may be used
only in that required service program.
• State ELPHS funding is subject to local maintenance of effort compliance.
Distribution of state ELPHS funds shall only be made to agencies with total local
general fund public health services spending in fiscal year (FY) 2023 of at least
the amount expended in FY 92/93. To be eligible for any of the State funding
increases from FY 94/95 through FY 2023, the FY 92/93 Local Maintenance of
Effort Level must be met.
Reporting Requirements (if different than contract language)
All final amendment ELPHS funding shift request memos need to be submitted no
later than May 1. Please send the official memo to request ELPHS funding shifts by
email to Laura de la Rambelje (DelaRambeljeL@michigan.gov) and copy Carissa Reece
(ReeceC@Michigan.gov).
Any Additional Requirements (if applicable)
• Assure the availability and accessibility of services for the following basic health
services: Prenatal Care; Immunizations; Communicable Disease Control; Sexually
Transmitted Disease (STD) Control; Tuberculosis Control; Health/Medical Annex of
Emergency Preparedness Plan.
• Fully comply with the Minimum Program Requirements for each of the required
services.
• Grantee will be held to accreditation standards and follow the accreditation process
and schedule established by the Department for the required services to achieve
full accreditation status. Grantees designated as “not accredited” may have their
Department allocations reduced for Departmental costs incurred in the assurance
of service delivery. The accreditation process is based upon the Minimum Program
Standards and scheduled on a three-year cycle. The Minimum Program Standards
include the majority of the required Department reviews. Some additional reviews,
as mandated by the funding agency, may not be included in the Program
Standards and may need to be scheduled at other times.
Onsite Wastewater Management
The Grantee shall perform the following services for private single- and two-family
homes and other establishments that generate less than 10,000 gallons per day of
sanitary sewage:
• Maintain an up-to-date regulation for on-site wastewater treatment systems
(Systems). The regulation shall be supplemented by established internal policies
and procedures. Technical guidance for staff that defines site suitability
requirements, the basis for permit approval and/or denial, and issues not specifically
addressed by the regulation shall be provided.
• Evaluate all parcels to determine the suitability of the site for the installation of
initial and replacement Systems in accordance with applicable regulation(s).
These evaluations shall be conducted by a trained sanitarian or equivalent and
shall consist of a review of the permit application for the installation of a System
and a physical evaluation of the site to determine suitability.
• Accurately record on the permit to install the initial or replacement System or on an
attachment to the permit the site conditions for each parcel evaluated including soil
profile data, seasonal high-water table, topography, isolation distances, and the
available area and location for initial and replacement Systems. The requirement
for identifying a replacement System applies to issuance of new construction
permits only.
• Issue a permit, prior to construction, in accord with applicable regulation(s) for
those sites that meet the criteria for the installation of a System. The permit shall
include a detailed plan and/or specification that accurately define the location of the
initial or replacement System, System size, other pertinent construction details, and
any documented variances.
• Provide and keep on file formal written denials, stating the reason for denial, for
those applications where site conditions are found to be unsuitable.
• Conduct a construction inspection prior to covering each System to confirm that the
completed System complies with the requirements of the permit that has been
issued. Maintain, on file, an accurate individual record of each inspection
conducted during construction of each system. In limited circumstances where
constraints prohibit staff from completing the required construction inspection in a
timely manner, an effective alternate method to confirm the adequacy of the
completed System shall be established. The effective alternative method shall be
utilized for no more than ten (10) percent of the total number of final inspections
unless specific authorization has been granted by the State for other percentage.
The results of all such inspections or an alternate method shall be clearly
documented.
• Maintain an organized filing system with retrievable information that includes
documentation regarding all site evaluations, permits issued or denied, final
inspection documentation, and the results of any appeals.
• Conduct review and approval or rejection of proposed subdivisions, condominiums
and also land divisions under one acre in size for site suitability according to the
statutes and Administrative Rules for Onsite Water Supply and Sewage Disposal
for Land Divisions and Subdivisions.
• Utilize the State’s “Michigan Criteria for Subsurface Sewage Disposal” (Criteria) for
Systems other than private single- and two-family homes that generate less than
10,000 gallons per day. Systems treating less than 1,000 gallons per day may be
approved in accordance with the Grantee’s regulation. Advise the State prior to
issuance of a variance from the Criteria. Variances are only to be issued by the
Director of Environmental Health of the Grantee after consultation with the State.
Appeals of any decision of the Grantee pursuant to the Criteria including systems
treating less than 1,000 gallons evaluated in accordance with the Grantee’s
regulation shall only be made to the State.
• Maintain quarterly reports that summarize the total number of parcels evaluated,
permits issued, alternative or engineered plans reviewed, and number of appeals,
number of inspections during construction, number of failed systems evaluated,
and number of sewage complaints received and investigated for each residential
(single and two-family homes) and non-residential properties. The report forms
EQP2057a.1 (Non-Residential) and EQP2057b.1 (Residential) are available on the
EGLE website. All quarterly reports are to be submitted directly to EGLE, to the
address noted on the form, within fifteen (15) days following the end of each
quarter.
• Review all engineered or alternative System plans. Conduct adequate
inspections during the various phases of construction to ensure proper installation.
• Collect data at the time of permit issuance when a System has failed to document
the System age, design, site conditions, and other pertinent factors that may have
contributed to the failure of the original System. Evaluations shall record
information indicated on the EGLE Onsite Wastewater Program Residential and
Non-Residential Information forms. The results for all failed Systems evaluated
shall be maintained in a retrievable file or database and summarized in an annual
calendar year data report. Annual summaries of failed system data shall be
provided to EGLE for input into the state-wide failed system database. The EGLE
Onsite Wastewater Program Residential and Non-Residential Information forms
shall be provided to the State no later than February 1st of the year following the
calendar year for which the data has been collected.
• Provide training for staff involved in the Program as necessary to maintain
knowledge of current regulations and internal policies and procedures and to keep
staff informed of technological improvements and advancements in Systems.
• Establish and maintain an enforcement process that is utilized to resolve violations
of the Local Entity and/or State’s rules and regulations.
• Maintain complaint forms and a filing system containing results of complaint
investigations and documentation of final resolution. Investigate and respond to all
complaints related to onsite wastewater in a timely manner.
Drinking Water:
The Grantee shall perform the following services including but not limited to:
• Perform water well permitting activities, pre-drilling site reviews, random
construction inspections, and water supply system inspections for code compliance
purposes with qualified individuals classified as sanitarians or equivalent.
• Assign one individual to be responsible for quarterly reporting of the data and to
coordinate communication with the assigned State staff. Reports shall be submitted
no later than fifteen (15) days following the end of the quarter on forms provided by
the State. The report form EQP2057 (07/2019) is available on the EGLE website.
All quarterly reports are submitted directly to the EGLE address noted on the form.
• Perform Minimum Program Requirements (MPRs) activities and associated
performance indicators. These are available on the EGLE website. Guidance
regarding the MPRs and indicators is available in the “Local Health Department
Guidance Manual for the Private and Type III Drinking Water Supply Systems.”
The guidance manual is available online at Michigan.gov/WaterWellConstruction.
PROJECT: Food Service Sanitation (FOOD ELPHS)
Start Date: 10/1/2022
End Date: 09/30/2023
Project Synopsis
State funding for ELPHS shall support and the Grantee shall provide for all the following
required services in accordance with P.A. 368, of 1978 and P.A. 92 of 2000, as
amended, Part 24 and Act No. 336, of 1998 Section 909:
Infectious/Communicable Disease Control
Sexually Transmitted Disease
Immunization
On-Site Wastewater Treatment Management
Drinking Water Supply
Food Service Sanitation
Hearing
Vision
• State funding for ELPHS can support administrative cost for the eight required
services including allowable indirect cost, or a Grantee’s cost allocation plan.
• ELPHS funding can also be used to fund other core health functions including:
Community Health Assessment & Improvement, Public Policy Development,
Health Services Administration, Quality Assurance, Creating & Maintaining a
Competent Work Force and Local Public Health Accreditation. These services
may be budgeted separately as part of the Administrative Budget element.
• Net allowable expenditures are the authorized actual/allowable expenditures
(total costs less specified exclusions). Available funding is also limited by state
appropriations.
• First- and second-party fees earned in each required service program may be
used only in that required service program.
Reporting Requirements (if different than contract language)
All final amendment ELPHS funding shift request memos need to be submitted no later
than May 1st. Please send the memo to Laura de la Rambelje
(DelaRambeljeL@michigan.gov) and copy Carissa Reece (ReeceC@michigan.gov)
Food Service Establishment Licensing
• Provide updates to MDARD on the 1st and 15th of each month, as necessary to:
• Provide a list of food service establishments approved for licensure/license
issued.
• Provide a list of food service establishment licenses that have not been
approved for licensure and are considered voided or deleted.
• Return the actual licenses to MDARD that are to be voided or deleted.
• Return renewal license applications and licenses that require correction.
Mark the corrections on the renewal application.
Temporary Food Establishment Licensing
Provide updates to MDARD on the 1st and 15th of each month, as necessary, to
provide:
• A copy of each temporary food establishment license issued.
• A list of lost or voided licenses by license number.
Any additional requirements (if applicable)
Food Service Establishment Licensing
• Accept responsibility for all licenses specified in the “Record of Licenses
Received.”
• Issue licenses in accordance with the Michigan Food Law 2000, as amended.
Temporary Food Establishment Licensing Upon receipt, sign and return the “Record of Licenses Received” to MDARD.
Issue licenses in accordance with the Michigan Food Law 2000, as amended.
Make every effort to issue temporary food establishment licenses in numerical order.
Michigan Department of Agriculture and Rural Development (MDARD) Agrees to:
Food Service Establishment Licensing
• Furnish pre-printed food service establishment license applications and pre-
printed licenses to the Grantee for each licensing year (May 1 through April 30)
using previous year active license data.
• Provide a count of all licenses sent to the Grantee titled “Record of Licenses
Received.”
• Reprint any licenses requiring correction and send corrected copies to the
Grantee.
• Bill the local health department for state fees upon notification by Grantee that
the license has been approved and issued.
Temporary Food Service Establishment Licensing
• Furnish blank temporary food service license application forms (forms FI-231, FI-
231A) and blank Combined License/Inspection forms (FI-229) upon request from
the local health department.
• Furnish a “Record of Licenses Received” with each order of Combined
Licenses/Inspection forms.
• Periodically reconcile temporary food service establishment licenses sent to
the Grantee with the licenses that have been issued (copy returned to MDARD).
• Bill the local health department for state fees upon notification by the
Grantee that the license has been approved and issued.
PROJECT TITLE: ELPHS Hearing and Vision
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The Hearing and Vision Programs screen over one million preschool and school-age
children each year. Screening services are conducted in schools, Head Starts, and
other preschool centers by local health department (LHD) hearing and vision
technicians. Children who fail their vision screening are referred to a licensed eye
doctor (Ophthalmologist or Optometrist) for an exam and treatment. Follow-up is
conducted by the LHD to confirm that the child gets the care that they need. Children
who do not pass their hearing screening are referred to their primary care physician,
audiologist, or Ear, Nose, and Throat physician for diagnosis, treatment, and
recommendations.
Reporting Requirements (if different than agreement language):
Upon completion of the FY23 grant agreement, grantees must submit a School-Based
Hearing and Vision Program Annual Narrative Progress Report to MDHHS-Hearing-
and-Vision@michigan.gov and cc: respective Program Consultants (Jennifer Dakers,
dakersj@michigan.gov and Dr. Rachel Schumann, schumannr@michigan.gov
The report must include:
1. Successes-accomplishments of the program/technician(s)
2. Challenges- issues that created difficulty in managing the program and/or
performing screening services.
3. Technical Assistance Needs- request support from the Hearing and/or Vision
Consultant.
4. Additional Feedback-questions in this section will change annually based on
relevant/current program topics/issues.
• Each Local Health Department (coordinators and technicians) should keep an
ongoing log of Successes and Challenges to compile and share at the end of the
fiscal year.
• Final reports are submitted by the grantee to MDHHS. The reports are due 30
days after the end of the fiscal year.
For questions regarding these reports, please contact:
Jennifer Dakers, MDHHS Hearing Consultant, dakersj@michigan.gov
Dr. Rachel Schumann, MDHHS Vision Consultant, schumannr@michigan.gov
Any additional requirements (if applicable):
Grantees must adhere to established Minimum Program Requirements for School-
Based Hearing & Vision Services as outlined in the Michigan Local Public Health
Accreditation Program 2019 MPR Indicator Guide.
PROJECT: MDHHS Essential Local Public Health Services (ELPHS)
Beginning Date: 10/1/2022
End Date: 09/30/2023
Project Synopsis
State funding for ELPHS shall support and the Grantee shall provide for all of the following
required services in accordance with P.A. 368, of 1978 and P.A. 92 of 2000, as
amended, Part 24 and Act No. 336, of 1998 Section 909:
Infectious/Communicable Disease Control
Sexually Transmitted Disease
Immunization
EGLE Drinking Water and Onsite Wastewater Management
Food Service Sanitation
Hearing
Vision
• State funding for ELPHS can support administrative cost for the eight required
services including allowable indirect cost, or a Grantee’s cost allocation plan.
• ELPHS funding can also be used to fund other core health functions including
Community Health Assessment & Improvement, Public Policy Development,
Health Services Administration, Quality Assurance, Creating & Maintaining a
Competent Work Force and Local Public Health Accreditation. These services
may be budgeted separately as part of the Administrative Budget element.
• Net allowable expenditures are the authorized actual/allowable expenditures
(total costs less specified exclusions). Available funding is also limited by state
appropriations.
• First and second party fees earned in each required service program may be
used only in that required service program.
• State ELPHS funding is subject to local maintenance of effort compliance.
Distribution of state ELPHS funds shall only be made to agencies with total local
general fund public health services spending in FY23 of at least the amount
expended in FY 92/93. To be eligible for any of the State funding increases from
FY 94/95 through FY23, the FY 92/93 Local Maintenance of Effort Level must be
met.
Reporting Requirements (if different than contract language)
• Local maintenance of effort reports are due:
1. Projected Current Fiscal Year – October 30
2. Prior Fiscal Year Actual – March 31
• A final statewide cost settlement will be performed to assure that all available
ELPHS funds are fully distributed and applied for required services.
• All final amendment ELPHS funding shift request memos need to be submitted
no later than May 1st. Please send the memo to Laura de la Rambelje
(DelaRambeljeL@michigan.gov) and copy Carissa Reece
(ReeceC@michigan.gov)
• Each LHD will be required to complete the MDHHS ELPHS Detail report at the
end of Quarter 2 and Quarter 4.
Any additional requirements (if applicable)
• Assure the availability and accessibility of services for the following basic health
services: Prenatal Care; Immunizations; Communicable Disease Control;
Sexually Transmitted Disease (STD) Control; Tuberculosis Control;
Health/Medical Annex of Emergency Preparedness Plan.
• Fully comply with the Minimum Program Requirements for each of the required
services.
• Grantee will be held to accreditation standards and follow the accreditation
process and schedule established by the Department for the required services to
achieve full accreditation status. Grantees designated as “not accredited” may
have their department allocations reduced for Departmental costs incurred in the
assurance of service delivery. The accreditation process is based upon the
Minimum Program Standards and scheduled on a three-year cycle. The
Minimum Program Standards include the majority of the required Department
reviews. Some additional reviews, as mandated by the funding agency, may not
be included in the Program Standards and may need to be scheduled at other
times.
PROJECT: Emerging Threats – Hepatitis C
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
Funds are provided to grantees to increase local capacity to make improvements in
hepatitis C virus (HCV) testing, case follow-up, and linkage to care. Progress will be
tracked by monitoring case completion rates and HCV linkage to care within the MDSS
and evaluating HCV testing volumes submitted by grantees through STARLIMS.
Reporting Requirements (if different than contract language)
• Grantees will keep a log of MDSS IDs on client interactions and linkage to care
progress for submission to the MDHHS Viral Hepatitis Unit on a quarterly basis.
• Grantees will participate on semi-routine group conference calls and/or 1:1
technical assistance check in calls to discuss best practices and identify barriers.
• Grantees will collect and submit specimens to the MDHHS Bureau of Laboratories
for HCV testing through their public health clinics.
Target Requirements
Grantees will meet the following objectives for Hepatitis C, Chronic follow-up:
Target 1: Interview attempted on 90% of Hepatitis C, Chronic cases within 30 days of
referral date.
Target 2: Interview completed on 50% of Hepatitis C, Chronic cases within 60 days of
referral date.
Target 3: Hepatitis C RNA test result on 50% of Probable Hepatitis C, Chronic cases
within 90 days of referral date.
Violation Monitoring:
The inability to meet the metrics will elicit the following response from MDHHS related to
this funding:
• Technical assistance
• Corrective action/performance improvement plans with MDHHS
• Reallocation of funds.
Any additional requirements (if applicable)
• Grantees will document process for carrying out the HCV project during the
current pandemic
• Grantees will document best practices or protocols for HCV case investigation and
linkage to care
• Grantees will document pathways to link patients to medical care
• Grantees may collaborate with the State Viral Hepatitis Unit for assistance
• Grantees can submit HCV specimens to the MDHHS Bureau of Laboratories at no
cost to them or the client
PROJECT TITLE: Ending the HIV Epidemic Implementation
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The purpose of this project is to implement activities to support the objectives of the
CDC PS20-2010 Ending the HIV Epidemic in Wayne County. The purpose of these
objectives is to reduce the incidence of HIV in and improve the overall health and well-
being of residents of Wayne County.
Reporting Requirements:
1. The Grantee will clean-up missing data by the 10th day after the end of each
calendar month. Grantee must report required variables as outlined by National
HIV Monitoring and Evaluation (NHM&E) and MDHHS.
2. Any such other information as specified in the Statement of Work, Attachment A
shall be developed and submitted by the Grantee as required by the Division of
HIV and STI Programs (DHSP).
3. The Quality Control and Daily Client Logs may be sent to the Contract Manager
via:
Email – Mary Roach (roachm@michigan.gov) and Safina Thomas
(thomass56@michigan.gov)
Fax - (517) 241-5922
Mailed - HIV Prevention Unit, Attn: CTR Coordinator, PO Box 30727,
Lansing, MI 48909
4. The Grantee shall permit the Department or its designee to visit and to make an
evaluation of the project as determined by the Division of HIV and STI Programs
(DHSP).
Grantee Report Submission Schedule
Report Period Due Date(s) Report submission
Counseling, Testing, and referrals
Quality Control
Reports Monthly 10th of the following
month Department Staff
Daily Client Logs Monthly 10th of the following
month Department Staff
HIV Testing
Proficiencies Annually Reviewed during
site visits Department Staff
HIV Testing
Competencies Annually
Sent to MDHHS
before the end of
the fiscal year
Department Staff
Non-Reactive
Results As needed Within 7 days of test APHIRM
PrEP Cascade Data Monthly 10th of the following
month APHIRM
Reactive Results As needed Within 24 hours of
test APHIRM
Case Report Forms
As needed in
the event of a
reactive result
Adult Case Report
Form Directions
LMS
MDHHS Surveillance
Partner Services & Linkage to Care (as applicable)
Linkage to Care and
Partner Services
Interview***
As needed Within 30 days of
service APHIRM
Internet Partner
Services (IPS) and
Partner Services
Interview****
Ongoing Within 30 days of
service APHIRM
Disposition on
Partners of HIV
Cases
Ongoing Within 30 days of
service APHIRM
Evidence Based Risk Reduction Activities (as applicable)
SSP Data Report, Quarterly 10th of the following
month
Syringe Utilization
Platform (SUP)
Clinical HIV/STI services (as applicable)
340b PrEP
Prescription Log Weekly Every Friday by the
close of business
DCH File Transfer –
MDHHS-340B PrEP PT
ADT*****
Billing Revenue
Report Quarterly
10th of the following
month
Department Staff
STI 340B
Utilization/Inventory
Report,
Quarterly
Within 10 days after
the end of the
quarter
Log into
SGRX340BFlex.com
website, generate a
quarterly report on the
reporting tab, and it will be
transferred automatically
to ScriptGuide/DHSP
*CDC/MDHHS required activities including: Condom Distribution Data, if applicable;
Social Marketing data; Evidence based intervention data; other prevention services and
activities, if applicable
** Aggregated testing data
***(e.g. client attended a medical care appointment within 30 days of diagnosis, and was
interviewed by Partner Services within 30 days of diagnosis)
****(e.g. client identify dating apps used to meet partners), if applicable
*****https://milogintp.michigan.gov
Any additional Requirements:
Publication Rights
When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
fund, the Grantee receiving Federal funds, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state:
1. The percentage of the total costs of the program or project that will be financed
with Federal funds.
2. The dollar amount of Federal funds for the project or program.
3. Percentage and dollar amount of the total costs of the project or program that will
be financed by non-governmental sources.
4. The Grantee will submit all educational materials (e.g., brochures, posters,
pamphlets, and videos) used in conjunction with program activities to DHSP for
review and approval prior to their use, regardless of the source of funding used to
purchase these materials. Materials may be emailed to: MDHHS-
HIVSTIoperations@michigan.gov.
Grant Program Operation
1. The Grantee will participate in DHSP needs assessment and planning activities,
as requested.
2. The Grantee will participate in regular Grantee meetings which may be face-to-
face, teleconferences, webinars, etc. The Grantee is highly encouraged to
participate in other training offerings and information-sharing opportunities,
network detection response and interventions in collaboration with DHSP
opportunities provided by DHSP.
3. Each employee funded in whole or in part with federal funds must record time
and effort spent on the project(s) funded. The Grantee must:
a. Have policies and procedures to ensure time and effort reporting.
b. Assure the staff member clearly identifies the percentage of time devoted to
contract activities in accordance with the approved budget.
c. Denote accurately the percent of effort to the project. The percent of effort
may vary from month to month, and the effort recorded for funds must match
the percentage claimed on the FSR for the same period.
d. Submit a budget modification to DHSP in instances where the percentage of
effort of contract staff changes (FTE changes) during the contract period.
e. If there are any changes in staff or agency operations, please email MDHHS
Operations MDHHS-HIVSTIoperations@michigan.gov.
4. If conducting HIV testing using rapid HIV testing, the Grantee will comply with
guidelines and standards issued by DHSP and:
a. Provide medical oversight letter/agreement signed by a licensed physician is
necessary to collect specimens and order HIV antibody/antigen, HIV
genotype, HIV incidence, syphilis, gonorrhea, chlamydia, and hepatitis C
testing. According to Part 15 of the Public Health Code MCL 333.17001(j),
‘practice of medicine’ is defined as
• “the diagnosis, treatment, prevention, cure, or relieving of a human
disease, ailment, defect, complaint, or other physical or mental condition,
by attendance, advice, device, diagnostic test, or other means, or offering,
undertaking, attempting to do, or holding oneself out as able to do, any of
these act”.
b. Conduct quality assurance activities, guided by written protocol and
procedures. Protocols and procedures, as updated and revised Quality
assurance activities are to be responsive to: Quality Assurance for Rapid HIV
Testing, MDHHS. See “Applicable Laws, Rules, Regulations, Policies,
Procedures, and Manuals.”
• Ensure provision of Clinical Laboratory Improvement Amendments (CLIA)
certificate.
• Report discordant test results to DHSP
Email – Mary Roach roachm@michigan.gov and Safina Thomas
(thomass56@michigan.gov)
Fax - (517) 241-5922
• Ensure that staff performing counseling and/or testing with rapid test
technologies has completed, successfully, rapid test counselor certification
course or Information Based Training (as applicable), test device training,
and annual proficiency testing.
• If conducting blood draws, the grantee must conduct the packaging and
shipping training via Bureau of Laboratories. BashoreM@michigan.gov
• Ensure that all staff and site supervisors have completed, successfully,
appropriate laboratory quality assurance training, blood borne pathogens
training and rapid test device training and reviewed annually.
• Develop, implement, and monitor protocol and procedures to ensure that
patients receive confirmatory test results.
• To maintain active test counselor certification, each HIV test counselor
must submit one competency per year to the appropriate departmental
staff.
5. If conducting SSP, the grantee will develop programs using MDHHS guidance
documents and will address issues such as identification and registration of
clients, exchange protocols, education, and trainings for staff, and referrals.
a. Grantees will participate on monthly or quarterly conference calls to discuss
best practices and identify barriers.
6. If conducting PS, the Grantee will comply with guidelines and standards issued
by the Department. See “Applicable Laws, Rules, Regulations, Policies,
Procedures, and Manuals.” The Grantee must:
a. Provide Confidential PS follow-up to infected clients and their at-risk partners
to ensure disease management and education is offered to reduce
transmission.
b. Effectively link infected clients and/or at-risk partners to HIV care and other
support services.
c. Work with Early Intervention Specialist to ensure infected clients are retained
in HIV care.
d. If applicable,
• Procure TLO or a TLO-like search engine.
• Ensure staff that are utilizing TLO or TLO-search engine complete the
TLO training to maintain and understand the confidential use of the
system.
• Effectively utilize the Internet Partner Services (IPS) Guidance to provide
confidential PS follow-up to at-risk partners named by infected clients who
were identified to have been met through the use of dating apps.
• Ensure staff and site supervisors successfully complete the Internet
Partner Services Training.
• Ensure staff conducting Internet Partner Services participant in monthly,
bi-monthly meetings, webinars or calls to discuss best practices and
identify barriers.
7. If conducting 340 B STI/PrEP clinical activities, the Grantee will comply with
guidelines and standards issued by DHSP and:
8. Funds generated by this program must be utilized to support the program,
including to hire a Mid-level provider, supporting staff, and program materials to
provide Pre-Exposure Prophylaxis (PrEP) services.
9. Any funds included in this agreement above must be re-invested in HIV/STI PrEP
services. This could mean improving, enhancing, and/or expanding your current
HIV/STI services or adding new services to improve patient health outcomes for
HIV/STI.
10. Any revenue or income generated via billing from this agreement must be
reinvested into this project.
Record Maintenance/Retention
The Grantee will maintain, for a minimum of five (5) years after the end of the grant
period, program, fiscal records, including documentation to support program activities
and expenditures, under the terms of this agreement, for clients residing in the State of
Michigan.
Software Compliance
1. The Grantee and its subcontractors are required to use APHIRM (formerly
Evaluation Web) to enter HIV client and service data into the centrally managed
database on a secure server.
2. The Grantee and its subcontractors are required to use APHIRM to enter PrEP
Cascade Data into the centrally managed database on a secure server.
3. The Grantee and its subcontractors are required to use APHIRM to enter EBI
Data into the centrally managed database on a secure server.
4. The Grantee and its subcontractors are required to use APHIRM (formerly
Partner Services Web) to enter Partner Services interview, linkage to care data,
and identified dating apps through the use of Internet Partner Services (IPS)
where appropriate.
5. The Grantee and its subcontractors are required to use SHOARS to request
amendments, supplies, data, technical assistance and to register for trainings.
6. New staff needing access to APHIRM are required to submit the APHIRM user
request form through SHOARS.
7. The Grantee shall notify MDHHS immediately via email at MDHHS-
HIVSTIoperations@michigan.gov of APHIRM users who are separated from the
agency for deactivation.
Mandatory Disclosures
1. The Grantee will provide immediate notification to DHSP, in writing, including but
not limited to the following events:
2. Any formal grievance initiated by a client and subsequent resolution of that
grievance.
3. Any event occurring or notice received by the Grantee or subcontractor, that
reasonably suggests that the Grantee or subcontractor may be the subject of, or
a defendant in, legal action. This includes, but is not limited to, events or notices
related to grievances by service recipients or Grantee or subcontractor
employees.
4. Any staff vacancies funded for this project that exceed 30 days.
a. All notifications should be made to DHSP by MDHHS-
HIVSTIoperations@michigan.gov.
Technical Assistance
1. Technical assistance (TA) requests must be submitted via the MDHHS SHOARS
system. In addition, if your contract is to be amended, the request will have to be
logged into SHOARS. Registration instructions and further information can be
found at: https://bit.ly/3HS7xdG
2. Recipient agency must register an Authorized Official and Program Manager in
the DHSP SHOARS system. These roles must match what the agency has listed
for these roles in the EGrAMS system. If you have access related questions,
contact MDHHS-SHOARS-SUPPORT MDHHS-SHOARS-
SUPPORT@michigan.gov .
3. You may request TA on the implementation of the HIV Prevention program. This
may include issues related to: APHIRM, Intervention Database, Programs,
Budget/Fiscal, Grants and Contracts, Risk Reduction Activities, Training, or other
activities related to carrying out HIV prevention activities.
Compliance with Applicable Laws
1. The Grantee should adhere to all Federal and Michigan laws pertaining to
HIV/AIDS treatment, disability accommodations, non-discrimination, and
confidentiality.
PROJECT: Environmental Health Data in Michigan
Start Date: 10/1/ 2022
End Date: 9/30/2023
Project Synopsis
The purpose of this project is to fund the Western Upper Peninsula Health Department
(WUPHD) to build on its existing June 2018 Flood After Action Report and Improvement
Plan.
Reporting Requirements (if different than contract language)
Grantee will attend bi-weekly virtual meetings to disucss project activities and progress of
the detailed year 1 workplan as submitted to and accepted by the CDC. Changes to the
workplan by WUPHD will be discussed and approved by MDHHS DEH CO-PIs and
reported to CDC prior to implementation. The WUPHD staff will provide written progress
reports at the time of the bi-weekly project team meetings.
Western Upper District Health Department staff will work with MDHHS DEH staff to
develop a detailed evaluation plan within six months of the grant award from CDC.
WUPHD staff will be required to collect and report on performance evaluation measures
to MDHHS DEH staff for inclusion in the Annual Performance Report and in the CDC
performance measures and evaluation results portal. A final project report is due from
WUPHD to MDHHS DEH within 30 days from the date of termination or final expenditure.
The report will include:
• Intro & Scope
1. Why was this project initiated?
2. What did we hope to accomplish?
• Goals & objectives
1. What were our intended outputs (tangible deliverables from the year 1
workplan to CDC)?
2. What were the intended outcomes (changes in: behavior, departmental
capacity, processes, partnerships, resource allocation, etc.)?
• Process
1. Who was involved and what was their role (project team, steering
committee, other agencies/stakeholders)?
2. What were the key steps in the project and when did they occur
(outreach and engagement, stakeholder meetings, drafts, etc.)?
3. What was accomplished (tangible outputs and outcomes)?
• Successes & challenges
1. Compare the intended outputs and outcomes to the actual (did they
change, if so, why and how?)
2. What was successful about the project?
3. What were the challenges?
• Next steps
1. How will the results be used?
2. Will this project encourage future activity in this area?
• Attach any of the final documents or notes on final processes that were
developed as a result of this funding
Any additional requirements (if applicable)
PROJECT: Expanding, Enhancing Emotional Health (All Locations)
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The E3 program funds mental health staff in schools to provide one on one therapy and
small group therapy.
Reporting Requirements (if different than contract language)
Work plans will be submitted annually, attached to the original grant application at the beginning of the year. Quarterly work plan reports will be submitted, attached to the FSR, within 30 days of the end of the quarter. Work plans and work plan reports can also be submitted via e-mail to your appropriate E3 consultant: Gina Zerka: zerkag@michigan.gov or Mario Wilcox: wilcoxm7@michigan.gov
All data previously reported will be submitted quarterly. The due dates are as follows:
a. Q1: Due January 31st,
b. Q2: Due April 30th,
c. Q3: Due July 31st and
d. Q4: Due September 30th.
All data shall continue to be entered into the Clinical Reporting Tool (CRT). See below for data definitions. The grantee shall permit the Department or its designee to visit and make an evaluation of the project as determined by the Contract Manager.
Number of Unduplicated Users (clients) by Demographic Designation per quarter
Definition of an Unduplicated User:
An unduplicated user is an individual who has presented themselves to the E3 Program
for service with the mental health provider (minimum Master’s prepared and licensed
mental health provider), and for whom a record has been opened. Opening a record
includes documenting an assessment, diagnosis and treatment plan. Once per year, the
user is counted to generate the number of unduplicated clients utilizing the E3 services
for that year.
Age Range Female Male Total
0-4
5-9
10-17
18-21
Number of Unduplicated Users (clients) by Race per quarter
White
Black/African-American
Asian
Native Hawaiian or Pacific Islander
American Indian or Alaskan Native
More than One Race
Number of Unduplicated Users (clients) by Ethnicity per quarter
Arab/Chaldean
Hispanic or Latino
Definition of a Visit:
A visit is a significant encounter between an E3 provider and a new (unduplicated) user
or established (duplicated) user. Each visit should be documented as appropriate to the
visit and provider (i.e., visits include an assessment, diagnosis and treatment plan
documented in the medical record and/or other documentation appropriate to the visit). A
user will likely have multiple visits per year.
Total Visits by Provider Type per quarter
*Mental Health Provider must be minimum Master’s prepared and licensed. Mental
Health Provider visits are counted as “face to face” contacts.
*Telehealth Visits can be tele-conferencing and tele-phonic. Telehealth visits should be
counted when using this mechanism during visit.
Note: Telehealth visits should be counted only once, as a Telehealth visit.
Do not count as a visit with BOTH the mental health provider AND a Telehealth visit.
Visits by Type per quarter
Count the visit by type of session provided. If the client was seen individually, count as an
individual visit. If the client was seen in a therapeutic group, count as a group visit. If a
client receives both individual and therapeutic group services, count both visit types.
QUALITY INDICATORS REPORT DEFINITIONS
For each of the following Quality Measures, report the YTD NUMBER each quarter.
Each quarter, your data will likely be equal to or greater than, the previous quarter. Note
that this is different than the quarterly reporting elements, where data is reported by
quarter for that specific quarter only.
Number of Unduplicated Clients Ages 10-21 Years with an Up-to-Date Depression
Screen
Report the number of unduplicated clients up-to-date with depression screening. This
information could come directly from a behavioral health screener or risk assessment, so
the number screened (flagged) for depression may equal or be very close to the number
of behavioral health screeners and/or risk assessments completed. (Note this is not the
same as a depression assessment conducted by a provider.) Do not double count
clients who were screened (flagged) for depression using behavioral health screen or risk
assessment and who also completed a specific depression screening tool (e.g., Beck’s,
PHQ-9, etc).
Number of Clients Age 12 and Up with a Positive Depression Assessment
(Diagnosis of Depression)
Report the number of clients (age 12 and older) with a diagnosis of depression according
to the score on the depression screening tool and psychosocial assessment by the
provider. Exclude the following: a) those who are already receiving documented care
elsewhere, and b) those who are referred out of the E3 site for treatment.
Number of Clients Age 12 and Up with a Diagnosis of Depression who have
Documented, Appropriate Follow-Up
Report the number of clients from the denominator who receive treatment at the E3 site
who have all of elements of an appropriate follow-up plan: a) had a psycho-social
assessment completed by 3rd visit (includes suicide risk assessment/safety plan), b) had
a treatment plan developed by 3rd visit, c) treatment plan reviewed @ 90 days (for those
on caseload for 90+ days), and d) screener re-administered at appropriate interval to
determine change in score.
For the following two quality measures, please note that you are NOT expected to
administer BOTH a behavioral health screen AND a risk assessment to each client. You
only need to administer one tool or the other as appropriate for age, developmental level
and need. Please report the number of behavioral health screens and/or risk
assessments provided to your clients:
Number of Unduplicated Clients Ages 5-21 Years with at least one Behavioral
Health Screen in the annual year.
Report the number of clients that receive a Behavioral Health Screen as appropriate for
age and developmental level. Examples of appropriate screening tools (to use) include
but are not limited to Pediatric Symptoms Checklist (17 or 34), Strength and Difficulties
Questionnaire.
Number of Unduplicated Clients with an Up-to-Date Risk Assessment / Anticipatory
Guidance
Report the number of clients that are complete with an annual risk assessment or
anticipatory guidance, as appropriate for age and developmental level. This may include
clients that are UTD because they completed the risk assessment/anticipatory guidance
in a previous fiscal year but are being seen in the E3 site in the current fiscal year.
BILLING REPORT DEFINITIONS
Reported on annual basis only, as requested:
Enter the dollar amount in claims submitted for services provided during the current
fiscal year (October 1- September 30), regardless of whether or not the claims were paid
during the fiscal year.
Enter the dollar amount received in revenue during the current fiscal year (October 1-
September 30), regardless of whether or not revenue resulted from claims filed during the
fiscal year.
For each of these entries, you will be entering data by:
Medicaid Health Plan/Medicaid (from a drop-down menu)
Commercial
Self-Pay
Other
Note that the Estimated Percent of Claims Paid and Unpaid (based on dollar amount, not
on number of claims) and Payor Mix will be auto totaled.
5 Most Common Reasons for Rejection of Submitted Claims
Select the five most common reasons for rejection of submitted claims from the
dropdown menu according to best-fit category.
DIAGNOSES AND PROCEDURE CODES AND FREQUENCY
Reported on annual basis only, as requested:
Mental Health Problem Diagnoses – Top 5 diagnoses from the mental health provider
CPT codes – Top 5 CPT codes - both the code and the name of procedure
End of the Year/ Fall Narrative
In addition to the quarterly data reporting. All E3 sites are required to submit an End of
Year/Fall Narrative Report. This report will focus on the Continues Quality Improvement
requirement as indicated in the Minimum Program Requirements document. The report
template will be given to E3 program sites by their assigned Program Consultant.
Completed Fall Narratives will be emailed to the assigned Program Consultant.
• Due on October 30 each year
MINIMUM PROGRAM REQUIREMENTS
October 1, 2022 - September 30, 2023
The E3 program shall be open and provide a full-time or full time equivalent mental health
provider (i.e., 40 hours) in one school building year-round. Services shall: a) fall within the
current, recognized scope of mental health practice in Michigan and b) meet the current,
recognized standards of care for children and/or adolescents.
Services provided by the mental health provider are designed specifically for children and
adolescents ages 5 through 21 years and are aimed at achieving the best possible social
and emotional health status.
Services
1. A minimum caseload of 50 clients (users) must be maintained annually.
2. In addition to maintaining a client caseload, the following services may be provided
and must be reflective of the needs of the school:
a. treatment groups using evidence-based curricula and interventions;
b. school staff training and professional development relevant to mental health;
c. building level promotion, such as school climate initiatives, bullying prevention,
suicide prevention programs, etc
d. classroom education related to mental health topics
e. case management to and partnerships with other private/public social service
agencies
3. A Behavioral Health Screen and/or Risk Assessment will be completed for
unduplicated users at least once in the current fiscal year.
4. The use of an Electronic Medical Records system is required.
Assurances
5. These services shall not supplant existing school services. This program is not meant
to replace current special education or general education related social work activities
provided by school districts. This program shall not take on responsibilities outside of
the scope of these Minimum Program Requirements (Individualized Educational
Plans, etc.).
6. Services provided shall not breach the confidentiality of the client.
7. The E3 program shall not provide abortion counseling, services, or make referrals for
abortion services.
8. The E3 program, if on school property, shall not prescribe, dispense, or otherwise
distribute family planning drugs and/or devices.
Staffing/Clinical Care
9. The mental health provider shall hold a minimum master’s level degree in an
appropriate discipline and shall be licensed to practice in Michigan. Clinical
supervision must be available for all licensed providers. For those providers that hold
a limited license working towards full licensure, supervision must be in accordance to
licensure laws/mandates and be provided by a fully licensed provider of the same
degree.
10. The E3 program shall be open during hours accessible to its target population.
Provisions must be in place for the same services to be delivered during times when
school is not in session. Not in session refers to times of the year when schools are
closed for extended periods such as holidays, spring breaks, and summer vacation.
These provisions shall be posted and explained to clients. The mental health provider
shall have a written plan for after-hours and weekend care, which shall be posted in
the center including external doors and explained to clients. An after-hours answering
service and/or answering machine with instructions on accessing after-hours mental
health care is required. If services are not able to continue during periods of not in
session, a written plan must be communicated to MDHHS for approval.
Administrative
11. Written approval by the school administration (ex: Superintendent, Principal, School
Board) exists for the following:
a. location of the E3 program within the school building;
b. parental and/or minor consent policy; and
c. services rendered through the E3 program.
A current signed interagency agreement or MOU must be established between the local
school district and mental health organization/fiduciary that defines the roles and
responsibilities of the mental health provider and of any other mental health staff working
within the school. This agreement must state a plan will be in place for transferring clients
and/or caseloads if the agreement is discontinued or expires.
12. The mental health provider or contracting agency must bill third party payors for
services rendered. Any revenue generated must be used to sustain the E3 program
and its services. E3 shall establish and implement a sliding fee scale, which is not a
barrier to health care for adolescents. No student will be denied services because of
inability to pay. E3 program funding must be used to offset any outstanding balances
(including copays) to avoid collection notices and/or referrals to collection agencies for
payment.
13. Policies and procedures shall be implemented regarding proper notification of
parents, school officials, and/or other health care providers when additional care is
needed or when further evaluation is recommended. Policies and procedures
regarding notification and exchange of information shall comply with all applicable
laws e.g., HIPAA, FERPA and Michigan statutes governing minors’ rights to access
care.
14. Implement a quality assurance plan. Components of the plan shall include, at a
minimum:
a. ongoing record reviews by peers (at least semi-annually) to determine that
conformity exists with current standards of practice. A system shall be in place to
implement corrective actions when deficiencies are noted;
b. conducting a client satisfaction survey/assessment at least once annually.
15. The E3 program must have the following policies as a part of overall policies and
procedures:
a. parental and/or minor consent;
b. custody of individual records, requests for records, and release of information
that include the role of the non-custodial parent and parents with joint custody;
c. confidential services; and
d. disclosure by clients or evidence of child physical or sexual abuse, and/or
neglect.
Physical Environment
16. The E3 program shall have space and equipment adequate for private counseling,
secured storage for supplies and equipment, and secure paper and electronic client
records. The physical facility must be youth-friendly, barrier-free, clean and safe.
PROJECT TITLE: Fetal Alcohol Spectrum Disorder Community Project
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
Grantees will collaborate with the Department to assist local communities with evidence-
based activities, to implement alcohol screening and prevent prenatal alcohol exposure
among women of reproductive age and to refer affected children, birth to 18 years of age,
and their families to an FASD Diagnostic Center for evaluation and intervention for the
purpose of improving care and services for women, infants and families.
Reporting Requirements (if different than agreement language):
The Grantee will collect data using the project evaluation/data tracking forms to monitor
the FASD community program effectiveness and report service numbers.
The Grantee will collect data using the FASD Workplan Narrative Report (A) and the
Data Evaluation Report (B) provided, to monitor the FASD community program
effectiveness.
The Grantee shall submit FASD Workplan report and the Data Evaluation Report
electronically to the MDHHS FASD Program Contact Person on dates specified below.
a. Grantee must provide documentation that FASD services are tracked for all
direct and enabling services provided, including individuals screened, and
referred through the FASD community project.
b. Any such other information as specified in the Statement of Work shall be
developed and submitted by the Grantee as required by the Contract Manager.
c. The Grantee shall permit the Department or its designee to visit and to make
an evaluation of the projects as determined.
FASD Report Guidance
Report Time Period Due Date Submit To
A
FASD
Work Plan
Narrative
Report
October 1 - December 31 January 15
Email to
lufta1@michigan.gov
January 1 - March 31 April 15
April 1 - June 30 July 15
July 1 - September 30 October 15
B
FASD
Data
Evaluation
Report
October 1 - March 31 April 15
Email to
lufta1@michigan.gov April 1 – September 30 October 15
FASD Quarterly Meetings
The Grantee will participate in quarterly Technical Assistance calls with MDHHS FASD
Program staff according to the schedule below. Technical Assistance calls are an
opportunity for FASD funded projects to share expertise, best practices and promote
collaboration for FASD program effectiveness.
FASD Technical Assistance Calls
January 16
April 16
July 16
October 16
PROJECT TITLE: Fetal Infant Mortality Review (FIMR) Case Abstraction
Start Date: 10/01/2022
End Date: 09/30/2023
Project Synopsis:
Qualified individuals will perform medical record case abstraction for Fetal Infant
Mortality Review to include the following:
• Utilize the FIMR Sampling Plan for case selection template provided.
• Review of medical records involved in fetal and infant death to include, but not
limited to hospital, prenatal, emergency, and medical examiner’s records.
• Interact with other agencies and service providers involved in infant’s death
(Child Protective Services, local health department, law enforcement).
• Develop de-identified case summaries from the above abstracted information,
as well as the FIMR interview.
• Attend the review team meetings to facilitate the presentation of the cases and
develop recommendations, utilizing the Michigan FIMR CRT Recommendation
Form and Michigan FIMR Log of Local Recommendations.
• Utilize the Michigan FIMR Health Equity Toolkit and/or other resources for
training FIMR CRT members on equity, bias, diversity, and inclusion.
• Enter cases into the National Fatality Review Case Reporting System (FIMR
database) at the National Center for Fatality Review and Prevention.
• Present FIMR findings and recommendations to local FIMR Community Action
Team (CAT) annually, at a minimum, to develop action plans.
Reporting Requirements (if different than agreement language):
Quarterly progress reports following the template provided. Quarterly reports are due
the 15th of the month following the end of the quarter and are submitted to Audra
Brummel, State coordinator, via email at brummela@michigan.gov.
Reporting Time Period Due Date
1st Quarter October 1 – December 31 January 15
2nd Quarter January 1 – March 31 April 15
3rd Quarter April 1 – June 30 July 15
4th Quarter July 1 – September 30 October 15
Any additional requirements (if applicable):
Each completed case abstraction will be compensated at $270.00 per case.
• FIMR team recommendations and information will be used to inform the State of
Michigan infant mortality reduction efforts.
Maximum Program Reimbursement:
Grantee Maximum Reimbursement Amount
Berrien County Health Department $ 4,050
Calhoun County Public Health Department $ 3,240
Detroit Health Department $ 2,700
Genesee County Health Department $ 4,115
Ingham County Health Department $ 3,240
Jackson County Health Department $ 3,240
Kalamazoo County Health and Community
Services Department
$ 6,480
Kent County Health Department $ 12,150
Macomb County Health Department $ 4,050
Public Health Muskegon County $ 2,700
Oakland County Department of Health and
Human Services/Health Division
$ 6,480
Saginaw County Health Department $ 4,860
PROJECT TITLE: Fetal Infant Mortality Review (FIMR) Interviews
Start Date: 10/01/2022
End Date: 09/30/2023
Project Synopsis:
Conduct Fetal Infant Mortality Review (FIMR) interviews with the intent of informing the
FIMR case abstraction process and informing the infant mortality reduction efforts both
locally and statewide.
Reporting Requirements (if different than agreement language):
Mid-year progress report and final report using the FIMR interviews template, which will
address what was learned about preventability at the individual, clinical care, health
system, community, and policy level are due April 15 and a final report due October 15
by submission to Audra Brummel, State coordinator, via email at
brummela@michigan.gov.
Any additional requirements (if applicable):
• Each completed FIMR interview will be compensated at $125.00 per interview. A
maximum of 6 visits are reimbursable per fetal/infant death up to the contract
allocation.
• FIMR team recommendations and information will be used to inform the State of
Michigan infant mortality reduction efforts.
• Utilize the following Michigan FIMR Network resources:
a) Michigan FIMR Network Maternal/Family Interview Guide
b) FIMR Case Review Team (CRT) Recommendation Form and the Log of
Local FIMR Recommendations
c) Michigan FIMR Network Health Equity Toolkit
Additional Requirements for Detroit Health Department only:
• At least 1 MMMS next of kin interviews will be completed by September 30, 2023.
Each completed MMMS next of kin interview will be compensated at $250.00 per
interview. A maximum of 6 visits are reimbursable per case up to the contract
allocation.
• The MMMS next of kin interview will follow the FIMR methodology and the
Michigan FIMR Interview Guide questionnaire with additional questions relevant to
maternal deaths.
• Use of consent forms, questionnaire, and template for collecting interview
summaries provided.
• The DHD FIMR Interviewer will be invited to MMMS Maternal Mortality Review
Committee (MMRC) meetings when an interview is completed to provide an
overview and additional details on the interview.
Maximum Program Reimbursement:
Grantee Maximum Reimbursement Amount
Berrien County Health Department $ 1,875
Calhoun County Public Health Department $ 1,500
Detroit Health Department $ 6,750 – FIMR
$ 2,000 – MMMS
Ingham County Health Department $ 2,500
Jackson County Health Department $ 1,250
Kalamazoo County Health and Community
Services Department
$ 2,250
Kent County Health Department $ 1,250
Macomb County Health Department $ 1,500
Public Health Muskegon County $ 625
Oakland County Department of Health and
Human Services/Health Division
$ 2,000
PROJECT TITLE: FFPSA (Family First Prevention Services Act) HV
Expansion
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The FFPSA project is a national initiative being implemented in Michigan to support the
prevention of the placement of children into foster care. FFPSA support Positive
Parenting Programs such as evidence-based home visiting models. Each HV Model is
implemented in accordance with the standards and tenants of that particular model.
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.
a. Staffing Changes: Within 10 days of a staffing change, notify the 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. In addition to other data required by MDHHS, LIAs are required to record and submit
monthly FFPSA billable reporting through REDCap by the 5th business day of each
month. This data includes:
• Family demographic information (including MiSACWIS IDs)
• The number of children in the family and corresponding MiSACWIS IDs (per
DHHS referral form)
• Enrollment date
• Eligible/ineligible status
• FFPSA eligibility change dates
• Closure date if family has exited home visiting services
c. Work Plan: Due annually on June 30 for preapproval. See the MDHHS Home
Visiting Guidance Manual for requirements related to Work Plan development and
reporting.
d. Work Plan Reports: Must be submitted within 30 days of the end of each quarter
(January 30, April 30, July 30, and October 30).
All reports and/or information (a-d), unless stated otherwise, shall be submitted
electronically to the MDHHS Home Visiting mailbox at MDHHS-
HVInitiative@michigan.gov.
e. Implementation Monitoring Data and HRSA data collection requirements due in
REDCap by the 5th business day of each month. HFA programs must use Home
Visiting On-Line (HVOL) and NFP programs must use Flo for all model and other
MDHHS required data.
f. Quality Improvement Reporting:
• Documentation of a QI team will be submitted with the quarterly Work Plan
Report.
• Documentation of QI activities will be submitted with the quarterly Work Plan
Report.
• Annual summary of QI activities will be submitted to the Model Consultant by
February 15
. g. HV CoIIN Reporting (for those LIAs participating) for QI efforts shall occur in accordance with the CoIIN’s schedule. Participating LIAs are required to use the HV CoIIN site to complete monthly submissions of PDSA cycles and required data (the frequency of data collection may vary).
Reports (e-g) shall be submitted as described above. Additional guidance concerning
data collection and Quality Improvement is provided in the MDHHS Home Visiting
Guidance Manual.
Any additional requirements (if applicable):
Home visitors funded through Family First Prevention Services Act will serve families
referred from local Child Welfare agencies, in proportion to their FFPSA FTE.
HFA
a. 10-12 FFPSA families per 1.0 FTE for first year of implementation as well as
new home visitors.
b. 12-16 FFPSA families per 1.0 FTE following second year of implementation.
NFP
c. 25 FFPSA families per 1.0 FTE
LIAs are required to work with MDHHS to complete a Memorandum of Understanding
with MDHHS to establish expectations for the relationship that is being built between
child welfare and the home visiting program. Healthy Families America (HFA) LIAs will
need to submit the HFA’s Child Welfare Protocol application to HFA National. They will
also need to work with their assigned Child Welfare Service Analyst to obtain the
signature of their local DHHS office on a letter of support. Both need to be completed
before an HFA LIA can enroll any families under FFPSA or the Child Welfare Protocol.
Maintain Fidelity to the Model
The LIA shall adhere to the Home Visiting model Best Practice Standards or Model
Elements. In addition, all Healthy Families America affiliates shall comply with the
requirements of the Central Administration for the Multi-Site State System (also known
as “The State Office”) housed within the Michigan Public Health Institute.
Comply with MDHHS Program Requirements
The LIA shall operate the program with fidelity to the requirements of MDHHS based on
the agreement executed in E-GrAMS and the conditions as outlined in the MDHHS
Home Visiting Guidance Manual. The LIA will fulfill these requirements while
strengthening efforts towards health and racial equity through staff education,
programmatic data evaluation and client supportive services.
P.A. 291
The LIA shall comply with the provisions of Public Act 291 of 2012. See the MDHHS
Home Visiting Guidance Manual for requirements related to PA 291.
Staffing
The LIA’s home visiting staff will reflect the community served. The LIA will provide
documentation to demonstrate due diligence if unable to fully meet this requirement
within 90 days of a MDHHS site visit in which this was a finding. See the MDHHS
Home Visiting Guidance Manual for requirements related to program staffing.
Performance Measures:
The LIA shall comply with MDHHS expectations of demonstrating improvement in the
performance measures as described in the MDHHS Home Visiting Guidance Manual.
Program Monitoring, Quality Assessment, Support and Technical Assistance
(TA):
The LIA shall fully participate with the Department and the Michigan Public Health
Institute (MPHI) with regards to program development and monitoring (including annual
site visits either in-person or virtual), training, support and technical assistance services.
See the MDHHS Home Visiting Guidance Manual for requirements related to program
monitoring, quality assessment, support and TA.
Professional Development and Training:
All of the LIA’s program staff associated with this funding will participate in professional
development and training activities as required by both the model and the Department.
See the MDHHS Home Visiting Guidance Manual for requirements related to
professional development and training activities.
Supervision:
The LIA shall adhere to the HV Model supervision requirements: HFA: Weekly 1.5 - 2 hours of individual supervision per 1.0 FTE and pro-rated as allowed by the Best Practice Standards. NFP: LIA shall adhere to the NFP supervision requirements. Written policies and procedures shall specify how reflective supervision is included in, or added to, that time to ensure provision for each home visitor at a minimum of one hour per month.
Engage and Coordinate with Community Members, Partners and Parents:
The LIA shall build a relationship with their local DHHS office. LIAs are expected to
inform the DHHS worker for their assigned FFPSA families of the enrollment date,
referral status within two weeks of referral, if a home visitor has not been able to
connect with a family in two weeks, and closure date. LIA will coordinate with DHHS
when approaching annual review for any enrolled FFPSA families.
The LIA shall ensure that there is a broad-based community advisory committee that is
providing oversight for their specific model.
The LIA shall build upon and maintain diverse community collaboration and support with
authentic engagement of parent representatives who have the lived experience and
expertise.
The LIA shall participate in the Local Leadership Group (LLG) (if it is not the community
advisory committee) or, if none, the Great Start Collaborative.
See the MDHHS Home Visiting Guidance Manual for requirements related to
engagement with community partners.
Data Collection:
The LIA shall comply with all model and MDHHS data training, collection, entry and
submission requirements. See the MDHHS Home Visiting Guidance Manual for
requirements related to data collection.
Quality Improvement (QI):
The LIA shall participate in all HV Model quality initiatives including research,
evaluation, and continuous quality improvement.
The LIA shall participate in all state and local Home Visiting QI activities as required by
MDHHS. Required activities include, but are not limited to:
• Developing and maintaining a QI team
• Participating in QI activities during the fiscal year.
• Consulting with QI coaches
See the MDHHS Home Visiting Guidance Manual for requirements related to QI.
Work Plan Requirements:
By June 30, the LIA must submit a Work Plan to the MDHHS Home Visiting mailbox (MDHHS-
HVInitiative@michigan.gov) for preapproval. See the MDHHS Home Visiting Guidance Manual for
requirements related to Work Plan development and reporting.
Promotional Materials:
If the LIA wishes to produce any marketing, advertising or educational materials using
grant agreement funds, they must follow the requirements outlined in the MDHHS Home
Visiting Guidance Manual.
PROJECT TITLE: Gonococcal Isolate Surveillance Project
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
This project will monitor trends in antimicrobial susceptibilities in N. gonorrhoeae via
collection and submission of required specimens and data to the Centers for Disease
Control and Prevention. Patient demographics and specimen phenotypes, particularly
for non-susceptible specimens, will be characterized, and genetic markers associated
with antimicrobial resistance will be identified and monitored using remnant NAATS.
Reporting Requirements (if different than agreement language):
Report Period Due Date(s) How to
Submit Report
Submit clinical and
demographic data to CDC Monthly 4 weeks after end of
month Via SAMS
Complete and submit shipping
manifest Monthly First Monday of the
following month
Paper copy
with isolates,
and electronic
FTP report to
ARLN
Collect and submit N.
gonorrhea isolates Monthly First Monday of the
following month Ship to ARLN
Collect and submit remnant
NAAT samples for gonorrhea-
positive isolates above
Monthly 4 weeks after end of
month
Ship directly to
CDC STD-
LRRB
Complete and submit annual
progress report Annually
90 days after end of
grant period, or as
defined by CDC
Collaborate
with
kentj3@michig
an.gov
The number of culture
specimens collected, and
number of presumptive positive
GC forwarded to CDC and their
designated laboratories for
further testing.
Quarterly January 15, April 15,
July 15, October 15
Written report
submitted to
kentj3@michig
an.gov;
Demographic and behavioral
data to MDHHS for clients with
GC positive isolates utilizing
the CDC required format.
Quarterly January 15, April 15,
July 15, October 15
Written report
submitted to
kentj3@michig
an.gov;
Report of any specimen that
exceeds the alert criteria:
Ceftriaxone MIC ≥ 0.125 µg/ml
Cefixime MIC ≥ 0.25 µg/ml
Azithromycin MIC ≥ 2.0 µg/ml
Immediate Per high-resistance
specimen
Phone or email
to Jim Kent
517-243-4932,
kentj3@michig
an.gov
GRANTEE REQUIREMENTS
Grant Program Operation
1. Monitor trends in antimicrobial susceptibilities in N. gonorrhoeae.
2. Characterize patients with gonorrhea (GC), particularly those infected with N.
gonorrhoeae that are not susceptible to recommended antimicrobials.
3. Phenotypically characterize antimicrobial-resistant isolates to describe the
diversity of antimicrobial resistance in N. gonorrhoeae.
4. For male STI clinic patients suspected of having GC, collect a NAAT sample
during the same visit as the urogenital sample collected above.
5. For the first 25 clients with positive isolates, submit culture specimens to CDC
assigned Regional Laboratory for further testing; and associated demographic
and behavioral data to the CDC and MDHHS at agreed intervals.
6. For the first 25 clients with positive isolates, submit residual NAAT specimens
directly to CDC molecular laboratory.
7. Monitor and track clinic totals including
a. Number of men with urethral sample collected and tested for gonorrhea
(positive and negative)
b. Number of gonococcal isolates submitted to Region Laboratory
c. Number of isolates found by Regional Laboratory to be non-viable or
contaminated.
d. Percentage of monthly isolate batches shipped to Regional Laboratory within
one week after the end of the month
e. Percentage of monthly demographic data transmissions submitted to CDC
within one month after the end of the month
f. Percentage of collected isolates that include a) age, b) gender of sex partner,
c) HIV status, d) antibiotic use, and d) treatment
g. Number of remnants NAAT samples submitted to CDC
h. Number of remnants NAAT testing positive, negative, or equivocal
Technical Assistance
1. Technical assistance (TA) requests must be submitted via the MDHHS SHOARS
system. In addition, if your contract is to be amended, the request will have to be
logged into SHOARS. Registration instructions and further information can be
found at: https://bit.ly/3HS7xdG
2. Recipient agency must register an Authorized Official and Program Manager in
the DHSP SHOARS system. These roles must match what the agency has listed
for these roles in the EGrAMS system. If you have access related questions,
contact MDHHS-SHOARS-SUPPORT MDHHS-SHOARS-
SUPPORT@michigan.gov
PROJECT: Harm Reduction Support Services
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
Grantees and subrecipients of these funds are authorized by the State of Michigan to
distribute syringes for the purposes of preventing the transmission of communicable
diseases. These dollars will be used by the grantee to plan and implement syringe
service programs within their jurisdictions. Grantees will develop policies and protocols
following best practice guidance with respect to client registration, supply disposal and
supply distribution, education of participants, staff training, referral to substance use
treatment, referral or testing for infectious diseases, and provision of naloxone for
overdose prevention.
Reporting Requirements (if different than contract language)
Grantees will be enrolled and submitting service delivery data to the Syringe Service
Program Utilization Platform (SUP)
Grantees will participate on monthly conference calls to discuss the state of SSP in
Michigan, share successes, challenges, and best practices
Any additional requirements (if applicable)
• Funds may not be used to buy sterile needles or syringes
• Grantees must establish relationships to link clients to care for substance use
disorder treatment
• Grantees must be able to provide clients with naloxone
• If sites are performing HIV and/or HCV testing, grantees should establish
relationships to link clients to care for HIV and/or HCV follow-up testing and
treatment.
• If sites are not performing HIV and or/HIV testing, grantees should establish
relationships to refer clients to HIV and/or HCV testing.
PROJECT TITLE: HIV Care Coordination
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The Ryan White HIV/AIDS Program provides a comprehensive system of HIV primary
medical care, essential support services, and medications for low-income people living
with HIV who are uninsured and underserved. The program provides funding to provide
care and treatment services to people living with HIV to improve health outcomes and
reduce HIV transmission among hard-to-reach populations.
Reporting Requirements:
1. The Grantee shall permit the Division of HIV/STI Programs (DHSP) or its designee
to conduct site visits and to formulate an evaluation of the project.
2. The Grantee and its subcontractors are required to use the HRSA-supported
software CW to enter client and service data into the centrally managed database
on a secure server. The Grantee must:
a. Enter all Ryan White services delivered to HIV-infected and affected clients.
b. Enter all data by the 10th of the following month.
c. Complete collection of all required data variables and the clean-up of any
missing data or service activities by the 10th of the following month.
3. To complete the Ryan White Services Report (RSR), a Health Resources and
Services Administration (HRSA) required annual data report, the Grantee must
assure that all CAREWare data is complete, cleaned, and entered into the HRSA
Electronic Handbook. RSR submission requirements include:
a. The RSR shall have no more than 5% missing data variables.
b. The Department validates the data within the Grantee’s RSR submission
before receipt by HRSA.
c. Data in CAREWare must be checked and validated every quarter.
Grantee Report Submission Schedule
Report Period Due Date(s) How to Submit
Report
All Agencies: Ryan White
services delivered to HIV-
infected and affected clients
Monthly 10th of the
following month
Enter into CAREWare
(CW)
All Agencies: Ryan White
Services Report (RSR)
Annual Generally,
Grantee
submission will
open in early
February and
close early
March.
Submission to HRSA
through Electronic
Handbook (EHB)
All Ryan White federally
funded agencies providing at
least one core medical
service: Quality Management
Plan
Annual December 31st Email report to
MDHHS-
HIVSTIoperations@mi
chigan.gov
All Ryan White federally
funded agencies: Complete
and submit at least one Plan-
Do-Study-Act worksheets to
document progress of QI project
10/1/22 –
9/30/23
As completed
over contract year
Email report to
MDHHS-
HIVSTIoperations@mi
chigan.gov
All Agencies: Complete
quarterly workplan progress
reports
Quarterly Thirty days after
the end of the
budget period
Submit in EGrAMS
Email report to
MDHHS-
HIVSTIoperations@mi
chigan.gov
All Ryan White federally
funded agencies: FY23 actual
expenditures by service
category, program income, and
administrative costs through the
RW Reporting Tool
Quarterly Thirty days after
the end of the
budget period
Attached to quarterly
FSR
All Ryan White federally
funded agencies: RW Form
2100 and RW Form 2300
Annually December 31st Uploaded to EGrAMS
Portal Agency Profile
*Reports and information shall be submitted to the Division of HIV/STI Programs (DHSP).
Please refer to the table for where to submit reports and information.
Any additional requirements:
Publication Rights
When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
money, the Grantee receiving Federal funds, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state:
1. The percentage of the total costs of the program or project that will be financed
with Federal money.
2. The dollar amount of Federal funds for the project or program.
3. Percentage and dollar amount of the total costs of the project or program that will
be financed by non-governmental sources.
Fees
The Grantee must establish and implement a process to ensure that they are maximizing
third party reimbursements, including:
a. Requirement, in agreement, that the Grantee maximize and monitor third party
reimbursements.
b. Requirement that Grantee document, in client record, how each client has been
screened for and enrolled in eligible programs.
c. Monitoring to determine that Ryan White is serving as the payer of last resort,
including review of client records and documentation of billing, collection policies
and procedures, and information on third party contracts.
d. Grantee must adhere to the National Monitoring Standards for Ryan White Part B
Grantees: Program and the National Monitoring Standards for Ryan White
Grantees: Fiscal; and bill for services that are billable in accordance with the
above.
e. Ensure appropriate billing, tracking, and reporting of program income to support
appropriate use for program activities.
f. Program income is added to funding provided by the State of Michigan for the
budget period and used to advance eligible program objectives.
g. Provide a report detailing the expenditure and reinvestment of program income in
the program (template will be provided by MDHHS).
Grant Program Operation
1. The Grantee will participate in the Department needs assessment and planning
activities, as requested.
2. The Grantee will participate in regular Grantee meetings which may be face-to-
face, teleconferences, webinars, trainings, etc. The Grantee is highly encouraged
to participate in other training offerings and information-sharing opportunities
provided by the Department.
3. The Grantee is responsible for ensuring that staff retain minimum educational
requirements for staff positions and are proficient in Ryan White-funded service
delivery in their respective roles within the organization. Ensure that Ryan White
funded staff receive MDHHS required case management training within one (1)
year of hire.
4. Each employee funded in whole or in part with federal funds must record time and
effort spent on the project(s) funded. The Grantee must:
a. Have policies and procedures to ensure time and effort reporting.
b. Assure the staff member clearly identifies the percentage of time devoted to
contract activities in accordance with the approved budget.
c. Denote accurately the percent of effort to the project. The percent of effort may
vary from month to month, and the effort recorded for Ryan White funds must
match the percentage claimed on the Ryan White FSR for the same period.
d. Submit a budget modification to the Department in instances where the
percentage of effort of contract staff changes (FTE changes) during the
contract period.
5. The Grantee must submit all details on advertising campaigns (print and social
media) completed via the quarterly workplan progress report submission in
EGrAMS.
6. The Grantee must include the following language in all Client Consent and
Release of Information forms used for services in this agreement:
“Consent for the collection and sharing of client information to
providers for persons living with HIV under the Ryan White Program
provided through (grantee name) is mandated to collect certain
personal information that is entered and saved in a federal data
system called CAREWare. CAREWare records are maintained in an
encrypted and secure statewide database. I understand that some
limited information in the electronic data may be shared with other
agencies if they also provide me with services and are part of the
same care and data network for the purpose of informing and
coordinating my treatment and benefits that I receive under this
Program. The CAREWare database program allows for certain
medical and support service information to be shared among
providers involved with my care, this includes but is not limited to
health information, medical visits, lab results, medications, case
management, transportation, Housing Opportunities for Persons with
AIDS (HOPWA) program, substance abuse, and mental health
counseling. I acknowledge that if I fail to show for scheduled medical
appointments, I may be contacted by an authorized representative of
(grantee name) in order to re-engage and link me back to care.”
7. The Grantee must notify the Continuum of Care Unit staff at MDHHS-
HIVSTIoperations@michigan.gov within 7 business days if a core medical or
support service category is added or removed from the Ryan White services
previously approved by DHSP. An approval from DHSP is required prior to the
change being implemented.
8. The Grantee must adhere to security measures when working with client
information and must:
a. Not email individual health information either internally or externally.
b. Keep all printed materials in locked storage cabinets in locked rooms.
c. Provide written documentation of annual Security and Confidentiality training
for all staff regarding the Health Insurance Portability Accountability Act
(HIPAA), the Health Information Technology for Economic and Clinical Health
(HITECH), and the Michigan Public Health Code.
d. Maintain the standards of CDC’s Data Security and Confidentiality Guidelines
for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis
Programs. CDC Website:
https://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelin
es.pdf.
9. The Grantee will complete the collection of all required data variables and clean-
up any missing data or service activities by the 10th day after the end of each
calendar month.
10. Subrecipient quality management program should:
a. Include: leadership support, dedicated staff time for QM activities, participation
of staff from various disciplines, ongoing review of performance measure data
and assessment of consumer satisfaction.
b. Include consumer engagement which includes, but is not limited to, agency-
level consumer advisory board, participation on quality management
committee, focus groups and consumer satisfaction surveys.
c. Include conduction of at least one quality improvement (QI) project throughout
the year, using the Plan-Do-Study-Act (PDSA) method to document progress.
This QI project must be aimed at improving client care, client satisfaction, or
health outcomes.
11. If the Grantee is federally funded for Ryan White services (one of which is a core
medical service), the Grantee will develop and/or revise a Quality Management
Plan (QMP) annually, to be kept on file at agency. QM Plans must contain these
eleven components:
a. Quality statement
b. Quality infrastructure
c. Annual quality goals
d. Capacity building
e. Performance measurement
f. Quality improvement
g. Engagement of stakeholders
h. Procedures for updating the QM plan
i. Communication
j. Evaluation
k. Work Plan
12. The Grantee must consult and adhere to the Policy Clarification Notice (PCN)
#16-02 established by Health Resources and Services Administration (HRSA).
PCN #16-02 describes the core medical and support services that HRSA
considers allowable uses of Ryan White grant funds and the individuals eligible to
receive those services. A copy of the revised PCN 16-02 is available at this link.
HRSA Unallowable Costs:
*An expanded list of “unallowable” grant costs is available in the PCN 16-02.
a. HRSA RWHAP funds may not be used to make cash payments to intended clients
of HRSA RWHAP-funded services. This prohibition includes cash incentives and
cash intended as payment for HRSA RWHAP core medical and support services.
Where a direct provision of the service is not possible or effective, store gift cards,
vouchers, coupons, or tickets that can be exchanged for a specific service or
commodity (e.g., food or transportation) must be used.
b. Off-premises social or recreational activities (movies, vacations, gym
memberships, parties, retreats)
c. Medical Marijuana
d. Purchase or improve land or permanently improve buildings
e. Direct cash payments or cash reimbursements to clients
f. Clinical Trials: Funds may not be used to support the costs of operating clinical
trials of investigational agents or treatments (to include administrative
management or medical monitoring of patients)
g. Clothing: Purchase of clothing
h. Employment Services: Support employment, vocational rehabilitation, or
employment-readiness services.
i. Funerals: Funeral, burial, cremation, or related expenses
j. Household Appliances
k. Mortgages: Payment of private mortgages
l. Needle Exchange: Syringe exchange programs, Materials, designed to promote or
encourage, directly, intravenous drug use or sexual activity, whether homosexual
or heterosexual
m. International travel
n. The purchase or improvement of land
o. The purchase, construction, or permanent improvement of any building or other
facility
p. Pets: Pet food or products
q. Taxes: Paying local or state personal property taxes (for residential property,
private automobiles, or any other personal property against which taxes may be
levied)
r. Vehicle Maintenance: Direct maintenance expense (tires, repairs, etc.) of a
privately-owned vehicle or any additional costs associated with a privately-owned
vehicle, such as a lease, loan payments, insurance, license or registration fees
s. Water Filtration: Installation of permanent systems of filtration of all water entering
a private residence unless in communities where issues of water safety exist.
t. It is unallowable to divert program income (income generated from charges/ fees
and copays from Medicare, Medicaid, other third-party payers collected to cover
RW services provided) toward general agency costs or to use it for general
purposes.
u. Pre-Exposure Prophylaxis (PrEP) HIV/AIDS BUREAU POLICY 16-02
v. Non-occupational Post-Exposure Prophylaxis (nPEP).
w. General-use prepaid cards are considered “cash equivalent” and are therefore
unallowable. Such cards generally bear the logo of a payment network, such as
Visa, MasterCard, or American Express, and are accepted by any merchant that
accepts those credit or debit cards as payment. Gift cards that are cobranded with
the logo of a payment network and the logo of a merchant or affiliated group of
merchants are general-use prepaid cards, not store gift cards, and therefore are
unallowable.
* HRSA RWHAP recipients are advised to administer voucher and store gift card
programs in a manner which assures that vouchers and store gift cards cannot be
exchanged for cash or used for anything other than the allowable goods or services, and
that systems are in place to account for disbursed vouchers and store gift cards.
Personnel Systems Access/Transfer/Terminations
1. New staff needing access to CAREWare are required to submit the CAREWare
user request form through SHOARS.
2. As required by NIST SP 800-53 Details - PS-7e, the Grantee must notify MDHHS
designated personnel in writing of any personnel transfers or terminations of
personnel who possess information system privileges within CAREWare or MIDAP
online data systems within 24 hours of change.
a. The Grantee shall notify MDHHS immediately via email at MDHHS-
HIVSTIoperations@michigan.gov of CAREWare users who are separated from
the agency for deactivation.
Record Maintenance/Retention
1. The Grantee will maintain, for a minimum of five (5) years after the end of the
grant period, program, fiscal records, including documentation to support program
activities and expenditures, under the terms of this agreement, for clients residing
in the State of Michigan.
2. The Grantee will maintain client files and charts from last date of service plus
seven (7) years. For minors, Grantee will maintain client files and records from last
date of service and until minor reaches the age of 18, whichever is longer, plus
3. seven (7) years.
Software Compliance
1. The Grantee and its subcontractors are required to use the HRSA-supported
software CAREWare to enter client and service data into the centrally managed
database on a secure server. The Grantee must:
a. Enter all Ryan White services delivered to HIV-infected and affected clients.
b. Enter all data by the 10th of the following month.
c. Successfully create, run, and document the results of their HRSA RSR report
in CAREWare in order to receive relevant support from data managers by the
10th of the following month. Documentation is to include with identifying
information omitted:
i. Missing records as depicted in the RSR Viewer module in
CAREWare
ii. A list of alert, warning, and error messages as depicted in the RSR
Validation Report module in CAREWare
iii. Efforts or decisions (including collaboration with MDHHS) to
resolve missing data or error messages as applicable
d. Complete collection of all required data variables and the clean-up of any
missing data or service activities by the 10th of the following month.
2. The Grantee must establish written procedures for protecting client information
kept electronically or in charts or other paper records. Protection of electronic
client-level data will minimally include:
a. Regular back-up of client records with back-up files stored in a secure location.
b. Use of passwords to prevent unauthorized access to the computer or Client
Level Data program.
c. Use of virus protection software to guard against computer viruses.
3. Provide annual training to staff on security and confidentiality of client level data
and sharing of electronic data files according to MDHHS policies concerning
sharing and Secured Electronic Data.
4. New staff needing access to CAREWare are required to submit the CAREWare
user request form through SHOARS.
5. As required by NIST SP 800-53 Details - PS-7e, the Grantee must notify MDHHS
designated personnel in writing of any personnel transfers or terminations of
personnel who possess information system privileges within CAREWare or MIDAP
online data systems within 24 hours of change.
a. The Grantee shall notify MDHHS immediately via email at MDHHS-
HIVSTIoperations@michigan.gov of CAREWare users who are separated from
the agency for deactivation.
6. The Grantee shall as be required by HRSA submit the Ryan White HIV/AIDS
Program Services Report (RSR) for the previous calendar year. The Grantee is
required to use the HRSA Electronic Handbook (EHB) portal for their submission:
a. The Grantee shall acquire access to their agency’s Grant Contract
Management System (GCMS) and their Provider Report prior to January when
notified by HRSA of the required federal report.
b. The Grantee is required to provide access to all staff and personnel
responsible for reviewing and completing the RSR.
c. The Grantee as per HRSA standards and compliance are mandated to require
relevant staff members to update their EHB account passwords as dictated by
HRSA email notifications.
d. The Grantee is mandated to update or add contact information for staff
responsible for completing and/or submitting the RSR and to notify MDHHS of
any changes in personnel immediately.
e. The Grantee shall correspond with MDHHS staff including data management
users to compare units of service provided to the funded services listed on the
EHB.
f. The Grantee shall notify MDHHS immediately if there are any discrepancies
between the funding sources and services listed for their agency’s report on
the Electronic Handbook (EHB) and their agency’s contracts and records.
g. The Grantee shall in these circumstances contact Ryan White Data Support by
email or by phone number (1-888-640-9356) between the hours of 10 am –
6:30 pm Eastern Standard Time (EST) on weekdays regarding the HRSA EHB
GCMS and/or RSR:
i. Issues with account lockouts, lost credentials, or account
creation
ii. Issues with accessing the GCMS through the HRSA EHB
iii. Issues with accessing the Provider Report through the HRSA
iv. Technical issues regarding functionality of the EHB portal
h. The Grantee shall attend webinars and instructional sessions to answer
questions about the RSR; Grantee shall utilize tools provided by data
management users to check on the accuracy and completeness of their client
level data (CLD) on a monthly basis leading up to the RSR. These include but
are not limited to:
i. TargetHIV/DISQ webinars regarding the RSR
ii. HRSA produced documentation and manuals on RSR reporting
requirements for the calendar year
iii. Manuals on utilizing CAREWare for completing the RSR
iv. PowerPoint presentations on aspects of the RSR
v. Staff invitations to Teams meetings and breakout sessions to
answer questions regarding the RSR
vi. CAREWare custom reports and financial reports designed to
assess:
1. The number of eligible clients
2. The number of eligible clients that need to be marked as such
3. Services provided by the Grantee
4. CLD on ZIP codes, ethnicity, and other features
vii. Emails from MDHHS staff regarding the above but also
including:
1. Updates on HRSA reporting requirements
2. New information provided from HRSA
3. Other resources HRSA is providing/will provide
7. The Grantee shall after notification from MDHHS staff including data management
users implement needed corrections and additions to CLD in CAREWare to
ensure compliance with HRSA federal reporting standards.
Mandatory Disclosures
1. The Grantee will provide immediate notification to the Department, in writing, in the
event of any of the following:
a. Any formal grievance initiated by a client and subsequent resolution of that
grievance.
b. Any event occurring or notice received by the Grantee or subcontractor, that
reasonably suggests that the Grantee or subcontractor may be the subject of,
or a defendant in, legal action. This includes, but is not limited to, events or
notices related to grievances by service recipients or Grantee or subcontractor
employees.
c. Any staff vacancies funded for this project that exceed 30 days. All notifications
should be made to DHSP by MDHHS-HIVSTIoperations@michigan.gov.
Technical Assistance
1. Technical assistance (TA) may be requested on the implementation of the Ryan
White program. This may include issues related to: CAREWare, Quality
Management, Ryan White B services, Budget/Fiscal, Grants and Contracts,
ADAP, or other activities related to carrying out Ryan White activities.
2. Technical assistance (TA) requests must be submitted via the MDHHS SHOARS
system. In addition, if your contract is to be amended, the request will have to be
logged into SHOARS. Registration instructions and further information can be
found at: https://bit.ly/3HS7xdG
3. Grantee must register an Authorized Official and Program Manager in the DHSP
SHOARS system. These roles must match what the agency has listed for these
roles in the EGrAMS system. If you have access related questions, contact
MDHHS-SHOARS-SUPPORT MDHHS-SHOARS-SUPPORT@michigan.gov.
ASSURANCES
Compliance with Applicable Laws
1. The Grantee should adhere to all Federal and Michigan laws pertaining to
HIV/AIDS treatment, disability accommodations, non-discrimination, and
confidentiality.
2. Ryan White is payer of last resort; as such, the Grantee must adhere to the Public
Health Service (PHS) Act.
3. The Grantee should have procedures to protect the confidentiality and security of
client information.
PROJECT TITLE: HIV Data to Care
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
Data to Care (D2C) is a Centers for Disease Control (CDC) program specifically focused
on people living with HIV (PLWH) that are not engaged in care. D2C employs an
intensive individualized outreach program which works to eliminate barriers
(transportation, insurance, access/knowledge of access to medical care, stigma-related
mental health issues, etc.) to accessing care through a combination of referrals and
linkage to existing Early Intervention Services (EIS) providers, Ryan White Service
providers and other community services. D2C is an essential program that facilitates
access to HIV treatment.
Reporting Requirements:
The Grantee shall maintain up to date information in CAREWare (CW) in preparation for
evaluation:
Report Period Due Date(s) How to Submit Report
NIC client level data and
services provided list Monthly 10th of the
following month Enter into CAREWare
All Funded agencies:
Complete quarterly
workplan progress reports
Quarterly 30 days after the
end of the budget
period
Email report to MDHHS-
HIVSTIoperations@michig
an.gov
All Agencies: Ryan White
Services Report (RSR)
Annual Generally,
Grantee
submission will
open in early
February and
close early March.
Submission to HRSA
through Electronic
Handbook (EHB)
All Agencies: FY23 actual
expenditures by service
category, program income,
and administrative costs
through the RW Reporting
Tool
Monthly Thirty days after
the end of the
budget period
Attached to monthly FSR
1. To complete the Ryan White Services Report (RSR), a Health Resources and
Services Administration (HRSA) required annual data report, the Grantee must
assure that all CW data is complete, cleaned, and entered into an online form via
the HRSA EHB. RSR submission requirements include:
a. The RSR shall have no more than 5% missing data variables.
b. Exact dates for the Grantee submission will be provided by the Department
each reporting year.
c. The Department validates the data within the Grantee’s RSR submission
before receipt by HRSA.
d. Data in CAREWare must be checked and validated every quarter.
2. Reports and information shall be submitted to the Division of HIV/STI Programs
(DHSP). Please refer to the table for where to submit reports and information.
3. The Grantee shall permit the Division of HIV/STI Programs (DHSP) or its designee
to conduct site visits and to formulate an evaluation of the project.
Any additional requirements:
Publication Rights
When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
money, the Grantee receiving Federal funds, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state:
1. The percentage of the total costs of the program or project that will be financed
with Federal money.
2. The dollar amount of Federal funds for the project or program.
3. Percentage and dollar amount of the total costs of the project or program that will
be financed by non-governmental sources.
Fees
The Grantee must establish and implement a process to ensure that they are maximizing
third party reimbursements, including:
a. Requirement, in agreement, that the Grantee maximize and monitor third party
reimbursements.
b. Requirement that Grantee document, in client record, how each client has been
screened for and enrolled in eligible programs.
c. Monitoring to determine that Ryan White is serving as the payer of last resort,
including review of client records and documentation of billing, collection policies
and procedures, and information on third party contracts.
d. Grantee must adhere to the National Monitoring Standards for Ryan White Part B
Grantees: Program and the National Monitoring Standards for Ryan White
Grantees: Fiscal; and bill for services that are billable in accordance with the
above.
e. Ensure appropriate billing, tracking, and reporting of program income to support
appropriate use for program activities.
f. Program income is added to funding provided by the State of Michigan for the
budget period and used to advance eligible program objectives.
g. Provide a report detailing the expenditure and reinvestment of program income in
the program (template will be provided by MDHHS).
Grant Program Operation
1. If Grantee is receiving NIC list via secure transfer (e.g. DCH file transfer):
a. Grantees must enter NIC lists into CW.
b. Grantees must maintain password protected NIC lists on secure server
locations and not in any portable storage devices.
c. Grantees must store NIC lists on shared servers and not on desktops or
personal computers.
d. Grantees must transmit updated surveillance data to MDHHS in pre-approved
secure manners (e.g. DCH file transfer).
e. If NIC lists or partial lists are sent via US Mail, list size must not exceed 10
individuals in a given mailing and words indicating HIV infection must not be
contained in the sent documents.
2. If Grantee is receiving NIC list via direct CW import, grantee must complete
necessary fields in CW for transfer back to Surveillance.
3. Grantees must not email NIC lists or individual health information contained on
NIC lists either internally or externally.
4. The Grantee must adhere to security measures when working with client
information and must:
a. Not email individual health information either internally or externally.
b. Keep all printed materials in locked storage cabinets in locked rooms.
c. Provide written documentation of annual Security and Confidentiality training
for all staff regarding the Health Insurance Portability Accountability Act
(HIPAA), the Health Information Technology for Economic and Clinical Health
(HITECH), and the Michigan Public Health Code.
d. Maintain the standards of CDC’s Data Security and Confidentiality Guidelines
for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis
Programs
https://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelin
es.pdf.
5. Grantees will document all data sharing agreements and share a copy with the
Department. The data sharing agreements may be emailed to MDHHS-
HIVSTIoperations@michigan.gov
6. Grantees must provide written documentation of annual Security and
Confidentiality training for all staff that have access to NIC lists.
7. Grantees will maintain the standards of CDC’s Data Security and Confidentiality
Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and
Tuberculosis Programs,
https://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.p
df
8. The Grantee will participate in the DHSP needs assessment and planning
activities, as requested.
a. The Grantee will participate in regular Grantee meetings which may be face-to-
face, teleconferences, webinars, etc. The Grantee is highly encouraged to
participate in other training offerings and information-sharing opportunities
provided by the DHSP.
b. The Grantee will use CW to report program activities, the Grantee must include
the following language in all Client Consent and Release of Information forms
used for services in this agreement: “I also understand that some limited
information in the electronic data may be shared with other agencies if they
also provide me with services and are part of the same care and data network.
[AGENCY] is mandated to collect certain personal information that is entered
and saved in a database system called CAREWare. CW records are
maintained in an encrypted and secure statewide database. The CW database
program allows for certain medical and support service information to be
shared among providers involved with your care, this includes but is not limited
to medical visits, lab results, medications, case management, transportation,
substance abuse, and mental health counseling.
9. The Grantee must notify the Continuum of Care Unit staff at MDHHS-
HIVSTIoperations@michigan.gov within 7 business days if a core medical or
support service category is added or removed from the Ryan White services
previously approved by DHSP. An approval from DHSP is required prior to the
change being implemented.
10. The Grantee must adhere to security measures when working with client
information and must:
a. Not email individual health information either internally or externally.
b. Keep all printed materials in locked storage cabinets in locked rooms.
c. Provide written documentation of annual Security and Confidentiality training
for all staff regarding the Health Insurance Portability Accountability Act
(HIPAA), the Health Information Technology for Economic and Clinical Health
(HITECH), and the Michigan Public Health Code.
d. Maintain the standards of CDC’s Data Security and Confidentiality Guidelines
for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis
Programs. CDC Website:
https://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelin
es.pdf.
11. In CW, the Grantee will complete the collection of all required data variables and
clean-up any missing data or service activities by the 10th day after the end of
each calendar month.
12. The Grantee must consult and adhere to the Policy Clarification Notice (PCN) #16-
02 established by Health Resources and Services Administration (HRSA). PCN
#16-02 describes the core medical and support services that HRSA considers
allowable uses of Ryan White grant funds and the individuals eligible to receive
those services. A copy of the revised PCN 16-02 is available at this link.
HRSA Unallowable Costs:
*An expanded list of “unallowable” grant costs is available in the PCN 16-02.
a. HRSA RWHAP funds may not be used to make cash payments to intended clients
of HRSA RWHAP-funded services. This prohibition includes cash incentives and
cash intended as payment for HRSA RWHAP core medical and support services.
Where a direct provision of the service is not possible or effective, store gift cards,
vouchers, coupons, or tickets that can be exchanged for a specific service or
commodity (e.g., food or transportation) must be used.
b. Off-premises social or recreational activities (movies, vacations, gym
memberships, parties, retreats)
c. Medical Marijuana
d. Purchase or improve land or permanently improve buildings
e. Direct cash payments or cash reimbursements to clients
f. Clinical Trials: Funds may not be used to support the costs of operating clinical
trials of investigational agents or treatments (to include administrative
management or medical monitoring of patients)
g. Clothing: Purchase of clothing
h. Employment Services: Support employment, vocational rehabilitation, or
employment-readiness services.
i. Funerals: Funeral, burial, cremation, or related expenses
j. Household Appliances
k. Mortgages: Payment of private mortgages
l. Needle Exchange: Syringe exchange programs, Materials, designed to promote or
encourage, directly, intravenous drug use or sexual activity, whether homosexual
or heterosexual
m. International travel
n. The purchase or improvement of land
o. The purchase, construction, or permanent improvement of any building or other
facility
p. Pets: Pet food or products
q. Taxes: Paying local or state personal property taxes (for residential property,
private automobiles, or any other personal property against which taxes may be
levied)
r. Vehicle Maintenance: Direct maintenance expense (tires, repairs, etc.) of a
privately-owned vehicle or any additional costs associated with a privately-owned
vehicle, such as a lease, loan payments, insurance, license or registration fees
s. Water Filtration: Installation of permanent systems of filtration of all water entering
a private residence unless in communities where issues of water safety exist.
t. It is unallowable to divert program income (income generated from charges/ fees
and copays from Medicare, Medicaid, other third-party payers collected to cover
RW services provided) toward general agency costs or to use it for general
purposes.
u. Pre-Exposure Prophylaxis (PrEP) HIV/AIDS BUREAU POLICY 16-02
v. Non-occupational Post-Exposure Prophylaxis (nPEP).
w. General-use prepaid cards are considered “cash equivalent” and are therefore
unallowable. Such cards generally bear the logo of a payment network, such as
Visa, MasterCard, or American Express, and are accepted by any merchant that
accepts those credit or debit cards as payment. Gift cards that are cobranded with
the logo of a payment network and the logo of a merchant or affiliated group of
merchants are general-use prepaid cards, not store gift cards, and therefore are
unallowable.
* HRSA RWHAP recipients are advised to administer voucher and store gift card
programs in a manner which assures that vouchers and store gift cards cannot be
exchanged for cash or used for anything other than the allowable goods or services, and
that systems are in place to account for disbursed vouchers and store gift cards.
Personnel Systems Access/Transfer/Terminations
1. New staff needing access to CAREWare are required to submit the CAREWare
user request form through SHOARS.
2. As required by NIST SP 800-53 Details - PS-7e, the Grantee must notify MDHHS
designated personnel in writing of any personnel transfers or terminations of
personnel who possess information system privileges within CAREWare or MIDAP
online data systems within 24 hours of change.
a. The Grantee shall notify MDHHS immediately via email at MDHHS-
HIVSTIoperations@michigan.gov of CAREWare users who are separated from
the agency for deactivation.
Record Maintenance/Retention
1. The Grantee will maintain, for a minimum of five (5) years after the end of the
grant period, program, fiscal records, including documentation to support program
activities and expenditures, under the terms of this agreement, for clients residing
in the State of Michigan.
2. The Grantee will maintain client files, charts, and electronic records from last date
of service plus seven (7) years. For minors, Grantee will maintain client files and
records from last date of service and until minor reaches the age of 18, whichever
is longer, plus seven (7) years.
Software Compliance
1. The Grantee and its subcontractors are required to use the HRSA-supported
software CAREWare to enter client and service data into the centrally managed
database on a secure server. The Grantee must:
a. Enter all Ryan White services delivered to HIV-infected and affected clients.
b. Enter all data by the 10th of the following month.
c. Successfully create, run, and document the results of their HRSA RSR report
in CAREWare in order to receive relevant support from data managers by the
10th of the following month. Documentation is to include with identifying
information omitted:
• Missing records as depicted in the RSR Viewer module in
CAREWare
• A list of alert, warning, and error messages as depicted in the RSR
Validation Report module in CAREWare.
• Efforts or decisions (including collaboration with MDHHS) to resolve
missing data or error messages as applicable
d. Complete collection of all required data variables and the clean-up of any
missing data or service activities by the 10th of the following month.
2. The Grantee must establish written procedures for protecting client information
kept electronically or in charts or other paper records. Protection of electronic
client-level data will minimally include:
a. Regular back-up of client records with back-up files stored in a secure location.
b. Use of passwords to prevent unauthorized access to the computer or Client
Level Data program.
c. Use of virus protection software to guard against computer viruses.
3. Provide annual training to staff on security and confidentiality of client level data
and sharing of electronic data files according to MDHHS policies concerning
sharing and Secured Electronic Data.
4. New staff needing access to CAREWare are required to submit the CAREWare
user request form through SHOARS.
5. As required by NIST SP 800-53 Details - PS-7e, the Grantee must notify MDHHS
designated personnel in writing of any personnel transfers or terminations of
personnel who possess information system privileges within CAREWare or MIDAP
online data systems within 24 hours of change.
a. The Grantee shall notify MDHHS immediately via email at MDHHS-
HIVSTIoperations@michigan.gov of CAREWare users who are separated from
the agency for deactivation.
6. The Grantee shall as be required by HRSA submit the Ryan White HIV/AIDS
Program Services Report (RSR) for the previous calendar year. The Grantee is
required to use the HRSA Electronic Handbook (EHB) portal for their submission:
a. The Grantee shall acquire access to their agency’s Grant Contract
Management System (GCMS) and their Provider Report prior to January when
notified by HRSA of the required federal report.
b. The Grantee is required to provide access to all staff and personnel
responsible for reviewing and completing the RSR.
c. The Grantee as per HRSA standards and compliance are mandated to require
relevant staff members to update their EHB account passwords as dictated by
HRSA email notifications.
d. The Grantee is mandated to update or add contact information for staff
responsible for completing and/or submitting the RSR and to notify MDHHS of
any changes in personnel immediately.
e. The Grantee shall correspond with MDHHS staff including data management
users to compare units of service provided to the funded services listed on the
EHB.
f. The Grantee shall notify MDHHS immediately if there are any discrepancies
between the funding sources and services listed for their agency’s report on
the Electronic Handbook (EHB) and their agency’s contracts and records.
g. The Grantee shall in these circumstances contact Ryan White Data Support by
email or by phone number (1-888-640-9356) between the hours of 10 am –
6:30 pm Eastern Standard Time (EST) on weekdays regarding the HRSA EHB
GCMS and/or RSR:
• Issues with account lockouts, lost credentials, or account creation
• Issues with accessing the GCMS through the HRSA EHB
• Issues with accessing the Provider Report through the HRSA
• Technical issues regarding functionality of the EHB portal
h. The Grantee shall attend webinars and instructional sessions to answer
questions about the RSR; Grantee shall utilize tools provided by data
management users to check on the accuracy and completeness of their client
level data (CLD) on a monthly basis leading up to the RSR. These include but
are not limited to:
• TargetHIV/DISQ webinars regarding the RSR
HRSA produced documentation and manuals on RSR reporting
requirements for the calendar year
• Manuals on utilizing CAREWare for completing the RSR
• PowerPoint presentations on aspects of the RSR
• Staff invitations to Teams meetings and breakout sessions to answer
questions regarding the RSR
• CAREWare custom reports and financial reports designed to assess:
1. The number of eligible clients
2. The number of eligible clients that need to be marked as such
3. Services provided by the Grantee
4. CLD on ZIP codes, ethnicity, and other features
• Emails from MDHHS staff regarding the above but also including:
1. Updates on HRSA reporting requirements
2. New information provided from HRSA
3. Other resources HRSA is providing/will provide
i. The Grantee shall after notification from MDHHS staff including data
management users implement needed corrections and additions to CLD in
CAREWare to ensure compliance with HRSA federal reporting standards.
Mandatory Disclosures
1. The Grantee will provide immediate notification to the Department, in writing, in the
event of any of the following:
a. Any formal grievance initiated by a client and subsequent resolution of that
grievance.
b. Any event occurring or notice received by the Grantee or subcontractor, that
reasonably suggests that the Grantee or subcontractor may be the subject of,
or a defendant in, legal action. This includes, but is not limited to, events or
notices related to grievances by service recipients or Grantee or subcontractor
employees.
c. Any staff vacancies funded for this project that exceed 30 days. All notifications
should be made to DHSP by MDHHS-HIVSTIoperations@michigan.gov.
Technical Assistance
1. Technical assistance (TA) may be requested on the implementation of the Ryan
White program. This may include issues related to: CAREWare, Quality
Management, Ryan White B services, Budget/Fiscal, Grants and Contracts,
ADAP, or other activities related to carrying out Ryan White activities.
2. Technical assistance (TA) requests must be submitted via the MDHHS SHOARS
system. In addition, if your contract is to be amended, the request will have to be
logged into SHOARS. Registration instructions and further information can be
found at: https://bit.ly/3HS7xdG
3. Grantee must register an Authorized Official and Program Manager in the DHSP
SHOARS system. These roles must match what the agency has listed for these
roles in the EGrAMS system. If you have access related questions, contact
MDHHS-SHOARS-SUPPORT MDHHS-SHOARS-SUPPORT@michigan.gov.
4.
ASSURANCES
Compliance with Applicable Laws
1. The Grantee should adhere to all Federal and Michigan laws pertaining to
HIV/AIDS treatment, disability accommodations, non-discrimination, and
confidentiality.
2. Ryan White is payer of last resort; as such, the Grantee must adhere to the Public
Health Service (PHS) Act.
3. The Grantee should have procedures to protect the confidentiality and security of
client information.
PROJECT TITLE: HIV Housing Assistance
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The HIV Housing Assistance project will work to address issues related to housing for
people living with HIV (PLWH). Housing has been shown as a significant barrier to
achieving viral load suppression and this project will help provide support to PLWH to
access stable housing to address this barrier and achieve positive outcomes.
Reporting Requirements:
1. The Grantee shall permit the Division of HIV/STI Programs (DHSP) or its
designee to conduct site visits and to formulate an evaluation of the project.
2. The Grantee and its subcontractors are required to use the HRSA-supported
software CW to enter client and service data into the centrally managed
database on a secure server. The Grantee must:
a. Enter all Ryan White services delivered to HIV-infected and affected clients.
b. Enter all data by the 10th of the following month.
c. Complete collection of all required data variables and the clean-up of any
missing data or service activities by the 10th of the following month.
Grantee Report Submission Schedule
Report Period Due Date(s) How to Submit
Report
All Agencies: Ryan White
services delivered to HIV-
infected and affected clients
Monthly 10th of the
following month
Enter into CAREWare
(CW)
All Funded agencies:
Complete quarterly workplan
progress reports
Quarterly Thirty days after
the end of the
budget period
Submit in EGrAMS
Email report to
MDHHS-
HIVSTIoperations@mi
chigan.gov
All Ryan White federally
funded agencies: FY23 actual
expenditures by service
category, program income, and
Quarterly Thirty days after
the end of the
budget period
Attached to quarterly
FSR
Report Period Due Date(s) How to Submit
Report
administrative costs through the
RW Reporting Tool
All Ryan White federally
funded agencies: RW Form
2100 and RW Form 2300
Annually December 31 Uploaded to EGrAMS
Portal Agency Profile
• Reports and information shall be submitted to the Division of HIV/STI Programs
(DHSP). Please refer to the table for where to submit reports and information.
Any additional requirements:
Publication Rights
When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
money, the Grantee receiving Federal funds, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state:
1. The percentage of the total costs of the program or project that will be financed
with Federal money.
2. The dollar amount of Federal funds for the project or program.
3. Percentage and dollar amount of the total costs of the project or program that will
be financed by non-governmental sources.
Fees
The Grantee must establish and implement a process to ensure that they are
maximizing third party reimbursements, including:
a. Requirement, in agreement, that the Grantee maximize and monitor third party
reimbursements.
b. Requirement that Grantee document, in client record, how each client has been
screened for and enrolled in eligible programs.
c. Monitoring to determine that Ryan White is serving as the payer of last resort,
including review of client records and documentation of billing, collection policies
and procedures, and information on third party contracts.
a. Grantee must adhere to the National Monitoring Standards for Ryan White Part B
Grantees: Program and the National Monitoring Standards for Ryan White
Grantees: Fiscal; and bill for services that are billable in accordance with the
above.
b. Ensure appropriate billing, tracking, and reporting of program income to support
appropriate use for program activities.
c. Program income is added to funding provided by the State of Michigan for the
budget period and used to advance eligible program objectives.
d. Provide a report detailing the expenditure and reinvestment of program income in
the program (template will be provided by MDHHS).
Grant Program Operation
1. The Grantee will participate in the Department needs assessment and planning
activities, as requested.
2. The Grantee will participate in regular Grantee meetings which may be face-to-
face, teleconferences, webinars, trainings, etc. The Grantee is highly encouraged
to participate in other training offerings and information-sharing opportunities
provided by the Department.
3. The Grantee is responsible for ensuring that staff retain minimum educational
requirements for staff positions and are proficient in Ryan White-funded service
delivery in their respective roles within the organization. Ensure that Ryan White
funded staff receive MDHHS required case management training within one (1)
year of hire.
4. Each employee funded in whole or in part with federal funds must record time
and effort spent on the project(s) funded. The Grantee must:
a. Have policies and procedures to ensure time and effort reporting.
b. Assure the staff member clearly identifies the percentage of time devoted to
contract activities in accordance with the approved budget.
c. Denote accurately the percent of effort to the project. The percent of effort
may vary from month to month, and the effort recorded for Ryan White funds
must match the percentage claimed on the Ryan White FSR for the same
period.
d. Submit a budget modification to the Department in instances where the
percentage of effort of contract staff changes (FTE changes) during the
contract period.
5. The Grantee must submit all details on advertising campaigns (print and social
media) completed via the quarterly workplan progress report submission in
EGrAMS.
6. If Grantee is receiving NIC list via secure transfer (e.g. DCH file transfer):
a. Grantees must enter NIC lists into CW.
b. Grantees must maintain password protected NIC lists on secure server
locations and not in any portable storage devices.
c. Grantees must store NIC lists on shared servers and not on desktops or
personal computers.
d. Grantees must transmit updated surveillance data to MDHHS in pre-approved
secure manners (e.g. DCH file transfer).
e. If NIC lists or partial lists are sent via US Mail, list size must not exceed 10
individuals in a given mailing and words indicating HIV infection must not be
contained in the sent documents.
f. If Grantee is receiving NIC list via direct CW import, grantee must complete
necessary fields in CW for transfer back to Surveillance.
g. Grantees must not email NIC lists or individual health information contained
on NIC lists either internally or externally.
7. The Grantee must adhere to security measures when working with client
information and must:
a. Not email individual health information either internally or externally.
b. Keep all printed materials in locked storage cabinets in locked rooms.
c. Provide written documentation of annual Security and Confidentiality training
for all staff regarding the Health Insurance Portability Accountability Act
(HIPAA), the Health Information Technology for Economic and Clinical Health
(HITECH), and the Michigan Public Health Code.
d. Maintain the standards of CDC’s Data Security and Confidentiality Guidelines
for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis
Programs
https://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguideli
nes.pdf.
e. Grantees will document all data sharing agreements and share a copy with
the Department. The data sharing agreements may be emailed to MDHHS-
HIVSTIoperations@michigan.gov
f. Grantees must provide written documentation of annual Security and
Confidentiality training for all staff that have access to NIC lists.
g. Grantees will maintain the standards of CDC’s Data Security and
Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted
Disease, and Tuberculosis Programs,
https://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguideli
nes.pdf
8. The Grantee must adhere to security measures when working with client
information and must:
a. Not email individual health information either internally or externally.
b. Keep all printed materials in locked storage cabinets in locked rooms.
c. Provide written documentation of annual Security and Confidentiality training
for all staff regarding the Health Insurance Portability Accountability Act
(HIPAA), the Health Information Technology for Economic and Clinical Health
(HITECH), and the Michigan Public Health Code.
d. Maintain the standards of CDC’s Data Security and Confidentiality Guidelines
for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis
Programs. CDC Website:
https://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguideli
nes.pdf.
9. The Grantee will complete the collection of all required data variables and clean-
up any missing data or service activities by the 10th day after the end of each
calendar month.
10. The Grantee must consult and adhere to the Policy Clarification Notice (PCN)
#16-02 established by Health Resources and Services Administration (HRSA).
PCN #16-02 describes the core medical and support services that HRSA
considers allowable uses of Ryan White grant funds and the individuals eligible
to receive those services. A copy of the revised PCN 16-02 is available at this
link.
HRSA Unallowable Costs:
*An expanded list of “unallowable” grant costs is available in the PCN 16-02.
a. HRSA RWHAP funds may not be used to make cash payments to intended
clients of HRSA RWHAP-funded services. This prohibition includes cash
incentives and cash intended as payment for HRSA RWHAP core medical and
support services. Where a direct provision of the service is not possible or
effective, store gift cards, vouchers, coupons, or tickets that can be exchanged
for a specific service or commodity (e.g., food or transportation) must be used.
b. Off-premises social or recreational activities (movies, vacations, gym
memberships, parties, retreats)
c. Medical Marijuana
d. Purchase or improve land or permanently improve buildings
e. Direct cash payments or cash reimbursements to clients
f. Clinical Trials: Funds may not be used to support the costs of operating clinical
trials of investigational agents or treatments (to include administrative
management or medical monitoring of patients)
g. Clothing: Purchase of clothing
h. Employment Services: Support employment, vocational rehabilitation, or
employment-readiness services.
i. Funerals: Funeral, burial, cremation, or related expenses
j. Household Appliances
k. Mortgages: Payment of private mortgages
l. Needle Exchange: Syringe exchange programs, Materials, designed to promote
or encourage, directly, intravenous drug use or sexual activity, whether
homosexual or heterosexual
m. International travel
n. The purchase or improvement of land
o. The purchase, construction, or permanent improvement of any building or other
facility
p. Pets: Pet food or products
q. Taxes: Paying local or state personal property taxes (for residential property,
private automobiles, or any other personal property against which taxes may be
levied)
r. Vehicle Maintenance: Direct maintenance expense (tires, repairs, etc.) of a
privately-owned vehicle or any additional costs associated with a privately-owned
vehicle, such as a lease, loan payments, insurance, license or registration fees
s. Water Filtration: Installation of permanent systems of filtration of all water
entering a private residence unless in communities where issues of water safety
exist.
t. It is unallowable to divert program income (income generated from charges/ fees
and copays from Medicare, Medicaid, other third-party payers collected to cover
RW services provided) toward general agency costs or to use it for general
purposes.
u. Pre-Exposure Prophylaxis (PrEP) HIV/AIDS BUREAU POLICY 16-02
v. Non-occupational Post-Exposure Prophylaxis (nPEP).
w. General-use prepaid cards are considered “cash equivalent” and are therefore
unallowable. Such cards generally bear the logo of a payment network, such as
Visa, MasterCard, or American Express, and are accepted by any merchant that
accepts those credit or debit cards as payment. Gift cards that are cobranded
with the logo of a payment network and the logo of a merchant or affiliated group
of merchants are general-use prepaid cards, not store gift cards, and therefore
are unallowable.
* HRSA RWHAP recipients are advised to administer voucher and store gift card
programs in a manner which assures that vouchers and store gift cards cannot be
exchanged for cash or used for anything other than the allowable goods or services,
and that systems are in place to account for disbursed vouchers and store gift cards.
Personnel Systems Access/Transfer/Terminations
1. New staff needing access to CAREWare are required to submit the CAREWare
user request form through SHOARS.
2. As required by NIST SP 800-53 Details - PS-7e, the Grantee must notify MDHHS
designated personnel in writing of any personnel transfers or terminations of
personnel who possess information system privileges within CAREWare or
MIDAP online data systems within 24 hours of change.
a. The Grantee shall notify MDHHS immediately via email at MDHHS-
HIVSTIoperations@michigan.gov of CAREWare users who are separated
from the agency for deactivation.
Record Maintenance/Retention
1. The Grantee will maintain, for a minimum of five (5) years after the end of the
grant period, program, fiscal records, including documentation to support
program activities and expenditures, under the terms of this agreement, for
clients residing in the State of Michigan.
2. The Grantee will maintain client files and charts from last date of service plus
seven (7) years. For minors, Grantee will maintain client files and records from
last date of service and until minor reaches the age of 18, whichever is longer,
plus seven (7) years.
Software Compliance
1. The Grantee and its subcontractors are required to use the HRSA-supported
software CW to enter client and service data into the centrally managed
database on a secure server.
2. The Grantee must establish written procedures for protecting client information
kept electronically or in charts or other paper records. Protection of electronic
client-level data will minimally include:
a. Regular back-up of client records with back-up files stored in a secure
location.
b. Use of passwords to prevent unauthorized access to the computer or Client
Level Data program.
c. Use of virus protection software to guard against computer viruses.
3. Provide annual training to staff on security and confidentiality of client level data
and sharing of electronic data files according to MDHHS policies concerning
sharing and Secured Electronic Data.
4. New staff needing access to CAREWare are required to submit the CAREWare
user request form through DHSP SHOARS.
Mandatory Disclosures
1. The Grantee will provide immediate notification to the Department, in writing, in
the event of any of the following:
a. Any formal grievance initiated by a client and subsequent resolution of that
grievance.
b. Any event occurring or notice received by the Grantee or subcontractor, that
reasonably suggests that the Grantee or subcontractor may be the subject of,
or a defendant in, legal action. This includes, but is not limited to, events or
notices related to grievances by service recipients or Grantee or
subcontractor employees.
c. Any staff vacancies funded for this project that exceed 30 days.
2. All notifications should be made to DHSP by MDHHS-HIVSTIoperations@michigan.gov
Technical Assistance
1. Technical assistance (TA) can be requested on the implementation of the Ryan
White program. This may include issues related to: CAREWare, Quality
Management, Ryan White B services, Budget/Fiscal, Grants and Contracts,
ADAP, or other activities related to carrying out Ryan White activities.
2. Technical assistance (TA) requests must be submitted via the MDHHS SHOARS
system. In addition, if your contract is to be amended, the request will have to be
logged into SHOARS. Registration instructions and further information can be
found at: https://bit.ly/3HS7xdG
3. Grantee must register an Authorized Official and Program Manager in the DHSP
SHOARS system. These roles must match what the agency has listed for these
roles in the EGrAMS system. If you have access related questions, contact
MDHHS-SHOARS-SUPPORT MDHHS-SHOARS-SUPPORT@michigan.gov.
ASSURANCES
Compliance with Applicable Laws
1. The Grantee should adhere to all Federal and Michigan laws pertaining to
HIV/AIDS treatment, disability accommodations, non-discrimination, and
confidentiality.
2. Ryan White is payer of last resort; as such, the Grantee must adhere to the
Public Health Service (PHS) Act.
3. The Grantee should have procedures to protect the confidentiality and security of
client information.
PROJECT TITLE: HIV/AIDS Linkage to Care
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
HIV/AIDS Linkage to Care is specifically focused on people living HIV (PLWH) that are
not engaged in care. The Ryan White HIV/AIDS Program provides a comprehensive
system of HIV primary medical care. The project eliminates barriers to accessing care
(transportation, insurance, access/knowledge of access to medical care, stigma-related
mental health issues, etc.) and funds linking the patient to care and treatment services
to people living with HIV to improve health outcomes and reduce HIV transmission
among hard-to-reach populations.
Reporting Requirements:
1. The Grantee shall permit the Division of HIV/STI Programs (DHSP) or its
designee to conduct site visits and to formulate an evaluation of the project.
2. The Grantee and its subcontractors are required to use the HRSA-supported
software CW to enter client and service data into the centrally managed
database on a secure server. The Grantee must:
a. Enter all Ryan White services delivered to HIV-infected and affected clients.
b. Enter all data by the 10th of the following month.
c. Complete collection of all required data variables and the clean-up of any
missing data or service activities by the 10th of the following month.
3. The Grantee shall maintain up to date information in CAREWare (CW) in
preparation for evaluation.
4. To complete the Ryan White Services Report (RSR), a Health Resources and
Services Administration (HRSA) required annual data report, the Grantee must
assure that all CAREWare data is complete, cleaned, and entered into the HRSA
Electronic Handbook. RSR submission requirements include:
a. The RSR shall have no more than 5% missing data variables.
b. Exact dates for the Grantee submission will be provided by the
Department each reporting year.
c. The Department validates the data within the Grantee’s RSR submission
before receipt by HRSA.
d. Data in CAREWare must be checked and validated every quarter.
Grantee Report Submission Schedule
Report Period Due Date(s) How to Submit
Report
NIC client level data and
services provided list Monthly 10th of the
following month Enter into CAREWare
All Agencies: Ryan White
Services Report (RSR) Annual
Generally,
Grantee
submission will
open in early
February and
close early
March.
Submission to HRSA
through Electronic
Handbook (EHB)
All Agencies: Complete
quarterly workplan progress
reports
Quarterly Thirty days after
the end of the
budget period.
Email report to
MDHHS-
HIVSTIoperations@mi
chigan.gov
All Ryan White federally
funded agencies: FY23
actual expenditures by
service category, program
income, and administrative
costs through the RW
Reporting Tool
Quarterly Thirty days after
the end of the
budget period
Attached to quarterly
FSR
All Ryan White federally
funded agencies: RW Form
2100 and RW Form 2300
Annually December 31,
2022
Uploaded to EGrAMS
Portal Agency Profile
• Reports and information shall be submitted to the Division of HIV/STI Programs
(DHSP). Please refer to the table for where to submit reports and information.
Any additional requirements:
Publication Rights
When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
money, the Grantee receiving Federal funds, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state:
1. The percentage of the total costs of the program or project that will be financed
with Federal money.
2. The dollar amount of Federal funds for the project or program.
3. Percentage and dollar amount of the total costs of the project or program that will
be financed by non-governmental sources.
Fees
The Grantee must establish and implement a process to ensure that they are
maximizing third party reimbursements, including:
a. Requirement, in agreement, that the Grantee maximize and monitor third party
reimbursements.
b. Requirement that Grantee document, in client record, how each client has been
screened for and enrolled in eligible programs.
c. Monitoring to determine that Ryan White is serving as the payer of last resort,
including review of client records and documentation of billing, collection policies
and procedures, and information on third party contracts.
d. Grantee must adhere to the National Monitoring Standards for Ryan White Part B
Grantees: Program and the National Monitoring Standards for Ryan White
Grantees: Fiscal; and bill for services that are billable in accordance with the
above.
e. Ensure appropriate billing, tracking, and reporting of program income to support
appropriate use for program activities.
f. Program income is added to funding provided by the State of Michigan for the
budget period and used to advance eligible program objectives.
g. Provide a report detailing the expenditure and reinvestment of program income in
the program (template will be provided by MDHHS).
Grant Program Operation
1. The Grantee will participate in the Department needs assessment and planning
activities, as requested.
2. The Grantee will participate in regular Grantee meetings which may be face-to-
face, teleconferences, webinars, trainings, etc. The Grantee is highly encouraged
to participate in other training offerings and information-sharing opportunities
provided by the Department.
3. The Grantee is responsible for ensuring that staff retain minimum educational
requirements for staff positions and are proficient in Ryan White-funded service
delivery in their respective roles within the organization. Ensure that Ryan White
funded staff receive MDHHS required case management training within one (1)
year of hire.
4. Each employee funded in whole or in part with federal funds must record time
and effort spent on the project(s) funded. The Grantee must:
a. Have policies and procedures to ensure time and effort reporting.
b. Assure the staff member clearly identifies the percentage of time devoted to
contract activities in accordance with the approved budget.
c. Denote accurately the percent of effort to the project. The percent of effort
may vary from month to month, and the effort recorded for Ryan White funds
must match the percentage claimed on the Ryan White FSR for the same
period.
d. Submit a budget modification to the Department in instances where the
percentage of effort of contract staff changes (FTE changes) during the
contract period.
5. The Grantee must submit all details on advertising campaigns (print and social
media) completed via the quarterly workplan progress report submission in
EGrAMS.
6. If Grantee is receiving NIC list via secure transfer (e.g. DCH file transfer):
a. Grantees must enter NIC lists into CW.
b. Grantees must maintain password protected NIC lists on secure server
locations and not in any portable storage devices.
c. Grantees must store NIC lists on shared servers and not on desktops or
personal computers.
d. Grantees must transmit updated surveillance data to MDHHS in pre-approved
secure manners (e.g. DCH file transfer).
e. If NIC lists or partial lists are sent via US Mail, list size must not exceed 10
individuals in a given mailing and words indicating HIV infection must not be
contained in the sent documents.
f. If Grantee is receiving NIC list via direct CW import, grantee must complete
necessary fields in CW for transfer back to Surveillance.
g. Grantees must not email NIC lists or individual health information contained
on NIC lists either internally or externally.
h. The Grantee must submit all details on advertising campaigns (print and
social media) completed via the quarterly workplan progress report
submission in EGrAMS.
7. The Grantee must include the following language in all Client Consent and
Release of Information forms used for services in this agreement:
“Consent for the collection and sharing of client information to
providers for persons living with HIV under the Ryan White
Program provided through (grantee name) is mandated to collect
certain personal information that is entered and saved in a federal
data system called CAREWare. CAREWare records are
maintained in an encrypted and secure statewide database. I
understand that some limited information in the electronic data may
be shared with other agencies if they also provide me with services
and are part of the same care and data network for the purpose of
informing and coordinating my treatment and benefits that I receive
under this Program. The CAREWare database program allows for
certain medical and support service information to be shared
among providers involved with my care, this includes but is not
limited to health information, medical visits, lab results,
medications, case management, transportation, Housing
Opportunities for Persons with AIDS (HOPWA) program, substance
abuse, and mental health counseling. I acknowledge that if I fail to
show for scheduled medical appointments, I may be contacted by
an authorized representative of (grantee name) in order to re-
engage and link me back to care.”
i. The Grantee must notify the Continuum of Care Unit staff at MDHHS-
HIVSTIoperations@michigan.gov within 7 business days if a core medical
or support service category is added or removed from the Ryan White
services previously approved by DHSP. An approval from DHSP is required
prior to the change being implemented.
8. The Grantee must adhere to security measures when working with client
information and must:
a. Not email individual health information either internally or externally.
b. Keep all printed materials in locked storage cabinets in locked rooms.
c. Provide written documentation of annual Security and Confidentiality training
for all staff regarding the Health Insurance Portability Accountability Act
(HIPAA), the Health Information Technology for Economic and Clinical Health
(HITECH), and the Michigan Public Health Code.
d. Maintain the standards of CDC’s Data Security and Confidentiality Guidelines
for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis
Programs
https://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguideli
nes.pdf.
e. Grantees will document all data sharing agreements and share a copy with
the Department. The data sharing agreements may be emailed to MDHHS-
HIVSTIoperations@michigan.gov
f. Grantees must provide written documentation of annual Security and
Confidentiality training for all staff that have access to NIC lists.
g. Grantees will maintain the standards of CDC’s Data Security and
Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted
Disease, and Tuberculosis Programs,
https://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguideli
nes.pdf
9. The Grantee will complete the collection of all required data variables and clean-
up any missing data or service activities by the 10th day after the end of each
calendar month.
10. The Grantee must consult and adhere to the Policy Clarification Notice (PCN)
#16-02 established by Health Resources and Services Administration (HRSA).
PCN #16-02 describes the core medical and support services that HRSA
considers allowable uses of Ryan White grant funds and the individuals eligible
to receive those services. A copy of the revised PCN 16-02 is available at this
link.
HRSA Unallowable Costs:
*An expanded list of “unallowable” grant costs is available in the PCN 16-02.
a. HRSA RWHAP funds may not be used to make cash payments to intended
clients of HRSA RWHAP-funded services. This prohibition includes cash
incentives and cash intended as payment for HRSA RWHAP core medical and
support services. Where a direct provision of the service is not possible or
effective, store gift cards, vouchers, coupons, or tickets that can be exchanged
for a specific service or commodity (e.g., food or transportation) must be used.
b. Off-premises social or recreational activities (movies, vacations, gym
memberships, parties, retreats)
c. Medical Marijuana
d. Purchase or improve land or permanently improve buildings
e. Direct cash payments or cash reimbursements to clients
f. Clinical Trials: Funds may not be used to support the costs of operating clinical
trials of investigational agents or treatments (to include administrative
management or medical monitoring of patients)
g. Clothing: Purchase of clothing
h. Employment Services: Support employment, vocational rehabilitation, or
employment-readiness services.
i. Funerals: Funeral, burial, cremation, or related expenses
j. Household Appliances
k. Mortgages: Payment of private mortgages
l. Needle Exchange: Syringe exchange programs, Materials, designed to promote
or encourage, directly, intravenous drug use or sexual activity, whether
homosexual or heterosexual
m. International travel
n. The purchase or improvement of land
o. The purchase, construction, or permanent improvement of any building or other
facility
p. Pets: Pet food or products
q. Taxes: Paying local or state personal property taxes (for residential property,
private automobiles, or any other personal property against which taxes may be
levied)
r. Vehicle Maintenance: Direct maintenance expense (tires, repairs, etc.) of a
privately-owned vehicle or any additional costs associated with a privately-owned
vehicle, such as a lease, loan payments, insurance, license or registration fees
s. Water Filtration: Installation of permanent systems of filtration of all water
entering a private residence unless in communities where issues of water safety
exist.
t. It is unallowable to divert program income (income generated from charges/ fees
and copays from Medicare, Medicaid, other third-party payers collected to cover
RW services provided) toward general agency costs or to use it for general
purposes.
u. Pre-Exposure Prophylaxis (PrEP) HIV/AIDS BUREAU POLICY 16-02
v. Non-occupational Post-Exposure Prophylaxis (nPEP).
w. General-use prepaid cards are considered “cash equivalent” and are therefore
unallowable. Such cards generally bear the logo of a payment network, such as
Visa, MasterCard, or American Express, and are accepted by any merchant that
accepts those credit or debit cards as payment. Gift cards that are cobranded
with the logo of a payment network and the logo of a merchant or affiliated group
of merchants are general-use prepaid cards, not store gift cards, and therefore
are unallowable.
* HRSA RWHAP recipients are advised to administer voucher and store gift card
programs in a manner which assures that vouchers and store gift cards cannot be
exchanged for cash or used for anything other than the allowable goods or services,
and that systems are in place to account for disbursed vouchers and store gift cards.
Personnel Systems Access/Transfer/Terminations
1. New staff needing access to CAREWare are required to submit the CAREWare
user request form through SHOARS.
2. As required by NIST SP 800-53 Details - PS-7e, the Grantee must notify MDHHS
designated personnel in writing of any personnel transfers or terminations of
personnel who possess information system privileges within CAREWare or
MIDAP online data systems within 24 hours of change.
a. The Grantee shall notify MDHHS immediately via email at MDHHS-
HIVSTIoperations@michigan.gov of CAREWare users who are separated
from the agency for deactivation.
Record Maintenance/Retention
1. The Grantee will maintain, for a minimum of five (5) years after the end of the
grant period, program, fiscal records, including documentation to support
program activities and expenditures, under the terms of this agreement, for
clients residing in the State of Michigan.
2. The Grantee will maintain client files and charts from last date of service plus
seven (7) years. For minors, Grantee will maintain client files and records from
last date of service and until minor reaches the age of 18, whichever is longer,
plus seven (7) years.
Software Compliance
1. The Grantee and its subcontractors are required to use the HRSA-supported
software CAREWare to enter client and service data into the centrally managed
database on a secure server. The Grantee must:
a. Enter all Ryan White services delivered to HIV-infected and affected clients.
b. Enter all data by the 10th of the following month.
c. Successfully create, run, and document the results of their HRSA RSR report
in CAREWare in order to receive relevant support from data managers by the
10th of the following month. Documentation is to include with identifying
information omitted:
• Missing records as depicted in the RSR Viewer module in CAREWare
• A list of alert, warning, and error messages as depicted in the RSR
Validation Report module in CAREWare
• Efforts or decisions (including collaboration with MDHHS) to resolve
missing data or error messages as applicable
d. Complete collection of all required data variables and the clean-up of any
missing data or service activities by the 10th of the following month.
2. The Grantee must establish written procedures for protecting client information
kept electronically or in charts or other paper records. Protection of electronic
client-level data will minimally include:
a. Regular back-up of client records with back-up files stored in a secure
location.
b. Use of passwords to prevent unauthorized access to the computer or Client
Level Data program.
c. Use of virus protection software to guard against computer viruses.
3. Provide annual training to staff on security and confidentiality of client level data
and sharing of electronic data files according to MDHHS policies concerning
sharing and Secured Electronic Data.
4. New staff needing access to CAREWare are required to submit the CAREWare
user request form through SHOARS.
5. As required by NIST SP 800-53 Details - PS-7e, the Grantee must notify MDHHS
designated personnel in writing of any personnel transfers or terminations of
personnel who possess information system privileges within CAREWare or
MIDAP online data systems within 24 hours of change.
a. The Grantee shall notify MDHHS immediately via email at MDHHS-
HIVSTIoperations@michigan.gov of CAREWare users who are separated
from the agency for deactivation.
6. The Grantee shall as be required by HRSA submit the Ryan White HIV/AIDS
Program Services Report (RSR) for the previous calendar year. The Grantee is
required to use the HRSA Electronic Handbook (EHB) portal for their submission:
a. The Grantee shall acquire access to their agency’s Grant Contract
Management System (GCMS) and their Provider Report prior to January
when notified by HRSA of the required federal report.
b. The Grantee is required to provide access to all staff and personnel
responsible for reviewing and completing the RSR.
c. The Grantee as per HRSA standards and compliance are mandated to
require relevant staff members to update their EHB account passwords as
dictated by HRSA email notifications.
d. The Grantee is mandated to update or add contact information for staff
responsible for completing and/or submitting the RSR and to notify MDHHS of
any changes in personnel immediately.
e. The Grantee shall correspond with MDHHS staff including data management
users to compare units of service provided to the funded services listed on
the EHB.
f. The Grantee shall notify MDHHS immediately if there are any discrepancies
between the funding sources and services listed for their agency’s report on
the Electronic Handbook (EHB) and their agency’s contracts and records.
g. The Grantee shall in these circumstances contact Ryan White Data Support
by email or by phone number (1-888-640-9356) between the hours of 10 am
– 6:30 pm Eastern Standard Time (EST) on weekdays regarding the HRSA
EHB GCMS and/or RSR:
• Issues with account lockouts, lost credentials, or account creation
• Issues with accessing the GCMS through the HRSA EHB
• Issues with accessing the Provider Report through the HRSA
• Technical issues regarding functionality of the EHB portal
h. The Grantee shall attend webinars and instructional sessions to answer
questions about the RSR; Grantee shall utilize tools provided by data
management users to check on the accuracy and completeness of their client
level data (CLD) on a monthly basis leading up to the RSR. These include but
are not limited to:
• TargetHIV/DISQ webinars regarding the RSR
• HRSA produced documentation and manuals on RSR reporting
requirements for the calendar year
• Manuals on utilizing CAREWare for completing the RSR
• PowerPoint presentations on aspects of the RSR
• Staff invitations to Teams meetings and breakout sessions to answer
questions regarding the RSR
• CAREWare custom reports and financial reports designed to assess:
1. The number of eligible clients
2. The number of eligible clients that need to be marked as
such
3. Services provided by the Grantee
4. CLD on ZIP codes, ethnicity, and other features
• Emails from MDHHS staff regarding the above but also including:
1. Updates on HRSA reporting requirements
2. New information provided from HRSA
3. Other resources HRSA is providing/will provide
b. The Grantee shall after notification from MDHHS staff including data
management users implement needed corrections and additions to CLD in
CAREWare to ensure compliance with HRSA federal reporting standards.
Mandatory Disclosures
1. The Grantee will provide immediate notification to the Department, in writing, in the
event of any of the following:
a. Any formal grievance initiated by a client and subsequent resolution of that
grievance.
b. Any event occurring or notice received by the Grantee or subcontractor, that
reasonably suggests that the Grantee or subcontractor may be the subject of,
or a defendant in, legal action. This includes, but is not limited to, events or
notices related to grievances by service recipients or Grantee or
subcontractor employees.
c. Any staff vacancies funded for this project that exceed 30 days. All notifications
should be made to DHSP by MDHHS-HIVSTIoperations@michigan.gov.
Technical Assistance
1. Technical assistance (TA) may be requested on the implementation of the Ryan
White program. This may include issues related to: CAREWare, Quality
Management, Ryan White B services, Budget/Fiscal, Grants and Contracts,
ADAP, or other activities related to carrying out Ryan White activities.
2. TA requests must be submitted via the MDHHS SHOARS system. In addition, if
your contract is to be amended, the request will have to be logged into
SHOARS. Registration instructions and further information can be found at:
https://bit.ly/3HS7xdG
3. Grantee must register an Authorized Official and Program Manager in the DHSP
SHOARS system. These roles must match what the agency has listed for these
roles in the EGrAMS system. If you have access related questions, contact
MDHHS-SHOARS-SUPPORT MDHHS-SHOARS-SUPPORT@michigan.gov.
ASSURANCES
Compliance with Applicable Laws
1. The Grantee should adhere to all Federal and Michigan laws pertaining to
HIV/AIDS treatment, disability accommodations, non-discrimination, and
confidentiality.
2. Ryan White is payer of last resort; as such, the Grantee must adhere to the
Public Health Service (PHS) Act.
3. The Grantee should have procedures to protect the confidentiality and security of
client information.
PROJECT TITLE: HIV PrEP Clinic
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The purpose of this project is to establish HIV Pre-Exposure Prophylaxis (PrEP)
services.
Reporting Requirements:
1. The Grantee will clean-up missing data by the 10th day after the end of each
calendar month. Grantee must report required variables as outlined by National
HIV Monitoring and Evaluation (NHM&E) and MDHHS.
2. Any such other information as specified in the Statement of Work, Attachment A
shall be developed and submitted by the Grantee as required by the Division of
HIV and STI Programs (DHSP).
3. The Quality Control and Daily Client Logs may be sent to the Contract Manager
via:
Email – Mary Roach (roachm@michigan.gov) and Safina Thomas
(thomass56@michigan.gov)
Fax - (517) 241-5922
Mailed - HIV Prevention Unit, Attn: CTR Coordinator, PO Box 30727,
Lansing, MI 48909
4. The Grantee shall permit the Department or its designee to visit and to make an
evaluation of the project as determined by DHSP.
Grantee Report Submission Schedule
Report Period Due Date(s) Report submission
Counseling, Testing, and referrals
Quality Control
Reports Monthly 10th of the following
month Department Staff
Daily Client Logs Monthly 10th of the following
month Department Staff
HIV Testing
Proficiencies Annually Reviewed during
site visits Department Staff
HIV Testing
Competencies Annually
Sent to MDHHS
before the end of
the fiscal year
Department Staff
Non-Reactive
Results As needed Within 7 days of test APHIRM
PrEP Cascade Data Monthly 10th of the following
month APHIRM
Reactive Results As needed Within 24 hours of
test APHIRM
Case Report Forms
As needed in
the event of a
reactive result
Adult Case Report
Form Directions
LMS
MDHHS Surveillance
Partner Services & Linkage to Care (as applicable)
Linkage to Care and
Partner Services
Interview***
As needed Within 30 days of
service APHIRM
Internet Partner
Services (IPS) and
Partner Services
Interview****
Ongoing Within 30 days of
service APHIRM
Disposition on
Partners of HIV
Cases
Ongoing Within 30 days of
service APHIRM
Evidence Based Risk Reduction Activities (as applicable)
SSP Data Report, Quarterly 10th of the following
month
Syringe Utilization
Platform (SUP)
Clinical HIV/STI services (as applicable)
340b PrEP
Prescription Log Weekly Every Friday by the
close of business
DCH File Transfer –
MDHHS-340B PrEP PT
ADT*****
Billing Revenue
Report Quarterly
10th of the following
month
Department Staff
STI 340B
Utilization/Inventory
Report,
Quarterly
Within 10 days after
the end of the
quarter
Log into
SGRX340BFlex.com
website, generate a
quarterly report on the
reporting tab, and it will be
transferred automatically
to ScriptGuide/DHSP
*CDC/MDHHS required activities including: Condom Distribution Data, if applicable;
Social Marketing data; Evidence based intervention data; other prevention services and
activities, if applicable
** Aggregated testing data
***(e.g. client attended a medical care appointment within 30 days of diagnosis, and was
interviewed by Partner Services within 30 days of diagnosis)
****(e.g. client identify dating apps used to meet partners), if applicable
*****https://milogintp.michigan.gov
Any additional Requirements:
Publication Rights
When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
fund, the Grantee receiving Federal funds, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state:
1. The percentage of the total costs of the program or project that will be financed
with Federal funds.
2. The dollar amount of Federal funds for the project or program.
3. Percentage and dollar amount of the total costs of the project or program that will
be financed by non-governmental sources.
4. The Grantee will submit all educational materials (e.g., brochures, posters,
pamphlets, and videos) used in conjunction with program activities to DHSP for
review and approval prior to their use, regardless of the source of funding used to
purchase these materials. Materials may be emailed to: MDHHS-
HIVSTIoperations@michigan.gov.
Grant Program Operation
1. The Grantee will participate in Division of HIV/STI Programs (DHSP) needs
assessment and planning activities, as requested.
2. The Grantee will participate in regular Grantee meetings which may be face-to-
face, teleconferences, webinars, etc. The Grantee is highly encouraged to
participate in other training offerings and information-sharing opportunities,
network detection response and interventions in collaboration with DHSP
opportunities provided by DHSP.
3. Each employee funded in whole or in part with federal funds must record time
and effort spent on the project(s) funded. The Grantee must:
a. Have policies and procedures to ensure time and effort reporting.
b. Assure the staff member clearly identifies the percentage of time devoted to
contract activities in accordance with the approved budget.
c. Denote accurately the percent of effort to the project. The percent of effort
may vary from month to month, and the effort recorded for funds must match
the percentage claimed on the FSR for the same period.
d. Submit a budget modification to DHSP in instances where the percentage of
effort of contract staff changes (FTE changes) during the contract period.
e. If there are any changes in staff or agency operations, please email MDHHS
Operations MDHHS-HIVSTIoperations@michigan.gov.
4. If conducting HIV testing using rapid HIV testing, the Grantee will comply with
guidelines and standards issued by DHSP and:
a. Provide medical oversight letter/agreement signed by a licensed physician is
necessary to collect specimens and order HIV antibody/antigen, HIV
genotype, HIV incidence, syphilis, gonorrhea, chlamydia, and hepatitis C
testing. According to Part 15 of the Public Health Code MCL 333.17001(j),
‘practice of medicine’ is defined as
• “the diagnosis, treatment, prevention, cure, or relieving of a human
disease, ailment, defect, complaint, or other physical or mental condition,
by attendance, advice, device, diagnostic test, or other means, or offering,
undertaking, attempting to do, or holding oneself out as able to do, any of
these act”.
b. Conduct quality assurance activities, guided by written protocol and
procedures. Protocols and procedures, as updated and revised Quality
assurance activities are to be responsive to: Quality Assurance for Rapid HIV
Testing, MDHHS. See “Applicable Laws, Rules, Regulations, Policies,
Procedures, and Manuals.”
• Ensure provision of Clinical Laboratory Improvement Amendments
(CLIA) certificate.
• Report discordant test results to DHSP
Email – Mary Roach roachm@michigan.gov and Safina Thomas
(thomass56@michigan.gov)
Fax - (517) 241-5922
• Ensure that staff performing counseling and/or testing with rapid test
technologies has completed, successfully, rapid test counselor
certification course or Information Based Training (as applicable), test
device training, and annual proficiency testing.
• If conducting blood draws, the grantee must conduct the packaging
and shipping training via Bureau of Laboratories.
BashoreM@michigan.gov
• Ensure that all staff and site supervisors have completed, successfully,
appropriate laboratory quality assurance training, blood borne
pathogens training and rapid test device training and reviewed
annually.
• Develop, implement, and monitor protocol and procedures to ensure
that patients receive confirmatory test results.
• To maintain active test counselor certification, each HIV test counselor
must submit one competency per year to the appropriate departmental
staff.
5. If conducting SSP, the grantee will develop programs using MDHHS guidance
documents and will address issues such as identification and registration of
clients, exchange protocols, education, and trainings for staff, and referrals.
a. Grantees will participate on monthly or quarterly conference calls to discuss
best practices and identify barriers.
6. If conducting PS, the Grantee will comply with guidelines and standards issued
by the Department. See “Applicable Laws, Rules, Regulations, Policies,
Procedures, and Manuals.” The Grantee must:
a. Provide Confidential PS follow-up to infected clients and their at-risk partners
to ensure disease management and education is offered to reduce
transmission.
b. Effectively link infected clients and/or at-risk partners to HIV care and other
support services.
c. Work with Early Intervention Specialist to ensure infected clients are retained
in HIV care.
d. If applicable,
• Procure TLO or a TLO-like search engine.
• Ensure staff that are utilizing TLO or TLO-search engine complete the
TLO training to maintain and understand the confidential use of the
system.
• Effectively utilize the Internet Partner Services (IPS) Guidance to provide
confidential PS follow-up to at-risk partners named by infected clients who
were identified to have been met through the use of dating apps.
• Ensure staff and site supervisors successfully complete the Internet
Partner Services Training.
• Ensure staff conducting Internet Partner Services participant in monthly,
bi-monthly meetings, webinars or calls to discuss best practices and
identify barriers.
7. If conducting 340 B STI/PrEP clinical activities, the Grantee will comply with
guidelines and standards issued by DHSP and:
8. Funds generated by this program must be utilized to support the program,
including to hire a Mid-level provider, supporting staff, and program materials to
provide Pre-Exposure Prophylaxis (PrEP) services.
9. Any funds included in this agreement above must be re-invested in HIV/STI PrEP
services. This could mean improving, enhancing, and/or expanding your current
HIV/STI services or adding new services to improve patient health outcomes for
HIV/STI.
10. Any revenue or income generated via billing from this agreement must be
reinvested into this project.
Record Maintenance/Retention
The Grantee will maintain, for a minimum of five (5) years after the end of the grant
period, program, fiscal records, including documentation to support program activities
and expenditures, under the terms of this agreement, for clients residing in the State of
Michigan.
Software Compliance
1. The Grantee and its subcontractors are required to use APHIRM (formerly
Evaluation Web) to enter HIV client and service data into the centrally managed
database on a secure server.
2. The Grantee and its subcontractors are required to use APHIRM to enter PrEP
Cascade Data into the centrally managed database on a secure server.
3. The Grantee and its subcontractors are required to use APHIRM to enter EBI
Data into the centrally managed database on a secure server.
4. The Grantee and its subcontractors are required to use APHIRM (formerly
Partner Services Web) to enter Partner Services interview, linkage to care data,
and identified dating apps through the use of Internet Partner Services (IPS)
where appropriate.
5. The Grantee and its subcontractors are required to use SHOARS to request
amendments, supplies, data, technical assistance and to register for trainings.
6. New staff needing access to APHIRM are required to submit the APHIRM user
request form through SHOARS.
7. The Grantee shall notify MDHHS immediately via email at MDHHS-
HIVSTIoperations@michigan.gov of APHIRM users who are separated from the
agency for deactivation.
Mandatory Disclosures
1. The Grantee will provide immediate notification to DHSP, in writing, including but
not limited to the following events:
2. Any formal grievance initiated by a client and subsequent resolution of that
grievance.
3. Any event occurring or notice received by the Grantee or subcontractor, that
reasonably suggests that the Grantee or subcontractor may be the subject of, or
a defendant in, legal action. This includes, but is not limited to, events or notices
related to grievances by service recipients or Grantee or subcontractor
employees.
4. Any staff vacancies funded for this project that exceed 30 days.
a. All notifications should be made to DHSP by MDHHS-
HIVSTIoperations@michigan.gov.
Technical Assistance
1. Technical assistance (TA) requests must be submitted via the MDHHS SHOARS
system. In addition, if your contract is to be amended, the request will have to be
logged into SHOARS. Registration instructions and further information can be
found at: https://bit.ly/3HS7xdG
2. Recipient agency must register an Authorized Official and Program Manager in
the DHSP SHOARS system. These roles must match what the agency has listed
for these roles in the EGrAMS system. If you have access related questions,
contact MDHHS-SHOARS-SUPPORT MDHHS-SHOARS-
SUPPORT@michigan.gov .
3. You may request TA on the implementation of the HIV Prevention program. This
may include issues related to: APHIRM, Intervention Database, Programs,
Budget/Fiscal, Grants and Contracts, Risk Reduction Activities, Training, or other
activities related to carrying out HIV prevention activities.
Compliance with Applicable Laws
The Grantee should adhere to all Federal and Michigan laws pertaining to HIV/AIDS
treatment, disability accommodations, non-discrimination, and confidentiality.
PROJECT TITLE: HIV Prevention
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The Purpose of this project is to implement a comprehensive HIV surveillance and
prevention program. Funding aim to Prevent new HIV infections, Improve HIV-related
health outcomes of people with HIV, Reduce HIV-related disparities and health
inequities, This funding supports coordinated efforts that address the HIV epidemic
including; implementation of integrated HIV/STI Services including referral and linkage
to appropriate services, social marketing campaigns, community mobilization efforts and
other evidence based risk reduction activities where feasible and appropriate and in
accordance with current CDC guidelines and recommendations
Reporting Requirements:
1. The Grantee will clean-up missing data by the 10th day after the end of each
calendar month. Grantee must report required variables as outlined by National
HIV Monitoring and Evaluation (NHM&E) and MDHHS.
2. Any such other information as specified in the Statement of Work, Attachment A
shall be developed and submitted by the Grantee as required by the Division of
HIV and STI Programs (DHSP).
3. The Quality Control and Daily Client Logs may be sent to the Contract Manager
via:
Email – Mary Roach (roachm@michigan.gov) and Safina Thomas
(thomass56@michigan.gov)
Fax - (517) 241-5922
Mailed - HIV Prevention Unit, Attn: CTR Coordinator, PO Box 30727,
Lansing, MI 48909
4. The Grantee shall permit the Department or its designee to visit and to make an
evaluation of the project as determined by DHSP.
Grantee Report Submission Schedule
Report Period Due Date(s) Report submission
Counseling, Testing, and referrals
Quality Control
Reports Monthly 10th of the following
month Department Staff
Daily Client Logs Monthly 10th of the following
month Department Staff
HIV Testing
Proficiencies Annually Reviewed during
site visits Department Staff
HIV Testing
Competencies Annually
Sent to MDHHS
before the end of
the fiscal year
Department Staff
Non-Reactive
Results As needed Within 7 days of test APHIRM
PrEP Cascade Data Monthly 10th of the following
month APHIRM
Reactive Results As needed Within 24 hours of
test APHIRM
Case Report Forms
As needed in
the event of a
reactive result
Adult Case Report
Form Directions
LMS
MDHHS Surveillance
Partner Services & Linkage to Care (as applicable)
Linkage to Care and
Partner Services
Interview***
As needed Within 30 days of
service APHIRM
Internet Partner
Services (IPS) and
Partner Services
Interview****
Ongoing Within 30 days of
service APHIRM
Disposition on
Partners of HIV
Cases
Ongoing Within 30 days of
service APHIRM
Evidence Based Risk Reduction Activities (as applicable)
SSP Data Report, Quarterly 10th of the following
month
Syringe Utilization
Platform (SUP)
Clinical HIV/STI services (as applicable)
340b PrEP
Prescription Log Weekly Every Friday by the
close of business
DCH File Transfer –
MDHHS-340B PrEP PT
ADT*****
Billing Revenue
Report Quarterly
10th of the following
month
Department Staff
STI 340B
Utilization/Inventory
Report,
Quarterly
Within 10 days after
the end of the
quarter
Log into
SGRX340BFlex.com
website, generate a
quarterly report on the
reporting tab, and it will be
transferred automatically
to ScriptGuide/DHSP
*CDC/MDHHS required activities including: Condom Distribution Data, if applicable;
Social Marketing data; Evidence based intervention data; other prevention services and
activities, if applicable
** Aggregated testing data
***(e.g. client attended a medical care appointment within 30 days of diagnosis, and was
interviewed by Partner Services within 30 days of diagnosis)
****(e.g. client identify dating apps used to meet partners), if applicable
*****https://milogintp.michigan.gov
Any additional Requirements:
Publication Rights
When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
fund, the Grantee receiving Federal funds, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state:
1. The percentage of the total costs of the program or project that will be financed
with Federal funds.
2. The dollar amount of Federal funds for the project or program.
3. Percentage and dollar amount of the total costs of the project or program that will
be financed by non-governmental sources.
4. The Grantee will submit all educational materials (e.g., brochures, posters,
pamphlets, and videos) used in conjunction with program activities to DHSP for
review and approval prior to their use, regardless of the source of funding used to
purchase these materials. Materials may be emailed to: MDHHS-
HIVSTIoperations@michigan.gov.
Grant Program Operation
1. The Grantee will participate in DHSP needs assessment and planning activities,
as requested.
2. The Grantee will participate in regular Grantee meetings which may be face-to-
face, teleconferences, webinars, etc. The Grantee is highly encouraged to
participate in other training offerings and information-sharing opportunities,
network detection response and interventions in collaboration with DHSP
opportunities provided by DHSP.
3. Each employee funded in whole or in part with federal funds must record time
and effort spent on the project(s) funded. The Grantee must:
a. Have policies and procedures to ensure time and effort reporting.
b. Assure the staff member clearly identifies the percentage of time devoted to
contract activities in accordance with the approved budget.
c. Denote accurately the percent of effort to the project. The percent of effort
may vary from month to month, and the effort recorded for funds must match
the percentage claimed on the FSR for the same period.
d. Submit a budget modification to DHSP in instances where the percentage of
effort of contract staff changes (FTE changes) during the contract period.
e. If there are any changes in staff or agency operations, please email MDHHS
Operations MDHHS-HIVSTIoperations@michigan.gov.
4. If conducting HIV testing using rapid HIV testing, the Grantee will comply with
guidelines and standards issued by DHSP and:
a. Provide medical oversight letter/agreement signed by a licensed physician is
necessary to collect specimens and order HIV antibody/antigen, HIV
genotype, HIV incidence, syphilis, gonorrhea, chlamydia, and hepatitis C
testing. According to Part 15 of the Public Health Code MCL 333.17001(j),
‘practice of medicine’ is defined as
i. “the diagnosis, treatment, prevention, cure, or relieving of a human
disease, ailment, defect, complaint, or other physical or mental condition,
by attendance, advice, device, diagnostic test, or other means, or offering,
undertaking, attempting to do, or holding oneself out as able to do, any of
these act”.
b. Conduct quality assurance activities, guided by written protocol and
procedures. Protocols and procedures, as updated and revised Quality
assurance activities are to be responsive to: Quality Assurance for Rapid HIV
Testing, MDHHS. See “Applicable Laws, Rules, Regulations, Policies,
Procedures, and Manuals.”
i. Ensure provision of Clinical Laboratory Improvement Amendments (CLIA)
certificate.
ii. Report discordant test results to DHSP
Email – Mary Roach roachm@michigan.gov and Safina Thomas
(thomass56@michigan.gov)
Fax - (517) 241-5922
iii. Ensure that staff performing counseling and/or testing with rapid test
technologies has completed, successfully, rapid test counselor certification
course or Information Based Training (as applicable), test device training,
and annual proficiency testing.
iv. If conducting blood draws, the grantee must conduct the packaging and
shipping training via Bureau of Laboratories. BashoreM@michigan.gov
v. Ensure that all staff and site supervisors have completed, successfully,
appropriate laboratory quality assurance training, blood borne pathogens
training and rapid test device training and reviewed annually.
vi. Develop, implement, and monitor protocol and procedures to ensure that
patients receive confirmatory test results.
vii. To maintain active test counselor certification, each HIV test counselor
must submit one competency per year to the appropriate departmental
staff.
5. If conducting SSP, the grantee will develop programs using MDHHS guidance
documents and will address issues such as identification and registration of
clients, exchange protocols, education, and trainings for staff, and referrals.
a. Grantees will participate on monthly or quarterly conference calls to discuss
best practices and identify barriers.
6. If conducting PS, the Grantee will comply with guidelines and standards issued
by the Department. See “Applicable Laws, Rules, Regulations, Policies,
Procedures, and Manuals.” The Grantee must:
a. Provide Confidential PS follow-up to infected clients and their at-risk partners
to ensure disease management and education is offered to reduce
transmission.
b. Effectively link infected clients and/or at-risk partners to HIV care and other
support services.
c. Work with Early Intervention Specialist to ensure infected clients are retained
in HIV care.
d. If applicable,
i. Procure TLO or a TLO-like search engine.
ii. Ensure staff that are utilizing TLO or TLO-search engine complete the
TLO training to maintain and understand the confidential use of the
system.
iii. Effectively utilize the Internet Partner Services (IPS) Guidance to provide
confidential PS follow-up to at-risk partners named by infected clients who
were identified to have been met through the use of dating apps.
iv. Ensure staff and site supervisors successfully complete the Internet
Partner Services Training.
v. Ensure staff conducting Internet Partner Services participant in monthly,
bi-monthly meetings, webinars or calls to discuss best practices and
identify barriers.
7. If conducting 340 B STI/PrEP clinical activities, the Grantee will comply with
guidelines and standards issued by DHSP and:
8. Funds generated by this program must be utilized to support the program,
including to hire a Mid-level provider, supporting staff, and program materials to
provide Pre-Exposure Prophylaxis (PrEP) services.
9. Any funds included in this agreement above must be re-invested in HIV/STI PrEP
services. This could mean improving, enhancing, and/or expanding your current
HIV/STI services or adding new services to improve patient health outcomes for
HIV/STI.
10. Any revenue or income generated via billing from this agreement must be
reinvested into this project.
Record Maintenance/Retention
The Grantee will maintain, for a minimum of five (5) years after the end of the grant
period, program, fiscal records, including documentation to support program activities
and expenditures, under the terms of this agreement, for clients residing in the State of
Michigan.
Software Compliance
1. The Grantee and its subcontractors are required to use APHIRM (formerly
Evaluation Web) to enter HIV client and service data into the centrally managed
database on a secure server.
2. The Grantee and its subcontractors are required to use APHIRM to enter PrEP
Cascade Data into the centrally managed database on a secure server.
3. The Grantee and its subcontractors are required to use APHIRM to enter EBI
Data into the centrally managed database on a secure server.
4. The Grantee and its subcontractors are required to use APHIRM (formerly
Partner Services Web) to enter Partner Services interview, linkage to care data,
and identified dating apps through the use of Internet Partner Services (IPS)
where appropriate.
5. The Grantee and its subcontractors are required to use SHOARS to request
amendments, supplies, data, technical assistance and to register for trainings.
6. New staff needing access to APHIRM are required to submit the APHIRM user
request form through SHOARS.
7. The Grantee shall notify MDHHS immediately via email at MDHHS-
HIVSTIoperations@michigan.gov of APHIRM users who are separated from the
agency for deactivation.
Mandatory Disclosures
1. The Grantee will provide immediate notification to DHSP, in writing, including but
not limited to the following events:
2. Any formal grievance initiated by a client and subsequent resolution of that
grievance.
3. Any event occurring or notice received by the Grantee or subcontractor, that
reasonably suggests that the Grantee or subcontractor may be the subject of, or
a defendant in, legal action. This includes, but is not limited to, events or notices
related to grievances by service recipients or Grantee or subcontractor
employees.
4. Any staff vacancies funded for this project that exceed 30 days.
a. All notifications should be made to DHSP by MDHHS-
HIVSTIoperations@michigan.gov.
Technical Assistance
1. Technical assistance (TA) requests must be submitted via the MDHHS SHOARS
system. In addition, if your contract is to be amended, the request will have to be
logged into SHOARS. Registration instructions and further information can be
found at: https://bit.ly/3HS7xdG
2. Recipient agency must register an Authorized Official and Program Manager in
the DHSP SHOARS system. These roles must match what the agency has listed
for these roles in the EGrAMS system. If you have access related questions,
contact MDHHS-SHOARS-SUPPORT MDHHS-SHOARS-
SUPPORT@michigan.gov .
3. Requests for technical assistance on the implementation of the HIV Prevention
program can be made. These requests may include issues related to: APHIRM,
Intervention Database, Programs, Budget/Fiscal, Grants and Contracts, Risk
Reduction Activities, Training, or other activities related to carrying out HIV
prevention activities.
Compliance with Applicable Laws
The Grantee should adhere to all Federal and Michigan laws pertaining to HIV/AIDS
treatment, disability accommodations, non-discrimination, and confidentiality.
PROJECT TITLE: HIV Ryan White Part B
HIV Ryan White Part B MAI
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The Ryan White HIV/AIDS Program provides a comprehensive system of HIV primary
medical care, essential support services, and medications for low-income people living
with HIV who are uninsured and underserved. The program provides funding to provide
care and treatment services to people living with HIV to improve health outcomes and
reduce HIV transmission among hard-to-reach populations.
Reporting Requirements:
1. The Grantee shall permit the Division of HIV/STI Programs (DHSP) or its designee
to conduct site visits and to formulate an evaluation of the project.
2. The Grantee and its subcontractors are required to use the HRSA-supported
software CW to enter client and service data into the centrally managed database
on a secure server. The Grantee must:
a. Enter all Ryan White services delivered to HIV-infected and affected clients.
b. Enter all data by the 10th of the following month.
c. Complete collection of all required data variables and the clean-up of any
missing data or service activities by the 10th of the following month.
3. To complete the Ryan White Services Report (RSR), a Health Resources and
Services Administration (HRSA) required annual data report, the Grantee must
assure that all CAREWare data is complete, cleaned, and entered into the HRSA
Electronic Handbook. RSR submission requirements include:
a. The RSR shall have no more than 5% missing data variables.
b. The Department validates the data within the Grantee’s RSR submission
before receipt by HRSA.
c. Data in CAREWare must be checked and validated every quarter.
Grantee Report Submission Schedule
Report Period Due Date(s) How to Submit
Report
All Agencies: Ryan White
services delivered to HIV-
infected and affected clients
Monthly 10th of the
following month
Enter into CAREWare
(CW)
All Agencies: Ryan White
Services Report (RSR)
Annual Generally,
Grantee
submission will
open in early
February and
close early March
Submission to HRSA
through Electronic
Handbook (EHB)
All Ryan White federally
funded agencies providing at
least one core medical
service: Quality Management
Plan
Annual December 31 Email report to
MDHHS-
HIVSTIoperations@mi
chigan.gov
All Ryan White federally
funded agencies: Complete
and submit at least one Plan-
Do-Study-Act worksheets to
document progress of QI project
10/1 – 9/30 As completed
over contract year
Email report to
MDHHS-
HIVSTIoperations@mi
chigan.gov
All Agencies: Complete
quarterly workplan progress
reports
Quarterly Thirty days after
the end of the
budget period
Submit in EGrAMS
Email report to
MDHHS-
HIVSTIoperations@mi
chigan.gov
All Ryan White federally
funded agencies: FY23 actual
expenditures by service
category, program income, and
administrative costs through the
RW Reporting Tool
Quarterly Thirty days after
the end of the
budget period
Attached to quarterly
FSR
All Ryan White federally
funded agencies: RW Form
2100 and RW Form 2300
Annually December 31 Uploaded to EGrAMS
Portal Agency Profile
• Reports and information shall be submitted to the Division of HIV/STI Programs
(DHSP). Please refer to the table for where to submit reports and information.
Any additional requirements:
Publication Rights
When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
money, the Grantee receiving Federal funds, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state:
1. The percentage of the total costs of the program or project that will be financed
with Federal money.
2. The dollar amount of Federal funds for the project or program.
3. Percentage and dollar amount of the total costs of the project or program that will
be financed by non-governmental sources.
Fees
The Grantee must establish and implement a process to ensure that they are maximizing
third party reimbursements, including:
a. Requirement, in agreement, that the Grantee maximize and monitor third party
reimbursements.
b. Requirement that Grantee document, in client record, how each client has been
screened for and enrolled in eligible programs.
c. Monitoring to determine that Ryan White is serving as the payer of last resort,
including review of client records and documentation of billing, collection policies
and procedures, and information on third party contracts.
d. Grantee must adhere to the National Monitoring Standards for Ryan White Part B
Grantees: Program and the National Monitoring Standards for Ryan White
Grantees: Fiscal; and bill for services that are billable in accordance with the
above.
e. Ensure appropriate billing, tracking, and reporting of program income to support
appropriate use for program activities.
f. Program income is added to funding provided by the State of Michigan for the
budget period and used to advance eligible program objectives.
g. Provide a report detailing the expenditure and reinvestment of program income in
the program (template will be provided by MDHHS).
Grant Program Operation
1. The Grantee will participate in the Department needs assessment and planning
activities, as requested.
2. The Grantee will participate in regular Grantee meetings which may be face-to-
face, teleconferences, webinars, trainings, etc. The Grantee is highly encouraged
to participate in other training offerings and information-sharing opportunities
provided by the Department.
3. The Grantee is responsible for ensuring that staff retain minimum educational
requirements for staff positions and are proficient in Ryan White-funded service
delivery in their respective roles within the organization. Ensure that Ryan White
funded staff receive MDHHS required case management training within one (1)
year of hire.
4. Each employee funded in whole or in part with federal funds must record time and
effort spent on the project(s) funded. The Grantee must:
a. Have policies and procedures to ensure time and effort reporting.
b. Assure the staff member clearly identifies the percentage of time devoted to
contract activities in accordance with the approved budget.
c. Denote accurately the percent of effort to the project. The percent of effort may
vary from month to month, and the effort recorded for Ryan White funds must
match the percentage claimed on the Ryan White FSR for the same period.
d. Submit a budget modification to the Department in instances where the
percentage of effort of contract staff changes (FTE changes) during the
contract period.
5. The Grantee must submit all details on advertising campaigns (print and social
media) completed via the quarterly workplan progress report submission in
EGrAMS.
6. The Grantee must include the following language in all Client Consent and
Release of Information forms used for services in this agreement:
“Consent for the collection and sharing of client information to
providers for persons living with HIV under the Ryan White Program
provided through (grantee name) is mandated to collect certain
personal information that is entered and saved in a federal data
system called CAREWare. CAREWare records are maintained in an
encrypted and secure statewide database. I understand that some
limited information in the electronic data may be shared with other
agencies if they also provide me with services and are part of the
same care and data network for the purpose of informing and
coordinating my treatment and benefits that I receive under this
Program. The CAREWare database program allows for certain
medical and support service information to be shared among
providers involved with my care, this includes but is not limited to
health information, medical visits, lab results, medications, case
management, transportation, Housing Opportunities for Persons with
AIDS (HOPWA) program, substance abuse, and mental health
counseling. I acknowledge that if I fail to show for scheduled medical
appointments, I may be contacted by an authorized representative of
(grantee name) in order to re-engage and link me back to care.”
7. The Grantee must notify the Continuum of Care Unit staff at MDHHS-
HIVSTIoperations@michigan.gov within 7 business days if a core medical or
support service category is added or removed from the Ryan White services
previously approved by DHSP. An approval from DHSP is required prior to the
change being implemented.
8. The Grantee must adhere to security measures when working with client
information and must:
a. Not email individual health information either internally or externally.
b. Keep all printed materials in locked storage cabinets in locked rooms.
c. Provide written documentation of annual Security and Confidentiality training
for all staff regarding the Health Insurance Portability Accountability Act
(HIPAA), the Health Information Technology for Economic and Clinical Health
(HITECH), and the Michigan Public Health Code.
d. Maintain the standards of CDC’s Data Security and Confidentiality Guidelines
for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis
Programs. CDC Website:
https://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelin
es.pdf.
9. The Grantee will complete the collection of all required data variables and clean-
up any missing data or service activities by the 10th day after the end of each
calendar month.
10. Subrecipient quality management program should:
a. Include: leadership support, dedicated staff time for QM activities, participation
of staff from various disciplines, ongoing review of performance measure data
and assessment of consumer satisfaction.
b. Include consumer engagement which includes, but is not limited to, agency-
level consumer advisory board, participation on quality management
committee, focus groups and consumer satisfaction surveys.
c. Include conduction of at least one quality improvement (QI) project throughout
the year, using the Plan-Do-Study-Act (PDSA) method to document progress.
This QI project must be aimed at improving client care, client satisfaction, or
health outcomes.
11. If the Grantee is federally funded for Ryan White services (one of which is a core
medical service), the Grantee will develop and/or revise a Quality Management
Plan (QMP) annually, to be kept on file at agency. QM Plans must contain these
eleven components:
• Quality statement
• Quality infrastructure
• Annual quality goals
• Capacity building
• Performance measurement
• Quality improvement
• Engagement of stakeholders
• Procedures for updating the QM plan
• Communication
• Evaluation
• Work Plan
12. The Grantee must consult and adhere to the Policy Clarification Notice (PCN)
#16-02 established by Health Resources and Services Administration (HRSA).
PCN #16-02 describes the core medical and support services that HRSA
considers allowable uses of Ryan White grant funds and the individuals eligible to
receive those services. A copy of the revised PCN 16-02 is available at this link.
HRSA Unallowable Costs:
*An expanded list of “unallowable” grant costs is available in the PCN 16-02.
a. HRSA RWHAP funds may not be used to make cash payments to intended clients
of HRSA RWHAP-funded services. This prohibition includes cash incentives and
cash intended as payment for HRSA RWHAP core medical and support services.
Where a direct provision of the service is not possible or effective, store gift cards,
vouchers, coupons, or tickets that can be exchanged for a specific service or
commodity (e.g., food or transportation) must be used.
b. Off-premises social or recreational activities (movies, vacations, gym
memberships, parties, retreats)
c. Medical Marijuana
d. Purchase or improve land or permanently improve buildings
e. Direct cash payments or cash reimbursements to clients
f. Clinical Trials: Funds may not be used to support the costs of operating clinical
trials of investigational agents or treatments (to include administrative
management or medical monitoring of patients)
g. Clothing: Purchase of clothing
h. Employment Services: Support employment, vocational rehabilitation, or
employment-readiness services.
i. Funerals: Funeral, burial, cremation, or related expenses
j. Household Appliances
k. Mortgages: Payment of private mortgages
l. Needle Exchange: Syringe exchange programs, Materials, designed to promote or
encourage, directly, intravenous drug use or sexual activity, whether homosexual
or heterosexual
m. International travel
n. The purchase or improvement of land
o. The purchase, construction, or permanent improvement of any building or other
facility
p. Pets: Pet food or products
q. Taxes: Paying local or state personal property taxes (for residential property,
private automobiles, or any other personal property against which taxes may be
levied)
r. Vehicle Maintenance: Direct maintenance expense (tires, repairs, etc.) of a
privately-owned vehicle or any additional costs associated with a privately-owned
vehicle, such as a lease, loan payments, insurance, license or registration fees
s. Water Filtration: Installation of permanent systems of filtration of all water entering
a private residence unless in communities where issues of water safety exist.
t. It is unallowable to divert program income (income generated from charges/ fees
and copays from Medicare, Medicaid, other third-party payers collected to cover
RW services provided) toward general agency costs or to use it for general
purposes.
u. Pre-Exposure Prophylaxis (PrEP) HIV/AIDS BUREAU POLICY 16-02
v. Non-occupational Post-Exposure Prophylaxis (nPEP).
w. General-use prepaid cards are considered “cash equivalent” and are therefore
unallowable. Such cards generally bear the logo of a payment network, such as
Visa, MasterCard, or American Express, and are accepted by any merchant that
accepts those credit or debit cards as payment. Gift cards that are cobranded with
the logo of a payment network and the logo of a merchant or affiliated group of
merchants are general-use prepaid cards, not store gift cards, and therefore are
unallowable.
* HRSA RWHAP recipients are advised to administer voucher and store gift card
programs in a manner which assures that vouchers and store gift cards cannot be
exchanged for cash or used for anything other than the allowable goods or services, and
that systems are in place to account for disbursed vouchers and store gift cards.
Personnel Systems Access/Transfer/Terminations
1. New staff needing access to CAREWare are required to submit the CAREWare
user request form through SHOARS.
2. As required by NIST SP 800-53 Details - PS-7e, the Grantee must notify MDHHS
designated personnel in writing of any personnel transfers or terminations of
personnel who possess information system privileges within CAREWare or MIDAP
online data systems within 24 hours of change.
a. The Grantee shall notify MDHHS immediately via email at MDHHS-
HIVSTIoperations@michigan.gov of CAREWare users who are separated from
the agency for deactivation.
Record Maintenance/Retention
1. The Grantee will maintain, for a minimum of five (5) years after the end of the
grant period, program, fiscal records, including documentation to support program
activities and expenditures, under the terms of this agreement, for clients residing
in the State of Michigan.
2. The Grantee will maintain client files and charts from last date of service plus
seven (7) years. For minors, Grantee will maintain client files and records from last
date of service and until minor reaches the age of 18, whichever is longer, plus
seven (7) years.
Software Compliance
1. The Grantee and its subcontractors are required to use the HRSA-supported
software CAREWare to enter client and service data into the centrally managed
database on a secure server. The Grantee must:
a. Enter all Ryan White services delivered to HIV-infected and affected clients.
b. Enter all data by the 10th of the following month.
c. Successfully create, run, and document the results of their HRSA RSR report
in CAREWare in order to receive relevant support from data managers by the
10th of the following month. Documentation is to include with identifying
information omitted:
• Missing records as depicted in the RSR Viewer module in CAREWare
• A list of alert, warning, and error messages as depicted in the RSR
Validation Report module in CAREWare
• Efforts or decisions (including collaboration with MDHHS) to resolve
missing data or error messages as applicable
d. Complete collection of all required data variables and the clean-up of any
missing data or service activities by the 10th of the following month.
2. The Grantee must establish written procedures for protecting client information
kept electronically or in charts or other paper records. Protection of electronic
client-level data will minimally include:
a. Regular back-up of client records with back-up files stored in a secure location.
b. Use of passwords to prevent unauthorized access to the computer or Client
Level Data program.
c. Use of virus protection software to guard against computer viruses.
3. Provide annual training to staff on security and confidentiality of client level data
and sharing of electronic data files according to MDHHS policies concerning
sharing and Secured Electronic Data.
4. New staff needing access to CAREWare are required to submit the CAREWare
user request form through SHOARS.
5. As required by NIST SP 800-53 Details - PS-7e, the Grantee must notify MDHHS
designated personnel in writing of any personnel transfers or terminations of
personnel who possess information system privileges within CAREWare or MIDAP
online data systems within 24 hours of change.
a. The Grantee shall notify MDHHS immediately via email at MDHHS-
HIVSTIoperations@michigan.gov of CAREWare users who are separated from
the agency for deactivation.
6. The Grantee shall as be required by HRSA submit the Ryan White HIV/AIDS
Program Services Report (RSR) for the previous calendar year. The Grantee is
required to use the HRSA Electronic Handbook (EHB) portal for their submission:
a. The Grantee shall acquire access to their agency’s Grant Contract
Management System (GCMS) and their Provider Report prior to January when
notified by HRSA of the required federal report.
b. The Grantee is required to provide access to all staff and personnel
responsible for reviewing and completing the RSR.
c. The Grantee as per HRSA standards and compliance are mandated to require
relevant staff members to update their EHB account passwords as dictated by
HRSA email notifications.
d. The Grantee is mandated to update or add contact information for staff
responsible for completing and/or submitting the RSR and to notify MDHHS of
any changes in personnel immediately.
e. The Grantee shall correspond with MDHHS staff including data management
users to compare units of service provided to the funded services listed on the
EHB.
f. The Grantee shall notify MDHHS immediately if there are any discrepancies
between the funding sources and services listed for their agency’s report on
the Electronic Handbook (EHB) and their agency’s contracts and records.
g. The Grantee shall in these circumstances contact Ryan White Data Support by
email or by phone number (1-888-640-9356) between the hours of 10 am –
6:30 pm Eastern Standard Time (EST) on weekdays regarding the HRSA EHB
GCMS and/or RSR:
• Issues with account lockouts, lost credentials, or account creation
• Issues with accessing the GCMS through the HRSA EHB
• Issues with accessing the Provider Report through the HRSA
• Technical issues regarding functionality of the EHB portal
h. The Grantee shall attend webinars and instructional sessions to answer
questions about the RSR; Grantee shall utilize tools provided by data
management users to check on the accuracy and completeness of their client
level data (CLD) on a monthly basis leading up to the RSR. These include but
are not limited to:
• TargetHIV/DISQ webinars regarding the RSR
• HRSA produced documentation and manuals on RSR reporting
requirements for the calendar year
• Manuals on utilizing CAREWare for completing the RSR
• PowerPoint presentations on aspects of the RSR
• Staff invitations to Teams meetings and breakout sessions to answer
questions regarding the RSR
• CAREWare custom reports and financial reports designed to assess:
1. The number of eligible clients
2. The number of eligible clients that need to be marked as such
3. Services provided by the Grantee
4. CLD on ZIP codes, ethnicity, and other features
• Emails from MDHHS staff regarding the above but also including:
1. Updates on HRSA reporting requirements
2. New information provided from HRSA
3. Other resources HRSA is providing/will provide
i. The Grantee shall after notification from MDHHS staff including data
management users implement needed corrections and additions to CLD in
CAREWare to ensure compliance with HRSA federal reporting standards.
Mandatory Disclosures
1. The Grantee will provide immediate notification to the Department, in writing, in the
event of any of the following:
a. Any formal grievance initiated by a client and subsequent resolution of that
grievance.
b. Any event occurring or notice received by the Grantee or subcontractor, that
reasonably suggests that the Grantee or subcontractor may be the subject of,
or a defendant in, legal action. This includes, but is not limited to, events or
notices related to grievances by service recipients or Grantee or subcontractor
employees.
c. Any staff vacancies funded for this project that exceed 30 days. All notifications
should be made to DHSP by MDHHS-HIVSTIoperations@michigan.gov.
Technical Assistance
1. Technical assistance (TA) can be requested on the implementation of the Ryan
White program. This may include issues related to: CAREWare, Quality
Management, Ryan White B services, Budget/Fiscal, Grants and Contracts,
ADAP, or other activities related to carrying out Ryan White activities.
2. Technical assistance (TA) requests must be submitted via the MDHHS SHOARS
system. In addition, if your contract is to be amended, the request will have to be
logged into SHOARS. Registration instructions and further information can be
found at: https://bit.ly/3HS7xdG
3. Grantee must register an Authorized Official and Program Manager in the DHSP
SHOARS system. These roles must match what the agency has listed for these
roles in the EGrAMS system. If you have access related questions, contact
MDHHS-SHOARS-SUPPORT MDHHS-SHOARS-SUPPORT@michigan.gov.
ASSURANCES
Compliance with Applicable Laws
1. The Grantee should adhere to all Federal and Michigan laws pertaining to
HIV/AIDS treatment, disability accommodations, non-discrimination, and
confidentiality.
2. Ryan White is payer of last resort; as such, the Grantee must adhere to the Public
Health Service (PHS) Act.
3. The Grantee should have procedures to protect the confidentiality and security of
client information.
PROJECT TITLE: HIV STI Partner Services Program
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
Grantee will provide STI and HIV partner services (PS) for select low morbidity health
departments within the State of Michigan in accordance with program standards and
Department oversight.
Reporting Requirements (if different than agreement language):
The Grantee shall submit the following reports on the following dates:
Report Period Due Date(s) How to Submit Report
HIV testing
notification/services to
delivered to individuals
Monthly 10th of the following
month Enter in Aphirm
Partner Services delivered
to individuals
Within 72
hours
10th of the following
month Enter in Aphirm
Syphilis Partner Counseling
and Referral
Within 72
hours Within 72 hours MDSS
• The Grantee shall permit the Department or its designee to visit and to make an
evaluation of the project as determined by the Contract Manager.
Any additional requirements (if applicable):
Publication Rights
When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
money, the Grantee receiving Federal funds, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state:
1. The percentage of the total costs of the program or project that will be financed
with Federal money.
2. The dollar amount of Federal funds for the project or program.
3. Percentage and dollar amount of the total costs of the project or program that will
be financed by non-governmental sources.
4. The Grantee will submit all educational materials (e.g., brochures, posters,
pamphlets, and videos) used in conjunction with program activities to the
Department for review and approval prior to their use, regardless of the source of
funding used to purchase these materials. These materials should be emailed to
MDHHS-HIVSTIOperations@michigan.gov.
Grant Program Operation
1. Pursuant to a protocol established by the Department, the Grantee will provide
positive test notification, HIV/STD and syphilis partner counseling and referral
services, victim notification and recalcitrant investigation for the following local
health departments: Bay County Health Department, Benzie-Leelanau District
Health Department, Central Michigan District Health Department, Chippewa
County Health Department, Dickinson-Iron District Health Department, District
Health Department # 2, District Health Department # 4, District Health Department
#10, Grand Traverse County Health Department, Luce-Mackinac-Alger-
Schoolcraft District Health Department, Marquette County Health Department,
Mid- Michigan District Health Department, Midland County Health Department,
Northwest Michigan Community Health Agency, Public Health, Delta and
Menominee Counties, and Western Upper Peninsula District Health Department.
2. The Grantee will establish, maintain and document (e.g., via MOU or MOA)
linkages with community resources that are necessary and appropriate to
addressing the needs of clients and that are essential to the success and
effectiveness of services supported under this agreement.
3. The Grantee will provide these services fifty-two weeks a year.
4. The Grantee will participate in the Department needs assessment and planning
activities, as requested.
5. The Grantee will participate in regular Grantee meetings which may be face-to-
face, teleconferences, webinars, etc. The Grantee is highly encouraged to
participate in other training offerings and information-sharing opportunities
provided by the Department.
6. Each employee funded in whole or in part with federal funds must record time and
effort spent on the project(s) funded. The Grantee must:
a. Have policies and procedures to ensure time and effort reporting.
b. Assure the staff member clearly identifies the percentage of time devoted to
contract activities in accordance with the approved budget.
c. Denote accurately the percent of effort to the project. The percent of effort may
vary from month to month, and the effort recorded for Ryan White funds must
match the percentage claimed on the Ryan White FSR for the same period.
d. Submit a budget modification to the Department in instances where the
percentage of effort of contract staff changes (FTE changes) during the
contract period.
7. The Grantee will complete the collection of all required data variables and clean-
up any missing data or service activities by the 10th day after the end of each
calendar month.
Record Maintenance/Retention
1. The Grantee will maintain, for a minimum of five (5) years after the end of the
grant period, program, fiscal records, including documentation to support program
activities and expenditures, under the terms of this agreement, for clients residing
in the State of Michigan.
2. The Grantee will maintain client records of HIV Positive or Negative with Syphilis
diagnosis. MDHHS recommends that this information be retained indefinitely or
until it is determined the client is deceased.
Software Compliance
1. The Grantee will adhere to reporting deadlines for all contractual Grantee
Reporting requirements.
2. The Grantee is required to use the following data systems to enter HIV and
Syphilis case investigation data: Aphirm and Michigan Disease Surveillance
System (MDSS)
a. All reactive results must be entered into Aphirm within 48 hours
b. All non-reactive results must be entered into Aphirm within seven days
c. All APhirm must be entered and missing variables entered by the 10th day
after the end of each calendar month.
3. The Grantee must establish written procedures for protecting client information
kept electronically or in charts or other paper records. Protection of electronic
client-level data will minimally include:
a. Regular back-up of client records with back-up files stored in a secure location.
b. Use of passwords to prevent unauthorized access to the computer or Client
Level Data program.
c. Use of virus protection software to guard against computer viruses.
d. Provide annual training to staff on security and confidentiality of client level
data and sharing of electronic data files according to MDHHS policies
concerning Sharing and Secured Electronic Data.
Mandatory Disclosures
1. The Grantee will provide immediate notification to the Department, in writing, in the
event of any of the following:
a. Any formal grievance initiated by a client and subsequent resolution of that
grievance.
b. Any event occurring or notice received by the Grantee or subcontractor, that
reasonably suggests that the Grantee or subcontractor may be the subject of,
or a defendant in, legal action. This includes, but is not limited to, events or
notices related to grievances by service recipients or Grantee or subcontractor
employees.
c. Any staff vacancies funded for this project that exceed 30 days.
d. This information may be emailed to:
MDHHS-HIVSTIOperations@michigan.gov
ASSURANCES
Compliance with Applicable Laws
The Grantee should adhere to all Federal and Michigan laws pertaining to HIV/AIDS
treatment, disability accommodations, non-discrimination, and confidentiality.
PROJECT TITLE: HIV/STI Testing and Prevention
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The City of Detroit bares a disproportionate burden of reported sexually transmitted
infection, including HIV. As a complement to public health clinical services, the Detroit
Health Department provides community level education and awareness building, along
with targeted screening activities to ensure additional access to service for early case
detection and linkage to care.
Reporting Requirements:
1. The Grantee will clean-up missing data by the 10th day after the end of each
calendar month. Grantee must report required variables as outlined by National
HIV Monitoring and Evaluation (NHM&E) and MDHHS.
2. Any such other information as specified in the Statement of Work, Attachment A
shall be developed and submitted by the Grantee as required by the Division of
HIV and STI Programs (DHSP).
3. The Quality Control and Daily Client Logs may be sent to the Contract Manager
via:
• Email – Mary Roach (roachm@michigan.gov) and Safina Thomas
(thomass56@michigan.gov)
Fax - (517) 241-5922
Mailed - HIV Prevention Unit,
Attn: CTR Coordinator
PO Box 30727, Lansing, MI 48909
4. The Grantee shall permit the Department or its designee to visit and to make an
evaluation of the project as determined by DHSP.
Grantee Report Submission Schedule
Report Period Due Date(s) Report submission
Counseling, Testing, and referrals
Quality Control
Reports Monthly 10th of the following
month Department Staff
Daily Client Logs Monthly 10th of the following
month Department Staff
HIV Testing
Proficiencies Annually Reviewed during site
visits Department Staff
HIV Testing
Competencies Annually
Sent to MDHHS
before the end of the
fiscal year
Department Staff
Non-Reactive Results As needed Within 7 days of test APHIRM
PrEP Cascade Data Monthly 10th of the following
month APHIRM
Reactive Results As needed Within 24 hours of
test APHIRM
Case Report Forms
As needed in
the event of a
reactive result
Adult Case Report
Form Directions
LMS
MDHHS Surveillance
Partner Services & Linkage to Care (as applicable)
Linkage to Care and
Partner Services
Interview***
As needed Within 30 days of
service APHIRM
Internet Partner
Services (IPS) and
Partner Services
Interview****
Ongoing Within 30 days of
service APHIRM
Disposition on
Partners of HIV
Cases
Ongoing Within 30 days of
service APHIRM
Evidence Based Risk Reduction Activities (as applicable)
SSP Data Report, Quarterly 10th of the following
month
Syringe Utilization Platform
(SUP)
Clinical HIV/STI services (as applicable)
340b PrEP
Prescription Log Weekly Every Friday by the
close of business
DCH File Transfer –
MDHHS-340B PrEP PT
ADT*****
Billing Revenue
Report Quarterly
10th of the following
month
Department Staff
STI 340B
Utilization/Inventory
Report,
Quarterly
Within 10 days after
the end of the
quarter
Log into
SGRX340BFlex.com
website, generate a
quarterly report on the
reporting tab, and it will be
transferred automatically to
ScriptGuide/DHSP
*CDC/MDHHS required activities including: Condom Distribution Data, if applicable; Social
Marketing data; Evidence based intervention data; other prevention services and activities,
if applicable
** Aggregated testing data
***(e.g. client attended a medical care appointment within 30 days of diagnosis, and was
interviewed by Partner Services within 30 days of diagnosis)
****(e.g. client identify dating apps used to meet partners), if applicable
*****https://milogintp.michigan.gov
Any additional Requirements:
Publication Rights
When issuing statements, press releases, requests for proposals, bid solicitations and
other documents describing projects or programs funded in whole or in part with Federal
fund, the Grantee receiving Federal funds, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state:
1. The percentage of the total costs of the program or project that will be financed
with Federal funds.
2. The dollar amount of Federal funds for the project or program.
3. Percentage and dollar amount of the total costs of the project or program that will
be financed by non-governmental sources.
4. The Grantee will submit all educational materials (e.g., brochures, posters,
pamphlets, and videos) used in conjunction with program activities to DHSP for
review and approval prior to their use, regardless of the source of funding used to
purchase these materials. Materials may be emailed to: MDHHS-
HIVSTIoperations@michigan.gov.
Grant Program Operation
1. The Grantee will participate in DHSP needs assessment and planning activities,
as requested.
2. The Grantee will participate in regular Grantee meetings which may be face-to-
face, teleconferences, webinars, etc. The Grantee is highly encouraged to
participate in other training offerings and information-sharing opportunities,
network detection response and interventions in collaboration with DHSP
opportunities provided by DHSP.
3. Each employee funded in whole or in part with federal funds must record time
and effort spent on the project(s) funded. The Grantee must:
a. Have policies and procedures to ensure time and effort reporting.
b. Assure the staff member clearly identifies the percentage of time devoted to
contract activities in accordance with the approved budget.
c. Denote accurately the percent of effort to the project. The percent of effort
may vary from month to month, and the effort recorded for funds must match
the percentage claimed on the FSR for the same period.
d. Submit a budget modification to DHSP in instances where the percentage of
effort of contract staff changes (FTE changes) during the contract period.
e. If there are any changes in staff or agency operations, please email MDHHS
Operations MDHHS-HIVSTIoperations@michigan.gov.
4. If conducting HIV testing using rapid HIV testing, the Grantee will comply with
guidelines and standards issued by DHSP and:
a. Provide medical oversight letter/agreement signed by a licensed physician is
necessary to collect specimens and order HIV antibody/antigen, HIV
genotype, HIV incidence, syphilis, gonorrhea, chlamydia, and hepatitis C
testing. According to Part 15 of the Public Health Code MCL 333.17001(j),
‘practice of medicine’ is defined as
• “the diagnosis, treatment, prevention, cure, or relieving of a human
disease, ailment, defect, complaint, or other physical or mental
condition, by attendance, advice, device, diagnostic test, or other
means, or offering, undertaking, attempting to do, or holding oneself
out as able to do, any of these act”.
b. Conduct quality assurance activities, guided by written protocol and
procedures. Protocols and procedures, as updated and revised Quality
assurance activities are to be responsive to: Quality Assurance for Rapid HIV
Testing, MDHHS. See “Applicable Laws, Rules, Regulations, Policies,
Procedures, and Manuals.”
• Ensure provision of Clinical Laboratory Improvement Amendments
(CLIA) certificate.
• Report discordant test results to DHSP
Email – Mary Roach roachm@michigan.gov and Safina Thomas
(thomass56@michigan.gov)
Fax - (517) 241-5922
• Ensure that staff performing counseling and/or testing with rapid test
technologies has completed, successfully, rapid test counselor
certification course or Information Based Training (as applicable), test
device training, and annual proficiency testing.
• If conducting blood draws, the grantee must conduct the packaging
and shipping training via Bureau of Laboratories.
BashoreM@michigan.gov
• Ensure that all staff and site supervisors have completed, successfully,
appropriate laboratory quality assurance training, blood borne
pathogens training and rapid test device training and reviewed
annually.
• Develop, implement, and monitor protocol and procedures to ensure
that patients receive confirmatory test results.
• To maintain active test counselor certification, each HIV test counselor
must submit one competency per year to the appropriate departmental
staff.
5. If conducting SSP, the grantee will develop programs using MDHHS guidance
documents and will address issues such as identification and registration of
clients, exchange protocols, education, and trainings for staff, and referrals.
a. Grantees will participate on monthly or quarterly conference calls to discuss
best practices and identify barriers.
6. If conducting PS, the Grantee will comply with guidelines and standards issued
by the Department. See “Applicable Laws, Rules, Regulations, Policies,
Procedures, and Manuals.” The Grantee must:
a. Provide Confidential PS follow-up to infected clients and their at-risk partners
to ensure disease management and education is offered to reduce
transmission.
b. Effectively link infected clients and/or at-risk partners to HIV care and other
support services.
c. Work with Early Intervention Specialist to ensure infected clients are retained
in HIV care.
d. If applicable,
• Procure TLO or a TLO-like search engine.
• Ensure staff that are utilizing TLO or TLO-search engine complete the
TLO training to maintain and understand the confidential use of the
system.
• Effectively utilize the Internet Partner Services (IPS) Guidance to provide
confidential PS follow-up to at-risk partners named by infected clients who
were identified to have been met through the use of dating apps.
• Ensure staff and site supervisors successfully complete the Internet
Partner Services Training.
• Ensure staff conducting Internet Partner Services participant in monthly,
bi-monthly meetings, webinars or calls to discuss best practices and
identify barriers.
7. If conducting 340 B STI/PrEP clinical activities, the Grantee will comply with
guidelines and standards issued by DHSP and:
8. Funds generated by this program must be utilized to support the program,
including to hire a Mid-level provider, supporting staff, and program materials to
provide Pre-Exposure Prophylaxis (PrEP) services.
9. Any funds included in this agreement above must be re-invested in HIV/STI PrEP
services. This could mean improving, enhancing, and/or expanding your current
HIV/STI services or adding new services to improve patient health outcomes for
HIV/STI.
10. Any revenue or income generated via billing from this agreement must be
reinvested into this project.
Record Maintenance/Retention
The Grantee will maintain, for a minimum of five (5) years after the end of the grant
period, program, fiscal records, including documentation to support program activities
and expenditures, under the terms of this agreement, for clients residing in the State of
Michigan.
Software Compliance
1. The Grantee and its subcontractors are required to use APHIRM (formerly
Evaluation Web) to enter HIV client and service data into the centrally managed
database on a secure server.
2. The Grantee and its subcontractors are required to use APHIRM to enter PrEP
Cascade Data into the centrally managed database on a secure server.
3. The Grantee and its subcontractors are required to use APHIRM to enter EBI
Data into the centrally managed database on a secure server.
4. The Grantee and its subcontractors are required to use APHIRM (formerly
Partner Services Web) to enter Partner Services interview, linkage to care data,
and identified dating apps through the use of Internet Partner Services (IPS)
where appropriate.
5. The Grantee and its subcontractors are required to use SHOARS to request
amendments, supplies, data, technical assistance and to register for trainings.
6. New staff needing access to APHIRM are required to submit the APHIRM user
request form through SHOARS.
7. The Grantee shall notify MDHHS immediately via email at MDHHS-
HIVSTIoperations@michigan.gov of APHIRM users who are separated from the
agency for deactivation.
Mandatory Disclosures
1. The Grantee will provide immediate notification to DHSP, in writing, including but
not limited to the following events:
2. Any formal grievance initiated by a client and subsequent resolution of that
grievance.
3. Any event occurring or notice received by the Grantee or subcontractor, that
reasonably suggests that the Grantee or subcontractor may be the subject of, or
a defendant in, legal action. This includes, but is not limited to, events or notices
related to grievances by service recipients or Grantee or subcontractor
employees.
4. Any staff vacancies funded for this project that exceed 30 days.
a. All notifications should be made to DHSP by MDHHS-
HIVSTIoperations@michigan.gov.
Technical Assistance
1. Technical assistance (TA) requests must be submitted via the MDHHS SHOARS
system. In addition, if your contract is to be amended, the request will have to be
logged into SHOARS. Registration instructions and further information can be
found at: https://bit.ly/3HS7xdG
2. Recipient agency must register an Authorized Official and Program Manager in
the DHSP SHOARS system. These roles must match what the agency has listed
for these roles in the EGrAMS system. If you have access related questions,
contact MDHHS-SHOARS-SUPPORT MDHHS-SHOARS-
SUPPORT@michigan.gov .
3. You may request for TA on the implementation of the HIV Prevention program.
This may include issues related to: APHIRM, Intervention Database, Programs,
Budget/Fiscal, Grants and Contracts, Risk Reduction Activities, Training, or other
activities related to carrying out HIV prevention activities.
Compliance with Applicable Laws
1. The Grantee should adhere to all Federal and Michigan laws pertaining to
HIV/AIDS treatment, disability accommodations, non-discrimination, and
confidentiality.
PROJECT: Immunization Action Plan
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
Offer immunization services to the public.
• Collaborate with public and private sector organizations to promote childhood,
adolescent and adult immunization activities in the county including but not limited
to recall activities.
• Educate providers about vaccines covered by Medicare and
Medicaid.
• Provide and implement strategies for addressing the immunization rates of
special populations (i.e., college students, educators, health care workers, long
term care centers, detention centers, homeless, tribal and migrant and childcare
employees).
• Develop mechanisms to improve jurisdictional and LHD immunization rates for
children, adolescents and adults.
• Ensure clinic hours are convenient and accessible to the community, operating
both walk-in and scheduled appointment hours.
• Coordinate immunization services, including WIC, Family Planning, and STD,
developing plans or memorandums of understanding.
• Collaboratively work with regional MCIR staff to ensure providers are using
MCIR appropriately.
• Develop strategies to identify and target local pocket of need
areas.
Reporting Requirements (if different than contract language)
1. IAP Reports are submitted electronically in accordance with due dates set by the
Department.
2. IAP Plan will be submitted electronically using a template provided by the
Department, in accordance with due dates set by the Department.
3. Utilize VAERS to report all adverse vaccine reactions
4. Ensure that all reportable diseases are reported to the Department in the time
specified in the public health code and appropriate case investigation is
completed.
5. By April 1, of each year provide one copy of the VFC provider with an online re-
enrollment form which includes a profile for each provider who receives vaccine
from the state. These documents must be submitted electronically in MCIR no
later than April 1.
Any additional requirements (if applicable)
1. Adhere to federal and state appropriation laws pertaining to use of programmatic
funds. See Immunization Allowable Expenditures in Attachment I for appropriate
use of Federal Funds.
2. Adhere to requirements set forth in the Omnibus Budget Reconciliation Act of
1993, section 1928 Part IV – Immunizations and the most current CDC Vaccines
for Children Operations Manual, Michigan Resource Book for VFC Providers, and
documents that are updated throughout the year pertaining to the Vaccines for
Children (VFC) Program.
3. Ensure that federally procured vaccine is administered to eligible children only
and is properly documented per VFC guidelines.
• The VFC Program provides VFC vaccine to only eligible children who meet
the following criteria: are Medicaid eligible, have no health insurance, are
American Indian or Alaskan Native, are served at a Federally Qualified
Health Center (FQHC), a Rural Health Center (RHC) or a public health
clinic affiliated with a FQHC and are also under-insured.
• Ensure state-supplied vaccines provided in the jurisdiction are
administered only to eligible clients as determined by the state. This
program allows for the immunization of select populations who are
underinsured and not served at a FQHC, RHC, or a public health
immunization clinic affiliated with a FQHC as defined by current state
program requirements.
• Ensure that all providers receiving vaccine from the state screen children
for VFC eligibility for children
4. Fraud or abuse of federally procured vaccine must be monitored and reported.
5. Adhere to all Federal and Michigan Laws pertaining to immunization administration
and reporting including reporting to the MCIR, VAERS and schools and daycare
reporting
6. Coordinate the submission of immunization data from schools and childcare
centers in your jurisdiction and follow-up with programs providing incomplete or
inaccurate data. Assure compliance levels are adequate to protect the public.
7. Provide education to the parents of children seeking a non-medical exemption in
your jurisdiction.
8. Monitor any provider receiving federally procured vaccine including but not limited to
VFC/QI site visit.
9. Ensure on-site attendance of at least 1 LHD immunization program staff to two (2)
Immunization Action Plan (IAP) meetings each year.
10. Implements Perinatal Hepatitis B program activities to prevent the spread of
Hepatitis B Virus (HBV) from mother to newborn.
• Verify pregnancy status on all hepatitis B surface antigen (HBsAg) positive
pregnant women of childbearing years (10-60 years of age.)
• Ensure HBsAg positive pregnant women are reported to the Perinatal
Hepatitis B case manager and according to the Public Health Code.
• Coordinate Perinatal Hepatitis B case management activities between
local health department, provider, and Perinatal Hepatitis B Case Manager
to:
11. Ensure that all infants, born to women who are HBsAg positive receive hepatitis B
vaccine and hepatitis B immune globulin (HBIG) within 12 hours of life, a complete
hepatitis B vaccine series with post vaccination serology testing and program
support services.
12. Ensure that all susceptible household and sexual contacts associated with HBsAg
positive women receive appropriate testing, vaccination, and support services.
13. Ensure birthing hospitals are able to offer hepatitis B vaccine to all newborns
prior to hospital discharge by enrolling them in the Universal Hepatitis B Vaccination
Program for Newborns.
14. Surveillance of vaccine preventable disease (VPD) activities
• Conduct active surveillance when indicated (i.e. during an outbreak) and
contact hospitals, laboratories, and/or other providers on a regular basis.
PROJECT: Immunization Action Plan- Pilot
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
Project to increase immunization rates within the jurisdiction with a focus on influenza
vaccination.
• Staffing to work with schools on implementing school-located vaccination clinics.
• Staff school-located vaccination clinics and provide vaccines to eligible students.
• Distribute report cards to providers within the jurisdiction and research methods
to increase immunization rates within the practice.
• Work with MDHHS staff to coordinate immunization services to schools.
Reporting Requirements (if different than contract language)
1. On a quarterly basis provide:
a. Number of clinics conducted and number of students vaccinated at school
located clinics.
b. The number of interventions initiated with provider offices to improve
immunization rates.
c. Number of influenza vaccines provided.
d. Number of non-influenza vaccines provided.
e. Number of educational materials created or updated.
f. Information on any other immunization outreach efforts conducted using
this funding.
2. At the end of Quarter 3 provide:
a. Total number of Kindergarten Roundups conducted.
b. Number of Kindergarten Roundups that offered vaccination opportunities.
Reports and information should be emailed to:
Kristina Paliwoda, Operations Section Manager
PaliwodaK@michigan.gov
Any additional requirements (if applicable)
PROJECT: Immunization Field Service Representative
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The Immunization Field Service Representative serves as a liaison, resource person
and as a regional expert for local health jurisdictions regarding all the Department
immunization programs and initiatives.
Reporting Requirements (if different than contract language)
Any additional requirements (if applicable)
PROGRAM SUPPORT:
• Assist with the regional MCIR activities and act as a regional resource on MCIR
processes and assessment protocols.
• Assist with the local implementation and monitoring of all state programs at the
regional level- including IAP implementation, VFC, IQIP, Accreditation, Perinatal
Hepatitis B, School / Childcare reporting, special projects and the INE program.
• Participate in planning for regional conferences, IAP Coordinator meetings, and
other Department programs and initiatives as needed.
• Assist state, regional and local epidemiologists and communicable disease staff
as needed with VPD surveillance and outbreak control.
PROGRAM QUALITY ASSURANCE:
• Assist in the orientation of new IAP Coordinators.
• Work with local health departments to assess and increase immunization levels
for all age groups, especially identifying and targeting pockets of need.
• Identify evidence-based strategies that support improved coverage levels in the
region, including use of recall, support for the IQIP program, coordination of LHD
services, and provider and LHD staff education.
• Consult with the local health department on the immunization component of the
accreditation process, including preparation for reviews and conducting a walk
through or mock accreditation review.
• Consult with local coalitions and private stakeholders to promote immunizations
and ensure consistent messages are relayed to the public.
• Consult with local health departments on the school and day care assessment
process.
• Encourage or provide educational updates and interventions on all immunization
issues with staff at local health departments, healthcare providers, school and
childcare staff and other stakeholders, may also include INE presentation if
applicable.
PROGRAM COMPLIANCE:
Monitor compliance with policies/legislation at national/state and local levels such as:
a. VFC program requirements and vaccine distribution and storage.
b. VAERS program
c. Public Health Code
d. Administrative Rules
e. School and childcare legislation and reporting requirements
f. MCIR legislation and rules
g. Communicable Disease Rules
PROGRAM OVERSIGHT and PROGRAM REVIEW:
• Perform oversight of the following programs with assigned local health
departments.
• Accreditation-Conduct reviews and monitor corrective actions.
• VFC including orientation and observation of LHD staff to annual VFC site visit
process, monitoring of VFC vaccine losses, submission of mandatory reports,
annual LHD VFC site visits and quality assurance review of all provider public
vaccine orders, perform E-VFC site visits to all LHD clinics, and unannounced
VFC storage and handling site visits.
• IQIP–including the required IQIP follow-up with VFC providers, and full
implementation of recommendations.
• Perinatal Hepatitis B-regional birth dose levels and universal vaccine program.
• Review and summarize LHD IAP Annual Plans and Biannual IAP Reports.
• Monitor LHD compliance with Comprehensive agreements and special
requirements relating to the Immunization program.
• Subrecipient monitoring of funds
NW Michigan Health Department
• Employ and oversee a full-time Immunization Field Representative for the
Immunization Program who shall be acceptable to the Department and who shall
be supported by this agreement, understanding that their full time is to be
devoted for regional immunization related activities, including travel time.
• Provide the Immunization Field Representative with permanent office space and
supplies, including, but not limited to a telephone, general office supplies, a
computer with high speed internet capabilities, a printer, a cellular telephone and
a use of vehicle or reimbursement mechanism for transportation unless
otherwise arranged.
• Ensure the Immunization Field Representative will be available to all local health
departments in the assigned regions to provide Immunization Program activities
equitable and at the direction of the Department. Refer to field representative
responsibilities as defined by the Department and distributed to the Grantee.
• Provide for reimbursement for reasonable telephone charges incurred in the
conduct of business by the Immunization Field Representative unless otherwise
arranged.
• Provide reasonable reimbursement for any travel and subsistence expenses
incurred by the Immunization Field Representative necessary to the conduct of
the Immunization Program. Travel could include the annual National
Immunization Conference or other professional immunization related
conferences, attendance at the Department Immunization staff meetings and
trainings, and accreditation visits made in other areas of the state, as determined
by the Division of Immunization.
Kent, Livingston, Marquette, NW Michigan, and Monroe Counties
• Provide adequate office space, telephone connections, high-speed internet
access, as well as access to fax and photocopiers.
• Provide feedback to Section Manager as needed, on employee work-related
conduct.
PROJECT: Immunization Fixed Fee (VFC/QI Site Visits)
Start Date: 10/01/2022
End Date: 9/30/2023
Project Synopsis
The format of the site visit will be based on the completed site visit questionnaires, the
CDC-PEAR and CDC-IQIP database systems reviewed at the most recent Fall IAP
meeting, web-training with MDHHS VFC and QI coordinators, in-person training with
Field Reps and the site visit guidance documents (VFC and QI) provided by the
department and the CDC. All site visit information shall be entered into the appropriate
database as required by CDC (PEAR and QI database system) within 10 days of the site
visit by the individual who conducted the site visit. VFC site visit documentation must be
entered online within PEAR during the time of the site visit.
Reporting Requirements (if different than contract language)
All reimbursement requests should be submitted on the quarterly Comprehensive
Financial Status Report (FSR).
• The submission should include, as an attachment, detail all the visits during the
quarter using the current spreadsheet information provided by the Department.
Any additional requirements (if applicable)
• The rate of reimbursement is $150 for a VFC Enrollment, AVP Only visit, or VFC
Only visit, $100 for a VFC Unscheduled Storage and Handling Visit, $350 for a
Combined VFC/QI site visit or Birthing Hospital visit, and $200 for a QI Only visit.
A VFC Enrollment visit is required for all new VFC enrolled provider sites.
Unannounced Storage and Handling Visits are not required but when performed,
must occur in conjunction with Immunization Nurse Education Sessions required
for VFC Providers that experience a loss exceeding a VFC dollar amount of
$1500. These visits can only be completed if eligible according to current CDC
requirements (e.g., visits cannot be performed for providers who have any visit
that is either in “In Progress” or “Submitted” status). Notify MDHHS VFC staff for
approval prior to performing these visits. MDHHS VFC will monitor the number of
Unannounced Storage and Handling visits performed and, if necessary, may limit
the allowable number of those that can be performed.
• All LHD staff involved with any site visits must complete the Department site visit
training webinar, presented by the Department VFC and QI Coordinator, prior to
conducting any site visits. Annual VFC and QI visit guidance and review materials
will be provided to each LHD at the IAP Meetings and consult will be conducted by
the Department Immunization Field Representative for each Grantee.
• Data from the CDC PEAR and CDC IQIP databases regarding the number and
type of site visits will be used to reconcile the agency request for reimbursement.
For additional detail on the program requirements, refer to the Resource Guide for
Vaccine for Children Providers and the current Department site visit guidance
documents, as well as other current guidance provided by the
Department/Immunization Program in correspondence to Immunization Action
Plan (IAP), Immunization Coordinators, or through health officers.
• Every VFC visit performed for a QI-eligible provider must receive a QI visit within
the same site visit cycle. This may be performed as either a Combined VFC-QI
visit or separate VFC Only and QI Only visit, according to current MDHHS
guidelines. A QI visit can only be conducted within a cycle in which a VFC visit has
also been conducted for the same provider.
• Local health departments must complete an in-person VFC or VFC/QI site visit for
every VFC provider at minimum, every 24-months, using the date of their previous
visit as a starting point. Site visits will vary in time an average of 1 hour for QI and
2 hours for VFC Compliance and must not exceed the two-year time frame.
Annual visits are encouraged but must not be conducted sooner than 11 months
from the previous site visit date.
• Combined VFC/QI site visits will be conducted using MCIR QI reports and QI tools
developed by the Department. All VFC and QI follow-up activities and outstanding
issues must be completed within CDC guidelines.
• Detroit Department of Health and Wellness Promotion Immunization Program is
required to complete visits annually to 100% of the VFC providers in accordance
with the SEMHA Quality Assurance Specialist (QAS) contractual obligations,
including the completed site visit questionnaires and the CDC-PEAR and the
CDC-IQIP database systems reviewed at the most recent Fall IAP meeting, web-
training with MDHHS VFC and QI coordinators, in-person training with Field Reps
and the current site visit guidance documents (VFC and QI) provided by the
department and the CDC. All site visit information shall be entered into the
appropriate database as required by CDC (PEAR and QI database system) within
10 days of the site visit by the individual who conducted the site visit. VFC site visit
documentation must be entered online within PEAR during the time of the site
visit.
PROJECT: Immunization Michigan Care Improvement Registry (MCIR)
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
MCIR is organized into six regions across the state of Michigan to provide MCIR
regional staff oversight for implementation, training of private and public providers,
governance, and evaluation. The staff will also perform community immunization
assessment and reporting to ensure providers report accurate data in a timely fashion.
Reporting Requirements
• Ensure the quarterly submission of status reports on work plan progress. Reports
are due within 30 days of the end of each quarter:
Report Period Report Due
October 1 – December 31 January 31
January 1 - March 31 April 30
April 1 - June 30 July 31
July 1 - September 30 October 31
• Final quarterly report shall be an annual report. The annual report will be distributed
to the Department. The report shall include a summary of all the required activities
listed above in the quarterly reports.
• Any other information as specified in the special requirements shall be developed
and submitted by the Grantee as required by the Department.
Reports and information should be submitted to:
Bea Salada, MCIR Coordinator
Michigan Department of Health & Human Services
Immunization Division
333 South Grand Ave
Lansing, MI 48909
Phone: (517) 284-4889
• The Grantee shall permit the Department or its designee to visit and to evaluate
on an as- needed basis.
Any additional requirements (if applicable)
• The Grantee shall ensure the performance of the following activities on behalf of
the Department to support the MCIR:
• Promote and train providers and Health Care Organizations (HCOs) on all features
of the MCIR Web application.
• Support regional MCIR users by operating the regional help desk in accordance
with Department approved procedures.
• Monitor and develop strategies to increase private provider and HCO enrollment
and participation in the MCIR which includes development of strategies to
encourage all providers to fully participate with the MCIR, (such as sites of
excellence awards).
• Process all user/usage agreements, according to the Department’s approved
procedures, to create user accounts.
• Implement and update marketing plans in support of increased provider and
parent acceptance and use of the MCIR.
• Keep regional users updated on MCIR status and system changes.
• Conduct ad hoc reporting and querying on behalf of MCIR users.
• Work with local health departments to establish a mechanism and internal
process to assure persons who have died within their county are appropriately
flagged in the MCIR.
• Maintain a listing of HCO private and public immunization providers. This listing
should be as comprehensive as possible and should include all providers in the
region.
• Conduct regular de-duplication activities to assure that duplicate records are
removed from the MCIR as quickly as possible.
• Process user petitions to change MCIR data according to Department approved
procedures.
• Monitor ongoing immunization data submission for all local health departments
and private providers.
• Conduct training functions as needed to assure that local health department staff
can train and educate providers on how to access and submit data into MCIR.
• Maintain a policy/procedure manual, approved by the Department.
• Process and file all “opt out” forms according to the Department approved
procedures.
• Attend regular MCIR regional Grantee/coordinator meeting.
• Conduct Onboarding activities as required for providers submitting immunization
data via HL7 messaging to MCIR.
• Perform quality assurance checks on the MCIR data for the region as
prescribed by the Department.
• Assist local health departments and private providers with methodologies to “clean
up” their data.
• Provide assistance to the Department on User Acceptance Testing (UAT) when
required to verify MCIR system releases of bug fixes and enhancements.
• Attend all UAT training sessions as required by the Department.
• The Grantee shall provide to the MCIR Regional Coordinator:
a) permanent office space
b) general office supplies
c) a land-based telephone
d) a computer with high-speed internet capabilities
e) a printer
f) a cellular telephone
g) use of a vehicle or in the alternative reimbursement mechanism for
transportation unless otherwise arranged
• When sufficient funding is available, provide to the MCIR Regional Coordinator
reimbursement for travel to attend the National Registry related meetings if
approved by the Department. This includes travel related expenses concerning air
fare, lodging, baggage processing, taxi services, etc.
• Consult with the Department on any personnel or performance issues that could
affect the above-mentioned contract requirements.
• Facilitate the Department’s attendance in the interview process for hiring of a
MCIR Regional Coordinator / MCIR staff. This process includes consultation
with the Department regarding selection of interview candidates as well as
participation in the hiring determination.
PROJECT: Immunization Vaccine Quality Assurance
Start Date: 10/01/2022
End Date: 9/30/2023
Project Synopsis
Reporting Requirements (if different than contract language)
Any additional requirements (if applicable)
1. Follow-up on vaccine losses and replacement for compromised vaccines for
immunization providers within the jurisdiction.
2. Monitor and approve all temperature logs, doses administered reports and ending
inventory reports received from participating VFC providers within the jurisdiction.
3. Monitor and approve vaccine orders for participating VFC providers within the
jurisdiction.
4. Act as the Primary Point of Contact (PPOC) for VFC providers within the
jurisdiction.
5. Provide education and intervention on inappropriate use of publicly purchased
vaccine.
6. Follow-up on VFC site visit non-compliance issues.
7. Assist VFC providers within the jurisdiction on issues related to balancing vaccine
inventories.
8. Assist with the redistribution of short-dated vaccine for providers within the
jurisdiction.
9. Assist with the equitable allocation of vaccines to providers in the jurisdiction
during a vaccine shortage.
PROJECT TITLE: Infant Safe Sleep
Start Date: 10/1/2022
End Date: 09/30/2023
Project Synopsis:
Local health departments will provide safe sleep educational activities, conduct safe
sleep community outreach/awareness efforts and engage community leaders to guide
programming.
Reporting Requirements (if different than agreement language):
1. LHD will attach the completed “Infant Safe Sleep Mini-Grant Work Plan” to the
indirect cost line of the budget for review and approval by the Infant Safe Sleep
program prior to the start of the fiscal year.
2. Prior to the submission of the proposed work plan, LHD will participate in an in-
person or virtual meeting with all mini-grantees facilitated by the Infant Safe Sleep
Program to review current data, discuss infant safe sleep best practices and answer
any questions related to mini-grant requirements.
3. LHD will submit the “Infant Safe Sleep Mini-Grant Work Plan and Reporting
Document” quarterly with the “Summary of Work Completed” and “Outputs” columns
completed and the “Community Engagement Questions” answered. It must be
attached to the indirect cost line of each quarterly FSR (Q1, Q2, Q3) and to the final
FSR.
4. LHD will participate in a monthly meeting (in-person, virtual or call) with the Infant
Safe Sleep Program to review progress, provide updates and coordinate activities
statewide. LHD will participate in more frequent calls if requested by program staff.
5. LHD will designate a staff person to serve as the contact with the Infant Safe Sleep
Program.
Any additional requirements:
1. Grantee must provide safe sleep educational activities, conduct safe sleep
community outreach/awareness efforts and engage community leaders to guide
programming.
2. Programming must adhere to the policy statement titled “SIDS and Other Sleep-
Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping
Environment” issued by the American Academy of Pediatrics or any subsequent
updates to that policy statement.
3. Activities must:
a. Be data driven and focus on communities or populations that experience a
high rate of sleep-related infant death and disparity. Input and feedback from
families at highest risk for sleep-related infant death must be utilized.
b. Be culturally appropriate based on the communities served.
c. Support families and encourage open and nonjudgmental conversations with
families about infant sleep practices, including risk reduction strategies.
4. Grantee must participate in and/or coordinate a local advisory team or regional group
(such as the county’s Regional Perinatal Quality Collaborative) to coordinate efforts
to promote infant safe sleep and reduce infant deaths related to unsafe sleep
environments. Grantee must make efforts to ensure membership represents a
diverse community of stakeholders and includes the following on the advisory team:
a. Community partners that can address social determinates of health including
partners that can meet resource needs of families and partners that work
further upstream.
b. Community members, such as families, parents and caregivers
5. Activities of the grantee must align with the Mother Infant Health and Equity
Improvement Plan to address preventable infant deaths and disparities through
evidence-based infant safe sleep program activities.
6. Funds may be used for the purchase of demonstration and/or educational items,
however, grantee is encouraged to use department-provided educational materials
when possible. Additionally, a maximum of 7% of the funding may be used for
giveaway items that are directly related to infant safe sleep such as cribs, pack and-
plays, and/or sleep sacks. A maximum of 5% of the funding may be used for
advertising, including billboards, bus signage and the purchase of radio, TV, and/or
print media.
7. Grantee must adhere to the approved work plan. Deviations to the work plan must
be approved by the Program Coordinator.
Program Coordinator
Colleen Nelson
nelsonc7@michigan.gov
517-243-1796
PROJECT: Informed Consent
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The Department will provide funding, at the fixed rate of $50 per woman served, for each
woman that expressly states that she is seeking a pregnancy test or confirmation of a
pregnancy for the purpose of obtaining an abortion and is provided a pregnancy test with
a determination of the probable gestational stage of a confirmed pregnancy.
Reporting Requirements (if different than contract language)
The number of services, rate per service and total amount due must be noted as a funding
source, under the element where the staff providing the services are funded, on the FSR
through the MI E-Grants system.
Any additional requirements (if applicable)
The following requirements apply to all Grantees, whether the Grantee operates a Family
Planning Clinic or not:
1. When a woman states that she is seeking an abortion and is requesting services
for that purpose the Grantee will provide:
a. A pregnancy test with a determination of the probable gestational stage of a
confirmed pregnancy.
Important Note: T he Grantee must destroy the individual “informed consent”
files containing identifying information (Name, Address, etc.) after 30 days.
2. When a woman seeks a pregnancy test and does not explicitly state that she is
doing so for the purpose of obtaining an abortion, she should be directed to a family
planning clinic or to her primary care provider for a pregnancy test. Services to
comply with PA 345 of 2000 should not be provided to a woman in a Title X funded
family planning clinic.
PROJECT: Laboratory Services Bio
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
As part of the emergency preparedness and response efforts, the regional laboratories
have been designated as partner organizations that assist with testing, transport, and
communications related to biothreat agents or other evolving infectious agent issues.
Reporting Requirements (if different than contract language)
Provide the Bureau of Laboratories records and reports as required, at least once per
year or upon special request.
Any additional requirements (if applicable)
Meet established standards of performance and objectives in the following areas:
Public Health Emergency Preparedness:
• Maintain a current list of contact information for local community hospital
laboratories to facilitate communication.
• Facilitate response with local community hospital laboratories in preparation for and
during public health threats.
• Coordinate and facilitate specimen collection and transport with facilities within
jurisdiction. This may include specimen packaging and shipping and coordination
with the courier service.
• Provide 24/7 contact information to hospital partners and BOL.
• Participate in and provide support for Department PHEP exercises with community
hospital laboratories within jurisdiction.
• The Grantee will designate one staff member as a liaison to the Bureau of
Laboratories. Each Grantee must designate appropriate staff to take part in LIMS
training activities.
• Provide information on specimen submission to local health jurisdictions to assure
that specimens are submitted to the BOL LRN laboratory, or other appropriate LRN
laboratory as determined by the Department.
PROJECT: Lactation Consultant
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The Lactation Consultant project provides lactation support to persons living in Flint and
the surrounding areas. All activities must support and promote human milk feeding.
Reporting Requirements (if different than contract language)
1. In anticipation of the FY23 contract, grantees must submit a Lactation Consultant
work plan to DrzalN@michigan.gov by 9/1/2022. The work plan must include:
a. Outcome objectives (a minimum of 2) for improved breastfeeding rates in
Genesee County.
b. Activities (a minimum of 3 per objective) that include names and numbers of
specific populations targeted for interventions.
c. The person responsible and deliverable quantifiable outcomes for each
activity.
2. Changes to the work plan throughout the year can occur with prior approval from
the MDHHS.
3. All activities, as specified in the initial approved work plan, shall be implemented.
Workplan Report Due Dates:
Work plan reports must be submitted quarterly or as requested by MDHHS. The reports
are due 30 days after each quarter and year end and include the following timeframes:
a. Initial work plan due August 1, 2022.
b. First quarter (covering period October 1 through December 31) is due January
30.
c. Second quarter report (covering period January 1 through March 31) is due
April 30.
d. Third quarter report (covering period April 1 through June 30) is due July 30.
e. Fourth quarter report (covering period July 1 through September 30) is due
October 30.
Any additional requirements (if applicable)
PROJECT: Lead Hazard Control
Start Date: 10/01/2022
End Date: 9/30/2023
Project Synopsis
The LHCCD grant funds local communities to provide residential lead hazard control
(LHC) services within their communities per the Medicaid Children’s Health Insurance
Program State Plan Amendment. The purpose is to provide LHC services to eligible
households with a Medicaid-enrolled child to reduce lead exposure in children. The
program consists of outreach, education, identification of sources of lead, as well as
remediation of lead hazards within the home that contribute to elevated blood lead
levels. The grant allows grantees to establish a tailored, high quality, and sustainable
lead hazard control program that best serves the residents in their community.
Reporting Requirements (if different or in addition to contract language)
A. Grantees must complete and submit monthly Enrollee Engagement Protocol
Tracking Reports via secured MDHHS File Transfer Protocol (FTP) system by
the 15th of each month for the prior month’s activity.
B. Grantees must complete and submit MDHHS-LSS Monthly Monitoring Reports
via secured FTP by the 15th of each month for the prior month’s activity. The
method of reporting may change following the MiCLEAR application
implementation.
C. Grantees must complete monthly expenditure and general ledger reports by the
30th of each month for the prior month. Monthly financial reports will be submitted
to applicable Program Coordinator on time.
D. Quarterly Financial Status Reports in EGrAMS are due by the 30th of the month
following the end of the quarter. Grantees shall provide applicable general
ledgers attached to the quarterly Financial Status Report in an Excel or PDF
format for reconciliation, review and analysis.
E. Grantees must submit quarterly Work Plan reports via FTP by the 15th of the
month following the end of each quarter, as specified in the Grant Agreement.
F. Grantees must complete benchmark form detailing monthly projected
environmental investigations, cleared projects and funds to be drawn.
Community Development Unit will complete monthly review of benchmarks and
develop a management plan on a quarterly basis for grantees who are not
meeting benchmarks. If management plan does not achieve projected results,
grantee must revise portions of contract including benchmarks and/or total
contract award in the next amendment cycle.
G. Grantees must have at least one representative participate in additional
monitoring and information conference calls as requested by LLSD.
H. Any other information as specified in the Statement of Work, shall be developed
and submitted by the Grantee as required by the Contract Manager.
I. Reports and information shall be submitted through the Lead Hazard Control
Community Development File Transfer Protocol (LHCCD FTP) shared area and
EGrAMS. Grantees shall follow the established MDHHS report and document
naming conventions for reports submitted via secured FTP. The method of
reporting may change following the MiCLEAR application implementation.
J. The Grantee shall permit the Department or its designee to visit and to make an
evaluation of the project as determined by Contract Manager.
Any additional requirements (if applicable)
A. Ensure compliance with laws, regulations, licensing requirements, protocols,
and guidelines for all funded activities under this RFP. Work must be conducted
by firms and persons certified according to the Michigan Lead Abatement Act
and/or EPA 40 CFR 745 possessing certification as lead abatement firms, EPA
certified renovation firms, risk assessors, inspectors, abatement supervisors,
abatement workers or certified renovators (for workers and supervisors
performing non-abatement work), as applicable to each unit’s scope of work.
Any abatement activities conducted under this program require a properly
certified abatement firm, certified abatement supervisor, certified abatement
worker credentialing. Any activities or other renovation activities not performed
during abatement activities under this program requires a properly certified EPA
renovation firm using only EPA-certified renovators. Each project will have a
clearance performed at the end of the abatement work and at the end of the
project. Compliance with the following is required for all sub-contractors, sub-
grantees, sub-recipients, and their contractors:
U.S. Department of Housing and Urban Development (HUD): 24 CFR 35
U.S. Occupational Safety and Health Administration (OSHA): 29 CFR
1910.1025,
29 CFR 1926 (Lead Exposure in Construction)
U.S. Environmental Protection Agency (EPA): 40 CFR 745
U.S. EPA, National Environmental Policy Act - Tier II Environmental
Review: 29 CFR Part 50-58.
National Historic Preservation Act. The National Historic Preservation Act
of 1966 (54 U.S.C. §300101) and the regulations at 36 CFR Part 800
apply to the lead-hazard control or rehabilitation activities that are
undertaken pursuant to this RFP.
State of Michigan regulations, including the Michigan Lead Abatement Act
(MCL 333.5451-333.3477), Lead Hazard Control Administrative Rules
(R325.99101-R325.99409), and Article 24 of Public Act 299 of 1980, as
amended, regarding residential building, maintenance, and alteration
contractor licensing and regulations.
Local regulations as applicable.
B. Applicants applying as a consortium must identify all partners, one Lead
Applicant, and Authorizing Official in their proposal. Identify the geographic
region each consortium partner is serving and their role.
C. Create an Enrollee Engagement Prioritization Plan that specifies how you will
adhere to the minimum requirements in the Enrollee Engagement Protocol.
Grantees must ensure that prioritized at-risk eligible households receive
adequate outreach for equitable inclusion and enrollment.
i. Grantees shall maintain a documented Enrollee Engagement Prioritization
Plan for their community, prioritizing the most at-risk families (e.g.
pregnant women, children with EBLs, age of child, housing stock, etc.).
Upon completion of a Data Use Agreement, MDHHS-LSS will provide
Grantees with a monthly Medicaid enrollee and Elevated Blood Lead
Level (EBLL) report for their geographic region to support this activity.
ii. Grantee’s plan shall include enough potential participants to attain
benchmarks. Conversely, Grantee’s plan must be targeted to avoid a
lengthy backlog of applicants.
iii. Once a Grantee has contacted a potential enrollee, the engagement
protocol shall be followed until an application is received or they are
disengaged according to the disengagement protocol.
iv. Grantee enrollee engagement must include application completion
assistance, if needed.
v. Grantee’s plan shall address how an applicant backlog will be tracked and
monitored if there are more applicants than they can serve.
vi. If Grantee doesn’t have a backlog, all eligible applicants shall be served
regardless of their prioritization status.
vii. If Grantee plans to use a partner to oversee or conduct their Enrollee
Engagement Prioritization Plan and Tracking, they must identify the
partner, agreements they have in place, and how PII and PHI data are
shared and protected.
viii. If Grantee proceeds with an application that does not follow their Enrollee
Engagement Prioritization Plan, Grantee must document the justification in
their project file.
D. Ensure lead abatement requirements are followed including:
i. A lead abatement supervisor is required for each lead abatement job and
must be present at the job site while all abatement work is being done. This
requirement includes set up and clean up time. The lead abatement supervisor
must ensure that all abatement work is done within the limits of federal, state,
and local laws.
ii. Services may be rendered to eligible physical structures and include the
surrounding land up to the property line.
iii. Services must be coordinated with water service line removal that occurs
outside of the property line.
iv. A certified lead inspector or risk assessor, who is independent of the abatement
company, shall perform clearance testing after abatement work is completed
and at the end of the project.
v. All laboratories selected for use in the lead-based paint hazards and
evaluation reports shall hold and maintain an accreditation to the ISO/IEC
17025:2005 standard, through an appropriate accreditation body, to
conduct lead testing services. The laboratory must be recognized by the
U.S. Environmental Protection Agency (EPA) National Lead Laboratory
Accreditation Program (NLLAP) for the analyses performed under this
contract, and shall, for work under this grant, use the same analytical
method used for obtaining the most recent NLLAP recognition. Additionally,
the laboratory must employ individuals, who perform the testing and review
and report out results, which meet the MDHHS Civil Service requirements
for staffing capabilities, which can be found below.
Grantee has two analytical laboratory options, which are to either (1) identify the
laboratory they plan to use; submit documentation of compliance with the
requirements stated in the RFP; (2) use the MDHHS Trace Metals Laboratory.
Copies of the chain-of-custody and sample results must be included within the
EBL EI or Lead Inspection/Risk Assessment report.
vi. Ensure water sampling protocols are followed in compliance with the EPA Lead
and Copper Rule and the MDHHS-LSS Residential Lead Hazard Control-Lead
in Water Protocol. A Michigan Department of Environment, Great Lakes and
Energy Certified Drinking Water Laboratory for Lead and Copper must be used.
All water samples must be analyzed within fourteen (14) days of collection. It is
recommended that all water samples be delivered to the approved laboratory
within ten (10) days of collection. Copies of the chain-of-custody and sample
results must be included within all Lead Hazard Control Environmental
Investigation, Clearance and Addendum reports.
vii. All residences designated within a Historic Preservation District must adhere to
state and local historical preservation requirements.
viii. The LSS – Local Lead Services and Development Unit (LLSD) is responsible
for conducting the Tier I Environment Review through the issuance of a public
notice in the form of a press release. Grantees are required to complete site
specific Tier II Environmental Reviews in accordance with U.S. EPA National
Environmental Policy Act, 24 CFR 50-58. Grantees must complete the required
Tiered Environmental Review Checklist for each project. The following
components shall be included in the review and adhered to:
a. Airport Runway Clear Zones and Clear Zones Disclosures
b. Coastal Barrier Resources Act
c. Coastal Zone Management
d. Flood Insurance
e. Flood Plain Management
f. Wetland Protection
g. Wild and Scenic Rivers
h. Clean Air Act
i. Contaminated and Toxic Substances
j. Endangered Species
k. Farmlands Protection
l. Explosive and Flammable Operations
m. Environmental Justice
E. Applicants must complete minimum work plan requirements, identify specific
program objectives and activities to be accomplished in a work plan. Objectives
should relate to the identified target community needs and be SMART (specific,
measurable, appropriate, realistic, and time-based). Each objective must have a
minimum of one related activity.
F. The following minimum objectives and activities shall be included in Applicant’s work
plan:
Objective: Education & Engagement
Activity: Adhere to Enrollee Engagement Protocol while utilizing
Program Prioritization Plan
Responsible Staff: [Please include responsible entity/individual who is
also listed in Budget section]
Date Range:
Expected Outcome: Receive and approve XX applications.
Measurement: Number of applications received/approved and families
contacted.
Objective: Investigations
Activity: Complete XX EBL/LIRA investigations including water
sampling according to MDHHS Water Protocol
Responsible Staff: [Please include responsible entity/individual who is
also listed in Budget section]
Date Range:
Expected Outcome: XX completed EBL/LIRA investigations
Measurement: Number of EBL/LIRA reports received
Objective: Abatement
Activity: Complete and clear XX abatement projects
Responsible Staff: [Please include responsible entity/individual who is
also listed in Budget section]
Date Range:
Expected Outcome: XX projects completed/cleared
Measurement: Number of projects completed/cleared
G. Collaboration and coordination requirements include:
i. If MDHHS-LSS-Lead Safe Home Program (LSHP) receives an application from
a Medicaid resident in a Grantee community, LSHP and the LLSD will
determine who shall be responsible for serving the applicant. LLSD will work
with Grantees to coordinate referrals.
ii. Services performed must be part of a coordinated plan that ensures abatement
activities of the eligible residential unit align with the community’s water service
line replacement plan (if applicable). The Grantee must replace the service line
if water test results are above acceptable limits. Applicants must include their
coordination plan as part of their proposal.
iii. MDHHS-LSS encourages collaboration and coordination to meet the
requirements of this RFP with other non-profit: communities, agencies, and
partners (such as childhood lead poisoning prevention programs, health
agencies, community development agencies, weatherization assistance
agencies, fair housing organizations, code enforcement agencies, community-
based organizations, faith-based organizations, financial institutions, or other
philanthropic entities).
iv. Grantees are required to enter into formal arrangements, such as
memorandums of understanding or similar contractual agreements, with service
delivery organizations receiving funds.
H. All high-cost projects exceeding $70,000 require MDHHS approval prior to
abatement.
I. Control/Elimination Strategies. All lead-based paint hazards identified in eligible
housing units and in common areas of multifamily housing enrolled in this Medicaid
CHIP program must be controlled or eliminated in accordance with the Michigan
Lead Abatement Act.
J. Data Collection and Use. Grantees must collect, maintain, assure data integrity, and
provide to MDHHS-LSS the data necessary to document, report, and evaluate
program outputs and outcomes. Grantees must document how PII or PHI data will
be securely shared with partnering entities, including the following components:
i. Data source, purpose, and use
ii. Specific data elements (e.g., age, gender, etc.)
iii. Time periods (e.g. October 1, 2020 through September 30, 2021)
iv. Identify what data transfer medium will be used (e.g., electronic through
secured FTP, hard copy via facsimile, encrypted email, etc.)
v. Identify who will have access to the data (e.g., project director, intake
specialist, etc.), and how access will be controlled.
vi. Identify how you will receive authorization from participants to share data with
any subcontractors or partners. Include how you will share the authorized data
with subcontractors or partners, and ensure those accessing data agree to the
same restrictions and conditions.
vii. Identify where data will be stored and how access will be restricted to
authorized individuals (e.g. encrypted or password protected)
viii. Identify how data will be retained in secured storage once the program is
completed to comply with records retention. Include how the data is destroyed
at conclusion of the retention period.
ix. Grantees are required to immediately notify LLSD if a staff member who has
access to FTP or Michigan Comprehensive Lead Abatement and Registry
(MiCLEAR) is no longer employed with the agency and/or permitted to have
access to PHI. LLSD will revoke their access immediately.
K. Grantee shall enter and maintain program and project data in an MDHHS online
application, MICLEAR, when available. Until such time, data shall be provided on
Excel spreadsheets or on data collection forms listed in Reporting Requirements.
L. Grantee must obtain Data Use Agreement with LLSD if the program is sharing PHI.
M. Required Trainings. Grantees are required to send a minimum of two
representatives to attend an annual Grantee Orientation and any additional Grantee
mandatory meetings scheduled by MDHHS-LLS throughout the fiscal year.
N. Lead-Based Paint and Lead Hazard Identification. A complete lead-based paint
inspection, lead hazard risk assessment, EBL environmental investigation (for
children with a blood level ≥5 µg/dL), and lead in water sampling
assessment/evaluation will be conducted; either separate reports or a combined
report is required for all properties enrolled under this program. Presumption of the
presence of lead-based paint or lead hazards is not permitted. Paint inspections and
risk assessments must follow the procedures as defined in the Michigan Lead
Abatement Act and HUD Guidelines for the Evaluation and Control of Lead-Based
Paint Hazards in Housing investigation, abatement and clearance. Lead in water
sampling must be conducted in accordance with MDHHS-LSS Residential Lead
Hazard Control-Lead in Water Protocol.
i. Individuals performing EBL/Lead Inspection Risk Assessments
and/or water sampling must use MDHHS approved Lead Hazard
Control Environmental Investigation, Clearance and Addendum
report templates.
O. Demolition. In rare cases, a portion of the housing unit or structure with lead
hazards may be determined to be of so little value, unfit for occupancy, or in a state
of extreme disrepair that pursuing lead hazard control may not be cost effective.
Partial demolition and removal of contaminated materials, soil, etc. is a covered
service only if pre-approved in writing by MDHHS-LSS.
P. Minimal residential rehabilitation is allowed to the extent that this work extends the
life of the lead abatement work done consistent with HUD guidelines, including
activities that are specifically required in order to carry out effective hazard control,
and without which the hazard control could not be completed, maintained, and
sustained, as defined by HUD Policy Guidance Number 2008-02
Q. Notification Requirements. All lead-based paint testing results, summaries of lead-
based paint hazard control treatments, and clearances must be provided to the
owner of the unit, together with a notice describing the owner’s legal duty to disclose
the results to tenants and buyers in accordance with 24 CFR 35.88 of the Lead
Disclosure Rule. Applicants must ensure that this information is provided in a
manner that is effective for persons with disabilities (24 CFR 8.6) and those persons
with limited English proficiency (LEP) will have meaningful access to it (see
Executive Order 13166). Applicant files must contain verifiable evidence of providing
lead hazard evaluation and control reports to owners and tenants, such as a signed
and dated receipt. Applicants must also describe how they will provide owners with
lead hazard evaluation and control information generated by activities under this
program, so that the owner can comply with the Lead Disclosure Rule (24 CFR part
35, subpart A, or the equivalent 40 CFR part 745, subpart F), the Lead Safe
Housing Rule (24 CFR part 35, subparts B–R), and the EPA’s Renovation, Repair,
and Painting (RRP) Rule (see 40 CFR part 745 and
http://www2.epa.gov/lead/renovation-repair-and-painting-program).
R. Procurement Requirements. Recipients must follow State of Michigan or established
grantee policies and procedures.
S. Temporary Relocation. Costs for the temporary relocation for residents required to
vacate housing during abatement activities must be controlled and reasonable for
the area. MDHHS-LSS expects that the lead hazard control work and temporary
relocation will take ten (10) days or less, unless pre-approved by MDHHS-LSS.
Rental unit landlords shall identify alternate relocation for residents during
abatement, if available.
T. If an X-ray fluorescent (XRF) instrument is used, all risk assessors must possess
current training, certification and licensing in the use of the XRF equipment under
appropriate federal, state or local authority.
U. Waste Disposal must adhere to the requirements of the Michigan Lead Abatement
Act, appropriate local, state, and federal regulatory agencies, and HUD Guidelines.
V. Written Policies and Procedures. Grantees will be required to develop written
policies and procedures to comply with the requirements of this RFP within the first
sixty (60) days of the new award. MDHHS-LSS Lead Safe Home Program will
provide Grantees with a minimum set of procedures to be followed. The policies and
procedures must describe how your program will handle items such as, but not
limited, to:
i. Enrollee Engagement Prioritization Plan and Tracking, including a plan for
targeted outreach, prioritization, maintenance of a backlog, documentation, and
reporting.
ii. Workforce development related to lead hazard control
iii. Processing program applications, validating unit eligibility, prioritization, and
selection
iv. All phases of lead hazard evaluation and control, including risk assessments,
inspections, water sampling, reporting, abatement and clearance,
development of specifications for contractor bids
v. Resident temporary relocation
vi. Procurement of abatement contractor
vii. Quality assurance of program data collection and data entry
viii. Financial controls
ix. Quality assurance abatement Plan
W. Grantees are required to retain all project records in a secured location for five (5)
years after project closeout.
X. Program administrative costs are recommended to not exceed ten percent (10%) of
the award for payments of reasonable administrative costs related to planning and
executing the project, preparation/submission of LLSD reports, etc. Administrative
costs are the reasonable, necessary, allocable, and otherwise allowable costs of
general management, oversight, and coordination of the proposal (i.e., program
administration). Administrative costs must be outlined in the budget narrative. If
administrative costs exceed ten percent (10%), justification must be provided.
Y. The Grantee can choose to use one of the approved methods outlined below in their
budget. In any method, grantee must provide appropriate documentation of proof.
i. Federal approved rate
ii. State approved rate
iii. Cost allocation plans
iv. De minimis rate: If the Grantee does not have an existing approved
indirect rate above and grantee elects to charge indirect costs, they
must use a 10% de minimis rate in accordance with Title 2 Code of
Federal Regulations (CFR) Part 200. De Minimis Rate cannot
exceed 10% and de minimis calculation form must be completed and
attached.
Z. The Grantee is responsible for assuring that environmental and pollution insurance
is obtained by certified abatement contractor and/or abatement firm. Contractor
and/or firm will provide the program with a copy of its current insurance certificate,
which will name the property owner and the State of Michigan as additionally
insured. The appropriate pollution/environmental coverage requirements as stated
above will be included in the certificate. The certificate must be received prior to the
issuance of a purchase order.
AA. Eligibility of Expenses
i. Roofs: Medicaid CHIP abatement project is eligible for roof
replacement when roof is beyond minimal rehab and repairable
condition. Documentation is needed stating that roof disrepair would
affect the integrity of the lead hazard control work being completed
on the property.
ii. Multi-Units: Multi-family rental properties are eligible and follows
compliance with HUD policy 5-66.
iii. Public Housing: Following HUD policy, properties that are HUD
voucher based/tenant-based are eligible for lead abatement
services. However, project-based housing owned by HUD is not
eligible for the Medicaid CHIP grant.
iv. Consent Decree: Following HUD policy, properties that have an
existing consent decree on the property are not eligible for the
Medicaid CHIP grant.
v. Demolition: In rare cases, a portion of the residential unit or
accessory structure with lead hazards may be determined to be unfit
for occupancy or in a state of extreme disrepair that pursuing lead
hazard control may not be cost effective or feasible. Partial
demolition and removal of contaminated materials, soil, etc. is a
covered service only if pre-approved by MDHHS-LSS and the
following CMS guidelines are adhered to:
i. Conduct clearance testing of the site and soil upon
completion of the project to make sure that the demolition did
not create new hazards.
ii. Attest that certified professionals are contracted to work on
the demolition to guarantee that it is conducted safely to
protect neighboring structures and residents.
iii. Obtain consent from the resident and property owner for the
demolition, to ensure all parties are in agreement.
vi. Dumpsters: Dumpsters or storage containers/pods are an allowable
expense for households where there are extreme hoarding issues
that would prevent contractors and inspectors from performing Lead
Hazard Control work.
vii. Fire Protection: Medicaid CHIP enrolled properties are eligible to
receive carbon monoxide detectors and smoke alarms based on
local code.
viii. Minimal Rehabilitation: Minimal residential rehabilitation is allowed to
the extent that this work extends the life of the lead abatement work
done consistent with HUD guidelines, including activities that are
specifically required in order to carry out effective hazard control, and
without which the hazard control could not be completed,
maintained, and sustained, as defined by HUD Policy Guidance
Number 2008-02.
ix. Relocation: Temporary relocation expenses are eligible when family
is required to vacate home during abatement activities. When
possible, the State rate for hotels should be used.
x. Fire Protection: Medicaid CHIP LLSD enrolled properties are eligible
to receive carbon monoxide detectors and smoke alarms based on
local code.
xi. Equipment: Any purchase or lease of equipment having a per-
unit cost in excess of $5,000 must be pre-approved by MDHHS
including the purchase or lease of X-ray fluorescence (XRF)
analyzers.
xii. Lead Certifications: Payment of professional certifications and
licenses are eligible which includes securing and maintaining
required certification and licenses for identification, remediation,
and clearance of lead and other housing-related health and
safety hazards.
xiii. Resident blood lead testing and analysis are not eligible services or
costs.
xiv. Costs of case management are not eligible services or costs.
CC. Grantee is responsible for overseeing internal Quality Assurance Plan and
COVID19 Preparedness Plan. To ensure safety of workers and residents,
grantee will confirm lead safe work practices are being performed as well as
COVID19-related precautions are being adhered to.
xv. Vendors must submit a COVID19 Preparedness Plan to grantees
and Community Development Unit before lead hazard control
activities can begin.
DD. Grantee agrees to follow asbestos recommendations and protocols as
prescribed by Healthy Homes Section.
EE. MDHHS Local Lead Services and Development Unit will complete quarterly
reviews of EBL/LIRA reports, specifications, site visits, file audits, abatement
projects completed, and financial expenditures. If significant findings are
concluded from quarterly reviews including but not limited to failure to meet
projected benchmarks or adhering to reporting requirements, grantee will develop
a Plan of Action. If Plan of Action does not achieve projected results in specified
amount of time, grantee must revise portions of contract including benchmarks
and/or total contract award in next amendment cycle. After previous measures are
implemented and grantee still fails to comply with grant requirements, MDHHS
reserves the right to rescind grant award.
PROJECT: Local Health Department Sharing
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
Local health departments participating in the project will utilize funds to support activities
pertinent to the exploration, preparation, planning, implementing, and improving sharing
of local health department services, programs or personnel.
Reporting Requirements (if different than contract language)
Grantees will receive notification of reports along with reporting templates. Reporting is
twice per year based on reporting dates required by the CDC.
Any additional requirements (if applicable)
Local health departments must submit a continuation workplan and budget for
continuation funding of the project “Local Health Department Collaboration and
Exploration of Shared Approach to Delivery of Services,”
Eligible Activities:
• Meeting activities, including time and travel costs
• Cost of research activities
• Supplies and presentation materials
• Legal fees and other professional services related to the project
• IT cost related to service sharing (grant funds may not be used to reimburse
equipment costs)
PROJECT TITLE: Local Maternal Child Health (LMCH)
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis: Local Maternal Child Health (LMCH)
LMCH funding is made available to local health departments to support the health of
women, children, and families in communities across Michigan. Funding addresses one
or more Title V Maternal and Child Health Block Grant national and state priority areas
and/or a local MCH priority need identified through a needs assessment process. Local
health departments complete an annual LMCH plan, and a year end report. Target
populations are women of childbearing age, infants, and children aged 1-21 years and
their families, with a special focus on those who are low income. The LMCH allocated
funds are to be budgeted as a funding source in two project categories for FY 2023.
LMCH
Local Maternal and Child Health (MCH)
ESCMCH MCH - Children
OTHERMCHV MCH – All Other
Reporting Requirements (if different than agreement language):
1. The LMCH Plan submission and due date will be communicated through a
notification mailing. The department will provide the format for the LMCH Plan.
The LMCH Plan, approved by the department, is to be uploaded with the budget
application into EGrAMS. The Plan and Plan amendments, if needed, need to be
approved in advance of the budget application and budget amendment.
2. The FY 2023 LMCH Year-End Report submission and due date will be
communicated through a notification mailing. The department will provide the
format for the LMCH Year-End Report. The Local MCH Year-End Report,
approved by the department, is to be uploaded in EGrAMS with the final FSR. The
Year-End Report must be approved in advance of the final FSR.
Any additional requirements (if applicable):
1. Local MCH funding must be used to address the unmet needs of the maternal
child health population and based on data and need(s) identified through the
Local Health Department community health assessment process.
2. Activities and programs supported with Local MCH funds must be evidence-
based/informed. Exceptions must be submitted in writing and pre-approved by
MDHHS.
3. Local MCH funding cannot be used under the WIC element, except in extreme
circumstances where a waiver is requested in advance of the expenditures and
evidence is provided that the expenditures satisfy all funding requirements.
4. Local MCH funds may not be used to supplant available/billable program income
such as Medicaid or Healthy Michigan Plan fees or additional funding under the
Medicaid Cost-Based Reimbursement process.
5. Local Health Departments should leverage all other funding sources, especially
third-party payers (Medicaid, private insurers) before utilizing LMCH MCH block
grant funds. LMCH funds are to be used for those services that cannot be paid for
through other sources or for gap filling services. Third party fees should be listed
in other funding sources. If no 3rd party fees are listed, an explanation must be
noted.
6. The approved LMCH Plan allocation table and the budget application MCH
source of funds must match. If an agency needs to move funds between projects,
an amended LMCH Plan must be approved in advance of the budget amendment
request period. Any specified expenditure in the LMCH Plan must be detailed in
the budget (e.g. incentives).
7. The LMCH program follows the same principle on budget transfers and
adjustments outlined in the comprehensive agreement. The comprehensive
agreement allows for budget transfers and adjustments of $10,000 or 15%,
whichever is greater. However, if the transfer or adjustment is greater than the
$10,000 or 15%, OR there are any changes made to any of the children
performance measures an amended LMCH Work Plan and budget will be
required.
8. LMCH is unable to accept cost distributions from MDHHS-ELPHS due to the
nature of the block grant and LMCH reporting requirements. LMCH will continue
to accept other cost distributions as in the past (such as Family Planning, CSHCS
Outreach and Advocacy, VQA, IAP, and Lead Prevention).
9. LMCH has adopted Title 2 Code of Federal Regulations 200 Cost principles.
PROJECT TITLE: Maternal Infant and Early Childhood Home Visiting
Initiative Local Home Visiting Group
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The purpose of the Local Leadership Group (LLG) is to support the development of a
local home visiting system that leads to improvement and coordination of home visiting
programs at the community or regional level.
Reporting Requirements (if different than agreement language):
The LLG shall submit all required reports in accordance with the Department reporting
requirements.
a. Staffing Changes: Within 10 days of a staffing change, notify the notify the State LLG Coordinator 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. LLG Work Plan: Due annually on June 30 for preapproval. See the Michigan
Department of Health and Human Services’ (MDHHS) Home Visiting Guidance Manual for
requirements related to Work Plan development and reporting.
c. Work Plan Reports: Must be submitted within 30 days of the end of each quarter
(January 30, April 30, July 30, and October 30).
d. See the MDHHS Home Visiting Guidance Manual for specific Continuous Quality
Improvement (CQI) reporting requirements which include: monthly data tracking,
PDSA cycle updates (due the 15th of each month) and story board and team
charter submissions.
e. The Contract Manager or his/her designee shall evaluate the reports submitted as
described for their completeness and adequacy.
f. The Grantee shall permit the Department or its designee to visit, either in person
or virtually, and make an evaluation of the project as determined by the Contract
Manager.
All reports and/or information (a-f), unless stated otherwise, shall be submitted
electronically to the Home Visiting mailbox at MDHHS-HVInitiative@michigan.gov.
Any additional requirements (if applicable):
Comply with MDHHS Home Visiting Program Requirements:
The Grantee shall operate the program with fidelity to the requirements of MDHHS as
outlined in the MDHHS Home Visiting Guidance Manual.
1. The LLG will work with the State LLG Coordinator and the Michigan Public Health
Institute (MPHI). See the MDHHS Home Visiting Guidance Manual for details.
2. The LLG will continue the following efforts started in previous years:
a. Ensure recruitment and participation of both required and strongly
encouraged LLG representatives.
b. Integrate parent leaders as active members of the LLG. Membership on
the LLG CQI team must include a parent leader. This includes their
attendance at local CQI meetings and the three LLG Grantee meetings.
c. Implement one strategy from the respective community’s local Home
Visiting Continuum of Models Project Plan.
d. Conduct a LLG Quality Improvement project.
e. Implement the community’s Sustainability Plan.
See the MDHHS Home Visiting Guidance Manual for requirements related to LLG
membership/participation, development of CQI strategies, as well as the implementation
of Continuum and Sustainability Plans.
Funding Requirements:
The funding can be used to:
a. Enable the LLG to pay for staff support.
b. Financially support LLG parent leaders to attend the Michigan Home
Visiting Conference.
c. Financially support LLG members, including parent leaders, to be part of
the LLG and CQI efforts.
d. Carry out MDHHS Home Visiting Unit activities as specified in this
agreement.
Promotional Materials
If the LLG wishes to produce any marketing, advertising or educational materials using
grant agreement funds, they must follow the requirements as outlined in the MDHHS
Home Visiting Guidance Manual.
PROJECT TITLE: Maternal Infant Early Child Home Visiting Initiative Rural
Local Home Visiting Group
and
Maternal Infant Early Child Home Visiting Initiative Rural Local Home
Visiting Group 3
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The purpose of the Local Leadership Group (LLG) is to support the development of a
local home visiting system that leads to improvement and coordination of home visiting
programs at the community or regional level.
Reporting Requirements (if different than agreement language):
The LLG shall submit all required reports in accordance with the Department reporting
requirements.
a. Staffing Changes: Within 10 days of a staffing change, notify the State LLG
Coordinator 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. LLG Work Plan: Due annually on June 30 for preapproval. See the Michigan
Department of Health and Human Services’ (MDHHS) Home Visiting Guidance
Manual for requirements related to Work Plan development and reporting.
c. Work Plan Reports: Must be submitted within 30 days of the end of each quarter
(January 30, April 30, July 30, and October 30).
d. See the MDHHS Home Visiting Guidance Manual for specific Continuous Quality
Improvement (CQI) reporting requirements which include: monthly data tracking,
PDSA cycle updates (due the 15th of each month) and story board and team
charter submissions.
e. The Contract Manager or his/her designee shall evaluate the reports submitted as
described for their completeness and adequacy.
f. The Grantee shall permit the Department or its designee to visit, either in person
or virtually, and make an evaluation of the project as determined by the Contract
Manager.
All reports and/or information (a-f), unless stated otherwise, shall be submitted
electronically to the Home Visiting mailbox at MDHHS-HVInitiative@michigan.gov.
Any additional requirements (if applicable):
Comply with MDHHS Home Visiting Program Requirements:
The Grantee shall operate the program with fidelity to the requirements of MDHHS as
outlined in the MDHHS Home Visiting Guidance Manual.
1. The LLG will work with the State LLG Coordinator and the Michigan Public Health
Institute (MPHI). See the MDHHS Home Visiting Guidance Manual for details.
2. The LLG will continue the following efforts started in previous years:
a. Ensure recruitment and participation of both required and strongly
encouraged LLG representatives.
b. Integrate parent leaders as active members of the LLG. Membership on
the LLG CQI team must include a parent leader. This includes their
attendance at local CQI meetings and the three LLG Grantee meetings.
c. Implement one strategy from the respective community’s local Home
Visiting Continuum of Models Project Plan.
d. Conduct a LLG Quality Improvement project.
e. Implement the community’s Sustainability Plan.
See the MDHHS Home Visiting Guidance Manual for requirements related to LLG
membership/participation, development of CQI strategies, as well as the implementation
of Continuum and Sustainability Plans.
Funding Requirements:
The funding can be used to:
a. Enable the LLG to pay for staff support.
b. Financially support LLG parent leaders to attend the Michigan Home
Visiting Conference.
c. Financially support LLG members, including parent leaders, to be part of
the LLG and CQI efforts.
d. Carry out MDHHS Home Visiting activities as specified in this agreement.
Promotional Materials
If the LLG wishes to produce any marketing, advertising or educational materials using
grant agreement funds, they must follow the requirements as outlined in the MDHHS
Home Visiting Guidance Manual.
PROJECT: Medicaid Outreach
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
Medicaid Outreach activities are performed to inform Medicaid beneficiaries or potential
beneficiaries about Medicaid, enroll individuals in Medicaid and improve access and
utilization of Medicaid covered services. All outreach activities must be specific to
Medicaid. Reference bulletin: MSA 18-41
Additional instructions can be found in Attachment I.
Reporting Requirements (if different than contract language)
Submit quarterly reports no later than 1 month after the end of the quarter. The
exception is the 4th quarter report which is due at the time as the final FSR. If the report
due date falls on a weekend or holiday, the report the next business day.
Reporting Period Due Date
October 1 – December 31 January 31
January 1 – March 31 April 30
April 1 – June 30 July 31
July 1 – September 30 November 30
• Quarterly reports must be attached/uploaded on the Source of Funds/Federal
Medicaid Outreach line on the FSR in EGrAMS.
• Reimbursements occur based on actual expenditures reported on Financial Status
Reports (FSR) using the reporting format and deadlines as required by the
Department through EGrAMS.
Any additional requirements (if applicable)
• All claimable outreach activities must be in support of the Medicaid program.
Activities that are part of a direct service are not claimable as Medicaid Outreach.
• Must maintain documentation in support of administrative claims which are
sufficiently detailed to allow determination of whether the activities were necessary
for the proper and efficient administration of the Medicaid State Plan.
• Must maintain a system to appropriately identify the activities and costs in
accordance with federal requirements.
• Must provide quarterly summary reports of Medicaid outreach activities conducted
during the quarter. The following reporting elements must be included in the
quarterly report:
1. Name of Health Department
2. Name and contact information of the individual completing the report.
3. Time period the report covers (e.g., FY 20: 1st quarter, or October-
December)
4. Types of services provided during the quarter (Note: the types of services
provided do not have to include every single activity the LHD conducted
during the quarter. Rather, simply include examples of the types of services
provided. The Grantee can include as much or as little detail as they
chose.)
5. Number of clients served.
6. Amount of funds expended during the quarter and total expenditures.
7. Number of FTEs who provided these activities.
Successes/Challenges
This is not a reporting requirement but provides an opportunity for the LHD to
share successes during the quarter (e.g., For the first time, someone from the
school board attended the Infant Mortality Reduction Coalition meeting) or to
describe any challenges encountered during the quarter (e.g., the health advocate
quit, and the lactation consultant went on maternity leave, so we are down 2 staff)
PROJECT TITLE: Michigan Adolescent Pregnancy and Parenting
Program
Start Date: 10/1/2022
End Date: 9/31/2023
Project Synopsis:
The goal of Michigan Adolescent Pregnancy and Parenting Program (MI-APPP) is to
create an integrated system of care, including linkages to support services, for pregnant
and parenting adolescents 15-19 years of age, the fathers, and their families. MI-APPP
grantees implement the Adolescent Family Life Program-Positive Youth Development
(AFLP-PYD; a California model), an evidence-informed case management curriculum
designed to elicit strengths, address various risk behaviors, the impact of trauma, and
provide a connection to health care and community services. In addition, MI-APPP
grantees engage communities through locally driven steering committees, a
comprehensive needs assessment, and creation of support services to ensure the
program is responsive to the needs of pregnant and parenting teens.
MI-APPP aims to:
1. Reduce repeat, unintended pregnancies,
2. Strengthen access to and completion of secondary education,
3. Improve parental and child health outcomes, and
4. Strengthen familial connections between adolescents and their support networks
Reporting Requirements (if different than agreement language):
Report Time Period Due Date Submit To
Program
Narrative
October 1- December 31 January 15
Program
Coordinator
January 1-March 31 April 15
April 1-June 30 July 15
July 1-September 30 October 15
Evaluation/Data
Submission Monthly Submit the 10th of
every month REDcap
Any additional requirements (if applicable):
• Information provided must be medically accurate, age-appropriate, culturally
relevant, and up-to-date.
• Pregnancy prevention education must be delivered separate and apart from any
religious education or promotion. MI-APPP funding cannot not be used to
support inherently religious activities including, but not limited to, religious
instruction, worship, prayer, or proselytizing (45 CFR Part 87).
• Family planning drugs and/or devices cannot be prescribed, dispensed, or
otherwise distributed on school property as part of the pregnancy prevention
education funded by MI-APPP as mandated in the Michigan School Code.
• Abortion services, counseling and/or referrals for abortion services cannot be
provided as part of the pregnancy prevention education funded under MI-APPP.
• Must adhere to the Minimum Program Requirements for MI-APPP.
• MI-APPP funding cannot be used to supplant funding for an existing program
supported with another source of funds.
PROJECT TITLE: MI Home Visiting Initiative Rural Expansion
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The Healthy Families America (HFA) program was designed by Prevent Child Abuse
America and is built on the tenants of trauma-informed care. The program is designed to
promote positive parent-child relationships and healthy attachment. It is a strengths-
based and family-centered approach.
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.
a. Staffing Changes: Within 10 days of a staffing change, notify the HFA 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. HFA Work Plan: Due annually on June 30 for preapproval. See the MDHHS Home
Visiting Guidance Manual for requirements related to Work Plan development and
reporting.
c. Work Plan Reports: Must be submitted within 30 days of the end of each quarter
(January 30, April 30, July 30 and October 30).
All reports and/or information (a-c), unless stated otherwise, shall be submitted
electronically to the MDHHS Home Visiting mailbox at MDHHS-
HVInitiative@michigan.gov.
d. Implementation Monitoring Data and HRSA data collection requirements due in
REDCap and/or HVOL by the 5th business day of each month.
e. Quality Improvement Reporting:
• Documentation of a QI team will be submitted with the quarterly Work Plan
Report.
• Documentation of QI activities will be submitted with the quarterly Work
Plan Report.
• Annual summary of QI activities will be submitted to the Model Consultant
by February 15.
f. HV CoIIN Reporting (for those LIAs participating) for QI efforts shall occur in
accordance with the CoIIN’s schedule. Participating LIAs are required to use the
HV CoIIN site to complete monthly submissions of PDSA cycles and required data
(the frequency of data collection may vary).
Reports (d-f) shall be submitted as described above. Additional guidance
concerning data collection and Quality Improvement is provided in the MDHHS
Home Visiting Guidance Manual.
Any additional requirements (if applicable):
The LIA shall serve families as a result of outreach efforts based on the findings of their
MDHHS- HVU Outreach Toolkit.
a. The Healthy Families Northern Michigan HFA Program (operated from the
Health Department of Northwest Michigan in collaboration with District Health
Department #2 and Central Michigan District Health Department) will serve the
applicable number of families in communities experiencing disadvantage per
section d. below.
b. The District Health Department #10 HFA Program will serve the applicable
number of families in communities experiencing disadvantage per section d.
below.
c. The Healthy Families Upper Peninsula (operated from the Luce-Mackinac-
Alger-Schoolcraft Health Department in collaboration with the Western Upper
Peninsula Health Department, Marquette County Health Department,
Dickinson-Iron District Health, and Public Health Delta Menominee counties)
HFA Program will serve the applicable number of families in communities
experiencing disadvantage per section d. below.
d. In general, across all regions, the home visitor-to-family ratio should agree with
the following:
a. 15 families per 1.0 experienced FTE serving one county
b. 14 families per 1.0 experienced FTE serving two counties
c. 12 families per 1.0 experienced FTE serving three or more counties
e. Total FY23 caseloads including experience levels of FSSs and number of
counties served by FSSs are expected as follows:
a. Day One – 6 families FFPSA
b. DHD #10 – 60 families Rural, 8 families FFPSA
c. HFNM – 103 families Rural
d. HFUP – 59 families Rural, 5 families FFPSA
Maintain Fidelity to the Model
The LIA shall adhere to the HFA Best Practice Standards. In addition, all Healthy
Families America affiliates shall comply with the requirements of the Central
Administration for the Multi-Site State System (also known as “The State Office”) housed
within the Michigan Public Health Institute. All HFA model-required training will be
accessed through the Central Administration as available. Contact the HFA State Office
for details.
Comply with MDHHS Program Requirements
The LIA shall operate the program with fidelity to the requirements of MDHHS based on
the agreement executed in E-GrAMS and the conditions as outlined in the MDHHS Home
Visiting Guidance Manual. The LIA will fulfill these requirements while strengthening
efforts towards health and racial equity through staff education, programmatic data
evaluation and client supportive services.
P.A. 291
The LIA shall comply with the provisions of Public Act 291 of 2012. See the MDHHS
Home Visiting Guidance Manual for requirements related to PA 291.
Staffing
The LIA’s HFA home visiting staff will reflect the community served. The LIA will provide
documentation to demonstrate due diligence if unable to fully meet this requirement
within 90 days of a MDHHS site visit in which this was a finding. See the MDHHS Home
Visiting Guidance Manual for requirements related to program staffing.
Performance Measures:
The LIA shall comply with MDHHS expectations of demonstrating improvement in the
performance measures as described in the MDHHS Home Visiting Guidance Manual.
Program Monitoring, Quality Assessment, Support and Technical Assistance (TA):
The LIA shall fully participate with the Department and the Michigan Public Health
Institute (MPHI) with regards to program development and monitoring (including annual
site visits either in-person or virtual), training, support and technical assistance services.
See the MDHHS Home Visiting Guidance Manual for requirements related to program
monitoring, quality assessment, support and TA.
Professional Development and Training:
All of the LIA’s HFA program staff associated with this funding will participate in
professional development and training activities as required by both HFA and the
Department. All LIA HFA
program staff must receive HFA-specific training from a Michigan-based approved HFA
training entity. See the MDHHS Home Visiting Guidance Manual for requirements
related to professional development and training activities.
Supervision:
The LIA shall adhere to the HFA supervision requirements of weekly 1.5 - 2 hours of individual supervision per 1.0 FTE and pro-rated as allowed by the Best Practice Standards. Written policies and procedures shall specify how reflective supervision is included in, or added to, that time to ensure provision for each home visitor at a minimum of one hour per month.
Engage and Coordinate with Community Members, Partners and Parents:
The LIA shall ensure that there is a broad-based community advisory committee that is
providing oversight for HFA.
The LIA shall build upon and maintain diverse community collaboration and support with
authentic engagement of parent representatives who have the lived experience and
expertise.
The LIA shall participate in the Local Leadership Group (LLG) or, if none, the Great Start
Collaborative.
See the MDHHS Home Visiting Guidance Manual for requirements related to
engagement with community partners.
Data Collection:
The LIA shall comply with all HFA and MDHHS data training, collection, entry and
submission requirements. See the MDHHS Home Visiting Guidance Manual for
requirements related to data collection.
Quality Improvement (QI):
The LIA shall participate in all HFA quality initiatives including research, evaluation and
continuous quality improvement.
The LIA shall participate in all state and local Home Visiting QI activities as required by
MDHHS. Required activities include, but are not limited to:
a. Developing and maintaining a QI team
b. Participating in QI activities during the fiscal year
c. Consulting with QI coaches
See the MDHHS Home Visiting Guidance Manual for requirements related to QI.
Work Plan Requirements:
By June 30, the LIA must submit a Work Plan for the next fiscal year to the MDHHS Home
Visiting mailbox (MDHHS-HVInitiative@michigan.gov) for preapproval. See the MDHHS Home
Visiting Guidance Manual for requirements related to Work Plan development and reporting
including Outreach and Retention plans.
Promotional Materials:
If the LIA wishes to produce any marketing, advertising or educational materials using
grant agreement funds, they must follow the requirements outlined in the MDHHS Home
Visiting Guidance Manual.
PROJECT TITLE: Maternal Infant Childhood Home Visiting Program
(MIECHVP) Healthy Families America Expansion
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The Healthy Families America (HFA) program was designed by Prevent Child Abuse
America and is built on the tenants of trauma-informed care. The program is designed to
promote positive parent-child relationships and healthy attachment. It is a strengths-
based and family-centered approach.
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.
a. Staffing Changes: Within 10 days of a staffing change, notify the HFA 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. HFA Work Plan: Due annually on June 30 for preapproval. See the MDHHS Home
Visiting Guidance Manual for requirements related to Work Plan development and
reporting.
c. Work Plan Reports: Must be submitted within 30 days of the end of each quarter
(January 30, April 30, July 30 and October 30).
All reports and/or information (a-c), unless stated otherwise, shall be submitted
electronically to the MDHHS Home Visiting mailbox at MDHHS-
HVInitiative@michigan.gov.
d. Implementation Monitoring Data and HRSA data collection requirements due in
REDCap and/or HVOL by the 5th business day of each month.
e. Quality Improvement Reporting:
• Documentation of a QI team will be submitted with the quarterly Work Plan
Report.
• Documentation of QI activities will be submitted with the quarterly Work
Plan Report.
• Annual summary of QI activities will be submitted to the Model Consultant
by February 15.
f. HV CoIIN Reporting (for those LIAs participating) for QI efforts shall occur in
accordance with the CoIIN’s schedule. Participating LIAs are required to use the
HV CoIIN site to complete monthly submissions of PDSA cycles and required data
(the frequency of data collection may vary).
Reports (d-f) shall be submitted as described above. Additional guidance
concerning data collection and Quality Improvement is provided in the MDHHS
Home Visiting Guidance Manual.
Any additional requirements (if applicable):
Grantee Specific Requirements:
The LIA shall serve families as a result of outreach efforts based on the findings of their
MDHHS-HVU Outreach Toolkit.
a. The Kalamazoo County Health and Community Services Department HFA
program will serve a minimum of 29 families under MIECHV funding plus 22
families under FFPSA. Kalamazoo home visiting programs should prioritize
outreach to families who have low-income and pregnant persons and families
who are African-American, Hispanic, Asian, Native-American, or multi-racial
who have historically experienced racism and are living in the City of
Kalamazoo and adjacent townships. Outreach priorities should also include
families with a history of child abuse or maltreatment, including parents who
were abused as children. In addition, Kalamazoo County should conduct
outreach to young (under 21) pregnant persons and families with low
educational attainment.
b. The Wayne County Babies HFA program will serve a minimum of 50 families
under MIECHV funding plus 40 families under FFPSA. Wayne County should
prioritize low-income families, families with pregnant persons who have not
attained age 21, families with a history of child abuse or neglect (including
parents who experienced abuse as children), families that have low
educational attainment, and families with children with developmental delays or
disabilities. Additionally, Wayne County should prioritize families who have
historically experienced racism, engaging families who identify as African-
American, Hispanic, Asian, Native-American, or multi-racial.
Maintain Fidelity to the Model
The LIA shall adhere to the HFA Best Practice Standards. In addition, all Healthy
Families America affiliates shall comply with the requirements of the Central
Administration for the Multi-Site State System (also known as “The State Office”) housed
within the Michigan Public Health Institute. All HFA model-required training will be
accessed through the Central Administration as available. Contact the HFA State Office
for details.
Comply with MDHHS Program Requirements
The LIA shall operate the program with fidelity to the requirements of MDHHS based on
the agreement executed in E-GrAMS and the conditions as outlined in the MDHHS Home
Visiting Guidance Manual. The LIA will fulfill these requirements while strengthening
efforts towards health and racial equity through staff education, programmatic data
evaluation and client supportive services.
P.A. 291
The LIA shall comply with the provisions of Public Act 291 of 2012. See the MDHHS
Home Visiting Guidance Manual for requirements related to PA 291.
Staffing
The LIA’s HFA home visiting staff will reflect the community served. The LIA will provide
documentation to demonstrate due diligence if unable to fully meet this requirement
within 90 days of a MDHHS site visit in which this was a finding. See the MDHHS Home
Visiting Guidance Manual for requirements related to program staffing.
Performance Measures:
The LIA shall comply with MDHHS expectations of demonstrating improvement in the
performance measures as described in the MDHHS Home Visiting Guidance Manual.
Program Monitoring, Quality Assessment, Support and Technical Assistance (TA):
The LIA shall fully participate with the Department and the Michigan Public Health
Institute (MPHI) with regards to program development and monitoring (including annual
site visits either in-person or virtual), training, support and technical assistance services.
See the MDHHS Home Visiting Guidance Manual for requirements related to program
monitoring, quality assessment, support and TA.
Professional Development and Training:
All of the LIA’s HFA program staff associated with this funding will participate in
professional development and training activities as required by both HFA and the
Department. All LIA HFA program staff must receive HFA-specific training from a
Michigan-based approved HFA training entity. See the MDHHS Home Visiting Guidance
Manual for requirements related to professional development and training activities.
Supervision:
The LIA shall adhere to the HFA supervision requirements of weekly 1.5 - 2 hours of individual supervision per 1.0 FTE and pro-rated as allowed by the Best Practice Standards. Written policies and procedures shall specify how reflective supervision is included in, or added to, that time to ensure provision for each home visitor at a minimum
of one hour per month.
Engage and Coordinate with Community Members, Partners and Parents:
The LIA shall ensure that there is a broad-based community advisory committee that is
providing oversight for HFA.
The LIA shall build upon and maintain diverse community collaboration and support with
authentic engagement of parent representatives who have the lived experience and
expertise.
The LIA shall participate in the Local Leadership Group (LLG) or, if none, the Great Start
Collaborative.
See the MDHHS Home Visiting Guidance Manual for requirements related to
engagement with community partners.
Data Collection:
The LIA shall comply with all HFA and MDHHS data training, collection, entry and
submission requirements. See the MDHHS Home Visiting Guidance Manual for
requirements related to data collection.
Quality Improvement (QI):
The LIA shall participate in all HFA quality initiatives including research, evaluation and
continuous quality improvement.
The LIA shall participate in all state and local Home Visiting QI activities as required by
MDHHS. Required activities include, but are not limited to:
a. Developing and maintaining a QI team
b. Participating in QI activities during the fiscal year
c. Consulting with QI coaches
See the MDHHS Home Visiting Guidance Manual for requirements related to QI.
Work Plan Requirements:
By June 30, the LIA must submit a Work Plan for the next fiscal year to the MDHHS Home
Visiting mailbox (MDHHS-HVInitiative@michigan.gov) for preapproval. See the MDHHS Home
Visiting Guidance Manual for requirements related to Work Plan development and reporting
including Outreach and Retention plans.
Promotional Materials:
If the LIA wishes to produce any marketing, advertising or educational materials using
grant agreement funds, they must follow the requirements outlined in the MDHHS Home
Visiting Guidance Manual.
PROJECT: Minority Health Community Capacity Building Initiative
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The focus of the program is to support culturally and linguistically appropriate community-
level projects that build capacity to identify and implement programs, policies, and
practices to address social determinants of health that contribute to health inequities for
racial and ethnic minority populations in Michigan.
Reporting Requirements (if different than contract language)
Quarterly Narrative Progress Report
Submit quarterly narrative progress reports in accordance with the following
dates:
Reporting Time Period Due Date
October 1 - December 31 January 31
January 1 - March 31 April 30
April 1 - June 30 July 31
July 1 - September 30 October 31
Any additional requirements (if applicable)
A. Ensure that activities implemented under this grant award are in accordance
with established OEMH program standards, as well as State and Federal policy
and statutes including HIPPA.
B. Participate in technical assistance, training, and/or skills enhancement
opportunities as recommended or required by MDHHS/OEMH. Training
participation should include one representative of the Lead Organization
(funded organization), the local evaluator/s, and one representative from a
partner organization in the multi-sector team. Representatives attending the
training will be responsible for the sharing and dissemination of information
received at the training with the complete multi-sectored team.
C. Convene and document agenda and minutes for a minimum of one monthly
multi-sector team meeting to obtain input from team members related to the
progress, barriers, and next steps in the implementation of work plan
objectives. Team meetings may be face to face, conference call, web based.
D. Adhere to timelines and work plans, budgets, and staffing plans submitted and
approved by MDHHS/OEMH. Deviations from approved timelines, work plans,
budgets and staffing plans must receive advance authorization from
MDHHS/OEMH. Failure to make reasonable progress in program development
may result in revocation or reduction of the grant award.
E. Collaborate with evaluation team consisting of OEMH staff and an evaluator.
The contractor must adhere to MDHHS policies and standards related to
Institutional Review Board.
F. Ensure that services and materials are culturally and linguistically appropriate
to meet the needs of the respective client populations.
G. Permit the OEMH staff or its designee to visit and to evaluate the project, on an
annual basis as determined by the Contract Manager. Contractors shall agree
to participate in an annual site visit during the three-year funding cycle The
designated months for completion of program sites visits to be conducted: June
- August
PROJECT TITLE: Nurse Family Partnership (NFP) Services
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
The Nurse-Family Partnership (NFP) program offers families one-on-one home visits with
a registered nurse. The model is grounded in human attachment, human ecology, and
self-efficacy theories. Home visitors use model-specific resources to build on a parent’s
own interests to attain the model goals.
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.
a. Staffing Changes: Within 10 days of a staffing change, notify the NFP 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. Medicaid Outreach Report (Berrien, Calhoun, Kalamazoo and Kent counties only):
Due within 30 days of the end of each quarter.
c. NFP Work Plan: Due annually on June 30 for preapproval. See the MDHHS Home
Visiting Guidance Manual for requirements related to Work Plan development and
reporting.
d. Work Plan Reports: Must be submitted within 30 days of the end of each quarter
(January 30, April 30, July 30 and October 30).
All reports and/or information (a-d), unless stated otherwise, shall be submitted
electronically to the MDHHS Home Visiting mailbox at MDHHS-
HVInitiative@michigan.gov .
e. Implementation Monitoring Data and HRSA data collection requirements due in
REDCap and Flo on the 5th business day of each month.
f. Quality Improvement Reporting:
• Documentation of a QI team will be submitted with the quarterly Work Plan
Report.
• Documentation of QI activities will be submitted with the quarterly Work
Plan Report.
• Annual summary of QI activities will be submitted to the Model Consultant
by February 15.
g. HV CoIIN Reporting (for those LIAs participating) for QI efforts shall occur in
accordance with the CoIIN’s schedule. Participating LIAs are required to use the
HV CoIIN site to complete monthly submissions of PDSA cycles and required data
(the frequency of data collection may vary).
Reports (e-g) shall be submitted as described above. Additional guidance concerning
data collection and Quality Improvement is provided in the MDHHS Home Visiting
Guidance Manual.
Any additional requirements (if applicable):
Maintain Fidelity to the Model:
The LIA shall adhere to the Nurse Family Partnership National Service Office (NSO)
program standards and operate the program with fidelity to the NSO Application Review
Team’s approved Implementation Plan.
Comply with MDHHS Program Requirements:
The LIA shall operate the program with fidelity to the requirements of MDHHS based on
the agreement executed in E-GrAMS and the conditions as outlined in the MDHHS Home
Visiting Guidance Manual. The LIA will fulfill these requirements while strengthening
efforts towards health and racial equity through staff education, programmatic data
evaluation and client supportive services.
Data-Informed Outreach:
Michigan is using NFP as a specialized home visiting service strategy for first-time
mothers who are low-income. This specialized service strategy is a focused way of using
limited resources, directing them to populations who live in communities placing them at
higher risk. The LIA will conduct outreach activities to the population groups identified in
their MDHHS-HVU Outreach Toolkit in order to enroll families from those outreach
efforts.
The MDHHS expects LIAs to maintain a caseload capacity of 25 families per 1.0 FTE.
P.A. 291:
The LIA shall comply with the provisions of Public Act 291 of 2012. See the MDHHS
Home Visiting Guidance Manual for requirements related to PA 291.
Staffing:
The LIA’s NFP home visiting staff will reflect the community served. The LIA will provide
documentation to demonstrate due diligence if unable to fully meet this requirement
within 90 days of a MDHHS site visit in which this was a finding. See the MDHHS Home
Visiting Guidance Manual for requirements related to program staffing.
Performance Measures:
The LIA shall comply with MDHHS expectations of demonstrating improvement in the
performance measures described in the MDHHS Home Visiting Guidance Manual.
Program Monitoring, Quality Assessment, Support and Technical Assistance (TA):
The LIA shall fully participate with the NFP NSO, the Department and the Michigan Public
Health Institute (MPHI) with regards to program development and monitoring (including
annual site visits either in-person or virtual), training, support and technical assistance
services. See the MDHHS Home Visiting Guidance Manual for requirements related to
program monitoring, quality assessment, support and TA.
Professional Development and Training:
All the LIA’s NFP staff associated with this funding will participate in professional
development and training activities as required by the NFP, NSO and the Department.
See the MDHHS Home Visiting Guidance Manual for requirements related to
professional development and training activities.
Supervision:
The LIA shall adhere to the NFP supervision requirements.
Engage and Coordinate with Community Members, Partners and Parents:
The LIA shall ensure that there is a broad-based community advisory committee that is
providing oversight for NFP.
The LIA shall build upon and maintain diverse community collaboration and support with
authentic engagement of parent representatives who have the lived experience and
expertise.
The LIA shall participate in the Local Leadership Group (LLG) or, if none, the Great Start
Collaborative.
See the MDHHS Home Visiting Guidance Manual for requirements related to
engagement with community partners.
Data Collection:
The LIA shall comply with all NFP and MDHHS data training, collection, entry and
submission requirements. See the MDHHS Home Visiting Guidance Manual for
requirements related to data collection.
Quality Improvement (QI):
The LIA shall participate in all NFP quality initiatives including research, evaluation, and
continuous quality improvement.
The LIA shall participate in all state and local Home Visiting QI activities as required by
MDHHS. Required activities include, but are not limited to:
a. Developing and maintaining a QI team
b. Participating in QI activities during the fiscal year
c. Consulting with QI coaches
See the MDHHS Home Visiting Guidance Manual for requirements related to QI.
Work Plan Requirements:
By June 30, the LIA must submit a Work Plan for the next fiscal year to the MDHHS
Home Visiting mailbox (MDHHS-HVInitiative@michigan.gov) for preapproval. See the
MDHHS Home Visiting Guidance Manual for requirements related to Work Plan
development and reporting including Outreach and Retention plans.
Promotional Materials:
If the LIA wishes to produce any marketing, advertising or educational materials using
grant agreement funds, they must follow the requirements outlined in the MDHHS Home
Visiting Guidance Manual.
PROJECT: Oral Health Kindergarten Assessment
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The focus of the program is to perform an oral health assessment of children entering
kindergarten or first grade to help identify dental needs if any. The assessment will provide
information on whether the child needs preventive, restorative or urgent needs, along with the
need for referral for treatment. Data to be gathered by LHD and submitted to the Oral Health
Program for analysis and review.
Reporting Requirements (if different than contract language)
Any additional requirements (if applicable)
PROJECT: Public Health Emergency Preparedness (PHEP)
and
Cities Readiness Initiative (CRI) as applicable
9 Month Project – BIONINE/CRININE
Beginning Date: 10/1/2022
End Date: 6/30/2023
3 Month Project – BIOTHREE/CRITHREE
Beginning Date: 7/1/2023
End Date: 9/30/2023
Project Synopsis
As a Grantee of funding provided through the Centers for Disease Control and
Prevention (CDC) Public Health Emergency Preparedness (PHEP) Cooperative
Agreement, each Grantee shall conduct activities to build preparedness and response
capacity and capability. These activities shall be conducted in accordance with the PHEP
Cooperative Agreement guidance for BP4 (2022-2023) plus any and all related guidance
from the CDC and the Department that is issued for the purpose of clarifying or
interpreting overall program requirements.
Reporting Requirements (if different than contract language)
1. Grantee are required to submit a 3-month (July 1 to September 30) budget and a
9-month (October 1 to June 30) for both Base PHEP and CRI funding, including
the 10% MATCH for those periods (see below for detail regarding Match).
Submitted to MDHHS-BETP-DEPR-PHEP@michigan.gov by April 15, 2022.
2. ALL activities funded through the PHEP cooperative agreement must be
completed between July 1, and June 30, and all BP4 funding must be obligated
by June 30, 2023, and activity completed by the August 15, 2023 Final FSR
submission deadline.
3. Grantee must submit required PHEP program data and reports by the stated
deadlines. This includes, but is not limited to, progress reports, performance
measure data reports, National Incident Management System (NIMS) compliance
reports, updated emergency plans, budget narratives, Financial Status Reports
(FSR), etc. Failure to do so will constitute a benchmark failure. All deliverables
must be submitted by the designated due date in the LHD BP4 work plan.
4. Grantee must maintain National Incident Management System (NIMS) compliance
as detailed in the LHD work plan and submit annually to the Department – DEPR
per the LHD BP4 work plan.
5. Each subrecipient Grantee must retain program-related documentation for
activities and expenditures consistent with Title 2 CFR Part 200; Uniform
Administrative Requirements, Cost Principles and Audit Requirements for Federal
Awards, to the standards that will pass the scrutiny of audit.
Any additional requirements (if applicable)
All Grantee activities shall be consistent with all approved BP4 work plan(s) and
budget(s) on file with the Department through the EGrAMS. In addition to these broad
requirements, the Grantee will comply with the following:
• Grantee provides the required 10% MATCH for July 1 to September 30 and
October 1 to June 30. Grantee are required to submit a letter (on agency
letterhead) stating the source, calculation, and narrative description of how the
match was achieved, unless said match is met using local dollars. This was due
with the narrative budget submission to the Division of Emergency Preparedness
and Response-DEPR.
• One (1) full time equivalent (FTE) emergency preparedness coordinator (EPC)
position, as a point of contact. In addition to the Grantee health officer, the EPC
shall participate in collaborative capacity building activities of the PHEP
Cooperative Agreement, all required reporting and exercise requirements and in
regional Healthcare Coalition (HCC) initiatives. Any changes to this staffing model
must be approved by the Public Health Emergency Preparedness Program
Manager at the Division of Emergency Preparedness and Response (517-335-
8150).
• Under the PHEP cooperative agreements, Grantees must continue to partner with
the Regional Healthcare Coalitions (HCC) and support HCC initiatives to ensure
that healthcare organizations receive resources to meet medical surge demands.
Working well together during a crisis is facilitated by meeting on a regular basis.
To this end, EPCs, supported by CDC PHEP are required to participate in and
support regional HCC initiatives. In addition, the EPC or designee is required to
attend regional HCC planning or advisory board meetings. The intent is for LHDs
that cross regional boundaries to align with one regional coalition.
• There are a number of special initiatives, projects, and/or supplemental funding
opportunities that are facilitated under this cooperative agreement. For example,
the Cities Readiness Initiative (CRI) performance and evaluation initiatives. Each
Grantee that is designated to participate in any of these types of supplemental
opportunities is required to comply with all CDC and the Department – Division of
Emergency Preparedness and Response (DEPR) guidance, and all
accompanying work plan and budgeting requirements implemented for the
purpose of subrecipient monitoring and accountability. Some or all supplemental
opportunities may require separate recordkeeping of expenditures. If so, this
separate accounting will be identified in separate project budgets in the EGrAMS.
These supplemental opportunities may also require additional reporting and
exercise activities.
• All budget amendments must be submitted to the Division of Emergency
Preparedness and Response (DEPR) for review prior to submitting them in the
EGrAMS. Budget amendments that contain line items deviating more than 15% or
$10,000 (whichever is greater) from the original budgeted line item must be
approved by DEPR prior to implementation via email to MDHHS-BETP-DEPR-
PHEP@michigan.gov.
• In response to repeated communications from CDC strongly urging states to
ensure all funds are spent each year a threshold has been established to limit the
amount of unspent funds. A maximum of 2% of the Grantee allocation or $3,000
(whichever is greater) of unspent funds is allowable each budget period. Failure to
meet this requirement, or misuse of funds, will affect the amount that is allocated
in subsequent budget periods.
Unallowable and Allowable Costs
• Grantee may not use funds for research.
• Grantee may not use funds for clinic care except as allowed by law.
• Generally, Grantee may not use funds to purchase furniture or equipment. Any
such proposed spending must be clearly identified in the budget.
• Reimbursement of pre-award costs generally is not allowed unless the CDC
provides written approval to the recipient.
• Other than for normal and recognized executive-legislative relationships, no funds
may be used for:
a. Publicity or propaganda purposes, for the preparation, distribution, or use of
any material designed to support or defeat the enactment of legislation
before any legislative body.
b. The salary or expenses of any grant or contract recipient, or agent acting
for such recipient related to any activity designed to influence the
enactment of legislation, appropriations regulation, administrative action, or
Executive order proposed or pending before any legislative body.
• Lobbying is prohibited.
• The direct and primary recipient in a cooperative agreement must perform a
substantial role in carrying out project outcomes and not merely serve as a conduit
for an award to another party or provider who is ineligible.
• Grantee may not use funds to purchase vehicles to be used as means of
transportation for carrying people or goods, e.g., passenger cars or trucks,
electrical or gas-driven motorized carts.
• Grantee can (with prior approval) use funds to lease vehicles to be used as means
of transportation for carrying people or goods, e.g., passenger cars or trucks and
electrical or gas-driven motorized carts.
• Payment or reimbursement of backfilling costs for staff is not allowed.
• No clothing may be purchased with these funds.
• Items considered as give away such as first aid kits, flashlights, shirts etc., are not
allowable.
• None of the funds awarded to these programs may be used to pay the salary
of an individual at a rate in excess of Executive Level II or $181,500 per year.
• Grantee may not use funds for construction or major renovations.
• Grantee may not use funds to purchase a house or other living quarter for those
under quarantine.
• PHEP funds may not be used to purchase or support (feed) animals for labs,
including mice. Any requests for such must receive prior approval of protocols
from the Animal Control Office within CDC and subsequent approval from the CDC
OGS as to the allowable of costs.
• Grantee may use funds only for reasonable program purposes, including travel,
supplies, and services.
• Grantee may supplement but not supplant existing state or federal funds for
activities described in the budget. Supplantation is the replacement of non-federal
funds with federal funds to support the same activities. Under Public Health
Service Act, Title I, Section 319(c), it strictly and expressly prohibits using
cooperative agreement funds to supplant any current state or local expenditures.
• Grantee may use funds only for reasonable program purposes including
personnel, travel, supplies and services.
• Grantee may (with prior approval) use funds for overtime for individuals directly
associated (listed in personnel costs) with the award.
• Grantee can (with prior approval) use funds to purchase material-handling
equipment (MHE) such as industrial or warehouse-use trucks to be used to move
materials, such as forklifts, lift trucks, turret trucks, etc. Vehicles must be of a type
not licensed to travel on public roads.
• Grantee can use funds to purchase caches of medical or non-medical
Counter measures for use by public health first responders and their families to
ensure the health and safety of the public health workforce.
• Grantee can use funds to support appropriate accreditation activities that meet the
Public Health Accreditation Board’s preparedness-related standards.
Audit Requirement
A grantee may use its Single Audit to comply with 42 USC 247d – 3a(j)(2) if at least once
every two years the awardee obtains an audit in accordance with the Single Audit Act (31
USC 7501 – 7507) and Title 2 CFR, Part 200 Subpart F; submits that audit to and has the
audit accepted by the Federal Audit Clearinghouse; and ensures that applicable PHEP
CFDA number 93.069 are listed on the Schedule of Expenditures of Federal Awards
(SEFA) contained in that audit.
Pandemic and All Hazards Preparedness and Advancing Innovation Act of 2018
Requires the withholding of amounts from entities that fail to achieve PHEP benchmarks.
The following PHEP benchmarks have been identified by CDC and MDHHS-DEPR for
the Fiscal Year:
• Demonstrated adherence to all PHEP application and reporting deadlines.
Grantees must submit required PHEP program data and reports by the stated
deadlines. This includes, but is not limited to, progress reports, performance
measure data reports, National Incident Management System (NIMS) compliance
reports, updated emergency plans, budget narratives, Financial Status Reports
(FSR), etc. Failure to do so will constitute a benchmark failure. All deliverables
must be submitted by the designated due date in the LHD BP4 work plan.
• Demonstrated capability to receive, stage, store, distribute, and dispense medical
countermeasures (MCM) l during a public health emergency, per the LHD BP4
Work Plan.
• Further guidance related to specific preparedness deliverables will be included in
the LHD workplan.
Benchmark Failure
Awardees are expected to “substantially meet” the PAHPIA benchmarks. Per the
Cooperative Agreement, failure to do so constitutes a benchmark failure, which carries an
allowable penalty withholding of funds. Failure to meet any one of the two benchmarks
and/or the spending threshold is considered a single benchmark failure. Any awardee (or
sub-awardee) that does not meet a benchmark, and/or the spending threshold will have
an opportunity to correct the deficiency during a probationary period. If the deficiency is
not corrected during this period, the awardee is subject to a 10% withholding of funds the
following budget period. Failure to meet the pandemic influenza plan requirement
constitutes a separate benchmark failure and is also subject to a 10% withholding. The
total potential withholding allowable is 20% the first year. If the deficiency is not
corrected, the allowable penalty withholding increases to 30% in year two and 40% in
year three.
Regional Epidemiology Support
For those Grantee receiving additional funds to provide workspace for Regional
Epidemiologists, the grantee must provide adequate office space, telephone connections,
and high-speed Internet access. The position must also have access to fax and
photocopiers.
PROJECT TITLE: Regional Perinatal Care System
Start Date: 10/01/2022
End Date: 09/30/2023
Project Synopsis:
The aim of the Regional Perinatal Quality Collaboratives (RQPCs) is to develop data-
driven innovative strategies and efforts that are tailored to the strengths and challenges
of each region to improve maternal, infant, and family outcomes; especially looking at
preterm birth, very low birth weight infants, low birth weight infants, and maternal health.
Furthermore, RPQCs ensure statewide alignment with the strategies and goals outlined
in the Michigan Mother Infant Health and Equity Improvement Plan (MIHEIP) and are
tasked with addressing disparities in birth outcomes and health inequities. Each RPQC
engages cross-sector, diverse stakeholders and implements evidence-based, or
promising practice, interventions utilizing quality improvement methodology.
Reporting Requirements (if different than agreement language):
The Grantee shall submit the following reports on a quarterly basis:
• Report on Aim statement, measures, and corresponding outcomes, as identified
by the grantee and MDHHS, through submission of quarterly progress reports.
• RPQCs will submit quarterly narrative reports summarizing member agency
efforts, new partnerships, community achievements, member participation in and
status of other MDHHS initiatives, as well as the composition and number of
attendees at each Collaborative meeting. This report will be submitted with the
quarterly progress report to the Contract Manager, Emily Goerge, via email at:
GoergeE@michigan.gov. A template for the narrative report will be provided.
• RPQCs will be required to report on the number of participants with ‘active
membership’ in their quarterly progress reports. See definitions below for what
qualifies as ‘active membership’.
Any such other information as specified above shall be developed and submitted by the
Grantee as required by the Contract Manager.
Any additional requirements (if applicable):
• In alignment with the Regional Perinatal Quality Collaborative’s (RPQC) role of
authentically engaging families and convening diverse stakeholders, the
Collaborative must be comprised of a multi-stakeholder and diverse membership;
ensuring to recruit families, faith-based organizations, clinicians, Medicaid Health
Plans, community-based organizations, business partners, and etcetera.
• MDHHS stresses the importance of garnering the input and feedback of families
most impacted by adverse birth outcomes. Therefore, continuing in fiscal year
2023, there must be family representation in the RPQC’s membership
• Family engagement is essential to the success of the RPQCs and can be fostered
via various avenues, for example: family groups through Great Start Collaborative
and Children Special Health Care Services, community centers, local churches,
focus groups, parent panel and etcetera
• RPQCs are expected to convene periodic (with frequency of at least quarterly)
collaborative meetings, inclusive of diverse regional partners, to garner feedback
and discussion, including but not limited to, regional maternal and infant vitality
concerns, review of data, analysis of gaps in care and birth outcomes, quality
improvement efforts, alignment with the Mother Infant Health and Equity
Improvement Plan and etcetera
*The collaborative meetings are to be in addition to any leadership or steering
team meetings that the RPQC may choose to convene as oversight for the RPQC.
Definitions
Active membership is defined as attending a minimum of two (2) Collaborative
meetings, participating in RPQC quality improvement efforts, reporting out on their
respective agency’s efforts related to maternal and infant mortality, and etcetera
Family active membership is defined as a family presence at a minimum of two
(2) Collaborative meetings, garnering family input at least twice per fiscal year,
and/or participation in the planning or implementation of quality improvement
efforts
• Family and community presence should comprise 10% of the RPQC’s active
membership.
Membership includes, but is not limited to:
• Families
• Clinicians
• Community-based organizations
• Local public health
• Medicaid health plans
• Faith-based organizations
• Business partners
• Others
To ensure regional stakeholders are aligned with the Mother Infant Health and Equity
Improvement Plan (MIHEIP), RPQCs will need to infuse maternal and infant Statewide
initiatives into their Collaborative (example: MMMS, FIMR, MI AIM, CDR, etc.)
• Each Collaborative will dedicate time during meetings for members to share
updates, as well as time for reporting out on participation in other Statewide
initiatives.
• Continuing in fiscal year 2023, RPQCs will specifically be required to:
1. Invite MI-AIM leads to share region-specific MI-AIM efforts at two (2) fiscal
year 2023 collaborative meetings. A list of MI-AIM leads in the region can
be obtained from your assigned State consultant.
2. Know the current MI-AIM designation status of the birthing hospitals in their
respective region.
• The names and titles of the RPQC leadership, and the Quality Improvement
project team leads, for fiscal year 2023, must be identified on the work plans
submitted to the Contract Manager via email, GoergeE@michigan.gov
• Selected quality improvement objective(s), corresponding evidence-based or
promising practices intervention(s), and all efforts put forth, must align with the
MIHEIP
All quality improvement efforts must:
• Be data driven.
• Utilize quality improvement methodology.
• Address disparate outcomes.
• Utilize evidence-based and/or promising practices interventions that address
improving outcomes for mothers, infants, and families.
• RPQCs must also actively address health inequities, social determinants of
health, and disparate outcomes throughout all efforts and as inclusive of their
dedication to improving birth outcomes
• As the RPQCs are a conduit to the community, the region must provide
representation at MIHEIP-related MDHHS meetings, such as the Mother Infant
Health and Equity Collaborative (MIHEC) meeting and the State Perinatal Quality
Collaborative meetings (i.e., RPQC Leadership meetings).
1. Attendance is required unless prior approval received from State consultant.
2. For MIHEC meetings, each RPQC should have two attendees present, with at
least one representing the leadership team.
3. For the quarterly State Perinatal Quality Collaborative meetings, at least two
members of the RPQC leadership team are required to attend.
4. Each region will be required to report on their efforts, challenges, successes
and etcetera at one of the quarterly MIHEC meetings.
5. Regional collaborative leadership is expected to work collectively with assigned
State consultant and other members of the MIHEIP team.
Budget Allowances
To ensure most of the awarded funding is funneled into the community for quality
improvement efforts:
• Budgets line items for external consultants must be capped at 25% for
contractors/consultants who have been hired as subject matter experts.
• Budgets must be capped at 75% for contractors hired to carry out the quality
improvement tasks of the collaborative.
PROJECT TITLE: SEAL! MI
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
SEAL! MI is the School Based Dental Sealant Program, providing oral health
prevention to students in Michigan schools.
Reporting Requirements (if different than agreement language):
• Quarterly Report Dental Sealant Tracking Form’s at the end of each quarter to the
Michigan Department of Health and Human Services Oral Health Program.
• Submit completed copies of the SEAL! MI MDHHS Student Data and Event Data
forms within two weeks of the end of the fiscal year and upon request.
Any additional requirements (if applicable):
• All program staff (paid and unpaid) must attend the annual SEAL! MI Training via
webinar.
• At least one person from program must attend the SEAL! MI Annual Workshop, in
person, all day.
• All monies collected from insurance billing from dental sealants must be allocated
back into the SEAL! MI program (equipment, staff, supplies, travel, incentives
etc.).
• There must be one EXTRA complete treatment set up available for program use in
the event of equipment failure (including: portable dental unit, curing light, Isolite
other isolation system, patient chair, operator light and operator chair).
• Patient privacy screens must be available for use
• Any MDHHS infection control policies specific to Covid-19 must be followed in all
SEAL! Michigan events.
PROJECT: Sexual Violence Prevention
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
This project will be used continue to implement community and societal-level approaches
to build capacity of current and future healthcare professionals to prevent sexual
violence.
Reporting Requirements (if different than contract language)
• Submit programmatic quarterly reports in REDCaps on January 15th, April 15th,
July 15th, and October 15th.
• Submit financial information documenting program expenses for January 1-31,
2023, by March 15, 2023.
Any additional requirements (if applicable)
Complete Required Disclosures for Federal Awardee Performance and Integrity
Information System (FAPIIS): Consistent with 45 CFR 75.113, applicants and recipients
must disclose in a timely manner, in writing to the CDC, with a copy to the HHS Office of
Inspector General (OIG), all information related to violations of federal criminal law
involving fraud, bribery, or gratuity violations potentially affecting the federal award.
Subrecipients must disclose, in a timely manner in writing to the prime recipient (pass
through entity) and the HHS OIG, all information related to violations of federal criminal
law involving fraud, bribery, or gratuity violations potentially affecting the federal award.
Disclosures must be sent in writing to the CDC and to the HHS OIG at the following
addresses:
CDC, Office of Grants Services
Monique Tatum, Grants Management Officer/Specialist
Centers for Disease Control and Prevention
OGS BRANCH 5
2939 Flowers Rd
Atlanta, Ga 30341
AND
U.S. Department of Health and Human Services
Office of the Inspector General
ATTN: Mandatory Grant Disclosures, Intake Coordinator
330 Independence Avenue, SW
Cohen Building, Room 5527
Washington, DC 20201
Fax: (202)-205-0604 (Include “Mandatory Grant Disclosures” in subject line) or Email:
MandatoryGranteeDisclosures@oig.hhs.gov
Recipients must include this mandatory disclosure requirement in all subawards
and contracts under this award.
Failure to make required disclosures can result in any of the remedies described in 45
CFR 75.371. Remedies for noncompliance, including suspension or debarment (See 2
CFR parts 180 and 376, and 31 U.S.C. 3321).
PROJECT TITLE: Sexually Transmitted Infection (STI) Control
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
Sexually Transmitted Infections (STIs) result in excessive morbidity, mortality, and health
care cost. Women, especially those of child-bearing age, and adolescents are particularly
at risk for negative health outcomes. Local health STI programs ensure prompt reporting
of cases, provide screening and treatment services for Michigan's citizens, and respond to
critical morbidity increases in their jurisdiction.
Reporting Requirements (if different than agreement language):
Report Period Due Date(s) How to Submit Report
STI 340B
Utilization/
Inventory
Report
Quarterly
Within 10 days
after the end of the
quarter
Log into SGRX340BFlex.com website,
generate a quarterly report on the
reporting tab, and it will be transferred
automatically to ScriptGuide/DHSP
Any additional requirements (if applicable):
Grant Program Operation
1. Maintain core STI clinical service, including prioritizing the testing, treatment of
individuals referred by MDHHS DIS; this includes people reported with a positive
lab result and those identified as contacts to incident cases of syphilis, gonorrhea,
and HIV.
2. Participate in technical assistance/capacity development, quality assurance, and
program evaluation activities as directed by Division of HIV and STI
Programs/Sexually Transmitted Infections (DHSP/STI).
3. Implement program standards and practices to ensure the delivery of culturally,
linguistically, and developmentally appropriate services. Standards and practices
must address sexual minorities.
4. For gonorrhea and chlamydia cases in the Michigan Disease Surveillance System,
50% shall be completed within 30 days and 60% within 60 days from the date of
specimen collection.
5. For gonorrhea and chlamydia cases, develop plans to respond to issues in quality,
completeness, and timeliness.
Mandatory Disclosures
1. Inform DHSP/STI at least two weeks prior to changes in clinic operation (hours,
scope of service, etc.).
Technical Assistance
1. Technical assistance (TA) requests must be submitted via the MDHHS SHOARS
system. In addition, if your contract is to be amended, the request will have to be
logged into SHOARS. Registration instructions and further information can be
found at: https://bit.ly/3HS7xdG
2. Recipient agency must register an Authorized Official and Program Manager in the
DHSP SHOARS system. These roles must match what the agency has listed for
these roles in the EGrAMS system. If you have access related questions, contact
MDHHS-SHOARS-SUPPORT MDHHS-SHOARS-SUPPORT@michigan.gov
PROJECT TITLE: Sexually Transmitted Infection (STI) Specialty Services
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
Sexually Transmitted Infections (STIs) result in excessive morbidity, mortality, and health
care cost. The purpose of this project is to provide a community access point for specialty
STI clinical service with a focus on the LGBTQ+ community.
Reporting Requirements (if different than agreement language):
Report Period Due Date(s)
How to
Submit
Report
Quarterly Progress Report &
Data Report Quarterly 30 days after the end
of the quarter
Email to
MDHHS
contract liaison
Any additional requirements (if applicable):
Mandatory Disclosures
Inform the Division of HIV and STI Programs (DHSP) at least two weeks prior to
changes in clinic operation (key staff, hours of operation, scope of service, etc.).
Technical Assistance
1. Technical assistance (TA) requests must be submitted via the MDHHS SHOARS
system. In addition, if your contract is to be amended, the request will have to be
logged into SHOARS. Registration instructions and further information can be
found at: https://bit.ly/3HS7xdG
2. Recipient agency must register an Authorized Official and Program Manager in the
DHSP SHOARS system. These roles must match what the agency has listed for
these roles in the EGrAMS system. If you have access related questions, contact
MDHHS-SHOARS-SUPPORT MDHHS-SHOARS-SUPPORT@michigan.gov
PROJECT TITLE: Southeast MI Infant Vitality
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
In 2019 Michigan achieved its lowest infant mortality rate both Statewide and in the City
of Detroit. This initiative is intended to provide insight into what may have led to the
decreased rate. The proposed initiative focuses on creating a comprehensive, collective
analysis of events, programs, and preventative efforts aimed at reducing infant mortality
within the City of Detroit, Wayne, Oakland, and Macomb counties in 2019 and in the
years preceding with the goals of garnering insight into actions that can be taken to
sustain health gains and inform decision making within systems and policy. This will be
achieved by partnering with community stakeholders, investigating qualitative and
quantitative data, and analyzing vital records. The recommendations will be compiled,
reported and used to inform the next iteration of the States Mother Infant Health &
Equity Improvement Plan.
Reporting Requirements (if different than agreement language):
The Grantee shall submit the following reports at the end of the Grant Cycle:
•Grantee will be required to partner with key informants, organizations, and
entities in the gathering and collating of information regarding successful
programming interventions and a comprehensive understanding of thriving
mothers and infants for 2019 and preceding years.
•Grantee will be required to hold at least 4 strength-based discussion sessions,
community conversations, and/or listening sessions to garner feedback from the
community, this includes the communities’ views on successful programming and
interventions, and their feedback on current and recommended policy and
regulation related to maternal and infant health outcomes.
•An asset-based report on the above data is required by the end of the grant
cycle, this should include any relevant mixed methods data, discussion sessions,
community conversations, listening sessions, surveys, and recommendations.
The final contract report is due by October 31 (30 days after the agreement end
date).
• Grantees are expected to submit quarterly work plan updates.
• The report and workplan will be submitted to the Contract Manager, Heather
Boyd, via email at: BoydH1@michigan.gov.
Any additional requirements (if applicable):
• MDHHS stresses the importance of authentically engaging families and
convening diverse stakeholders, the asset-based assessments and strength-
based discussion sessions and listening sessions should include multi-
stakeholder and diverse participation; ensuring to recruit families, faith-based
organizations, clinicians, Medicaid Health Plans, community-based
organizations, community leaders, grass roots organizations, business partners,
and etcetera.
• Grantees are expected to meet periodically with MDHHS and the Southeast
Michigan partners working on the Infant Vitality project (Partnering organizations
include, but are not limited to, Birth Detroit, Focus: Hope & the Southeast
Michigan Perinatal Quality Improvement Coalition (SEMPQIC), as well as the
Wayne, Oakland, Macomb, and the City of Detroit Health Departments.)
PROJECT: Statewide Lead Case Management
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
All local health departments in Michigan are eligible to participate in this program to
receive reimbursement for nursing case management services to children not enrolled
in Medicaid, as well as reimbursement for community health workers (CHWs) to
complete case management activities. This will allow LHD nurses to offer case
management to all children regardless of insurance status. NCM visits will be
reimbursed at a rate of $201.58 and community health worker visits at a rate of $100.
This funding is to support local health departments in providing case management
services to all children with elevated blood lead levels in Michigan. All services should
be provided according to CLPPP guidance documents for case management for nurses
and community health workers.
Reporting Requirements (if different than contract language)
Quarterly FSR and FSR Supplemental Attachment
Submit request for reimbursement through the EGrAMS system based on the “fixed unit
rate” method. The fixed rate for case management services is $201.58 per home visit,
for up to 6 home visits and $100 for community health worker visits, for up to 2 visits.
Additionally, a FSR supplemental attachment form is required to be uploaded in
EGrAMS that specifies the number of children and home visits for which reimbursement
is being requested on. The FSR and the FSR supplemental attachment form must be
submitted no later than thirty (30) days after the close of the quarter.
Quarterly Case Management Logs
A complete spreadsheet of CM activities is due quarterly, submitted electronically
through the CLPPP’s secure DCH-File Transfer Site available through MiLogin, using a
template provided by CLPPP. There are two spreadsheets, one for nursing case
management and one for community health worker visits. The quarterly spreadsheets
must be submitted no later than thirty (30) days after the close of the quarter.
Annual Report
An Annual Report covering the reporting period for FY23 is October 1 – September 30.
The format and due date for the submission will be determined by CLPPP,
communicated to the local health departments.
Any additional requirements (if applicable)
Continuation of this project is contingent upon funding availability.
The local health department shall:
• For NCM visits, have home case management conducted by a registered nurse
trained by MDHHS CLPPP. To be reimbursed for a home visit, the visit must be
completed by a registered nurse.
• For CHW visits, have home case management conducted by a certified
community health worker trained by MDHHS CLPPP. To be reimbursed for a
home visit, the visit must be completed by a certified community health worker.
• Sign up for the DCH-File Transfer Site available through MiLogin maintained by
MDHHS CLPPP, to be used for data sharing of confidential information.
• Complete case management activities according to the MDHHS CLPPP Case
Management Guide.
• Document all required case management activities in the child’s electronic file in
the HHLPPS database. Required documentation includes an initial home visit
form, follow-up visit forms, dates of chelation therapy, and plan of care.
PROJECT: TAKING PRIDE IN PREVENTION (TPIP)
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The purpose of this project is to implement a comprehensive, evidence-based teen pregnancy
prevention program for youth 12-19 years of age.
Reporting Requirements
The Grantee shall submit the following reports and data via the appropriate reporting
mechanism on the dates specified below:
Report Time Period Due Date Submit To
Work Plan
October 1 - December 31 January 31
EGrAMS
https://egrams-mi.com/mdhhs
January 1 - March 31 April 15
April 1 - June 30 July 31
July 1 - September 30 October 15
Program
Narrative
October 1 - December 31 January 31
EGrAMS
https://egrams-mi.com/mdhhs
January 1 - March 31 April 15
April 1 - June 30 July 31
July 1 - September 30 October 15
Participant
Level Data
(Youth)
October 1 - December 31 January 15
REDCap
https://chc.mphi.org
January 1 - March 31 April 5
April 1 - June 30 July 15
July 1 - September 30 October 5
Program
Level Data
(Parents)
October 1 - December 31 January 15
REDCap
https://chc.mphi.org
January 1 - March 31 April 5
April 1 – June 30 July 15
July 1 - September 30 October 5
Program
Level Data
(Performance
Measures)
October 1, 2022 –
September 30, 2023
(MPHI will open this data section in
REDCap in June)
July 15 REDCap
https://chc.mphi.org
Fidelity Logs February 2023 March 31 Email to MDHHS
andersonk10@michigan.gov May 2023 June 30
A. Any other information, as specified in the Statement of Work and TPIP Report Fact Sheet,
shall be developed and submitted by the Grantee as required by the Contract Manager.
Additional Program Requirements
• TPIP programs must serve 80, 175 or 250 unduplicated youth each fiscal year (FY) who
complete at least 75% of the program, which is determined by the intensity level of the
selected curriculum:
• TPIP programming must be delivered separate and apart from any religious education or
promotion and funding cannot be used to support inherently religious activities including,
but not limited to, religious instruction, worship, prayer, or proselytizing.
• Family planning drugs and/or devices cannot be prescribed, dispensed, or otherwise
distributed on school property at any time, including as part of the pregnancy prevention
education funded under TPIP.
• Abortion services, counseling and/or referrals for abortion services cannot be provided as
part of the pregnancy prevention education funded under TPIP.
• TPIP funding may not be used to pay for costs associated with health care services, for
which referrals are made.
• TPIP funding may not be used for fundraising activities, political education, or lobbying.
• TPIP grantees must adhere to all of the TPIP Minimum Program Requirements (MPRs)
• The Grantee shall permit the Department or its designee to visit and to make an
evaluation of the projects as determined by the Contract Manager.
Approved Curriculum Intensity
Level Target Number Minimum Target
Number
Number of unduplicated
youth who complete at
least 75% of program
each FY
90% of the target
number
Teen Outreach Program
(TOP) High 80 72
Michigan Model-Healthy &
Responsible Relationships Medium 175 156
Making Proud Choices Low 250 225
PROJECT: Tobacco Control Grant Program
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
The focus of the program is to reduce tobacco use by Michigan residents by providing an
evidence-based telephonic tobacco cessation counseling program which will be titled as
the Michigan Tobacco Quitline.
Reporting Requirements (if different than contract language)
The Grantee shall submit the following reports on the following dates:
1. Evaluation data tracking tool bi-annually in April 15 and October 15 (format to be
provided by MDHHS TCP).
2. Quarterly progress reports are due January 15, April 15, July 15, and October 15,
2023.
Any additional requirements (if applicable)
• Grantee will create action plans for any recommendation of the MDHHS TCP
Contract Manager. Grantee will meet weekly with the MDHHS TCP Contract
Manager.
• Grantee will submit twice monthly budget projections (October 2022-February
2023) and weekly projections the last 2 months of the CDC budget (March 2023-
April 2023) and the SOM Fiscal Year (August 2023-September 2023).
• Grantee will submit 2022 outcomes report for enrollees to the Michigan Tobacco
Quitline by May 1 2023.
PROJECT: Transforming Youth Suicide Prevention
Start Date: 10/1/2022
End Date: 09/30/2023
Project Synopsis
The Transforming Youth Suicide Prevention project focuses on early identification and
intervention of suicide risk in young adults aged 18-24 years old via creative marketing,
trainings, and loss support group facilitation.
Reporting Requirements (if different than contract language)
The Grantee shall submit the following reports on the following dates:
1. An Annual Report, to include a summary of activities, challenges, and successes
is due by September 1. The format and information to be concluded will be
determined by MDHHS in consultation with the Grantee.
2. Quarterly Reports, to include agreed upon evaluation metrics and activities,
challenges, and successes, will be due 15 days after the end of each quarter.
3. Reports and information shall be submitted to the Contract Manager by e-mail to
decampl@michigan.gov.
a. Any request for extension of a reporting deadline must be approved in
advance by MDHHS and may not exceed an additional 5 business days
from the original due date.
Any additional requirements (if applicable)
The Grantee shall permit the Department or its designee to visit and to make an
evaluation of the project as determined by Contract Manager
PROJECT: Tuberculosis Control
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
Each Grantee as a sub-recipient of the CDC Tuberculosis Elimination
Cooperative Agreement shall conduct activities for the purposes of tuberculosis
control and elimination.
• Funds may be used to support personnel, purchase equipment and supplies,
and provide services directly related to core TB control front-line activities, with
a priority emphasis on DOT (Directly Observed Therapy) and electronic DOT,
case management, completion of treatment and contact investigations.
• Funds may also be used to support incentive or enabler offerings to
mitigate barriers for patients to complete treatment.
• Disallowed Costs: Federal (CDC) guidelines prohibit the use of these funds
to purchase anti-tuberculosis medications or to pay for inpatient services.
• Examples of appropriate incentive/enabler offerings include retail coupons,
public transit tickets, food, non-alcoholic beverages, or other goods/services that
may be desirable or critical to a particular patient.
For more information and suggested uses of incentive/enabler options, refer to
CDC's Self-Study Module #6, Managing Tuberculosis Patients and Improving
Adherence, at Self-Study Modules - Continuing Education Activities | TB | CDC.
Reporting Requirements (if different than contract language)
DOT Logs are maintained on site and available if needed. All other data must be entered
into MDSS as stipulated in contract specific requirements.
Ensure that confidential public health data is maintained and transmitted to the
Department in compliance with applicable standards defined in the "CDC Data
Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted
Diseases, and Tuberculosis Programs"
http://www.cdc.gov/nchhstp/programintegration/docs/PCSIDataSecurityGuidelines.pdf
Any additional requirements (if applicable)
• Utilize DOT as the standard of care to achieve at minimum 80% of TB cases
enrolled in DOT or electronic DOT (Jan 1- Dec 31).
• Document in Michigan Disease Surveillance System (MDSS) all changes to
treatment regimen using the Report of Verified Case of Tuberculosis (RVCT)
comments field (pg. 12), and completion of therapy using RVCT Follow-Up 2 (pg.
7).
• Maintain evidence of monthly DOT logs on site (to be made available if needed).
Submission of DOT logs to the MDHHS TB Program is not required.
• Achieve at least 94% completion of treatment within 12 months for eligible TB
cases. The determination of treatment completion is based on the total number of
doses taken, not solely on the duration of therapy. Consult the most current ATS
document Treatment of Tuberculosis for guidance in the number of doses needed
and the length of treatment required following any interruptions in therapy.
• Maintain appropriate documentation on site (to be made available if needed).
Document the appropriate use of expenditures for incentive and enablers for
clients to best meet their needs to complete appropriate therapy.
• Ensure >90% completion of RVCT pages 1 - 6 in MDSS within one month of
diagnosis.
Unallowable Costs per federal guidelines
• Funds cannot be used for procurement of anti-tuberculosis medications.
• Funds cannot be used for research.
• Funds cannot be used for inpatient services.
PROJECT: Vector-Borne Disease Surveillance
Beginning Date: 4/1/2023
End Date: 9/30/2023
Project Synopsis
This agreement is intended to support the development of vector-borne disease
surveillance and control capacity at the local health department level. Funds may be used
to support a low-cost, community-level surveillance system for 1) the early detection of
arbovirus threats by identifying potential invasive mosquito vectors or local virus
transmission in mosquitoes and 2) populations of ticks including Ixodes scapularis,
Amblyomma americanum, and Haemaphysalis longicornis. This information can be
utilized by participating local health departments to notify its citizens of any local
transmission risk using education campaigns and to potentially work with local
municipalities to conduct vector control activities such as drain management, scrap-tire
campaigns, breeding site removal, landscape modifications, or pesticide application.
Requirements for participation in this program include providing for the placement of a
minimum number of mosquito traps, operating for at least five “trap-nights” per week,
conducting a minimum number of targeted tick “drags,” and identifying ticks and
mosquitoes. Bi-weekly (occurring every two weeks) reporting to MDHHS of grant
activities is also required. MDHHS EZID should be notified immediately if an invasive
mosquito or tick species is identified.
Reporting Requirements (if different than contract language)
The subrecipient shall submit bi-weekly tables of surveillance data (template provided)
documenting trap rates and disease detections to Emily Dinh (dinhe@michigan.gov) and
Rachel Wilkins (rwilkins3@michigan.gov) at the MDHHS EZID Section.
• A final report on all activities completed is due by October 15, 2023.
Any additional requirements (if applicable)
• Mosquito and/or Tick Surveillance
• Minimum recommended mosquito and tick surveillance effort according to the
point formula in Table 1 (below) over a period of 14 weeks.
• Provide bi-weekly reporting of surveillance results to MDHHS EZID Section (see
contact information below).
• Use surveillance data to notify the public of risks related to vector borne disease in
mosquitoes or ticks in the jurisdiction.
• The total funds allocated for this project to participating local health departments
must be utilized prior to September 30.
• Each local health department as a sub-recipient of the State of Michigan Emerging
Public Health Funds shall conduct activities for the purposes of mosquito and tick
surveillance in their jurisdiction. For mosquito surveillance, funds may be used to
support personnel, to purchase equipment and supplies related to conducting
mosquito surveillance in areas of historically high incidence of arboviral disease,
and to produce and distribute educational and other materials related to mosquito-
borne disease prevention and control. For tick surveillance, funds may be used to
support personnel, to purchase equipment and supplies, and to produce and/or
distribute educational and other materials related to tick-borne disease prevention
and control.
• Activities can be conducted according to the needs of the local jurisdiction but
must conform to the point allocation formula in the table below. For instance, if
mosquitoes are more of a concern in the jurisdiction, the funded LHD can focus its
efforts on mosquito surveillance, educational activities, etc. If ticks are more of a
concern in the jurisdiction, the funded LHD can focus its efforts on tick
surveillance, educational activities, etc.
Local Health Department VBDSP Activity Formula
*Devices can include BG-2 traps, CDC light traps, resting boxes, etc.
Activity Required
Activity / Weeks
Metric
5 mosquito collection devices*
placed for 24-hour period
20/10 Report to MDHHS bi-weekly
2 mosquito collection devices*
placed for 24-hour period in
August
2/4 Report to MDHHS bi-weekly
1,000 meter tick drag 4 / 2 Report to MDHHS bi-weekly
Educational outreach activity /
event
Report to MDHHS bi-weekly
Press release Report to MDHHS bi-weekly
Coordination of control efforts
with local municipalities / other
prevention efforts
Report to MDHHS bi-weekly
PROJECT: West Nile Virus Community Surveillance
Start Date: 5/1/2023
End Date: 9/30/2023
Project Synopsis
This agreement is intended to support the development of a low-cost surveillance
system for the early detection of West Nile virus in mosquitoes at the community level,
for the purpose of educating the public and healthcare providers and preventing
outbreaks. This information can be utilized by participating local health departments to
notify its citizens and healthcare providers of any local transmission risk using education
campaigns, press-releases and other means, and to potentially work with local
municipalities to conduct mosquito population mitigation activities such as drain
management, scrap-tire campaigns, breeding site removal, larviciding, and adulticiding.
Requirements for participation in this program include providing for the placement of a
minimum number of mosquito traps, operating for at least two “trap nights” per week,
identifying mosquitoes, and weekly reporting to the Department of surveillance results.
Reporting Requirements (if different than contract language)
The Grantee shall submit weekly tables of surveillance data (template provided)
documenting trap rates and disease detections to Emily Dinh (dinhe@michigan.gov),
and Rachel Wilkins (wilkinsr3@michigan.gov) at the MDHHS EZID Section.
• A final report on all activities completed is due by October 15, 2023.
Any additional requirements (if applicable)
Each Grantee as a sub-recipient of the Centers for Disease Control and Prevention
(CDC) Epidemiology and Laboratory Capacity Cooperative Agreement shall conduct
activities for the purposes of West Nile virus (WNV) surveillance among mosquito
populations in their jurisdiction. Funds may be used to support personnel and travel, to
purchase equipment and supplies related to conducting mosquito surveillance in areas
of historically high incidence of WNV, and to produce and/or distribute educational and
other materials related to West Nile virus prevention and control.
Mosquito Surveillance:
• Minimum recommended mosquito traps for this project is 5 traps utilized per
county, operating 2 nights per week for a total of 10 “trap nights” per week for
approximately 16 weeks.
• Provide weekly reporting of surveillance results to the Department EZID Section
(see contact information below).
• Use surveillance data to notify the public and healthcare providers of any risk
related to West Nile Virus in mosquitoes in the jurisdiction.
• The total funds allocated for this project to participating local health departments
must be utilized prior to September 30.
PROJECT TITLE: Wisewoman
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis:
WISEWOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation)
is a program designed to screen women for chronic disease risk factors, counsel them
about lifestyle changes to reduce risk factors, and refer them for medical treatment of
hypertension, hyperlipidemia, and/or diabetes mellitus.
Reporting Requirements (if different than agreement language):
All Grantees implementing WISEW OMAN shall submit Quarterly Progress Reports Period Covered Report Due
October 1 - December 31 January 31
January 1 - March 31 April 30
April 1 - June 30 July 31
July 1 - September 30 October 31
Quarterly Reports shall be submitted to the Program Director:
Courtney Cole
E-mail: ColeC13@michigan.gov
Each agency must provide matching funds in the amount of $1 for each $3 of Coordination dollars. A WISEWOMAN Matching Funds Report form along with instructions is issued by MDHHS for LCAs to use for documentation of amounts and types of community match. It is available at www.michigan.gov/wisewoman The Matching Funds Report should be submitted in EGrAMS as an attachment to the final Financial Status Report.
Any additional requirements (if applicable):
Instructions for contractor use of MBCIS, the statewide database, are provided in
manuals for programs that contribute data to this database. The CPCS will exchange
relevant program reports with appropriate contractors through a secure file transfer
system, as noted in the same program manuals.
For specific WISEWOMAN Program requirements, refer to the most current
WISEWOMAN Program Manual available at www.michigan.gov/wisewoman.
PROJECT: Women Infant Children (WIC)
WIC Breastfeeding
WIC Migrant
WIC Resident
WIC Special Supplemental
Start Date: 10/1/2022
End Date: 9/30/2023
Project Synopsis
Women, Infants, and Children (WIC) is a federally funded Special Supplemental
Nutrition Program of the Food and Nutrition Service of the United States Department of
Agriculture and is administered by the Michigan Department of Health and Human
Services to serve low and moderate income pregnant, breastfeeding, and postpartum
women, infants, and children up to age five who are found to be at nutritional risk
through its statewide local WIC agencies.
WIC is a health and nutrition program that has demonstrated a positive effect on
pregnancy outcomes, child growth and development. The program provides a
combination of nutrition education, supplemental foods, breastfeeding promotion and
support, and referrals to health care. Participants redeem WIC food benefits at
approved retail grocery stores and pharmacies. WIC foods are selected to meet nutrient
needs such as calcium, iron, folic acid, vitamins A & C.
Reporting Requirements (if different than contract language)
• A Financial Status Report (FSR) must be submitted to the Department on a
quarterly basis by deadlines as defined by MDHHS Expenditure Operations.
Grantees shall (when requested) annually report expenditures on a supplemental
form, if needed and required, to be provided by the Department and attached to the
final Financial Status Report (FSR) which is due on November 30 after the end of the
fiscal year in EGrAMS.
• As part of the Breastfeeding Peer Counseling Grant, the Grantee must submit
quarterly progress reports to the State Breastfeeding Peer Counselor
Coordinator (or designee) by the 15th of the month following end of quarter.
• Funds allocated for the Breastfeeding Peer Counseling Program are exempt
from the WIC Nutrition Education and Breastfeeding Time Study.
Additional Requirements
• The Grantee is required to comply with all applicable WIC federal regulations,
policy and guidance.
• The Grantee is required to comply with all State WIC Policies.
• The Grantee is required to complete the NE and BF Time Study as instructed by the
MDHHS WIC Program. Breastfeeding Peer Counseling grant, if supported with
funds allocated through the WIC funding formula, must report as time study data.
• The Grantee must follow the allowable expense guidelines provided by USDA
FNS for the Peer Counselor Grant.
The primary purpose of these funds is to provide breastfeeding support services
through peer counseling to WIC participants. The Grantee must follow the
staffing requirements as set forth in the WIC Breastfeeding Model Components
for Peer Counseling and through a signed allocation letter for the Breastfeeding
Peer Counseling Grant. This signed letter needs to be returned annually to the
State Breastfeeding Peer Counselor Coordinator.
Due to the limited nature of the Breastfeeding Peer Counselor Funding total
indirect cost shall not exceed 30% of the total grant award. To maintain
consistency across budgets, County-City Central Services reported under a
direct expense line item will be included as indirect cost even if captured outside
of indirect line item on the budget. Additional local funds can be supplemented to
cover indirect costs exceeding 30%.
• Comply with the requirements of the WIC program as prescribed in the
Code of Federal Regulations (7 CFR, Part 246) including the following special
provisions from Part 246.6 (f)(1)(2):
(f) Outreach/Certification In Hospitals. The State agency shall ensure that
each local agency operating the program within a hospital and/or that has
a cooperative arrangement with a hospital:
(1) Advises potentially eligible individuals that receive inpatient or
outpatient prenatal, maternity, or postpartum services, or that accompany
a child under the age of 5 who receives well-child services, of the
availability of program services; and
(2) To the extent feasible, provides an opportunity for individuals who may
be eligible to be certified within the hospital for participation in the WIC
Program. [246.6(F)(1)].
• The Grantee in accordance with the general purposes and objectives of this
agreement, will comply with the federal regulations requiring that any individual
that embezzles, willfully misapplies, steals or obtains by fraud, any funds,
assets or property provided, whether received directly or indirectly from the
USDA, that are of a value of $100 or more, shall be subject to a fine of not more
than $25,000.
• The Grantee is required to operate the Project FRESH Program within the
guidelines as laid out in the “WIC Project FRESH Local Agency Guidebook”.
• The Grantee is required to abide by the Dissemination License Agreement
between Michigan State University and Michigan Department of Health and
Human Services for “Mothers in Motion.” Any use of these licensed materials in
the provision of program related services is subject to the terms and conditions
outlined in the licensure agreement, which is included in Addendum 1, as
reference.
WIC Resident Services/Migrant/Breastfeeding Peer Counseling Grant Training and
Education Requirements:
The Grantee is required to comply with MI-WIC Policy 1.07L Staff Training Plan as
detailed for applicable staff as it pertains to all State WIC training opportunities.
ADDENDUM 1
Dissemination License Agreement for "Mothers in Motion"
Between
Michigan State University
And
Michigan Department of Health and Human Services
This License Agreement ("Agreement"}, effective as of October 16, 2015 ("Effective Date"), is made by and
between Michigan State University, having offices at 325 E. Grand River, Suite 350, East Lansing, MI
48823 ("Licensor") and State of Michigan Department of Health and Human Services Women, Infants
and Children, having offices at 320 S. Walnut, Lansing, MI 48913 ("Licensee") (individually a "Party" and
collectively, the "Parties").
WHEREAS, Licensor has created the "Mothers in Motion" materials (herein, "Physical Materials"), MSU
reference number TEC2015-0036 utilizing funds from a grant from the National Institutes of Health (NIH),
grant number 1Rl8-DK083934-01A2 ("Grant").
WHEREAS, Licensor is the owner of certain rights, title and interest in the Physical Materials and has the
right to grant licenses thereunder.
WHEREAS, Licensee wishes to license the Physical Materials for dissemination purposes and Licensor, in
order to meet its obligations under the NIH grant, desires to grant such license to Licensee on the terms
and conditions herein.
WHEREAS, Licensee wishes to obtain this Agreement in order to carry out the intent of their master
agreement between Licensee and Licensor with an effective date of FY 2015-2016.
NOW THEREFORE, the parties agree as follows:
I. Definitions.
a. "Physical Materials" shall mean all physical items listed in Schedule A.
b. "Sublicenseable Materials" shall mean one electronic copy of the Physical Materials.
c. "Materials Modification Guide" shall mean the specifications outlined in Schedule B.
d. "Derivative Works" means all works developed by Licensee or Sublicensee which would be
characterized as derivative works of the Physical Materials and/or Sublicenseable Materials under the
United States Copyright Act of 1976, or subsequent revisions thereof, specifically including, but not limited
to, translations, abridgments, condensations, recastings, transformations, or adaptations thereof, or works
consisting of editorial revisions, annotations, elaborations, or other modifications thereof. The term
"Derivative Work" shall not include those derivative works which are developed by Licensor.
e. "Sublicense" means an agreement which may take the form of, but is not limited to, a sublicense
agreement, memorandum of understanding, or special provisions added as an amendment to an existing
agreement between Licensee and a Sublicensee in which Licensee grants or otherwise transfers any of
the rights licensed to Licensee hereunder or other rights that are relevant to using the Sublicenseable
Materials.
AGR2015-0l 146 1
TEC2015-0036 f. "Sublicensee" means any entity to which a Sublicense is granted.
1. Grant of License
1.1 Subject to the terms and conditions of this Agreement, to the extent that Licensee's rights to
Physical Materials as a result of Licensor's grant of rights to the Federal Government in accordance
with the terms and conditions of the Grant are insufficient for Licensee's activities hereunder,
Licensor hereby grants to Licensee a nonexclusive, nontransferable, worldwide, license to use,
perform, reproduce, publically display and create Derivative Works (as outlined in the Physical
Materials Modification Guide) of the Physical Materials. Notwithstanding the foregoing, Licensee
may only distribute the Physical Materials within Licensee managed locations within the state of
Michigan. Licensee is not permitted to sell or receive consideration for any of the Physical Materials
or reproductions of the Physical Materials.
1.2. Licensor grants Licensee the right to grant Sublicenses of its rights under Section 1.1 of
the Sublicensable Materials to Sublicensee for the sole purpose of placing the content contained
in the Sublicenseable Materials on a website that is controlled by Sublicensee and that is
access limited, password protected. Any Sublicense shall be in accordance with Article 3 below.
Sublicensee may be granted the right to create Derivative Works of the Sublicenseable Materials
limited to that which is described in the Materials Modification Guide and only to ensure that the
Sublicenseable Materials meet - technical specifications necessary to place the content contained
in the Sublicenseable Materials on Sublicensee's controlled website. Notwithstanding the
foregoing, Sublicensee may create split-up lessons (meaning placing the content of a full-length
lesson into multiple videos) of the full-length lessons contained in the DVD portion of the
Sublicenseable Materials only in order to conform to the technical format of Sublicensee's
website platform; the content, however, shall not be modified. Sublicensee is not permitted to
sell or receive consideration for the Sublicenseable Materials in any format. Any content created
solely by Sublicensee that supports the implementation of the Sublicensable Materials shall be
owned by Sublicensee. If a Derivative Work is created by Sublicensee, Sublicensee shall own their
creative contribution to the Derivative Work and Licensor retain all copyright rights to the original
Sublicensable Materials contained in such Derivative Work. Licensee and Sublicensee may address
ownership of Sublicensee's creative contribution to Derivative Works in the Sublicense
agreement.
1.3 In such incidences where, for financial reasons, Licensee is not able to reproduce the
label displayed on the original master copy of the DVD portion of the Physical Materials,
Licensee must ensure that the entire content of the DVD portion of the Physical Materials are
reproduced in its entirety so that the inclusion of the copyright notice, Licensor owned logos
(including wordmark), grant number information, title of each lesson, and acknowledgements are
maintained.
1.4 Except as provided in Section 1.2 and 1.3, Licensee will refrain, and shall require
Sublicensees to refrain, from using the name of the Licensor in publicity or advertising without
the prior written
approval of Licensor. Notwithstanding the foregoing, Licensee may, without· prior approval from
Licensor, use Licensor's name in a manner that is (a) informational in nature (i.e. describes
the existence, scope and/or nature of the relationship of the Parties and/or the fact that the
Physical Materials were developed by Licensor), (b) does not suggest Licensor's endorsement of
Licensee or its goods or services, (c) does not create the appearance that the source of the
communication is Licensor or any party other than Licensee, and (d) otherwise consistent with the
terms of the Agreement.
AGR2015-0l 146 2 TEC2015-0036
Except as described in Section 1.2 and 1.3 and this Section 1.4, the use of the name of the Licensor
does not extend to any trademark, logo, or other name or unit of Licensor.
1.5 Licensor shall provide Physical Materials to Licensee by October 31, 2015. Licensor assumes
no responsibility for distributing Physical Materials to the state of Michigan Licensee locations.
2. Licensor's Rights
2.1 Notwithstanding the rights granted in Article l hereof, Licensee acknowledges that all right,
title and interest in the Physical Materials, including any copyright applicable thereto, shall
remain the property of Licensor and/or the third party rights holders. With the exception of the
portion contributed by Licensee or Sublicensee in a Derivative Work of the Physical Materials,
Licensee or Sublicensee shall have no right, title or interest in the Physical Materials, including any
copyright applicable thereto, except as expressly set forth in this Agreement.
2.2 Any rights not granted hereunder are reserved by Licensor and/or the third party rights holders.
2.3 As of Licensor's present knowledge, MSU Extension (which is a unit within Licensor) is the
copyright holder of the pizza recipe included in the Physical Materials. If Licensor is notified that
a third party is the copyright holder to the pizza recipe, Licensor will in good faith attempt to secure
the copyright rights from the third party rights holder in order for Licensor, Licensee and
Sublicensee to maintain using the Physical Materials as described in the Agreement herein. In the
event Licensor is unable to secure such rights, Licensor will use reasonable efforts to identify a
replacement for such third party material.
3. Sublicense
3.1 (a) Any Sublicense entered into hereunder (i) shall contain terms no less protective of
Licensor's rights than those set forth in this Agreement, (ii) shall not be in conflict with this
Agreement, and (iii) shall identify Licensor as an intended third party beneficiary of the Sublicense.
Licensee shall provide Licensor with a complete electronic or paper copy of each Sublicense within
thirty (30) days after execution of the Sublicense. Licensee shall provide Licensor with a copy of
each report received by Licensee pertinent to any data produced by Sublicensee that would pertain
to the report due under Section 4. Licensee shall be fully responsible to Licensor for any breach of
the terms of this Agreement by a Sublicensee. Licensee and Sublicensee may address ownership of
Sublicensee's creative contribution to Derivative Works in the Sublicense agreement.
(b) Upon termination of this Agreement for any reason, all Sublicenses shall terminate. If
a Sublicensee was in compliance with the terms of its Sublicense in effect on the date of
termination, Licensor may grant such Sublicensee that so requests, a license with terms and use _
rights as are acceptable to Licensor. In no event shall Licensor have any obligations of any
nature whatsoever with respect to (i) any past, current or future obligations that Licensee may have
had, or may in the future have, for the payment of any amounts owing to any Sublicensee,
(ii) any past obligations whatsoever, and (iii) any future obligations to any Sublicensee beyond
those set forth in the new license between Licensor and such Sublicensee.
AG R2015-0 l 146 3 TEC2015-0036
4. Consideration
In consideration of the rights granted herein, Licensee will provide to Licensor two effectiveness and
utilization data reports based on the use of the Physical Materials. One data report shall include:
a) number of clients who access the Physical Materials lessons; h) number of times specific lessons
are completed; c) number of unique users; d) client perceptions for useful ness and helpfulness of
lessons; and e) client beliefs in relation to ability to make changes based on lesson completion and
shall be due to Licensor two years from the Effective Date and one data report containing the
same data as described above shall be due thirty (30) days after the end of the five (5) year term.
The reports shall be sent to Mci-Wei.Chang@.ht.msu.edu and msulagrr@msu.edu.
5. Diligence
Licensee shall use its reasonable efforts to disseminate the Physical Materials in a fashion that
Licensee determines aliens with its mission in order to provide public benefit.
6. Term and Termination
6.1 This Agreement shall commence as of the Effective Date and shall extend for a period of five
(5) years unless earlier terminated in accordance with paragraph 6.2 hereof.
6.2. In the event that either Party believes that the other has materially breached any obligation
under this Agreement, such Party shall so notify the breaching Party in writing. The breaching
Party shall have thirty (30) days from the receipt of notice to cure the a lleged breach and to notify
the non-breaching Party in writing that said cure has been affected. If the breach is not cured
within said period, the non- breaching Party shall have the right to terminate the Agreement without
further notice.
1.3 Effect of Termination.
6.3.1 Upon termination, Licensee shall cease using, distributing and displaying the Physical
Materials, and shall confirm in writing to Licensor that the Physical Materials have either been
returned to Licensor or have been destroyed (in Licensor's sole discretion). All Sublicenses shall
terminate upon termination of this Agreement pursuant to Section 3(b).
6.3.2 Upon termination, the following provisions shall survive and remain in effect; 2.1; 4; 6.3; 8.
7. Representations and Warranties
7.1 Licensor and third parties hereby represent that it has. full right, power and authority to enter
into this Agreement and to provide the license of rights granted under this Agreement.
7.2 LICENSOR, INCLUDING ITS TRUSTEES, OFFICERS AND EMPLOYEES, MAKES NO
REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE PHYSICAL
MATERIALS AND SUBLICENSEABLE MATERIALS AND HEREBY DISCLAIMS ALL
REPRESENTATIONS AND WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, WITHOUT
LIMITATION, ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR
PURPOSE OR NONINFRINGEMENT. LICENSEE ASSUMES THE ENTIRE RISK
AGR2015-01 146 4 TEC10 l 5-0036
AND RESPONSIBILITY FOR THE SAFETY, EFFICACY, PERFORMANCE, DESIGN, MARKETABILITY AND QUALITY OF THE PHYSICAL MATERIALS AND SUBLICENSEABLE MATERIALS.
WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, THE PARTIES, INCLUDING THEIR
OFFICERS AND EMPLOYEES, ACKNOWLEDGE THAT (A) THE PHYSICAL MATERIALS AND
SUBLICENSEABLE MATERIALS AND DERIVATIVE WORKS ARE PROVIDED "AS IS";(B) NEITHER THE PHYSICAL MATERIALS NOR SUBLICENSEABLE MATERIALS MAY BE FUNCTIONAL ON EVERY
MACHINE OR IN EVERY ENVIRONMENT; AND (C) THE PHYSICAL MATERIALS AND SUBLICENSEABLE
MATERIALS ARE PROVIDED WITHOUT ANY WARRANTIES THAT IT IS ERROR-FREE OR THAT LICENSOR IS UNDER ANY OBLIGATION TO CORRECT SUCH ERRORS.
8. Limitation of Liability
8.1 Each Party acknowledges and represents that it will be responsible for any claim for
personal injury or property damage asserted by a third party and arising out of or related to its acts or
omissions in the performance of its obligations hereunder to the extent that a court of competent
jurisdiction determines such Party to be at fault or otherwise legally responsible for such claim.
8.2 In no event shall either Party be liable to the other Party or to any third party, whether
under theory of contract, tort or otherwise, for any indirect, incidental, punitive, consequential, or
special damages, whether foreseeable or not and whether such Party is advised of the
possibility of such damages.
9. Assignment and Transfer
Neither Party may assign, directly or indirectly, all or part of its rights or delegate its obligations under
this Agreement without the prior written consent of the other Party.
10. Dispute Resolution
10.1 In the event of any dispute or controversy arising out of or relating to this Agreement or
the subject matter hereof, the Parties shall use their best efforts to resolve the dispute as soon as
possible. The Parties shall, without delay, continue to perform their respective obligations under this
Agreement which are not affected by the dispute.
10.2 This Agreement and any disputes arising out of or relating to this Agreement shall be governed
by and construed in accordance with the laws of the State of Michigan without regard to the conflicts of
law provisions thereof. In any action to enforce this Agreement, the prevailing Party will be entitled to
recover reasonable costs and attorneys' fees.
11. Force Majeure
Neither Party shall be liable for damages or subject to injunctive or other relief, or have the right to
terminate this Agreement, for any delay or default in performance hereunder if such delay or default is
caused by conditions beyond its control including, but not limited to, Acts of God or force majeure,
government restrictions (including the denial or cancellation of any necessary license), wars,
insurrections and/or any other cause beyond the reasonable control of the Party whose performance
is affected.
AGR2015-0l 146 5 TEC2015-0036
12. Entire Agreement
This Agreement constitutes the entire agreement of the Parties and supersedes all prior communications,
understandings and agreements relating to the subject matter hereof, whether orator written.
13. Amendment
No modification or claimed waiver of any provision of this Agreement shall be valid except by written
amendment signed by authorized representatives of Licensor and Licensee.
14. Severability
If any provision of this Agreement is determined to be invalid or unenforceable under applicable law, it shall not affect the validity or enforceability of the remainder of the terms of this Agreeme nt, and without further action by the Parties hereto, such provision shall be reformed to the minimum extent necessary to make such provision valid and enforceable.
15. Waiver
Waiver of any provision herein .shall not be deemed a waiver of any other provision herein, nor shall waiver of any breach of this Agreement be construed as a continuing waiver of other breaches of the
same or other provisions of this Agreement.
16. Notices
All notices given pursuant to this Agreement shall be in writing and may be hand delivered, or shall be
deemed received within three (3) days after mailing if sent by registered or certified mail, return receipt
requested. If any notice is sent by facsimile, confi rmation copies must be sent by mail or hand delivery to
the specified address. Either party may from time-to-time change its notice address by written notice to
the other Party.
If to Licensor:
Licensing Notices:
MSU Technologies
Attention: Agreement Coordinator AGR2015-01146
325 E. Grand River Suite 350
City Center Building
East Lansing, MI 48823
517-884· I 605
msutagr@.msu.edu
AGR201 5-0 l 146 6 TEC2015-0036
If to Licensee:
Michigan Department of Health and Human Services, WIC Division
Attn: Kristen Hanulcik
Manager, Consultation and Nutrition Services Unit
320 S. Walnut, Lewis Cass Bldg., 6th Floor
Lansing, MI 48913
517-335-8545
hanulcikk@michigan.gov
17. Article Headings
The Parties have carefully considered this Agreement and have determined that ambiguities, if any, shall not be construed or enforced against the drafter. Furthermore, the headings of Articles have been inserted
for convenience of reference only and shall not control or affect the meaning or construction of any of the
agreements, terms, covenants or conditions of this Agreement i n any manner.
18. Relationship of Pa rties
Licensor and Licensee each acknowledge ;and agree that the other is an independent contractor in the performance of each and every part of this Agreement and is solely responsible for all of its employees and
students and such Party's labor costs and expenses arising i n connection therewith. The Parties are not
partners, joint venturers or otherwise affiliated, and neither has any right or authority to make any statements, representations or commitments of any kind, or to take any action, which shall be binding on the other Party, without the prior written consent of such other Party.
(remainder of page intentionally left blank)
AG R2015-0 l 1 46 7 TEC201 5-0036
IN WITNESS WHEREOF, the Parties have executed this Agreement by their respective, duly
authorized repre sentative as of the date first above written.
LICENSOR: Michigan State University
Signature on file Date: 10/15/15 By: Dr. Richar:d W. Chylla
Executive Director, MSU Technologies
LICENSEE: State of Michigan Department of Health and Human Services Women; Infants &
Children Signature on file
By: Kim Stephen Date: 10/16/15 Bureau of Purchasing
Michigan Department of Health and Human Services stephenk@michigan.gov
517-241-1196
Signature on file
By: Stan Bien, Director Date: 10/16/15
WIC Division
Michigan Department of Health and Human Services
320 S. Walnut, Lewis Cass Bldg., 6th Floor
Lansing, Ml 48913 biens@michigan.gov
517-335-8448
AGRZO l5-QI 146 8 TEC2Ql 5-0036
Schedule A
Physical Materials
I. Client Materials
A. Mothers in Motion intervention materials
I. 260 sets packaged in Mothers in Motion bag. One set includes:
a. l Mothers in Motion DVD set (I set is comprised of 3 DVDs)
b. I looped DVD of Mothers in Motion Overview and Introduction
c. Folder containing Mothers in Motion worksheets (e.g., "Goal and Plans" and
"Where Do I Go from Here?" worksheets, and stress log) and
reference/guidance sheet detailing contents of each Mothers in Motion lesson
(Total of 11 lessons)
d. 1 CD containing PDF formatted documents of Mothers in Motion worksheets to
accommodate additional printing needs.
2. All Mothers in Motion intervention materials listed above will also be saved on 2
external drives provided by WIC.
II. Staff Materials
A. "Rethinking How We Listen and Respond in WIC" Videos/DVDs
I. 260 "Rethinking How We Listen and Respond in WIC" DVDs [included in Mothers
In Motion bag described above (I DVD per bag)]
2. "Rethinking How We Listen and Respond in WIC" contents saved in video format
on 2 external drives provided by WIC
**All Items listed above will be saved on total of 4 external drives, provided by WIC**
AGR2015-01146 9 TEC2015-0036
Schedule B
Materials Modification Guide
I. Client Materials 1
A. Mothers In Motion DVD
I. The following Items are NOT permitted to be altered on DVDs
a. DVD content
i. MSU and Mothers in Motion logo
ii. Grant number (NIH-NIDDK, 1Rl8-DK083934-01A2)
iii. All lesson module and intervention content [exception: food label reading if
contents become outdated]
iv. Acknowledgement section
v. Copyright notice
b. Label on Disks*
i. MSU and Mothers in Motion logo
ii. Grant number (NIH-NIDDK, 1Rl8-DK083934-01A2)
iii. Title of each lesson
iv. Copyright notice
2. Items that may be reproduced
a. Mothers in Motion DVDs
b. CD contains all Mothers in Motion worksheets
B. Mothers In Motion Worksheets
I. The following items are NOT permitted to be altered on worksheets
a. Grant number (NIH-NIDDK, IR18-DK083934-01A2)
b. Mothers In Motion logo
c. Title of each lesson
d. Copyright notice
2. The following items are permitted to be altered on Worksheets
A. Contents in the worksheets
3. Items that may be reproduced
a. All worksheets
b. Reference/guidance sheet detailing contents of each Mothers In Motion lesson
II. Staff Materials 1
A. "Rethinking How We Listen and Respond in WIC" Videos/DVD I. Items that are NOT
permitted to be altered on DVD
a. DVD content
i. MSU and Mothers in Motion logo
ii. Grant number (NlH-NIDDK, 1Rl8-DK083934-01A2)
iii. Acknowledgement section
iv. Video/DVD Contents
v. Copyright notice
b. Label on Disks*
i. MSU and Mothers in Motion logo
ii. Grant number (NIH-NIDDK, 1Rl8-DK083934-01A2)
iii. Title of each lesson
iv. Copyright notice
AGR2015-01 146 10 TEC2015-0036
*WIC is allowed to duplicate DVDs without label or grant number on the disks, if necessary. 1 Sublicensee
may create content that supports the implementation of the content contained in the
Mothers in Motion DVDs, Mothers in Motion Worksheets and "Rethinking How We Listen and Respond in
WIC" Videos/DVD. Any content created solely by Sublicensee shall be owned in accordance with Section
l.2 and Section 3.l(a). Implementation of the content contained in the Mothers in Motion DVDs, Mothers in
Motion Worksheets and "Rethinking How We Listen and Respond in WIC" Videos/DVD shall be in
accordance with Section l.2.
AGR2015-0l 146 11 TEC2015-0036
ADDENDUM 2
FOOTNOTES: FY 2022/2023
a) Refer to Plan and Budget Framework for element definitions.
b) Refer to master comprehensive agreement and program and budget instructions package for further explanation of applicability
of these reimbursement methods.
c) Negotiated starting from the average of the past two complete years' actual number where available.
d) Calculated by multiplying the "Total Performance Expectation" column by the ratio of the elements total State funding (DCH
0410, Line 24) to "Total Expenditures” DCH 0410, Line 17). Prior to calculation, adjustments will be made for unallowable cost,
equipment funded by local funds and MDHHS reimbursement not performance based (I.E., fixed unit rate, staffing).
e) Calculated by multiplying the "State Funded Element Target Performance" column by the "Percent" column.
f) Refer to master comprehensive agreement and budget instructions package for further explanation regarding these
designations.
1. CSHCS Care Coordination
A. Case Management
1. Maximum of six (6) services per year
2. Reimbursement - $201.58 per service provided face-to-face in the home setting.
2. CARE COORDINATION
A. LEVEL I PLAN OF CARE
1. Annual Plan of Care in the home or home-like setting that requires the Care Coordinator
to travel to a non-LHD site - $150
2. Annual Plan of Care over the telephone -$100
B. LEVEL II CARE COORDINATION
1. Level II Care Coordination is reimbursed at $30.00 per unit
2. A maximum of 15 units per beneficiary per eligibility year will be reimbursed.
(2) Reimbursement Chart for Fixed Rates
AIDS/HIV Prevention Non- Categorical $11.00 per blood draw for non-categorical health departments. Limited
annually to $2,000
Body Art $288.98 / appl. annual license prior to July1
$144.49 / appl. annual license after July 1
$130.03 / appl. temporary license
$288.98 / appl. renewal prior to December 1
$433.47 / appl. renewal after December/1
$28.89 / duplicate license
CSHCS-Medicaid Elevated Blood Lead Case
Management
$201.58 per home visit, for up to 6 home visits
Fetal Infant Mortality Review (FIMR) Case
Abstractions
$270.00 per case, not to exceed the maximum set for each Grantee
Immunization Assessment Feedback Incentive
Exchange (AFIX) Follow-up
$100 per personal visit or $50 for a phone call (with information mailed
afterward) to the provider office, not to exceed the maximum set for
each individual contractor.
Immunization Nurse Education $200 per session except Vaccines Across the Lifespan, which is to be
reimbursed at $250 per session, upon completion and submission of
Provider Contracts and Report Forms. Reimbursement can only be
made for one in-service module session per physician clinic site per
year.
Immunization VFC (only) Provider Site Visits $150 per site visit, not to exceed the maximum set for each individual
Grantee
Immunization VFC/AFIX Combined Provider Site
Visits
$350 per site visit, not to exceed the maximum set for each individual
Grantee
Informed Consent $50 per woman served, for each woman that expressly states that she
is seeking a pregnancy test or confirmation of a pregnancy for the
purpose of obtaining an abortion and is provided the services.
SIDS (FIMR Interviews) $125 for each family support visit. A maximum of six (6) visits per
infant death is reimbursable
(3) Allocation to be reflected in individual programs during budgeting process.
(4) Funding Source (not a single element). Hearing and Vision are single elements.
(5) Subject to Statewide Maintenance of Effort requirement for Title X.
(6) State funding is first source (after fees and other earmarked sources).
(7) Fixed unit rate subject to actual costs.
(8) The performance reimbursement target will be the base target caseload established by MDHHS.
(9) Subject to a match requirement (hard or in-kind) of $1 for each $3 of MDHHS agreement funding for Coordination.
(10) Fixed rate limited to contract amount.
(11) Up to six (6) visits per family.
(12) Non-categorically funded Health Departments will be reimbursed at $11.00 per HIV test conducted up to a maximum of $2,000
annually.
(13) Each delegate agency must serve a minimum percentage of Title X users to access their total allocated funds. Semi-annual FPAR
data will be used to determine total Title X users.
(14) Public Health Emergency Preparedness (PHEP) funding BP1 must be expended by June 30 and is subject to a 10% match
requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHDs must
submit a nine-month budget and a quarterly Financial Status Report (FSR) column for this program element.
(15) Public Health Emergency Preparedness (PHEP) funding for October 1–June 30, and July 1–September 30, is subject to a 10%
match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHDs
must submit a three-month budget and a quarterly Financial Status Report (FSR) column for this program element.
(16) Project meets the Research and Development criteria as defined by Title 2 CFR, Section 200.87.
(17) Not Applicable
(18) Subject to match requirement as specified in Attachment III - Program Assurances and Specific Requirements.
NOTE: Some footnotes may not apply to this agency.
Version: Comprehensive
1
MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
FY 22/23 AGREEMENT ADDENDUM A
1. This addendum adds the following section to Part I and Renumbers existing 11
Special Certification to 12 and existing 12 Signature Section to 13:
Part I
11. Agreement Exceptions and Limitations
Notwithstanding any other term or condition in this Agreement including, but
not limited to, any provisions related to any services as described in the
Annual Action Plan, any Contractor (Oakland County) services provided
pursuant to this Agreement, or any limitations upon any Department funding
obligations herein, the Parties specifically intend and agree that the
Contractor may discontinue, without any penalty or liability whatsoever, any
Contractor services or performance obligations under this Agreement when
and if it becomes apparent that State or Department funds for any such
services will be no longer available. Notwithstanding any other term or
condition in this Agreement, the Parties specifically understand and agree
that no provision in this Agreement shall operate as a waiver, bar or limitation
of any kind, on any legal claim or right the Contractor may have at any time
under any Michigan constitutional provision or other legal basis (e.g., any
Headlee Amendment limitations) to challenge any State or Department
program funding obligations; and, the parties further agree that no term or
condition in this Agreement is intended and no such provision shall be
argued to state or imply that the Contractor voluntarily assumed or undertook
to provide any services as described in the Annual Action Plan, and thereby,
waived any rights the Contractor may have had under any legal theory, in law
or equity, without regard to whether or not the Contractor continued to
perform any services herein after any State or Department funding ends.
2. This addendum modifies the following sections of Part II, General Provisions:
Part II
I. Responsibilities-Grantee
J. Software Compliance. This section will be deleted in its entirety and
replaced with the following language:
Version: Comprehensive
2
The Michigan Department of Health and Human Services and the
County of Oakland will work together to identify and overcome
potential data incompatibility problems.
III. Assurances
A. Compliance with Applicable Laws. This first sentence of this
paragraph will be stricken in its entirety and replace with the following
language:
The Contractor will comply with applicable Federal and State laws,
and lawfully enacted administrative rules or regulations, in carrying out
the terms of this agreement.
M. Health Insurance Portability and Accountability 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.