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Home My WebLink AboutHRSA Bioterrorism Program ,~- DIVISION OF PUBLIC HEALTH Contract # 12762 Contract Agreement Amendment for HRSA Bioterrorism Program Agency Number: 472894 Agency Type: 11 The Agreement entered into for the period January 1, 2004 to December 31, 2004, between the Division of Public Health, Department of Health and Family Services and Oshkosh Health Department, is hereby amended as follows: Contract Amount: Profile Name Profile # Current Contract Change (-/+) to New Contract Profile Amount Contract Profile Amount Amount HRSA Bioterrorlsm 155172 $100,910 $686,400 $787,310 Contract Addendum: Attached is a replacement Addendum Exhibits 1 and II to reflect current contract provisions, Contract Pavment Process: Section IV. 1) is changed from "Payments will be made on a monthly basis. The Contractee will receive one-twelfth (1112) of the total contract amount each month unless Contractee has failed to maintain quality criteria or proposed progress towards achievement of Contract objectives as determined by the Contractor. In these situations the Contractor can make reductions in the monthly payment pùrsuant to Section XVI." to "Payments will be made on a monthly basis unless Contractee has failed to maintain quality criteria or proposed progress towards achievement of Contract objectives as determined by the Contractor. In these situations the Contractor can make reductions in the monthly payment pursuant to Section XVI." Timelv Contract Sil!ninl!: This agreement amendment becomes null and void if the time between the earlier dated signature and the later dated signature on this contract agreement amendment exceeds sixty (60) days inclusive of the two signature dates. All other terms on the contract shall remain in force as previously executed. IN WITNESS THEREOF, tlæ p"'" """" ~=" '" ,.."ill.", 0'( ~~~ . (\ ~ CITY ATTORNEY OSHKOSH, WISCONSIN ontr tee's A thoriz R resentative Richard A. WJllangk, City ManéQäte PaJœla R- Ubrig, City Clerk )/p-ó 1 ðt Contractor's Authorized Representati C/ . Date Thomas E. Alt, Interim Administrator, Dtvision of Public Health Department of Health and Family Services Contract Agreement Addendum: Exhibit I Program Quality Criteria Generally high program quality criteria for the delivery of quality and cost-effective administration of health care programs have been, and will continue to be, required in each public health program to be operated under the terms of this contract. This Exhibit contains only applicable quality criteria for this contract. 02/06/2004 08,19 AM DPH Gmn" and Contr"" Contract #, 12762 Contract Agreement Addendum: Exhihit I Agency: Oshkosh Health Department Contract Year: 2004 No Applicable Quality Criteria 02/06/2004 OS,19 AM DPH Omn" and Contr"" Contract Agreement Addendum: Exhibit n Program Objectives (A) Contract Funds and Program/Objective Values (B) Objective Details 02/06/2004 OS,19 AM DPH Gmnts and Con""" Contract #: 12762 Contract Agreement Addendum: Exhibit II(A) Agency: Oshkosh Health Department Contract Year: 2004 Bioterror HRSA Hospital Prepare Program Total Value $787,310 2 By December 31, 2004, primary and affiliate members of the Region Six Hospital Bioterrorism Preparedness Planning Team will document their ability to manage surge capacity during a public health threat or emergency. By December 31, 2004, primary and affiliate members of the Region Six Hospital Bioterrorism Preparedness Planning Team will complete an exercise to test the State of Wisconsin Hospital Bioterrorism Preparedness Plan through participation in the 2nd Annual State of Wisconsin Bioterrorism Preparedness Exercises. By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Calumet Medical Center in Chilton with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. 4 By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Ripon Medical Center in Ripon with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Berlin Memorial Hospital in Berlin with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. 5 7 By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at St. Elizabeth Hospital in Appleton with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at New London Family Medical Center in New London with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. 9 By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Appleton Medical Center in Appleton with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Riverside Medical Center in Waupaca with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Teåm. 10 By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Wild Rose Community Hospital in Wild Rose with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Mercy Medical Center of Oshkosh in Oshkosh with associated costS subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. 11 12 By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Theda Clark Medical Center in Neenah with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. Total of Contract Objective Values $95,910 $5,000 $38,800 $40,000 $38,800 $100,000 $40,000 $155,000 $40,000 $40,000 $38,800 $155,000 $787,310 02/06/2004 OS,19AM DPH Gran" 'nd Contrac" Contract #: 12762 Agency: Oshkosh Health Department Contract Agreement Addendum: Exhibit ll(A) Contract Source of Funds Sonrce Program Oshkosh Bioterrorism, Hospital Assess.& Plan Contract Match Requirements Program Amount Bioterror HRSA Hospital Prepare $0 Contract Year: 2004 Amount $787,310 $787,310 Contract Amount, $787,310 Program Sub-Contractee Program Sub-Contracts Bioterror HRSA Hospital None Reported Prepare 02/06/2004 08,19 AM Sub-Contract Amount $0 DPH Grant' and Con',"c" Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: I of 12 Contract Year: 2004 Objective Value: $95,910 Objective: Primary Details Objective Statement By December 31, 2004, primary and affiliate members of the Region Six Hospital Bioterrorism Preparedness Planning Team will document their ability to manage surge capacity during a public health threat t)r emergency. Deliverable Due Date: 01/31/2005 Contract Deliverable (Evidence) A completed Deliverables Checklist One and ~ccompanying documentation delivered to the Wisconsin Division of Public Health, Hospital Bioterrorism Preparedness Program. Programs Providing Funds for this Objective Bioterrorism HRSA Hospital Preparedness: $95,910 Agency Funds for this Objective: Data Source for Measurement Region Six Hospital Bioterrorism Preparedness Planning Team records. Baseline for Measurement This is a new initiative so baseline data will be established during the contract year. Context The Region Six Hospital Bioterrorism Preparedness Team (TEAM) will be better prepared to respond to bioterrorism, outbreaks of infectious disease, and other public health threats and emergencies as part of an overall post-event preparedness strategy to manage surge capacity by completing infrastructure enhancements represented by the Health Research and Services Administration (HRSA) FFY 2003 Contract Deliverables Checklist. The Contract Deliverables Checklist One is intended to address the Benchmarks of the FFY03 funding from HRSA to implement a response to a bioterrorist event, infectious disease outbreaks and other public health threats and emergencies involving mass casualties. These Contract Deliverables have been designed so they can be accomplished given the limited funds available per region. FFY03 is, for the purposes of this Contract, equivalent to calendar year 2004. The Contract Deliverables Checklist One outlines all the activities that are to be implemented by the hospital members of the Region Six TEAM. This will allow the TEAM to accomplish the FFY03 Benchmarks to best prepare for a regional response in a mass casualty event. Meeting these Benchmarks is dependent, in part, upon recommendations from State Expert Panels due to the TEAM no later than September 30, 2004. What follows in this Context section, and is completed in the Input Activities Section for this contract, is an itemization of the Benchmarks and the number of deliverables (in parenthesis) for the Benchmark. Critical Benchmark #1 (number of deliverables = I): Develop and maintain a financial accounting system capable of tracking expenditures by priority area, by critical benchmark, and by funds allocated to hospitals and other health care entities. Critical Benchmark #2-1 (number of deliverables = 7): Establish a system that allows the triage, treatment and disposition of 500 adult and pediatric patients per 1,000,000 population with acute illness or trauma requiring hospitalization from a biological, chemical, radiological or explosive terrorist incident. Critical Benchmark #2-2 (number of deli.verables = 2): Upgrade or maintain airborne infectious disease isolation capacity to have at least one negative pressure, HEPA-filtered isolation facility per awardee, to be placed in accord with the findings of the awardee's needs assessments. Such facilities must be able to support the initial evaluation and treatment of 10 adult and pediatric patients at a time, having a clinical contagious syndrome suggestive of smallpox, plague or hemorrhagic fever, prior to movement to a definitive isolation facility. Critical Benchmark #2-3 (this is FYI: number of deliverables = 0): Establish a response system that allows the immediate deployment of 250 or more additional patient care personnel per 1,000,000 population in urban areas, and 125 or more additional patient care personnel per 1,000,000 of population in rural areas, that would meaningfully increase hospital patient care surge capacity. Critical Benchmark #2-4 (number of deliverables = 2): Develop a system that allows the credentialing and supervision of clinicians not normally working in facilities responding to a terrorist incident. Critical Benchmark #2-5 (number of deliverables = I): Establish local or regional systems whereby pharmacies based in hospitals or otherwise participating in the local or regional health care response plan have surge capacity to provide pertinent pharmaceuticals in response to bioterrorisin or other public health emergencies. Critical Benchmark #2-6 (this is FYI: number of deliverables = 0): Ensure adequate personal protective equipment (PPE) to protect 250 or more health care personnel per 1,000,000 population in urban areas, and 125 or more health care personnel per 1,000,000 population in rural areas during a biological, chemical or radiological incident. Input Activities Critical Benchmark #2-7 (number of deliverables = 1): Ensure that adequate portable or fixed decontamination systems exist for managing 500 adult and pediatric patients and health care workers per 1,000,000 population who have been exposed to biological, chemical or radiological agents. Critical Benchmark #2-8 (number of deliverables = 2): Establish a system that provides for a graded range of acute psycho-social interventions and longer-term mental health services to 5,000 adult and pediatric clients and- 02/06/200408,19 AM DPH Gmn"'nd Cont"", Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Program: Bioterrorism HRSA Hospital Preparedness Agency: Oshkosh Health Department Objective#: lof12 Contract Year: 2004 Objective Valne: $95,910 health care workers per 1,000,000 population exposed to a biological, chemical, radiological or explosive terrorist incident. Benchmark #2-9 (number of deliverables = 3): Enhance statewide trauma care capacity to be able to respond to a mass casualty incident due to terrorism. This plan should ensure the capability of providing trauma care to at least 50 severely injured adult and pediatric patients per million of population per day. Critical Benchmark #2-10 (number of deliverables = 2): Establish a secure and redundant communications system that ensures connectivity during a terrorist incident between health care facilities and state and local health departments. Critical Benchmark #3 (number of deliverables = 1): Develop a mutual aid plan for upgrading and deploying EMS units in jurisdictions they do not normally cover in response to a mass casualty incident due to terrorism. This plan must ensure the capability of providing EMS coverage for at least 500 adult and pediatric patients per 1,000,000 population per day. Critical Benchmark #4-1 (this is FYI: number of deliverables = 0): Implement a hospital laboratory program that is coordinated with currently funded CDC laboratory capacity efforts, and which provides rapid and effective hospital laboratory services responding to terrorism and other public health emergencies. Critical Benchmark #4-2 (number of deliverables = 1): Enhance the capability of rural and urban hospitals, clinics, emergency medical services systems and poison control centers to report syndromic and diagnostic data that is suggestive of terrorism to their associated local and state health departments on a 24-hour-a-day, 7-day-a- week basis. Benchmark #5 (number of deliverables = 1): Develop education and training programs for adult and pediatric hospital, outpatient and pre-hospital health care professionals responding to a terrorist incident. Critical Benchmark #6 (this is FYI: number of deliverables = 0): As part of a written evaluation strategy of the awardee's program, conduct at least one bioterrorism disaster exercise in the jurisdiction during FY 2003 that covers a large-scale epidemic scenario affecting both adults and children. Calendar year 2003 Contract Deliverables deferred to calendar year 2004 contract: (number of deliverables = 3). Objective: Risk Profile Corresponding Potential Recoupment Amounts 1$95,9101 $86,3191 $76,7281 $67,1371 $57,5461 $47,9551 $38,3641 $28,7731 $19,1821 $14,3861 $9,591 I $4,795 1 $0 Definition of Percent Accomplished 0% Accomplishment None of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 100/0 Accomplishment Less than 12 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 20% Accomplishment 17 of the Deliverablesreferenced in the Context section and Input Activities section for this objective were accomplished. 30% Accomplishment 18 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 40% Accomplishment 19 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 50% Accomplishment 20 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 60% Accomplishment 21 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 70% Accomplishment 22 of the DeJiverables referenced in the Context section and Input Activities section for this objective were accomplished. 80% Accomplishment 23 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 85% Accomplishment . 24 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 90% Accomplishment 25 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 02/06/2004 OS,19 AM DPH Gran" and Con",," Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 1 of 12 Contract Year: 2004 Objective Value: $95,910 95% Accomplishment 26 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 100% Accomplishment 27 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. , Tn.."';,,. None I 02/0612004 OS,19AM DPH Gmn" ond Con'mc" Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 2 of 12 Contract Year: 2004 Objective Value: $5,000 Objective: frimary Details Objective Statement By December 31,2004, primary and affiliate members of the Region Six Hospital Bioterrorism Preparedness Planning Team will complete an exercise to test the State of Wisconsin Hospital Bioterrorism Preparedness Plan through participation in the 2nd Annual State of Wisconsin Bioterrorism Preparedness Exercises. Deliverable Due Date: 01/31/2005 Contract Deliverable (Evidence) A completed Deliverables Checklist Two and accompanying documentation delivered to the Wisconsin Division of Public Health, Hospital Bioterrorism Preparedness Program. Programs Providing Funds for this Objective Bioterrorism HRSA Hospital Preparedness: $5,000 Agency Funds for this Objective: Data Source for Measurement Region Six Hospital Bioterrorism Preparedness Planning Team records. Baseline for Measurement This is a new initiative so baseline data will be established during the contract year. Context The Region Six Hospital Bioterrorism Preparedness Team will be better prepared to respond to bioterrorisrn, outbreaks of infectious disease, and other public health threats and emergencies as part of an overall post-event preparedness strategy to manage surge capacity by participating in the 2nd Annual State of Wisconsin Bioterrorism Preparedness Exercises to test the State of Wisconsin Hospital Bioterrorism Preparedness Plan. The actual focus of the exercise will be determined by the HRSA Leadership Group. Input Activities Objective: Risk Profile ,Percent of Objective Accomplished I 0% I 10% I 20% I 30% I 40% I 50% I 60% Correspondiug Percentage Recoupment I 100% I . 90% I 80% I 70% I 60% I 50% I 40% I 70% I 80% I 85% I 90% I 95% I 100% I Corresponding Potential Recoupment Amounts I $5,000 I $4,500 I $4,000 I $3,500 I $3,000 I $2,500 I $2,000 I $1,500 I Definition of Percent Accomplished 0% Accomplishment None of the primary and affiliate members of the Region Six Hospital Bioterrorism Preparedness Planning Team completed an exercise to test the State of Wisconsin Hospital Bioterrorism Preparedness Plan through participation in the 2nd Annual State of Wisconsin Bioterrorism Preparedness Exercises. 50% Accomplishment 50% of the primary and affiliate members of the Region Six Hospital Bioterrorism Preparedness Planning Team completed an exercise to test the State of Wisconsin Hospital Bioterrorism Preparedness Plan through participation in the 2nd Annual State of Wisconsin Bioterrorism Preparedness Exercises. 100% Accomplishment 100% of the primary and affiliate members of the Region Six Hospital Bioterrorism Preparedness Planning Team completed an exercise to test the State. of Wisconsin Hospital Bioterrorism Preparedness Plan through participation in the 2nd Annual State of Wisconsin Bioterrorism Preparedness Exercises. I 30% I 20% I $1,000 I 15% 10% I $500 I 5% I $250 I $0 0% $750 I Conditions of Eligibility for an Incentive I None 02/06/2004 08,19 AM DPH Gnu", ,nd Controc" Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 . Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 3 of 12 Contract Year: 2004 Objective Value: $38,800 Objective: Primary Details Objective Statement . By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Calumet Medical Center in Chilton with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. Deliverable Due Date: 01/31/2005 Contract Deliverable (Evidence) A written report to document 1) amounts and dates of subsidy payments, 2) status of negative pressure airborne isolation room capacity construction project. Programs Providing Funds for this Objective Bioterrorism HRSA Hospital Preparedness: $38,800 Agency Funds for this Objective: Data Source for Measurement Region Six Hospital Bioterrorism Preparedness Planning Team records. Baseline for Measurement This is a new initiative so baseline data will be established during the contract year. Context What follows is language from the associated Memorandum of Understaniling between Calumet Medical Center (HOSPITAL) and the Region Six Hospital Bioterrorism Preparedness Planning Team (TEAM). "The HOSPITAL accepts from the TEAM the funding award from the FY 2003 HRSA Grant, as stated in Attachment A, to enhance negative pressure airborne isolation room (NPAir) capacity at its facility, as also described in Attachment A. The HOSPITAL understands that the award made to the HOSPITAL may not cover all costs associated with this project to add NPAir capacity and this award is meant only to subsidize the total costs of adiling NPAir capacity. The HOSPITAL commits to beginning'the project to add NPAir capacity to the HOSPITALno later than December 31, 2004, unless another date has been mutually agreed ùpon prior to the execution of this Agreement and the mutually agreed upon project start date is identified in an Attachment to this Agreement. The definition of "project to begin" is demonstrated by an agreement between the HOSPITAL and their Contractor to begin work on the NP Air project or a project that includes the addition of NPAir, signed on or before December 31,2004. If the HOSPITAL, for any reason, does not start its project to add NPAircapacity to the HOSPITAL by December 31, 2004, the HOSPITAL has the obligation to either return all monies awarded to the HOSPITAL by the TEAM unless another start date has been mutually agreed upon by the HOSPITAL and the TEAM. The HOSPITAL commits to the project as originally specified in Attachment A. If there is a change to the project scope in that further NPAircapacity is added, it is understood by the HOSPITAL that no further funds will be available to the HOSPITAL from the TEAM. If the there is a change to the project scope in that NPAir capacity, as identified in Attachment A, is to be less than the original project scope, then the HOSPITAL shall reimburse the TEAM according to Attachment B..Modifications to Attachment A by the HOSPITAL must be made in writing and mutually agreed upon by both the HOSPITAL and the TEAM before such modifications shall become effective. The HOSPITAL understands and accepts that the awarding ofFY 2003 HRSA Grant funds for the purpose of enhancing NPAircapacity at the HOSPITAL does not in any way exempt the HOSPITAL from all applicable rules and regulations, codes and other provisions required by the HOSPITAL in its construction or renovation project, which will enhance NPAir capacity. Upon completion of the project to add NPAir capacity to the HOSPITAL, the HOSPITAL shall send a letter to the TEAM stating that the project has been completed. The letter shall designate that the rooms, identified in Attachment A, have been completed. This Agreement shall be in full force upon signature by the HOSPITAL, TEAM and the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health." Input Activities Any financial awards that are returned to the Region Six Hospital Bioterrorism Preparedness Planning Team by Calumet Medical Center are to be retained by the Team, but their use is restricted to uses as determined by the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health and the HRSA Leadership Group. Objective: Risk Profile Percent of Objective Accornplished I 0% I 10% I 20% I 30% I 40% I 50% I 60% I 70% I 80% I 85% I 90% I 95% I 100% I Corresponding Percentage Recoupment 02/0612004 OS,19AM DPH Gcan" ,nd Con""" Contract Agreement Addendum: Exhibit II(B) Contract#: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 3 of 12 Contract Year: 2004 Objective Value: $38,800 Corresponding Potential Recoupment Amounts I $38,800 I $34,920 I $31,040 I $27,160 I $23,280 I $19,400 I $15,520 ~ $7,760 I $5,820 I~ $1,940 I $0 Definition of Percent Accomplished 0% Accomplishment A construction project to enhance negative pressure airborne isolation room capacity was not begun at Calumet Medical Center. 100% Accomplishment Subsidy payments by the Region Six Hospital Bioterrorism Preparedness Planning Team to Calumet Medical Center totaled $38 800. Conditions of Eligibility for an Incentive ¡None 02/0612004 OS,19AM DPH Gmnts and Contra'" Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 4 of 12 Contract Year: 2004 Objective Value: $40,000 Objective: Primary Details Objective Statement By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Ripon Medical Center in Ripon with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. Deliverable Due Date: 01/31/2005 Contract Deliverable (Evidence) A written report to document 1) amounts and dates of subsidy payments, 2) status of negative pressure airborne isolation room capacity construction project. Programs Providing Funds for this Objective Bioterrorism HRSA Hospital Preparedness: $40,000 Agency Funds for this Objective: Data Source for Measurement Region Six Hospital Bioterrorism Preparedness Planning Tea¡n records. Baseline for Measurement , This is a new initiative so baseline data will beestablished during the contract year. Context What follóws is language from the associated Memorandum of Understanding between Ripon Medical Center (HOSPITAL) and the Region Six Hospital Bioterrorism Preparedness Planning Team (TEAM). "The HOSPITAL accepts from the TEAM the funding award from the FY 2003 HRSA Grant, as stated in Attachment A, to enhance negative pressure airborne isolation room (NPAir) capacity at its facility, as also described in Attachment A. The HOSPITAL understands that the award made to the HOSPITAL may not cover all costs associated with this project to add NPAir capacity and this award is meant only to subsidize the total costs of adding NPAir capacity. The HOSPITAL commits to beginning the project to add NPAir capacity to the HOSPITAL no later than December 31, 2004, unless another date has been mutually agreed upon prior to the execution of this Agreement and the mutually agreed upon project start date is identified in an Attachment to this Agreement. The definition of "project to begin" is demonstrated by an agreement between the HOSPITAL and their Contractor to begin work on .the NPAir project or a project that includes the addition ofNP Air, signed on or before December 31, 2004. If the HOSPITAL, for any reason, does not start its project to add NPAir capacity to the HOSPITAL by December 31,2004, the HOSPITAL has the obligation to either return all monies awarded to the HOSPITAL by the TEAM unless another start date has been mutually agreed upon by the HOSPITAL and the TEAM. The HOSPITAL commits to the project as originally specified in Attachment A. If there is a change to the project scope in that further NPAir capacity is added, it is understood by the HOSPITAL that no further funds will be available to the HOSPITAL from the TEAM. If the there is.a change to the project scope in that NPAir capacity, as identified in Attachment A, is to be less than the original project scope, then the HOSPITAL shall reimburse the TEAM according to Attachment B. Modifications to Attachment A by the HOSPITAL must be made in writing and mutually agreed upon by both the HOSPITAL and the TEAM before such modifications shall become effective. The HOSPITAL understands and accepts that the awarding ofFY 2003 HRSA Grant funds for the purpose of enhancing NPAir capacity at the HOSPITAL does not in any way exempt the HOSPITAL from all applicable rules and regulations, codes and other provisions required by the HOSPITAL in its construction or renovation project, which will enhance NPAir capacity. Upon completion of the project to add NPAir capacity to the HOSPITAL, the HOSPITAL shall send a letter to the TEAM stating that the project has been completed. The letter shall designate that the rooms, identified in Attachment A, have been completed. This Agreement shall be in full force upon signature by the HOSPITAL, TEAM and the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health." Input Activities Any financial awards that are returned to the Region Six Hospital Bioterrorism Preparedness Planning Team by Ripon Medical Center are to be retained by the Team, but their use is restricted to uses as determined by the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health and the HRSA Leadership Group. Objective: Risk Profile Percent of Objective Accomplished I 0% I 10% I 20% I 30% I 40% I 50% I 60% I 70% 80% I 85% I 90% I 95% I 100% I Corresponding Percentage Recoupment 02/0612004 OS, 19 AM DPH G,an" and Con",," Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 4 of 12 Contract Year: 2004 Objective Value: $40,000 Corresponding Potential Recoupment Amounts I $40,000 I $36,000 I $32,000 I $28,000 I $24,000 I $20,000 I $16,000 I $12,000 I $8,000 I $6,000 I $4,000 I $2,000 I $0 Definition of Percent Accomplished 0% Accomplishment A construction project to enhance negative pressure airborne isolation room capacity was not begun at Ripon Medical Center. 100% Accomplishment Subsidy payments by the Region Six Hospital Bioterrorism Preparedness Planning Team to Ripon Medical Center totaled $40 000. Conditions of Eligibility for an Incentive I None 02/06/2004 Og,19AM DPH Gmn" ,nd Con""" Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 5 of 12 Contract Year: 2004 Objective Value: $38,800 Objective: Primary Details Objective Statement By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Berlin Memorial Hospital in Berlin with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. Deliverable Due Date: 01/31/2005 Contract Deliverable (Evidence) A written report to document I) amounts and dates of subsidy payments, 2) status of negative pressure airborne isolation room capacity construction project. Programs Providing Funds for this Objective Bioterrorism HRSA Hospital Preparedness: $38,800 Agency Funds for this Objective: Data Sonrce for Measurement Region Six Hospital Bioterrorism Preparedness Planning Team records. Baseline for Measurement This is a new initiative so baseline data will be established during the contract year. Context What follows is language from the associated Memorandum of Understanding between Berlin Memorial Hospital (HOSPITAL) and the Region Six Hospital Bioterrorism Preparedness Planning Team (TEAM). "The HOSPITAL accepts from the TEAM the funding award from the FY 2003 HRSA Grant, as stated in Attachment A, to enhance negative pressure airborne isolation room (NPAir) capacity at its facility, as also described in Attachment A. The HOSPITAL understands that the award made to the HOSPITAL may not cover all costs associated with this project to add NPAir capacity and this award is meant only to subsidize the total costs of adding NPAir capacity. The HOSPITAL commits to beginning the project to addNPAir capacity to the HOSPITAL no later than December 31, 2004, unless another date has been mutually agreed upon prior to the execution of this Agreement and the mutually agreed upon project start date is identified in an Attachment to thisAgreement. The definition of "project to begin" is demonstrated by an agreement between the HOSPITAL and their Contractor to begin work on the NPAir project or a project that includes the addition of NPAir, signed on or before December 31,2004. If the HOSPITAL, for any reason, does not start its project to add NPAir capacity to the HOSPITAL by December 31,2004, the HOSPITAL has the obligatibn to either return all monies awarded to the HOSPITAL by the TEAM unless another start date has been mutually agreed upon by the HOSPITAL and the TEAM. The HOSPITAL commits to the project as originally spe~ified in Attachment A. If there is a change to the project scope in that further NPAir capacity is added, it is understood by the HOSPITAL that no further funds will be available to the HOSPITAL from the TEAM. If the there is a change to the project scope in that NP Air capacity, as identified in Attachment A, is to be less than the original project scope, then the HOSPITAL shall reimburse the TEAM according to Attachment B. Modifications to Attachment A by the HOSPITAL must be made in writing and mutually agreed upon by both the HOSPITAL and the TEAM before such modifications shall become effective. The HOSPITAL understands and accepts that the awarding of FY 2003 HRSA Grant funds for the purpose of enhancing NPAir capacity at the HOSPITAL does not in any way exempt the HOSPITAL from all applicable rules and regulations, codes and other provisions required by the HOSPITAL in its construction or renovation project, which will enhance NPAircapacity. Upon completion of the projectto add NPAir capacity to the HOSPITAL, the HOSPITAL shall send a letter to the TEAM stating that the project has been completed. The letter shall designate that the rooms, identified in Attachment A, have been completed. This Agreement shall be in full force upon signature by the HOSPITAL, TEAM and the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health." Input Activities Any financial awards that are returned to the Region Six Hospital Bioterrorism Preparedness Planning Team by Berlin Memorial Hospital are to be retained by the Team, but their use is restricted to uses as determined by the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health and the HRSA Leadership Group. Objective: Risk Profile Percent of Objective Accomplished I 0% I 10% I 20% I 30% I 40% Corresponding Percentage Recoupment I 50% I 60% I 70% 80% I 85% I 90% I 95% I 100% I 02/06/2004 08:19AM DPH Gmn" 'nd Con'mcts Contract Agreement Addendum: Exhibit II(B) Contract#: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 5 of 12 Contract Year: 2004 Objective Value: $38,800 [ 100% I 90% I 80% [ 70% [ 60% [ 50% I 40% I 30% [ 20% I 15% [ 10% I 5% 0% Corresponding Potential Recoupment Amounts [ $38,800 I $34,920 [ $31,040 [ $27,160 I $23,280 I $19,400 [ $15,520 I $11,640 [ $7,760 [ $5,820 I $3,880 [ $1,940 [ $0 Definition of Percent Accomplished 0% Accomplishment A construction project to enhance negative pressure airborne isolation room capacity was not begun at Berlin Memorial Hospital. ' 100% Accomplishment Subsidy payments by the Region Six Hospital Bioterrorism Preparedness Planning Team to Berlin Memorial Hospital totaled $38,800. Conditions of Eligibility for an Incentive [None 02/06/2004 08,19 AM DPH G"n" ond Con'",", Contract Agreement Addendum: Exhibit II(B) Contract#: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 6 of 12 Contract Year: 2004 Objective Valne: $100,000 Objective: Primary Details Objective Statement By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at St. Elizabeth Hospital in Appleton with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. Deliverable Due Date: 01/31/2005 Contract Deliverable (Evidence) A written report to document 1) amounts and dates of subsidy payments, 2) status of negative pressure airborne isolation room capacity construction project. Programs Providing Funds for this Ohjective Bioterrorism HRSA Hospital Preparedness: $100,000 Agency Funds for this Objective: Data Source for Measurement Region Six Hospital Bioterrorism Preparedness Planning Team records. Baseline for Measurement This is a new initiative so baseline data will be established during the contract year. Context What follows is language from the associated Memorandum of Understanding between SI. Elizabeth Hospital (HOSPITAL) and the Region Six Hospital Bioterrorism Preparedness Planning Team (TEAM). "The HOSPITAL accepts from the TEAM the funding award from the FY 2003 HRSA Grant, as stated in Attachment A, to enhance negative pressure airborne isolation room (NPAir) capacity at its facility, as also described in Attachment A. The HOSPITAL understands that the award made to the HOSPITAL may not cover all costs associated with this project to add NPAir capacity and this award is meant only to subsidize the total costs of adding NPAir capacity. The HOSPITAL commits to beginning the project to add NPAir capacity to the HOSPITAL no later than December 31, 2004, unless another date has been mutually agreed upon prior to the execution of this Agreement and the mutually agreed upon project start date is identified in an Attachment to this Agreement. The definition of "project to begin" is demonstrated by an agreement between the HOSPITAL and their Contractor to begin work on the NPAir project or a project that includes the addition of NPAir, signed on or before December 31, 2004. If the HOSPITAL, for any reason, does not start its project to add NPAir capacity to the HOSPITAL by December 31, 2004, the HOSPITAL has the obligation to either return all monies awarded to the HOSPITAL by the TEAM unless another start date has been mutually agreed upon by the HOSPITAL and the TEAM. The HOSPITAL commits to the project as originally specified in Attachment A. If there is a change to the project scope in that further NPAir capacity is added, it is understood by the HOSPITAL that no further funds will be available to the HOSPITAL from the TEAM. If the there is a change to the project scope in that NPAir capacity, as identified in Attachment A, is to be less than the original project scope, then the HOSPITAL shall reimburse the TEAM according to Attachment B. Modifications to Attachment A by the HOSPITAL must be made in wri'ting and mutually agreed upon by both ,the HOSPITAL and the TEAM before such' modifications shall become effective. The HOSPITAL understands and accepts that the awarding of FY 2003 HRSA Grant funds for the purpose of enhancing NPAir capacity at the HOSPITAL does not in any way exempt the HOSPITAL from all applicable rules and regulations, codes and other provisions required by the HOSPITAL in its construction or renovation project, which will enhance NPAir capacity. Upon completion of the project to add NPAir capacity to the HOSPITAL, the HOSPITAL shall send a letter to the TEAM stating that the project has been completed. The letter shall designate that the rooms, identified in Attachment A, have been completed. This Agreement shall be in full force upon signature by the HOSPITAL, TEAM and the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health." Input Activities Any financial awards that are returned to the Region Six Hospital Bioterrorism Preparedness Planning Team by St. Elizabeth Hospital are to be retained by the Team, but their use is restricted to uses as determined by the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health and the HRSA Leadership Group. Objective: Risk Profile Percent of Objective Accomplished I 0% I 10% I 20% I 30% I 40% I 50% I 60% I 70% I Corresponding Percentage Recoupment 80% I 85% I 90% I 95% I 100% I 02/06/2004 08,19 AM DPH G"n" and Con'"cts Contract Agreement Addendum: Exhibit II(B) Contract#: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 6 of 12 Contract Year: 2004 Objective Value: $100,000 Definition of Percent Accomplished 0% Accomplishment A construction project to enhance negative pressure airborne isolation room capacity was not begun at St. Elizabeth Hospital. 100% Accomplishment Subsidy payments by the Region Six Hospital Bioterrorism Preparedness Planning Team to St. Elizabeth Hospital totaled $100000. Conditions of Eligibility for an Incentive ¡None 02/06/2004 08,19 AM DPH Gmnts and Conlrac" Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective#: 7 of 12 Contract Year: 2004 Objective Value: $40,000 Objective: Primary Details Objective Statement By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at New London Family Medical Center in New London with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. DeliverableDneDate: 01/3112005 Contract Deliverable (Evidence) A written report to document 1) amounts and dates of subsidy payments, 2) status of negative pressure airborne isolation room capacity construction project. Programs Providing Funds for this Objective Bioterrorism.HRSA Hospital Preparedness: $40,000 Agency Funds for this Objective: Data Source for Measurement Region Six Hospital Bioterrorism Preparedness Planning Team retords. Baseline for Measurement This is a new initiative so baseline data will be established during the contract year. Coutext What follows is language from the associated Memorandum of Understanding between New London Family Medical Center (HOSPITAL) and the Region Six Hospital Bioterrorism Preparedness Planning Team (TEAM). "The HOSPITAL accepts from the TEAM the funding award from the FY 2003 HRSA Grant, as stated in Attachment A, to enhance negative pressure airborne isolation room (NPAir) capacity at its facility, as also described in Attachment A. The HOSPITAL understands that the award made to the HOSPITAL may not cover all costs associated with this project to add NPAir capacity and this award is meant only to subsidize the total costs of adding NPAir capacity. The HOSPITAL commits to beginning the project to add NPAircapacity to the HOSPITAL no later than December 31, 2004, unless another date has been mutually agreed upon prior to the execution of this Agreement and the mutually agreed ùpon project start date is identified in an Attachment to this Agreement. The definition of "project to begin" is demonstrated by an agreement between the HOSPITAL and. their Contractor to begin work on the NPAir project or a project that includes the addition ofNPAir, signed on or before December 31, 2004. If the HOSPITAL, for any reason, does not start its project to add NP Air capacity to the HOSPITAL by December 31, 2004, the HOSPITAL has the obligation to either return all monies awarded to the HOSPITAL by the TEAM unless another start date has been mutually agreed upon by the HOSPITAL and the TEAM. The HOSPITAL commits to the project as originally specified in Attachment A. If there is a change to the project scope in that further NPAir capacity is added, it is understood by the HOSPITAL that no further funds will be available to the HOSPITAL from the TEAM. If the there is a change to the project scope in that NPAir capacity, as identified in Attachment A, is to be less than the original project scope, then the HOSPITAL shall reimburse the TEAM according to Attachment B. Modifications to Attachment A by the HOSPITAL must be made in writing and mutually agreed upon by both the HOSPITAL and the TEAM before such modifications shall become effective. The HOSPITAL understands and accepts that the awarding of FY 2003 HRSA Grant funds for the purpose of enhancing NP Air capacity at the HOSPITAL does not in any way exempt the HOSPITAL from all applicable rules and regnlations, codes and other provisions required by the HOSPITAL in its construction or renovation project, which will enhance NPAir capacity. Upon completion of the project to add NPAir capacity to the HOSPITAL, the HOSPITAL shall send a letter to the TEAM stating that the project has been completed. The letter shall designate that the rooms, identified in Attachment A, have been completed. This Agreement shall be in full force upon signature by the HOSPITAL, TEAM and the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health." Input Activities Any financial awards that are returned to the Region Six Hospital Bioterrorism Preparedness Planning Team by New London Family Medical Center are to be retained by the Team, but their use is restricted to uses as determined by the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health and the HRSA Leadership Group. Objective: RiskProqle Percent of Objective Accomplished I 0% I 10% I 20% I 30% I 40% I 50% I 60% I 70% I Corresponding Perceutage Recoupment 80% I 85% I 90% I 95% I 100% I 02/06/2004 OS,¡9AM DPH Gmnts and Contract, Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 7 of 12 Contract Year: 2004 Objective Value: $40,000 Corresponding Potential Recoupment Amounts I $40,000 I $36,000 I $32,000 I $28,000 I $24,000 I $20,000 I $16,000 I $12,000 ~I $4,000 I $2,000 I $0 Definition of Percent Accomplished 0% Accomplishment A construction project to enhance negative pressure airborne isolation room capacity was not begun at New London Family Medical Center. 100% Accomplishment Subsidy payments by the Region Six Hospital Bioterrorism Preparedness Planning Team to New London Family Medical Center totaled $40 000. Conditions of Eligihility for an Incentive INone 02/0612004 08,19 AM DPH Gran" ,nd Con",," Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 8 of 12 Contract Year: 2004 Objective Value: $155,000 Objective: Primary Details Objective Statement By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Appleton Medical Center in Appleton with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. Deliverable Due Date: 01/31/2005 Contract Deliverable (Evidence) A written report to document 1) amounts and dates of subsidy payments, 2) status of negative pressure airborne isolation room capacity construction project. Programs Providing Funds for this Objective Bioterrorism HRSA Hospital Preparedness: $155,000 Agency Funds for this Objective: Data Source for Measurement Region Six Hospital Bioterrorism Preparedness Planning Team records. Baseline for Measurement This is a new initiative so baseline data will be established during the contract year. Context What follows is language from the associated Memorandum of Understanding between Appleton Medical Center (HOSPITAL) and the Region Six Hospital Bioterrorism Preparedness Planning Team (TEAM). "The HOSPITAL accepts from the TEAM the funding award from the FY 2003 HRSA Grant, as stated in Attachment A, to enhance negative pressure airborne isolation room (NPAir) capacity at its facility, as also described in Attachment A. The HOSPITAL understands that the award made to the HOSPITAL may not cover all costs associated with this project to add NPAir capacity and this award is meant only to subsidize the total costs of adding NPAir capacity. The HOSPITAL commits to beginning the project to add NPAir capacity to the HOSPITAL no later than December 31, 2004, unless another date has been mutually agreed upon prior to the execution of this Agreement and the mutually agreed upon project start date is identified in an Attáchment to this Agreement. The definition of "project to begin" is demonstrated by an agreement between the HOSPITAL and their Contractor to begin work on the NPAir project or a project that includes the addition ofNPAir, signed on or before December 31, 2004. If the HOSPITAL, for any reason, does not start its project to add NPAircapacity to the HOSPITAL by December 31, 2004, the HOSPITAL has the obligation to either return all monies awarded to the HOSPITAL by the TEAM unless another start date has been mutually agreed upon by the HOSPITAL and the TEAM. The HOSPITAL commits to the project as originally specified in Attachment A. If there is a change to the project scope in that further NP Air capacity is added, it is understood by the HOSPITAL that no further funds will be available to the HOSPITAL from the TEAM. If the there is a change to the project scope in that NPAircapacity, as identified in Attachment A, is to be less than the o\'Ìginal project scope, then the HOSPITAL shall reimburse the TEAM according to AttachmentB. Modifications to Attachment A by the HOSPITAL must be made in writing and mutually agreed upon by both the HOSPITAL and the TEAM before such modifications shall become effective. The HOSPITAL understands and accepts that the awarding ofFY 2003 HRSA Grant funds for the purpose of enhancing NPAir capacity at the HOSPITAL does not in any way exempt the HOSPITAL from all applicable rules and regulations, codes and other provisions required by the HOSPITAL in its construction or renovation project, which will enhance NPAir capacity. Upon completion of the project to add NPAir capacity to the HOSPITAL, the HOSPITAL shall send a letter to the TEAM stating that the project has been completed. The letter shall designate that the rooms, identified in Attachment A, have been completed. This Agreement shall be in full force upon signature by the HOSPITAL, TEAM and the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health." Input Activities Any financial awards that are returned to the Region Six Hospital Bioterrorism Preparedness Planning Team by Appleton Medical Center are to be retained by the Team, but their usê is restricted to uses as determined by the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health and the HRSA Leadership Group. Objective: Risk Profile Corresponding Percentage Recoupment 02/06/2004 Og,19AM DPH Gmn" and Con""," Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective#: 8 of 12 Contract Year: 2004 Objective Value: $155,000 1 100% 1 90% I 80% I 70% 1 60% 1 50% I 40% 1 30% I 20% 15% 1 10% 1 5% 0% Corresponding Potential Recoupment Amounts 1$155,0001$139,5001$124,0001$108,5001 $93,000 ¡ $77,500 1 $62,000 1 $46,500 I $31,000 1 $23,250 1 $15,500 1 $7,750 ¡ $0 Definition of Percent Accomplished 0% Accomplishment A construction project to enhance negative pressure airborne isolation room capacity was not begun at Appleton Medical Center. 100% Accomplishment Subsidy payments by the Region Six Hospital Bioterrorism Preparedness Planning Team to Appleton Medical Center totaled $155000. Couditions of Eligibility for an Incentive ¡None 02/06/2004 08,19 AM DPH G<an" and Cont<ac" Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 9 of 12 Contract Year: 2004 Objective Valne: $40,000 Objective: Primary Details Objective Statement By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Riverside Medical Center in Waupaca with associated costs subsidized by the Region Six Hospital Bioteriorism Preparedness Planning Team. Deliverable Due Date: 01/31/2005 Contract Deliverable (Evidence) A written report to document 1) amounts and dates of subsidy payments, 2) status of negative pressure airborne isolation room capacity construction project. Programs Providing Funds for this Objective Bioterrorism HRSA Hospital Preparedness: $40,000 Agency Funds for this Objective: Data Source for Measurement Region Six Hospital Bioterrorism Preparedness Planning Team records. Baseline for Measurement This is a new initiative so baseline data will be established during the contract year. Context What follows is language from the associated Memorandum of Understanding between Riverside Medical Center (HOSPITAL) and the Region Six Hospital Bioterrorism Preparedness Planning Team (TEAM). "The HOSPITAL accepts from the TEAM the funding award from the FY 2003 HRSA Grant, as stated in Attachment A, to enhance negative pressure airborne isolation room (NPAir) capacity at its facility, as also described in Attachment A. The HOSPITAL understands that the award made to the HOSPITAL may not cover all costs associated with this project to add NPAir capacity and this award is meant only to subsidize the total costs of adding NPAir capacity. The HOSPITAL commits to beginning the project to add NPAir capacity to the HOSPITAL no later than December 31, 2004, unless another date has been mutually agreed upon prior to the execution of this Agreement and the mutually agreed upon project start date is identified in an Attachment to this Agreement. The definition of "project to begin" is demonstrated by an agreement between the HOSPITAL and their Contractor to begin work on the NP Air project or a project that includes the addition of NPAir, signed on or before December 31, 2004. If the HOSPITAL, for any reason, does not start its project to add NP Air capacity to the HOSPITAL by December 31, 2004, the HOSPITAL has the obligation to either return all monies awarded to the HOSPITAL by the TEAM.unless another start date has been mutually agreed upon by the HOSPITAL and the TEAM. The HOSPITAL commits to the project as originally specified in Attachment A. If there is a change to the project scope in that further NP Air capacity is added, it is understood by the HOSPITAL that no further funds will be available to the HOSPITAL from the TEAM. If the there is a change to the project scope in that NPAir capacity, as identified in Attachment A, is to be less than the original project scope, then the HOSPITAL shall reimburse the TEAM according to Attachment B. Modifications to Attachment A by the HOSPITAL must be made in writing and mutually agreed upon by both the HOSPITAL and the TEAM before such modifications shall become effective. The HOSPITAL understands and accepts that the awarding of FY 2003 HRSA Grant funds for the purpose of enhancing NPAir capacity at the HOSPITAL does not in any way exempt the HOSPITAL from all applicable rules and regulations, codes and other provisions required by the HOSPITAL in its construction or renovation project, which will enhance NPAir capacity. Upon completion of the project to add NPAir capacity to the HOSPITAL, the HOSPITAL shall send a letter to the TEAM stating that the project has been completed. The letter shall designate that the rooms, identified in Attachment A, have been completed. This Agreement shall be in full force upon signature by the HOSPITAL, TEAM and the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health." Input ACtivities Any financial awards that are returned to the Region Six Hospital Bioterrorism Preparedness Planning Team by Riverside Medical Center are to be retained by the Team, but their use is restricted to uses as determined by the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health and the HRSA Leadership Group. Objective: Risk Profile Percent of Objective Accomplished I 0% I 10% I 20% I 30% I 40% I 50% Corresponding Percentage Recoupment I 60% I 70% 80% I 85% I 90% I 95% I 100% I 02/06/2004 OS,19AM DPH G,an" and Contrac" Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 9 of 12 Contract Year: 2004 Objective Value: $40,000 Corresponding Potential Recoupment Amounts I $40,000 I $36,000 I $32,000 I $28,000 I $24,000 I $20,000 I $i6,000 r~ $2,000 I $0 Definition of Percent Accomplished 0% Accomplishment A construction project to enhance negative pressure airborne isolation room capacity was not begun at Riverside Medical Center. 100% Accomplishment Subsidy payments by the Region Six Hospital Bioterrorism Preparedness Planning Team to Riverside Medical Center totaled $40 000. Conditions of Eligibility for an Incentive ¡None 02/0612004 OS: 19 AM DPH Gmn" ,nd Contract<; Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 10 of 12 Contract Year: 2004 Objective Valne: $40,000 Objective: Primary Details Objective Statement By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Wild Rose Community Hospital in Wild Rose with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. Deliverable Due Date: 01/31/2005 Contract Deliverable (Evidence) A written reporr to document 1) amounts and dates of subsidy payrnents, 2) status of negative pressure airborne isolation room capacity construction project. Programs Providing Funds for this Objective Bioterrorism HRSA Hospital Preparedness: $40,000 Agency Funds for this Objective: Data Source for Measurement Region Six Hospital Bioterrorism Preparedness Planning Team records. Baseline for Measurement This is a new initiative so baseline data will be established during the coutract year. Context What follows is language from the associated Memorandum of Understanding between Wild Rose Community Hospital (HOSPITAL) and the Region Six Hospital Bioterrorism Preparedness Planning Team (TEAM). "The HOSPITAL accepts from the TEAM the funding award from the FY 2003 HRSA Grant, as stated in Attachment A, to enhance negative pressure airborne isolation room (NPAir) capacity at its facility, as also described in Attachment A. The HOSPITAL understands that the award made to the HOSPITAL may not cover all costs associated with this project to add NPAir capacity and this award is meant only to subsidize the total costs of adding NPAir capacity. The HOSPITAL commits to beginning the project to add NPAircapacity to the HOSPITAL no later than December 31, 2004, unless another date has been mutually agreed upon prior to the execution of this Agreement and the mutually agreed upon project start date is identified in an Attachment to this Agreement. The definition of "project to begin" is demonstrated by an agreement between the HOSPITAL and their Contractor to begin work on the NPAir project or a project that includes the addition of NPAir, signed on or before December 31, 2004. If the HOSPITAL, for any reason, does not start its project to add NPAircapacity to the HOSPITAL by December 31, 2004, the HOSPITAL has the obligation to either return all monies awarded to the HOSPITAL by the TEAM unless another start date has been mutually agreed upon by the HOSPITAL and the TEAM. The HOSPITAL commits to the project as originally specified in Attachment A. If there is a change to the project scope in that further NPAir capacity is added, it is understood by the HOSPITAL that no further funds will be available to the HOSPITAL from the TEAM. If the there is a change to the project scope in that NPAir capacity, as identified in Attachment A, is to be less than the original project scope, then the HOSPITAL shall reimburse the TEAM according to Attachment B. Modifications to Attachment A by the HOSPITAL must b.e made in writing and rnutually agreed upon by both the HOSPITAL and the TEAM before such modifications shall become effective. The HOSPITAL understands and accepts that the awarding of FY 2003 HRSA Grant funds for the purpose of enhancing NPAir capacity at the HOSPITAL does not in any way exempt the HOSPITAL from all applicable rules and regulations, codes and other provisions required by the HOSPITAL in its construction or renovation project, which will enhance NPAir capacity. Upon completion of the project to add NPAir capacity to the HOSPITAL, the HOSPITAL shall send a letter to the TEAM stating that the project has been completed. The letter shall designate that the rooms, identified in Attachment A, have been completed. This Agreement shall be in full force upon signature by the HOSPITAL, TEAM and the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health." Input Activities Any financial awards that are returned to the Region Six Hospital Bioterrorism Preparedness Planning Team by Wild Rose Community Hospital are to be retained by the Team, but their use is restricted to uses as determined by the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health and the HRSA Leadership Group. Objective: Risk Profile Perceut of Objective Accomplished I 0% I 10% I 20% I 30% I 40% I 50% 60% I 70% I 80% I 85% I 90% I 95% I 100% I Corresponding Percentage Recoupment 02/06/2004 OS,19 AM DPH Gmn" and Controc" Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 10 of 12 Contract Year: 2004 Objective Value: $40,000 Corresponding Potential Recoupment Arnounts I $40,000 I $36,000 I $32,000 I $28,000 I $24,000 I $20,000 I $16,000 ~I $2,000 I $0 Definition of Percent Accomplished 0% Accomplishment A construction project to enhance negative pressure airborne isolation room capacity was not begun at Wild Rose Community Hospital. 100% Accomplishment Subsidy payments by the Region Six Hospital Bioterrorism Preparedness Planning Team to Wild Rose Community Hospital totaled $40 000. Conditions of Eligibility for an Incentive INone 02/06/2004 OS,19AM DPH Gmnts and Con'mc" Contract Agreement Addendum: Exhibit II(B) Contract#: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 11 of 12 Contract Year: 2004 Objective Valne: $38,800 Objective: Primary Details Objective Statement By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Mercy Medical Center of Oshkosh in Oshkosh with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. Deliverable Due Date: 01131/2005 Contract Deliverable (Evidence) A written report to document 1) amounts and dates of subsidy payments, 2) status of negative pressure airborne isolation room capacity construction project. Programs Providing Funds for this ,Objective Bioterrorism HRSA Hospital Preparedness: $38,800 Agency Fnnds for this Objective: Data Source for Measurement Region Six Hospital Bioterrorism Preparedness Planning Team records. Baseline for Measurement This is a new initiative so baseline data will be established during the contract year. Context What follows is language from the associated Memorandum of Understanding between Mercy Medical Center of Oshkosh (HOSPITAL) and the Region Six Hospital Bioterrorism Preparedness Planning Team (TEAM). "The HOSPITAL accepts from the TEAM the funding award from the FY 2003 HRSA Grant, as stated in Attachment A, to enhance negative pressure airborne isolation room (NPAir) capacity at its facility, as also described in Attachment A. The HOSPITAL understands that the award made to the HOSPITAL may not cover all costs associated with this project to add NPAir capacity and this award is meant only to subsidize the total costS of adding NPAir capacity. The HOSPITAL commits to beginning the project to add NPAir capacity to the HOSPITAL no later than December 31, 2004, unless another date has been mutually agreed upon prior to the execution of this Agreement and the mutually agreed upon project start date is identified in an Attachment to this Agreement. The definition of "project to begin" is demonstrated by an agreement between the HOSPITAL and their Contractor to begin work on the NPAir project or a project that includes the addition of NP Air, signed on or before December 31, 2004. If the HOSPITAL, for any reason, does not start its project to add NPAircapacity to the HOSPITAL by December 31, 2004, the HOSPITAL has the obligation to either return all monies awarded to the HOSPITAL by the TEAM unless another start date has been mutually agreed upon by the HOSPITAL and the TEAM. The HOSPITAL commits to the project as originally specified in Attachment A. If there is a change to the project scope in that further NPAir capacity is added, it is understood by the HOSPITAL that no furtherfunds will be available to the HOSPITAL from the TEAM. If the there is a change to the project scope in that NPAir capacity, as identified in Attachment A, is to be less than the original project scope, then the HOSPITAL shall reimburse the TEAM according to Attachment B. Modifications to Attachment A by the HOSPITAL must be made in writing and mutually agreed upon by both the HOSPITAL and the TEAM before such modifications shall become effective. The HOSPITAL understands and accepts that the awarding ofFY 2003 HRSA Grant funds for the purpose of enhancing NPAir capacity at the HOSPITAL does not in any way exempt the HOSPITAL from all applicable rules and regulations, codes and other provisions required by the HOSPITAL in its construction or renovation project, which will enhance NPAircapacity. Upon completion of the project to add NPAir capacity to the HOSPITAL, the HOSPITAL shall send a letter to the TEAM stating that the project has been completed. The letter shall designate that the rooms, identified in Attachment A, have been completed. This Agreement shall be in full force upon signature by the HOSPITAL, TEAM and the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health." Input Activities Any financial awards that are returned to the Region Six Hospital Bioterrorism Preparedness Planning Team by Mercy Medical Center of Oshkosh are to be retained by the Team, but their use is restricted to uses as determined by the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health and the HRSA Leadership Group. Objective: Risk Profile Corresponding Percentage Recoupment 02/06/2004 OS,19 AM DPH G,an" and Cont<ac" J, ' Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 11 of 12 Contract Year: 2004 Objective Valne: $38,800 I 100% I 90% 80% I 70% I 60% I 50% I 40% I 30% I 20% Corresponding Potential Recoupment Amounts I $38,800 I $34,920 I $31,040 I $27,160 I $23,280 I $19,400 I $15,520 I $11,640 I $7,760 I $5,820 I $3,880 I $1,940 I $0 Definition of Percent Accomplished 0% Accomplishment A construction project to enhance negative pressure airborne isolation room capacity was not begun at Mercy Medical Center of Oshkosh. 100% Accomplishment Subsidy payments by the Region Six Hospital Bioterrorism Preparedness Planning Team to Mercy Medical Center of Oshkosh totaled $38 800. Conditions of Eligibility for an Incentive I None 15% 10% I 5% 0% 02/06/2004 08,19 AM DPH Grants and Contme" "" , Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrorism HRSA Hospital Preparedness Objective #: 12 of 12 CootractYear: 2004 Objective Valne: $155,000 Objective: Primary Details Objective Statement By December 31, 2004, a construction project to enhance negative pressure airborne isolation room capacity has commenced at Theda Clark Medical Center in Neenah with associated costs subsidized by the Region Six Hospital Bioterrorism Preparedness Planning Team. Deliverable Due Date: 0113112005 Contract Deliverable (Evidence) A written report to document 1) amounts and dates of subsidy payments, 2) status of negative pressure airborne isolation room capacity construction project. Programs Providing Funds for this Objective Bioterrorism HRSA Hospital Preparedness: $155,000 Agency Funds for this Objective: Data Source for Measurement Region Six Hospital Bioterrorism Preparedness Planning Team records. Baseline for Measurement This is a new initiative so baseline data will be established during the contract year. Context . What follows is language from the associated Memorandum of Understanding between Theda Clark Medical Center (HOSPITAL) and the Region Six Hospital Bioterrorism Preparedness Planning Team (TEAM). "The HOSPITAL accepts from the TEAM the funding award from the FY 2003 HRSA Grant, as stated in Attachment A, to enhance ne~ative pressure airborne isolation room (NPAir) capacity at its facility, as also described in Attachment A. The HOSPITAL understands that the award made to the HOSPITAL may not cover all costs associated with this project to add NPAir capacity and this award is meant only to subsidize the total costs of adding NPAir capacity. The HOSPITAL commits to beginning the project to add NPAir capacity to the HOSPITAL no later than December 31, 2004, unless another date has been mutually agreed upon prior to the execution of this Agreement and the mutually agreed upon project start date is identified in an Attachment to this Agreement. The definition of "project to begin" is demonstrated by an agreement between the HOSPITAL and their Contractor to begin work on the NPAir project or a project that includes the addition of NPAir, signed on or before December 31,2004. lithe HOSPITAL, for any reason, does not start its project to add NPAir capacity to the HOSPITAL by December 31, 2004, the HOSPITAL has the obligation to either return all monies awarded to the HOSPITAL by the TEAM unless another start date has been mutually agreed upon by the HOSPITAL and the TEAM. The HOSPITAL commits to the project as originally specified in Attachment A. If there is a change to the project scope in that further NPAir capacity is added, it is understood by the HOSPITAL that no further funds will be available to the HOSPITAL from the TEAM. If the there is a change to the project scope in that NPAircapacity, as identified in Attachment A, is to be less than the original project scope, then the HOSPITAL shall reimburse the TEAM according to Attachment B. Modifications to Attachment A by the HOSPITAL must be made in writing and mutually agreed upon by both the HOSPITAL and the TEAM before such modifications shall become effective. The HOSPITAL understands and accepts that the awarding of FY 2003 HRSA Grant funds for the purpose of enhancing NPAir capacity at the HOSPITAL does not in any way exempt the HOSPITAL from all applicable rules and regulations, codes and other provisions required by the HOSPITAL in its construction or renovation project, which will enhance NPAir capacity. Upon completion of the project to add NPAir capacity to the HOSPITAL, the HOSPITAL shall send a letter to the TEAM stating that the project has been completed. The letter shall designate that the rooms, identified in Attachment A, have been completed. This Agreement shall be in full force upon signature by the HOSPITAL, TEAM and the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health." Input Activities Any financial awards that are returned to the Region Six Hospital Bioterrorism Preparedness Planning Team by Theda Clark Medical Center are to be retained by the Team, but their use is restricted to uses as determined by the Director, Hospital Bioterrorism Preparedness, Wisconsin Division of Public Health and the HRSA Leadership Group. Objective: Risk Profile Percent of Objective Accornplished I 0% I 10% I 20% I 30% I 40% I 50% I 60% I 70% I 80% I 85% I 90% I 95% I 100% I Correspouding Percentage Recoupment 02/06/2004 OS,¡9AM DPH Gmn" and Cancract, Preamble This Agreement is entered into between of Wisconsin represented by its of Public Family Services, whose principal business address is One West Wilson Street, PO Madison, Wisconsin 53701-2659, hereinafter referred to as Contractor, and Oshkosh Health Department, whose principal business address is 215 Church Street, PO Box 1130, Oshkosh WI 54902-1130, hereinafter referred to as Contractee. , . . The Contactee address above is the address to which payments shall be mailed. If any legal notices required to bè sent to the Contractee in the execution of this Agreement should be sent to an address different from the Contractee address above, that address should be provided below: Whereas, the Contractor wishes to purchase servièes from the Contractee as it is authorized to do by Wisconsin law; and Whereas, the Contractee is engaged in furnishing the desired services; Now, therefore, the Contractor and the Contractee agree as follows: SERVICES TO BE PROVIDED The Contractee agrees toprovide services consistent with the purposes it has agreed to attain within the contract period. The Contractee also agrees to provide to the docurnentation (as agreed to in negotiations with the Contractor) of the attainment of those objectives no later than 30 days after the end of the contract period or as specified in Exhibit lI. A detailed description of the objectives tó be attained and the documentation associated with that attainment is part of this Agreement as listed in Exhibits I and lI, which are attached to this Agreement. II. CONTRACT ADMINISTRATION The Contractor's Contract Administratór is Jody Moesch-Ebeling of the of Public whose principal business address is 200 N. Jefferson, Suite 126, Green Bay, WI 54301. The telephone number of the Contractor's Contract Administrator is (920) 448-5230. In the event that the Contract Administrator is unable to administer this Contract Agreement, the Contractor will contact the Contractee and designate a new Contract Administratór. ' The Contractee's Contract Administrator is Paul Spiegel, whose principal business address is 215 Church Street, PO Box 1130, Oshkosh WI 54902-1130. The telephone number of the Contractee's Contract Administrator is (920) 236-5034. In the event that the Contract Administrator is unable to adrninister this Contract Agreement, the Contractee will contact the Contractor and designate a new Contract Administrator. III. PAYMENT LIMIT The Contractor agrees to pay the Contractee an amount not to exceed $81,266. This amount is Contractor(s). The Contractor will not rnake payments in excess of the Contract Agreement amounts, with the exception of performance-based incentive funds pursuant to Section XXI. Revised 10/03 CC.LPHD , . , " ) IV. V. PAYMENT PROCESS 1. 2. VI. Payments will be made on a monthly basis. The Contractee will receive one-twelfth (1/12) of the total contract amount each month unless Contractee has failed to maintain quality criteria or proposed progress towards achievernent of Contract objectives as detennined by the Contractor. In these situations the Contractor can make reductions in the rnonthly payment pursuant to Section XVI. All payments shall be released by the Department on the last business day before the fifth day of the month for municipalities, or the last business day of each month for non-municipalities, with the exception that the payment that would normally be released on the last working day of June shall be released instead on the fITSt working day of July. Checks will be mailed to the Contractee's principal business address unless the Contractee requests, in writing, subject to approval, that the Department mail the checks to a different address. PROGRAM REPORTING 1. The Contractee shall comply with the program reporting requirements of the Contractor as specified during the negotiation process and as stated in Exhibits I and 11. The required reports shall be forwarded to the Contractor's Contract Administrator according to the schedule as specified in Exhibits I and II. 2. Failure to submit the reports specified in the reporting instructions may result in the Contractor renderipg sanctions pursuant to Section XVI of this contract. STATE AND FEDERAL RULES AND REGULATIONS 1. The Contractee agrees to meet state and federal laws, rules and regulations, and program policies applicable to this Contract Agreement. 2. The Contractee agrees to comply with Public Law 103-227, also known as the Pro-Children Act of 1994, which prohibits tobacco smoke in any portion of a facility owned or leased or contracted for by an entity which receives federal funds, either directly or through the State, for the purpose of providing services to children under the age of 18. 3. Affirmative Action Plan/Civil Rights Cornpliance Affirmative Action Plans A. For Agreements of twenty-five thousand ($25,000) or more, Contractee shall submit a written Affmnative Action (AA) Plan, which may cover a two-year period. Contractees with an annual work force of less than twenty-five employees and Contractees who are governmental entities are excluded from the requirement to submit an AA Plan. B. "Affrrrnative Action Plan" is a written document that details an affl11llative action program. Key parts of an affmnative action plan are: (1) a policy statement pledging nondiscrimination and affirmative action ernployment, (2) internal and external dissemination of the policy, (3) assignment of a key employee as the equal opportunity officer, (4) a work force analysis that identifies job classifications where representation of women, minorities and the disabled is deficient, (5) goals and timetables that are specific and measurable and that are set to correct deficiencies and to reach a balanced work force, (6) revision of employment practices to ensure that they do not have discriminatory effects, and (7) establishrnent of internal monitoring and reporting systems to measure progress regularly. C. In addition, for Agreements of ten thousand ($10,000) or more, regardless of work force size, Contractee shall conduct, keep on file, and update annually, a separate and additional accessibility self-evaluation of all programs and facilities, including Revi,oo 10/03 CC-lPHD 2 , , ? ) employment practices for compliance with ADA regulations, unless an updated self- evaluation under Section 504 of the Rehabilitation Act of 1973 exists which meets the ADA requirements. Contractees are to contact the Department's Affmnative Action/Civil Rights Compliance Office, Department of Health and Family Services, One West Wilson Street, Room 672, PO Box 7850, Madison WI53707-7850, for technical assistance on Equal Opportunity. A. Civil Rights Compliance B. Rev;sed 10/03 CC-LPHD For Agreements for the provision of services to clients, the Contractee must comply with Civil Rights requirements. Contractees with an annual work force of less than ten employees, regardless of Agreement amount, and Contractees with Agreements less than $10,000 are not required to submit a Civil Rights Compliance Action Plan, but must, at a minimum, submit Civil Rights Compliance Assurances. For Agreernents of $10,000 or more, Contractee shall submit a written Civil Rights Cornpliance (CRe) Action Plan, which may cover a two-year period. The Contractee assures that it has submitted to the Contractor's Affmnative Action/Civil Rights Compliance Office a current copy of its two-year Civil Rights Compliance Action Plan for Meeting Equal Opportunity Requirements under Title VI and VII of the Civil Rights Act of 1964, Sections 503 and 504 of the Rehabilitation Act of 1973, Title VI and XVI of the Public Health Service Act, the Age Discrimination in Employment Act of 1967, the Age Discrimination Act of 1975, the Omnibus Reconciliation Act of 1981, the Americans with Disabilities Act (ADA) of 1990, and the Wisconsin Fair Ernployrnent Act. If a Plan was reviewed and approved during the previous year, a plan update rnust be submitted for this Agreement period. I) No otherwise qualified person shall be excluded from participation in, be denied the benefits of, or otherwise be subject to discrimination in any rnanner on the basis of race, color, national origin, sexual orientation, religion, sex, disability or age. This policy covers eligibility for and access to service delivery, and treatment in all programs and activities. AIl employees of the Contractee are expected to support goals and programmatic activities relating to nondiscrimination in service delivery. 2) No otherwise qualified person shall be excluded frorn employment, be denied the benefits of employment or otherwise be subject to discrimination in employment in any manner or term of ernployment on the basis of age, race, religion, sexual orientation, color, sex, national origin or ancestry, handicap (as defined in Section 504 and the Americans with Disabilities Act), arrest or conviction record, marital status, political affiliation, or military participation- All employees are expected to support goals and programmatic activities relating to non-discrimination in employment. 3) The Contractee shall post the Equal Opportunity Policy, the name of the Equal Opportunity Coordinator and the discrimination complaint process in conspicuous places available to applicants and clients of services, and applicants for employment and ernployees. The cornplaint process will be according to Contractor standards and made available in languages and formats understandable to applicants, clients and employees. The Contractor will continue to provide appropriate translated program brochures and forms for distribution. 4) The Contractee agrees to comply with the Contractor's guidelines in the Civil Rights Compliance Standards and a Resource Manual for Equal Opportunity in Service Delivery and Ernployrnent for the Wisconsin Department of Health and Family Services, its Service Providers and their Subcontractors (October 1997 Edition). 3 5) C. VD. SUBCONTRACTS Requirements hereiu stated apply to any subcontracts or contracts. The Contractee has primary responsibility to take constructiv" steps, as per the CRC Standards and Resource Manual, to ensure the compliance of its subcontractors. However, where the Contractor has a direct contract with another Contractee, the Contractee need not obtain a Subcontractor or Subcontractee Civil Rights Compliance Action Plan or monitor that Subcontractee. 6) The Contractor will monitor the Civil Rights Compliance of the Contractee. The Contractor will conduct reviews to ensure that the Contractee is ensuring compliance by its subcontractors or Contractees according to guidelines in the CRC Standards and Resource Manual. The Contractee agrees to comply with Civil Rights monitoring reviews. including the examination of records and relevant files maintained by the Contractee, as well as interviews with staff, clients, applicants for services, subcontractors, Contractees, and referral agencies. The reviews will be conducted according to Department procedures. The Contractor will also conduct reviews to address immediate concerns of cornplainants. 7) The Contractee agrees to cooperate with the Contractor in developing, implernenting and monitoring corrective action plans that result from complaint investigations or monitoring efforts. The Contractee agrees that it will: (I) hire staff with special translation or sign language skills and/or provide staff with special translation or sign language skills training, or find qualified persons who are available within a reasonable period of time and who can communicate with limited- or non-English speaking or speech- or hearing-impaired clients at no cost to the client; (2) provide aids, assistive devices and other reasonable accommodations to the client during the application process, in the receipt of services, and in the processing of complaint or appeals; (3) train staff in human relations techniques, sensitivity to persons with disabilities and sensitivity to cultural characteristics; (4) rnake programs and facilities accessible, as appropriate, through outstations, authorized representatives, adjusted work hours, ramps, doorways, elevators, or ground floor rooms, and Braille, large print or taped information for the visually or cognitively impaired; (5) post and/or make available informational materials in languages and formats appropriate to the needs of the client population. The Contractee rnay subcontract all or part of this Agreement as agreed to during the contract negotiation session(s). The Contractor reserves the right of approval for any subcontracts and the Contractee shall report information relating to subcontracts to the Contractor. A change in a subcontractor or a change from direct service provision to a subcontract may only be executed with the prior written approval of the Contractor. In addition, the Contractor approval may be required regarding the terms and conditions of the subcontracts, and the subcontractors selected. Approval of the subcontractors will be withheld if the Contractor reasonably believes that the intended subcontractor will not be a responsible provider in terms of services provided, objectives to be attained, or required quality criteria. 1. The Contractee retains responsibility for fulfillment of all terms and conditions of this Agreement when it enters into sub-contractual Agreements and will be subject to enforcement of all the terms and conditions of this Contract Agreernent. 2. Recoupment of Contractor payments to the Contractee for failure to comply with either the attainment of contract objectives or the maintenance of quality criteria by either the Contractee or its subcontractor(s) will be made from the Contractee. 3. Rev¡,e<J 10/03 CC-LPHD 4 vm. IX. GENERAL PROVISIONS 1. Any payments of rnonies to the Contractee by the Contractor for services provided under this Contract Agreement shall be deposited in a bank with Federal Deposit Insurance Corporation (hereinafter FDIC) insurance coverage. Any balance exceeding FDIC coverage must be collaterally secured. 2. The Contractee shall conduct all procurement transactions in a manner that provides maxirnum open and free competition. 3. The Contractee shall not engage the services of any person or persons concurrently employed by the State of Wisconsin, including any Department, commission or board thereof, to provide services relating to this Contract Agreement without the written consent of the employer of such person or persons and oftlÍe Contractor. 4. This Contract Agreement is voidable if the Contractee is a state public official, a member of a state public official's immediate family, or an organization in which the official or immediate family member owns or controls at least 10% of the outstanding equity, voting rights, or outstanding indebtedness and failed to make the written disclosure required under sec. 19.45 Stats. This disclosure is required to be made to the State of Wisconsin Ethics Board, 44 East Washington Avenue, Suite 601, Madison WI 53703-2800, [Telephone (608) 266-8123]. 5. If Contractee or any subcontractor is a corporation other than a Wisconsin corporation, it must dernonstrate prior to providing services under this Contract Agreement that it possesses a certificate of authority from the Wisconsin Secretary of State, and rnust have, and continuously rnaintain, a registered agent, and otherwise conform to all requirements of Chapters 180 and 181, Wisconsin Statutes, relating to foreign corporations. 6. The Contractee agrees that funds provided under this Contract Agreement shall be used to supplement/expand the Contractee's current public health service efforts, not to replace or allow for the release of available local (Contractee) funds for alternative uses. If the Contractor determines that local funds supporting public health services or funds under this Agreernent have been released for alternative uses (supplanting), the Contractee may be subject to a proportionate reduction in funding under this Agreement in the current or subsequent contract year. ACCOUNTING REOUIREMENTS 1. For Agreernents of twenty-five thousand dollars ($25,000) or more, the Contractee shall maintain a uniform double entry, full accrual accounting system and a financial managernent information system in accordance with Generally Accepted Accounting Principles. (See DHFS _Allowable Cost Policy Manual, available upon request from Contract Administrator or from the Office of Prograrn Review and Audit, Department of Health and Family Services, One West Wilson Street, PO Box 7850, Madison WI 53707-7850.) 2. For Agreements of less than twenty-five thousand dollars ($25,000), the Contractee shall at least rnaintain a simplified double entry bookkeeping system as defined in the Department's Allowable Cost Policy Manual. 3. The Contractee' s accounting system shall allow for accounting of total funds included in this Agreement, and document that contract funds were not diverted outside of such set of programs. Diversion outside of the set of programs included in the Agreement will be subject to recouprnent. 4. As an innovation involving federal funds, the Department is in the process of securing federal Agreernent to the accounting refonns in this contract. Until such time as the Contractee receives final written notice frorn the Contractor that the Federal Government has waived program specific cost-based reporting requirements for all programs, the Contractee shall maintain sufficient information within their accounting records to provide cost-based information by program. The Contractee shall provide this information to the Contractor electronically upon request for Revised 10/03 CC-LPHD 5 / x. XI. statewide reconciliation, however, this information will not be requested by the Contractor unless necessary to support the claiming of federal funds. 5. If program specific cost information is requested under paragraph 4 above, the Contractor will make the request in writing at least 30 days prior to the due date for such information; will limit the breakdown of the information to what is required by the Contractor's funding sources and; will only request the information as of the end of the contract period for the full contract period. 6. The Contractee shall reconcile costs and match to expenses recorded in the Contractee's accounting or simplified bookkeeping system on an ongoing and periodic basis. The Contractee agrees that reconciliation will be completed at least quarterly, will be documented, and supplied to the Contractor upon request. The Contractee shall retain the reconciliation documentation in accordance with the record retention requirement specified in Section XIV. 7. Monthly submittals of expenditure reports on the use of funds within this contract are not required for contract payment purposes. 8. Nothing in this Section precludes the Contractee from keeping such information as needed for internal management purposes. 9. Expenditures of funds from this contract must rneet the Department's allowable cost definitions as defined in the Departrnent's Allowable Cost Policy Manual. CHANGES IN ACCOUNTING PERIOD 1. The Contractee's accounting records are maintained on a fiscal year basis. beginning on the date indicated on the CARS Payrnent Information form attached to this contract. During the contract period. the accounting period may only be changed with prior written approval from the Contractor. The Contractor may approve a change in accounting period only if the Contractee has a substantial, verifiable business reason for changing the accounting period and agrees to submit a close-out audit, as defined in section (XII, 8), within 90 days after the first day of the new accounting period. 2. Proof of Internal Revenue Service approval shall be considered verification that the Contractee has a substantial business reason for changing its accounting period. 3. A change in accounting period shall not relieve the Contractee of reporting or audit requirements of this Agreement. An audit meeting the requirements of this Agreement shall be submitted within 90 days after the first day of the start of the new accounting period for the short accounting period and within 180 days of the close òfthe new accounting period for the new period. For purposes of determining audit requirements, expenses and revenues incurred during the short accounting period shall be annualized. PROPERTY MANAGEMENT REOUIREMENTS 1. Property insurance coverage will be provided by the Contractee for fire and extended coverage of any equipment funded under this Contract Agreement which the Contractor retains ownership of, and which is in the care, custody and control of the Contractee. 2. The Contractor shall have all ownership rights in any hardware funded under this Agreement or supplied by the Contractor and in any software or rnodifications thereof and associated documentation designed, developed or installed as a result of this Contract Agreement. The Contractee is responsible for keeping all of Contractor's property secure from theft, damage or other loss. 3. The Contractee agrees that if any rnaterials are developed under this Contract Agreement, the Contractor shall have a royalty-free. non-exclusive, and irrevocable right to reproduce. publish or otherwise use, and to authorize others to use, such materials. Any discovery or invention arising Revised 10/03 CC-LPHD 6 out of, or developed in the course of work aided by this Contract Agreement, shall be promptly and fully reported to the Contractor. XII. AUDIT REQUIREMENTS 1. Requirement to have an audit: Unless waived by the Contractor, the Contractee shall submit an annual audit to the Contractor if the total amount of annual funding provided by the Contractor (from any and all of its Divisions taken collectively) through this and other contracts is $25,000 or more. In determining the amount of annual funding provided by the Contractor, the Contractee shall consider both: (a) funds provided through direct contracts with the Contractor; and (b) funds from the Contractor passed through another agency which has one or more contracts with the Contractee. 2. Audit requirements: The audit shall be perfonned in accordance with generally accepted auditing standards, s.46.036, Wis. Stats., Government Auditing Standards, and other provisions in this contract. In addition, the Contractee is responsible for ensuring that the audit complies with other standards that may be applicable depending on the type of Contractee and the nature and amount of financial assistance received from all sources: Federal OMB Circular A-133 "Audits of States, Local Governments and Nonprofit Organizations," which applies only to Contractees that expend $300,000 from all federal funding sources (this contract and other contracts, direct or indirect, frorn this Contractor or another), during a Contractee's fiscal year. State Single Audit Guidelines (SSAG), which are applicable to local governments having A- 133 audits; and/or Provider Agency Audit Guide (PAAG). All Contractees who do not meet the requirernents of the SSAG shall have audits in conformance with the PAAG. 3. Reporting package: The Contractee shall subnùt to the Contractor a reporting package which includes the following: A. Financial statements and other audit schedules and reports required for the type of audit applicable to the Contractee. B. Summary schedule of prior year findings and the status of addressing these findings. C. The Managernent Letter (or sinùlar document conveying auditor's cornments issued as a result of the audit) m: written assurance that a Management Letter was not issued with the audit report. D. Management responses/corrective action plan for each audit issue identified in the audit. E. . If program specific cost-based infonnation is needed, the Contractor may require it as part of the reporting package. 4. Submitting the Reporting Package: The Contractee shall subnùt the required reporting package to the Contractor either: (I) within nine months of the end of the Contractee's fiscal year if the Contractee is a local government; or (2) within 180 days of the end of the Contractee's fiscal year for non-governmental Contractee agencies. Two copies of the audit report must be sent to the Contractor at the following address: Office of Program Review and Audit Department of Health and Family Services PO Box 7850 Madison WI 53707-7850 Telephone: (608) 266-2924 Revised 10/03 CC-LPHD 7 , .. /' XßI. 5. Access to auditor's work papers: When contracting with an audit firm, the Contractee shall authorize its auditor to provide access to work papers, reports, and other materials generated during the audit to the appropriate representatives of the Department. Such access shall include the right to obtain copies of the work papers and computer disks, or other electronic media, upon which records! working papers are stored. 6. Access to Contractee records: The Contractee shall pennit appropriate representatives of the Department and/or the Contractor to have access to the Contractee's records and financial statements as necessary to review Contractee's cornpliance with the federal and state requirernents for the use of the funding. 7. Failure to comply with the requirements of this section: In the event that the Contractee fails to have an appropriate audit performed or fails to provide a complete audit report to the Contractor within the specified timefrarnes, in addition to applying one or more of the sanctions available in Section XVI of this contract, the Contractor may: A. Conduct an audit or arrange for an independent audit of the Contractee and charge the cost of completing the audit to the Contractee; B. Charge the Contractee for all loss of Federal or State aid or for penalties assessed to the Contractor because the Contractee did not subuùt a cornplete audit report within the required time frame; and/or C. Disallow the cost of audits that do not rneet these standards. 8. Close-out Audits: A. A contract specific audit of an accounting period ofless than twelve (12) months is required when a Contract Agreement is tenninated for cause, when the Contractee ceases operations or when the Contractee changes its accounting period (fiscal year). The purpose of the audit is to closeout the short accounting period. The required closeout contract specific audit may be waived by the Contractor upon written request from the Contractee, except when the Contract Agreement is tenninated for cause. The required closeout audit may not be waived when a Contract Agreement is tenninated for cause. B. The Contractee shall ensure that its auditor contacts the Contractor prior to beginning the audit. The Contractor, or its representative, shall have the opportunity to review the planned audit program, request additional compliance or internal control testing and attend any conference between the Contractee and the auditor. Payment of increased audit costs, as a result of the additional testing requested by the Contractor, is the responsibility of the Contractee. C. The Contractor may require a closeout audit that meets the audit requirernents specified in XII, 2 above. In addition, the Contractor may require that the auditor annualize revenues and expenditures for the purposes of applying OMB Circular A-133 and determining major Federal financial assistance programs. This information shall be disclosed in a note to the schedule of Federal awards. D. All other provisions in the Audit Requirements section apply to Closeout Audits unless in conflict with the specific Closeout Audits requirements. OTHER ASSURANCES I. The Contractee shall notify the Contractor in writing, within thirty (30) days of the date payment was due of any past due liabilities to the Federal government, State government or their agents for incorne tax withholding, FICA, Workers' Cornpensation, Unernployrnent Compensation, garnishments or other employee related liabilities, Sales Tax, Income Tax of the Contractee, or Revised 10/03 CC.t.PHD XIV. XV. 2, other monies owed. The written notice shall indude the amount(s) owed, the reason the monies are owed, the due date, the amount of any penalties or interest, known or estimated, the unit of governrnent to which the monies are owed, the expected payment date and other related infonnation. The Contractee shall notify the Contractor, in writing, within thirty (30) days of the date payment was due, of any past due payment in excess of five hundred dollars ($500), or when total past due liabilities to anyone or more vendors exceed one thousand dollars ($1000), related to the operation of this Contract Agreement for which the Contractor has reimbursed or will reimburse the Contractee. The written notice shall include the amount(s) owed, the reason the monies are owed, the due date, the amount of any penalties or interest, known or estirnated, the vendor to which the monies are owed, the expected payment date and other related information. If the liability is in dispute, the written notice shall contain a discussion of facts related to the dispute and the information on steps being taken by the Contractee to resolve the dispute. 3. The Contractor may require written assurance at the time of entering into this Contract Agreement that the Contractee has in force and will maintain for the course of this Contract Agreement employee dishonesty bonding in a reasonable amount to be determined by the Contractor. 4. The Contractee certifies that neither the Contractee organization nor any of its principals are debarred, suspended, or proposed for debarment for federal financial assistance (e.g., General Services Administration's List of Parties Excluded from Federal Procurement and Non- Procurement Programs). The Contractee further certifies that potential sub-recipients, contractors, or any of their principals are not debarred, suspended or proposed for debarment. RECORDS 1. The Contractee shall maintain such records (in either written or electronic form) as required by State and Federal law and as required by program policies. Records shall be retained for no less than the retention period specified in law or policy. Records for periods which are under audit or subject to dispute or litigation must be retained until the auditldisputellitigation, and any associated appeal periods, have ended. 2. The Contractee will allow inspection of records and programs, insofar as is permitted by State and Federal law, by representatives of the Contractor and its authorized agents, and Federal agencies, in order to confmn the Contractee's compliance with the specifications of this Agreement. 3. The Contractee agrees to retain and make available to the Contractor all program and fiscal records in accordance with the retention period specified in section I above. Upon the Contractor's request, at the expiration of the Contract Agreement, the Contractee will transfer at no cost to the Contractor, records regarding the individual recipients who received services frorn the Contractee under this Agreernent. The transfer of records includes transfer of any record, regardless of media, if that is the only method under which records were maintained. 4. The Contractee and its subcontractors shall comply with all state and federal confidentiality laws concerning the information in both the records it maintains and in any of the Contractor's records that the Contractee accesses to provide the services under this Agreement. AGREEMENT REVISIONS AND/OR TERMINATION 1. The Contractee agrees to renegotiate with the Contractor this Agreement or any part thereof in such circumstances as: Increased or decreased volume of services as required by the Contractor; Changes required by State and Federal law or regulations, or court action; or, Increase or reduction in the monies available affecting the substance of this Agreement. Revised 10/03 CC-LPHD 9 XVI. Failure to agree to a renegotiated Agreernent under these circumstances is cause for the Contractor to terminate this Agreement. 2. This Agreeme~t can be terminated for any reason by a 3D-day written notice by either party. 3. Revision of this Agreement may be made by rnutual agreement The revision will be effective only when the Contractor and Contractee attach an addendum or amendrnent to this Agreement, which is signed by the authorized representatives of both parties, except in circumstances in which increased caseload or grant award amount, where such increase in funds is for the same purpose as originally agreed upon, the agreement may be amended by a unilateral amendment made by the Contractor. 4. The Contractee shall notify the Contractor whenever it is unable to provide the required quality or quantity of services required. Upon such notification, the Contractor shall determine whether such inability will require revision or termination of this Agreement. 5. If the Contractor finds it necessary to terminate this Agreernent prior to the stated expiration date for reason other than non-performance by the Contractee, payment by the Contractor shall cease upon termination. Termination of the contract does not nullify the recoupment of funds by the Contractor per the negotiated Agreement associated with failure to attain program objectives or the failure to maintain quality criteria. NON-COMPLIANCE. SANCTIONS AND REMEDIAL MEASURES I. If the Contractor determines, after notice to the Contractee and opportunity to respond, that the Contractee: Is out of compliance with the program quality criteria as listed in Exhibit I, the Contractor rnay withhold part or all of the Contractee's funding at a level deemed appropriate by the Contractor as defined in paragraph 3 below. Has not attained the negotiated objective(s) as listed in Exhibit II, the Contractee shall refund the amount designated in Exhibit II under Risk Profile. Recoupments will be collected during the subsequent contract year via an adjustment (decrease) in the monthly payment. In such case where a Contractee is subject to recouprnent and no longer holds a Contract Agreement with the Contractor, the Contractor will issue an invoice to be paid by the Contractee. The Contractor may also, at its sole discretion, effectuate such refunds by withholding money from future payments due the Contractee at any time during or after the contract period or may recover such funds by any other legal means. 2. Failure to comply with any part of this Agreement may be considered cause for revision, suspension or termination of this contract Agreement. Suspension includes withholding part or all of the payments that otherwise would be paid the Contractee under this Agreernent, ternporarily having others perform, and receive reimbursement for, the services to be provided under this Agreement and any other measure that suspends the Contractee's participation in the Agreement if the Contractor determines it is necessary to protect the interests of the State. 3. The Contractee shall provide written notice to the Contractor of all instances of non-compliance with the terms of program quality criteria associated with this Agreement by itself or its subcontractors. Notice shall be given as soon as practicable but in no case later than 15 days after the Contractee became aware, or should have been aware, of the non-compliance. Non-Compliance can also be determined by the Division of Public Health Regional Office Contract Administrator through on-site inspection or desk review of documentation. The written notice shall include information on reason(s) for and effect(s) of the non-compliance. The Contractee shall provide the Contractor with a plan to correct the non-compliance and a timetable for the implementation of that plan to correct. The plan to correct must be approved by the Contractor. If at the end of the implernentation period, the Contractee is found to still be out of compliance, at its sole discretion, the Contractor rnay take whatever action it Revised 10/03 CC.LPHD 10 deems necessary to protect the interests of the State, including withholding part or all of the Contractee's funding, if it reasonably believes that the non-compliance will continue or will reoccur. 4. The Contractee shall provide within 30 days after the end of the contract period (or by the date specified in Exhibit II) to the Contractor via the Contract Administrator, the documentation specified in Exhibit II relating to attainment or failure to attain the objectives agreed to in this contract. If any objective is not attained, the Contractor will determine, at its sole discretion, the proportion of non- attainment and will recoup from the Contractee an amount as defined by the risk profile identified in Exhibit II. Any degree of non-attainment as judged by the sole discretion of the Contractor, shall be used by the Contractor in determining the conditions of any continuation of this Contract Agreement. 5. If the Contractor determines that non-compliance with other requirements (not stated in Exhibit I or Exltibit II) in this Agreement has occurred, or is occurring, it shall demand immediate correction of continuing non-compliance and it may irnpose whatever sanctions or remedial measures it deems necessary to protect the interests of the State. Such sanctions and measures may include termination of the Agreernent, suspension of the Agreement as defined in paragraph 2 above, imposing additional reporting requirements and monitoring of subcontractors and any other measures it deems appropriate and necessary. 6. If audits are not submitted when due, the Contractor may take action pursuant to Section XII of this Contract Agreement. 7. If required program deliverables or other required information or reports, other than audits, are not submitted when due, the Contractor rnay withhold all payments that otherwise would be paid the Contractee under this Agreernent until such time as the reports and information are submitted. In addition, the Contractor can hold implementation of continuations of this contract pending submittal of this documentation. XVII. DISPUTE RESOLUTION If any dispute arises between the Contractor and Contractee under this Agreement, including the Contractor's finding of non-compliance and irnposition of sanctions or remedial measures, the following process will be the exclusive administrative review. 1. The Contractor's and Contractee's Contract Administrators will attempt to resolve the dispute, in coordination with the Division of Public Health Regional Office Director and appropriate program staff within the Division. 2. If the dispute cannot be resolved by the Contract Administrators, the Contractee may ask for review by the Administrator of the Division of Public Health. 3. If the dispute is still not resolved, the Contractee rnay request a final review by the Secretary of the Department of Health and Family Services. xvIll. INDEMNITY The Contractor and Contractee agree they shall be responsible for any losses or expenses (including costs, damages, and attorney's fees) attributable to the acts or omissions of their officers, employees or agents. XIX. SURETY BOND The Contractor may require the Contractee to have a surety bond. The surety bond shall be in force for the period of the Contract Agreement and shall be a reasonable amount to be determined by the Contractor. Revised 10/03 CC-LPHD 11 xx. XXL CONDITIONS OF THE PARTIES' OBLIGATIONS I. This Agreement is contingent upon authorization of Wisconsin and United States law, and any material amendment or repeal of the same affecting relevant funding or authority of the Contractor shall serve to revise or terminate this Agreement, except as further agreed to by the parties hereto. 2. The Contractor and Contractee understand and agree that no clause, term or condition of this Agreement shall be construed to supersede the lawful powers or duties of either party. 3. It is understond and agreed that the entire Agreement between the parties is contained herein, except for those matters incorporated herein by reference, and that this Agreement supersedes all oral agreements and negotiations between the parties relating to the subject matter thereof. SPECIAL PROVISIONS I. If the Contractor determines that the Contractee has exceeded the agreed upon program objective(s) to the level specified in Exhibit II, Conditions for an Incentive Payment, the Contractee may be eligible to receive performance-based incentive funds if such funds are available as determined by the Contractor. 2. The Contractor may make these incentive awards at its discretion based on the amount of available incentive funding and the terms of agreement with the Federal agency(s) as to the distribution of such incentive funding. The awards will be made during the subsequent contract year via an adjustment (increase) in the rnonthly payment. In such case where a Contractee is eligible for an incentive payment and no longer holds a Contract Agreement with the Contractor, the Contractor will make a separate payment to the Contractee. The incentive funds must be expended by the Contractee within the subsequent contract or calendar year and can not be diverted outside of the set of programs defined by this Contract Agreement or used for supplanting purposes. 3. To the extent allowed by law, all funding recouped by the Contractor from the Contractee shall be held by the Contractor in a fund designated for use within the program area associated with the recoupment action. These funds may be used to award other Contractees who have exceeded their objectives in that program, general funding of the program area to all Contractees via formula in the next contract period, general funding of the program for all Contractees during the current contract period, or retumed to the Federal funding agency of that program. These funds cannot be used by the Contractor for their own operational costs. 4. If at the end of the contract year, the Contractee has attained its contract objectives and is in compliance with the quality criteria, it may retain any unspent funds from this Contract Agreement not expended during the contract year. However, those funds must be expended in the current contract year or the contract year immediately following and their use must fall within the program boundaries established under this Contract Agreernent. These retained funds cannot be diverted outside of the scope of this Contract Agreernent, the Local Public Health Department's budget, or used to supplant local public health tax levy levels. These funds shall be retained in a non-lapsing account for the sole use of the Local Public Health Department; these funds may not lapse to the general fund. The Contractee shall report how these funds were utilized upon request of the Contractor. :xxn CONTRACT RENEWAL OPTIONS This contract can be renewed on an annual basis for up to two (2) one-year extensions with the rnutual Agreement of both the Contractor and Contractee. The objectives to be attained by program will be re- negotiated each year by the Contractor and Contractee, as well as documentation deliverables and risk conditions. Revised 10/03 CC-LPHD 12 ,.. This Contract Agreement becomes null and void if the time between the earlier dàted signature and the later dated signature of the Contractee's and Contractor's Authorized Representative on this Agreement (or addendum) exceeds sixty (60) days inclusive of the two signature dates. Contractor's Authorized Representative Kenneth Baldwin, Administrator, Division otPu Department of Health & Family Services CARS PAYMENT INFORMATION The information below is used by the Department's Bureau of Fiscal Services, CARS Unit to facilitate the processing and recording of payments made under this Contract Agreement. Agency Name Agency Number Agency Type Contract Period Contract Amount Agency Fiscal Year Profile ID# Profile 1D# Profile 1D# Profile 1D# Profile 1D# Profile 1D# Oshkosh Health Department 472894 11 January 1, 2004 through December 31,2004 $81,266 January through December 155015 155020 157720 159320 159324 159220 $17,975 $13,711 $9,445 $30,379 $171 $9,585 Bioterrqrism Immunization Lead Matemal Child Health Maternal Child Health - HRSA Prevention ' Amôunt Amount Amount Amount Amount Amount DPH Consolidated Contract # 12298 CFDA#" Bio'elTori,m Immuniza,ion MCH MCH HRSA Preven,ion Revi,ed 10/03 CC-LPHD 93.283 93.268 93.778 93.003 93.991 Generally high program quality criteria for the delivery of quality and cost-effective administràtion of health care programs have been, and will continue to be, required in each public health program to be operated under the terms of this contract. This Exhibit contains only applicable quality criteria for this contract. 11/04/2003 09,46PM DPH Gran" and Contmcts , , 1) Assessment and surveillance of public health to identify 'community needs and to support systematic, competent program planning and sound policy development with activities focused at both the individual and community levels. . . i . . A) Contractees will periodically assess public health preparedness within their Consortium by having their member agencies complete Division of Public Health (DPH) identified assessments or surveys. 2) Delivery of public health services to citizens by qualified health professionals in a manner that is family centered, culturalíy competent, and consistent with the best practices; and delivery of public health programs for communities for the improvement of health status. i A) There are no separate sub-criteria to this Quality Criterion Category. I 3) Record keeping for individual focused services that assu~es documentation and tracking of client health care needs, response to known health care problems on a timely basi's, and confidentiality of client infonnation. A) There are no separate sub-criteria to this Quality Criterion Category. i I 4)Information, education, and outreach programs intended'to åddress known health risks in the general and certain target populations to encourage appropriate decision making by those at risk and to affect policy and environmental changes at the community level. I A) Contractees will regularly present to the media, public partners and other stakeholders information on their Consortium a¡{d the Public HealthPreparectness Program in coordination with DPH Focus Area F staff and - the Preparedness Program Speakers Bureau. 5) Coordination with related programs to åssure that identi~ed public health needs are add;essed in a comprehensive, cost- effective manner across programs and throughout the community. A) Contractees will coordinate with other preJaredness programs by assuring representation at the appropriate following meetings: I) Hospital (HRSA) Region, 2) Regional Trauma Advisory Council (RTAC), 3) Joint CDC/HRSA Advisory CommÍttee, 4) Cons'ortia.Fiscal Agent Meetings, 5) Consortia Program Coordinator Meetings, 6) Expert Panel Committees, 7) Local Emergency PlanningC~mmittees (LEPCs). B) Contractees will utilize the Public Health I~formationNetwork (PHIN) and the Health Alert Network (HAN) as appropriate and as these systems:develop. t 6) A referral network sufficient to assure the accessibility and timely provision of services to address identified public health care needs. A) There are no separate sub-criteria to this Quality Criterion Category. , , , . 7) Provision of guidance to staff through program and policy manuals and other means sufficient to assure quality health care and cost-effective program administration. A) There are no separate sub-criteria to this Q~ality Criterion Category. 8) Financial management practices sufficient to assure accurate eligibility determination, appropriate use of state and federal funds, prompt and accurate billing and payment for services provided and purchased, accurate expenditure reporting, and, when required, pursuit of third-party insurance and Medical Assistance Program coverage of services provided. ' 11/04/2003 09,46 PM 1) Assessment and surveillance of public health to identify community needs and to support systernatic, competent program planning and sound policy development with activities focused at both the individual and community levels. A) Contractee must assess local surveillance data for lead poisoning risks and known prevalence. 2) Delivery of public health services to citizens by qualified health professionals in .. manner that is family centered, culturally competent, and consistent with the best practices; and delivery of public health programs for communities for the improvement of health status. A) Contracteesmust provide services that support the elimination o(childhood lead poisoning, and the early detection and treatment of children with lead poisoning including compliance with WI Stat 254, WI Admin Rule 181, WI Admin Rule 163, and the practice standards presented in the Wisconsin Childhood Lead Poisoning Prevention & Control Handbook. 4) Information, education, and outreach programs intended. to. address known health risks in the general and certain target populations to encourage appropriate decision making by those at risk and to affect policy and environmental changes at the community l~vel. A) Contractee must provide information viithin the community about lead hazards, lead hazard reduction, primary prevention, and screening for lead poisoning must be to one or more target audiences as referenced in the boundary statement. 5) Coordination with related programs to assure that identified public health needs are addressed in a comprehensive, cost- effective manner across programs and throughout the community. A) Contractee must build partnerships with local health care providers and agencies involved in health, social services, housing, child care to incorporate lead hazard awareness into encounters with families of young children or their environments. C) If the Contractee serves a community receiving entitlement funds, to accept the funding available to those communities, they must establish and maintain a relationship with the local housing agency that distributes the funds with the goal of addressing lead hazards in the housing stock. 7) Provision of guidance to staff through program and policy manuals and other means sufficient to assure quality he¡¡lth care and cost:effective program administration. A) Contractee must assure that local childhood lead poisoning prevention program staff have access to, are knowledgeable óf, and in compliance with the Wisconsin Childhood Lead Poisoning Prevention & Control Handbook for Local Health Departments, the Wisconsin Blood Lead Screening Guidelines, state statutes administrative rules, and/or local ordinance. 9) Data collection, analysis, and reporting to assure program outcome goals are met or to identify program management problems that need to be addressed. A) Contractee must regularly collect and analyze local data to determine trends and effectiveness of screening of target audiences, timely follow-up of lead poisoned children, successful and timely completion of lead hazard reduction orders, commu~ity lead poisoning education, prevention and control efforts. DPH Gmn," ,nd Con',"'," 11/04/2003 09,46 PM 1) Assessment and surveillance of public health to identify community needs and to support systematic, competent program planning and sound policy development with activities focused at both the individual and community levels. A) Contractees must assúre report~d vaccine preventable diseases are in;"estigated and controiIed as detailéd in the Wisconsin Disease Surveillance Manual (EPINET). Immunization programs should contact local required reporters to encourage prof pi reporting. B) Contractees must annually evaluate their local immunization delivery and vaccine preventable disease surveillance systems and improve t ese systems where needed. 2) Delivery of public health services tp citizens by ualified health professionals in a manner that is family centered, culturally competent, and consistent with the bes practices; and delivery of public health programs for communities for the improvement of health status. ' A) Contractees must assure thedelive of immunization services in a safe, effective, and efficient manner as detailed in the Immunization Progr m Policies and Procedures and in section 252, HFS 145, Wis. Admin. Code. Contractees must assure the mmunization of children is consistent with Healthy People 2010 goals. 3) Record kee.Ping for individual.f...ocused service. s t~a. t...assures documentation and tr.aCking of client heal.th care nee..d.. s, response to known health care problems on a tim ly basis, and confidentiality of client information. A) Contractees must use the Wisconsi Immunization Registry (WlR) or an electronic immunization data system that links with the WIR. Th data system must have a tracking and recall function to identify children whose immunization recorts are behind schedule. B) Contractees' immun,..i.zatiOn. P.ra,ctic. e I . ust assure the imm.unization of children, and share children s immunization records with schools ¡md day care centers as provided by the Wisconsin School Immunization Law. 4) Information, education, and outreach programs intended to address known health risks in the general and certain target populations to encourage appropriate decisiOh making by thoseat riskandto affect policy and environmentalchangesat the community, leveL A) Contractees must promote com¡nunity partnerships to identify and address the needs of high-risk populations and to educate families and the community on the importance of immunizations. 5) Coordination with related programs to assur~that'identifieclpu¡'lic health needs are addressed inacomprehensive, cost- effective manner across programs andthroudhoutthe community. . .1.,. ., ... ..'. .',....,..'. A) Contractees must coordmate ,mmumzatlOn sefV1ceswlth local chIld health care (sefV1ce) provIders; e.g., WlC Projects, Medical Assistance programs, and other local public health programs, to assess the immunization status of, refer, and provide immunization services to under-immunized children. 6) A referral network sufficient to assure the accessibility and timely provision of services to address identified public health care needs. A) Contractees must develop relationships among public and private health cáre providers to facilitate access by children and families to immunization services. Contractees should work with these providers to assure that current immunization guidelinès are followed. These relationships should also be used to promote the 11/0412003 09,46 PM DPH a'an" and Con",," . prompt reporting of suspect'vaccine preventable diseases. 1) When possible the local public health department should refer the vaccine recipients to their medical home provider for subsequent immunizations and coordinate with this medical provider to assure adherence to the recommended immunization schedule. 2) Promote the exchange and sharing of immunization data through the use of immunization registries. 3) Educate providers on the importance of the prompt reporting of all suspect cases of ~accine preventable diseases. 7) Provision of guidance to staff through program and policy manuals and other rneans sufficient to as'sure quality health care and cost-effective program administration. A) Contractees wi1l ensure program staff are competent in current immunization program policy and process information including that provided through the Centers for Disease Control and Prevëntion (CDC) distance learning course and CDC updates. 'B) The local health departmënt must have written policies on the proper handling and of state vaccine. These policies must be reviewed with all Immunization Program related staff on at least an annual basis: 8) Financial management practices sufficient to assure accurate,ligibility determination, appropriate use of state and federal funds, prompt and accurate billing and payment for servicës provided and purchased, accurate expenditnre reporting, and, when required, pursuit of third-party insurance and Medical Assistance Program coverage of services provided. A) Bi1ling for payment of childhood immunization services is not required under this section. B) Local public health departments must assure that parents of children who are on Medical Assistance (!viA) will not be charged a vaccine administration fee or be requested to make a donation for vaccine or vaccine related services. 9) Data collection, an~lysis, and reporting to assure program outcome goals are met or to identify program management problems that needto be addressed. . A) Contractees must collect and analyze agency and available private provider immunization data for children 12.35 months of age, school immunization law reports and other available population based information needed to identify strengths and weaknesses in local delivery systems and plan improvements. B) The local public health department wi1l utilize the CDC Clinic Assessment Software Application (CASA) for immunization level data analysis. C) The deliverable for all objectives dealing with immunization level assessments utilizing CASA wiÍ1 include a written summary report and a copy of the CASA data diskette. The data diskette should be sent to the Régional Office Immunization Program Advisor. 1) Assessment';cid surveillance of public health to identify community needs and to support systematic, competent program planning and sound policy development with activities focused at. both the individual and community levels. . . ' A) Contractees must include a maternal and child health needs assessment, at least every five years as requiréd by Title V of the Social Security Act, in their community needs assessment process. 2) Delivery 'of public health services to éitizens by qualified health professionals in a manner that is family centered, culturally èompetent, and consistent with the best practices; and delivery of public health programs for communities for the improv,ment of health status. A) Contractees must assure that maternal and child health services are delivered and supervised by qualified staff as required by the activity or service being delivered. B) Contractees must designate a staff person as the maternal and child health contact to receive, disseminate, and respond to policy and program info.rmation provided by the State. C) Contractees must designate a staff person as the children with special health carenéedscontact to receive and disseminatè policy and program information provided by the State and Regional CSHCN Centers. D) The Contractee mllstassure quality by'utilizing one or more of the following documents as guidance for be.st practice in the organization and delivery of services: 1) GuidanceManual for Prenatal Care Coordination, 2) Family Planning Reproductive Health Standards of Practice, 3) Bright Futures: Guidelines for Health Supervision ofInfants, Children and Adolescents, Second Edition, 4) Caring for Our Children: National Health and Safety Performance Standards Guidelines for Out-of-Home Child Care Programs: Second Edition, 2002, 5) Bright Futures in Practice: Oral Health, 6) Bright Futures in Practicè: Physical Activity, 7) Bright Futures in Practice: Nutrition, Second Edition, 8) Bright Futures in Practice: Mental Health. All programs will be evaluated based on these best practice guidelines. 1f an LPHD wants to use an alternate, but comparable document, the State of Wisconsin Maternal and Child Health Program must approve it. , . E) Contractees must. integrate the MCH Five Guiding Principles in MCH programs, services and systems. 3) Record keeping for individual focused services that assures documentation and tracking of client health care needs, response to known health care problems on a timely basis, and confidentiality of client information. A) Contractees must assure that all general health care records are kept c.onfidential as required by s. 146.82, Wis. Stats: 4) Information, education, and outreach programs intended to address known health risks in the general and certain target populations to encourage appropriate decision making by those at risk and to affect policy and environmental changes at the community level. A) Contractees must assure effective outreach strategies to high-risk women of childbearing age, pregnant women, and children birth to 21 years old, including children with special health care needs, and their families in the maternal and child health population. B) Allmàtérials for public distributlon developed by a Contractee with Title V MCH Block Grant funds must identify the funding Source on the publication as follows: "Funded in part by the MCH Title V Services Block Grant, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S.. 11104/2003 09,46 PM DPH Gmnts and Coo""" .. . . . . . A) Local health departments that provide maternal and child heàlth prevention and intervention services must have a referral network. Referral network may include: health care providers including mental health and oral health, Regional CSHCN Centers, childcare centers, WlC, human or social services, schools, Birth to Three programs, and other relevant services. 7) Provision of guidance to staff through program and policy manuals and other means sufficient to assure quality health care and cost-effective program administration. . A)Contracteesmust assure staff are provided with current policy, process, and practice information, including information provided by statewide MCH contractors, Division of Public Health regional education and training programs, and central office staff. 8) Financial management practices sufficient to assure accurate eligibility determination, appropriate use of state and . federal funds, prompt and accurate billing and payment for services provided and purchased, accurate expenditure . . reporting, and, when required, pursuit of third-party insurance and Medical Assistance Program coverage of services provided. A) Contractees must seek other available funding sources, as Title V MCH Block Grant is payer of last resort. B) Contractees must bill the Wisconsin Medical Assistance Program for all covered services provided to eligible recipients. C) Contractees must provide 75% match ($0.75 local contribution for every $1.00 federal) for an Title V MC¡'¡ Block grant funds. 9) Data collection, analysis, and reporting to assure program outcome goals are met or to identify program management problemsthat need to be addressed. A) Contractees must collect and analyze data on all public health activities and interventions provided. B) Contractees must report using SPHERE (Secure Public Health Electronic Record Environment). C) Contractees will comply with year-end program reporting requirements set by the State of Wisconsin MCH Program including documentation of75% match ($0.75 local contribution for every $1.00 federal). , ' , I) Assessment and surveillance of public health to identify communitý'needs and t~ support syste~ati~, comp~te~.t program planning and sound policy development with activities focused both the individual and community levels. A) Thereare no separate sub-criteria to this Quality Criterion Category. 3) Record keeping for individual focused services that assures documentation and tracking of client health care needs, response to known health care problems on a timely basis, and confidentiality of client information. A) There are no separate sub-criteria to this Quality Criterion Category. 4) Information, education, and outreach programs intended to address known heåJth risks in the general and certain targe't populations to encourage appropriate decision making by those at risk and to affect policy and environmental changes at the community level. A) Provision of public information and education, and/or outreach activities focused on high-risk populations that increase awareness of disease risks, environmental health risks, and appropriate preventiveactivities. Note: All materials produced with PHHS Block Grant funds must inc.lude the following statement: "This publication was made possible by the PHHS Block Grant from the Centers for Disease Control." 5) Coordination with related programs to assure that identified public health needs are addressed in a comprehensive, cost- effective manner across programs and throughout the community. A)There are no separate sub-criteria to this Quality Criterion Category. 6) A referral network sufficient to assure the accessibility and timely provision of services to address identified public health care needs. A) There are no separate sub-criteria to this Quality Criterion Category. 7) Provision of guidance to staff through program and policy manuals and other means sufficient to assure quality health care and cost-effective program administration. A) Provision of written policy and program information about the current guidelines, standards, and recommendations for community and/or clinical preventive care. 8) Financial management practices sufficient to assure accurate eligibility determination, appropriate use of state and federal funds, prompt and accurate billing and payment for service~ provided and purchased, accurate expenditure reporting, and, when required, pursuit of third-party insurance and Medical Assistance Program coverage of services provided. A) Program-specific data collection, analysis, and reporting to assure program outcome goals are met or to 11/04/2003 09A6 PM 11/04/2003 09,46 PM DPH Gmnts and Con",," 11104/i'°03 09,46 PM Source Program Oshkosh Oshkosh Oshkosh Immunization - Consolidated lAP Oshkosh Maternal Child Health - Consolidated $30,379 $171 Oshkosh Maternal Child Health - HRSA/BT Oshkosh $9,585 Program Amount Childhood Lead $0 $0 BiD-terror CDC Focus A Immunization $0 $22,784 MCH Prevention $0 Program Sub-Contracts Program Sub-Contractee Bio-terror CDC Focus A None Reported Childhood Lead None Reported $0 $0 Immunization None Reported None Reported $0 None Reported 11/ll/2003 09:38 PM By December 31, 2004, all Fox Valley Public Healih Preparedness Consortium membèr âgency requíreinents related to the accomplishment of the public health preparedness objectives will be met by the Oshkosh Health Department. 2 By December 31,2004, a referral policy will be established by the Oshkosh Health Services Divísion and the local agency responsible for the administration of Community Development Block Grant funds for the City of Oshkosh. ' . By December 31,2004,25 pregnant women or mothers of newborns residing in pre-1978 housing Ìûcatect in the City of Oshkosh Health Department jurisdiction will receive childhood lead poisoning prevention education as part of their prenatal or postpartum services. $1,441 Immunization Program Total Value $13,711 By ùecèmber 31,'2004, 91% of children served by the Oshkosh City Health Department Immunization Program who were 12-35 months of age as of January 1,2004 will receive age appropriate immunizations. $13,711 MCH Program Total Value $30,550 Prevention Program Total Value $9,585 By December 31, 2004, 65 City of Oshkosh residents with children ages birth to 3 will eliminate 4 safety hazards in their home. By December 31, 2004, 40 parents or other caregivers of children-ages birth through 8 years from the City of Oshkosh will demonstrate the proper instaIlation of a child care passenger seat system. 2 By December 31, 2004, one City of Oshkosh child care center with more than 40 children will develop and institute a curriculum that includes organized physical activity for children ages 1-2. By December 31, 2004, 30 City of Oshkosh employees or family members of employees will complete a 10,000 Step Program for a 4 month time period. $9,585 11/04/2003 09,46 PM Objective Statement By December 31, 2004, a referral policy will be established by the Oshkosh Health Services Division ànd the local agency responsible for the administration of Community Development Block Grant funds for the City of Oshkosh. DeliverableDueDate: 01/3112005 Contract Deliverable (Evidence) A signed copy of the referral policy. Programs Providing Funds for this Objective Childhood Lead Poisoning Prevention: $1,441 Agency Funds for this Objective: Data Source for Measurement' A signed copy of the referral policy. Baseline for Measurement This builds upon the2003 signed cooperative ágreement betwéen the Oshkosh Health Services Division and the local agency responsible for the administration of Community Development Block Grant funds for the City of Oshkosh. Context The Oshkosh Planning Division is responsible for the administration of Community Development Block Grant funds for the City of Oshkosh. They provide approximately $200,000 yearly for repairing homes (in a lead safe .manner) for single family, owner occupied, low and moderate income households in the City of Oshkosh. Each year, approximately 1 0 hous~holds receive Community Development Block Grant funded housing rehabilitation loans. A need was seen by the Planning Division and the Health SerVices Division to provide lead education for households receiving Community Development Block Grant funded housing rehabilitation loans that have children less than seven years residing in the residence. This referral policy will help to facilitate this need. This policy will also provide provisions for the Oshkosh Health Services Divisiòn to refer families or individuals to the Oshkosh Planning Division for the purposes of assessing if they would be eligible for Community Development Block Grant funded housing rehabilitation loans. Input Activities The Oshkosh Planning Division and the.Oshkosh Health Services Division will collaborate to develop a policy of referral for funding of Community Development Block Grant housing rehabilitation loans and lead education. Objective: Risk Profile Percent of Objective Accomplished I 0% I 10% I 20% I 30% I 40% I 50% I 60% I 70% 80% I 85% I 90% I 95% I 100% I Corresponding Percentage Recoupment I 100% I ]00% I ]00% I 100% I 100% I 100% I 100% I 100% I 100% I 100% I 100% I 100% I Corresponding Potential Recoupment Amounts I $1,441 I $1,441 I $1,44] I $1,441 I $1,441 I $1,441 I $1,441 I $1,441 I $1,441 I $1,441 I $1,441 I $1,441 I 0% $0 Definition o!Percent Accomplished 0% Accomplishment No referral policy has been established. 100% Accomplishment A referral policy has been established by the Oshkosh Health Services Division and. the local agency responsible for the administration of Communit Develo ment Block Grant funds for the Cit of Oshkosh. Conditions of Eligibility for an Incentive ¡None 11104/2003 09A6 PM Objective Statement . By December 31, 2004, 25 pregnant women or mothers of newborns residing in pre-1978 housing located in the City of Oshkosh Health Department jurisdiction wi]] receive childhood lead poisoning prevention education as part of their prenatal or postpartum services. Deliverable Due Date: 01/31/2005 Contract Deliverable (Evidence) A report to document the number of pregnant women or mothers of newborns residing in pre-1978 housing located in the éity of Oshkosh Health Department jurisdiction who received childhood lead poisoning prevention as part of their prenatal or postpartum services. Programs Providing Funds for this Objective Childhood Lead Poisoning Prevention: $8,004 Agency Funds for this Objective: Data Source for Measurement A database will be constructed to include the number of pregnant women or mothers of newborns living in pre-1978 housing who received education related to lead poisoning. Baseline for Measurement New initiative. Context Oshkosh is a city of 63,000 people and has an average birth rate of approximately 550'650 a year. The homes in most. neighborhoods were built prior to 1978. Children living in these homes are at high risk from exposure to lead. By educating pregnant mothers or mothers of newborns of the dangers of lead poisoning, we can help prevent lead poisoning in many children. The targeted group will include thos.e pregnant women or mothers of newborns residing in pre-1978 housing located in Oshkosh. Input Activities City of Oshkosh Health Depàrtment will conduct home visits 'to identify potential1ead hazards. Provide property owners with information about lead safe work practices and property maintenance. Recommend and demonstrate specific lead hazard reduction activities to client. Educate client on correct lead swab techniques. Provide incentives to families for participation. Adapt home visit protocol, education and documentation tools for visits. Objective: Risk Profile Percent of Objective Accomplished I 0% I 10% I 20% I 30% I 40% I 50% I 60% I 70% 80% I 85% I 90% I 95% I 100% I Corresponding Percentage Recoupment I 100% I 90% I 80% I. 70% I 60% I 50% I 40% I 30% I 20% I 15% I 10% I 5% 0% C;orresponding Potential Recoupment Amounts I $8,004 I $7,203 I $6,403 I $5,602 I $4,802 I $4,002 I $3,201 I $2,401 I $1,600 I $1,200 I $800 I $400 I $0 Definition of Percent Accomplished 0% Accomplishment No pregnant women or mothers of newborns residing in pre-1978 housing located in the City of Oshkosh Health Department jurisdiction received childhood lead poisoning prevention education as part of their prenatal or postpartum services. 10% Accomplishment 3 pregnant women or mothers of newborns residing in pre-1978 housing located in the City of Oshkosh Health Department jurisdiction received childhood lead poisoning prevention education as part of their prenatal or postpartum services. 20% Accomplishment 5 pregnant women or mothers of newborns residing in pre-1978 housing located in the City of Oshkosh Health Department jurisdiction received childhood lead poisoning prevention education as part of their prenatal or postpartum services. 30% Accomplishment 8 pregnant women or mothers of newborns residing in pre-1978 housing located in the City of Oshkosh Health Department jurisdiction received childhood lead poisoning prevention education as part of their prenatal or postpartum services. 11/04/2003 09,46 PM 40% Accomplishment 10 pregnant women or mothers of newborns residing in pre-1978 housing located in the City of Oshkosh Health Department jurisdiction received childhood lead poisoning prevention education as part of their prenatal or postpartum services. 50% Accomplishment ' " 13 pregnant women or mothers òf newborns residing in pre-1978 hòusing located in the City of Oshkosh Health DepOrtment jurisdiction received childhood lead poisoning prevention education as part of their prenatal or postpartum services. 60% Accomplishment 15 pregnant women or mothers of newborns residing in pre-1978 housing located in the City of Oshkosh Health Department jurisdiction received childhood lead poisoning prevention education as part of their prenatal or postpartum services. 70% Accomplishment 17 pregnant women or mothers of newborns residing in pre-1978 housing located in the City of Oshkosh Health Department jurisdiction received childhood lead poisoning prevention education as part of their prenatal or postpartum services. 80% Accomplishment 20 pregnant women or mothers of newborns residing in pre"1978 housing located in the City of Oshkosh Health Department jurisdiction received childhood lead poisoning prevention education as part of their prenatal or postpartum services. 85% Accomplishment 22 pregnant women or mothers of newborns residing in pre-1978 housing located in the City of Oshkosh Health Department jurisdiction received childhood lead poisoning prevention education as part of their prenatal or postpartum services. 90% Accomplishment . 23 pregnant women or mothers of newborns residing in pre-1978 housing located in the City of Oshkosh Health Department jurisdiction received childhood lead poisoning prevention education as part of their prenatal or postpartum services. 95% Accomplishment 24 pregnant women or mothers of newborns residing in pre-I 978 housing located in the City of Oshkosh Health Department jurisdiction received childhood lead poisoning prevention education as part of their prenatal or postpartum servic;es. 100% Accomplishment - 25 pregnant women or mothers of newborns residing in pre-1978 housing located in the City of Oshkosh Health Department 'urisdiction received childhood lead oisonin revention education as art of their renatal'or ost artum services. , Conditions of Eligibility for an Incentive The agency may be eligible for an incentive if 30 pregnant women or mothers of newborns residing in pre-1978 housing located in the City of Oshkosh Health Department jurisdiction received childhood lead poisoning prevention education as part of their prenatal or postpartum services. Context Children aged 12'35 months will be assessed for their completion of the 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 HepB immunÍzation series by 24 months of age. The estimate is there are 346 children in this cohort of patients. As of July 2003, 89% of children, or approximately 200, who were served by Oshkosh Hea1th Department completed their primary immunizations. Input Activities Monthly immunization consent forms are sent out to families with children needing appropriate immunizations. Oshkosh City Health Department reviews the Wisconsin Immunization Registry tö assess client's need for immunizations, ongoing contact with health care providers and staff to track and recall clients for referral for immunizations, and staffing monthly immunization clinics. Administration of vaccine, evaluating, and educating the community on importance of receiving immunizations are implemented at the clinics. Oshkosh Health Services Division clinic schedules are distributed to all area medical providers and throughout the Oshkosh Area School System. Clinic schedules are sent out to families monthly to remind them to bring their children in for current immunizations. Another way we target our families with young children is by sending schedules out in our postpartum packets and handing out at child safety home visits. . Objective: Risk Proflle Corresponding Potential Recoupment Arnounts I $13,711 I $13,711 ~ $1,371 I $685 I $0 Definition of Percent Accomplished 0% Accomplishment 69% of children served by the Oshkosh City Health Department Immunization Program who were 12-35 months of age as of January 1,2004 received age appropriate immunizations. 80% Accomplishment 70% of children served by the Oshkosh City Health Department Immunization Program who were 12-35 months of age as of January 1,2004 received age appropriate immunizations. 85% Accomplishment , 80% of children served by the Oshkosh City Health Department Immunization Program who were 12-35 months of age as of January 1,2004 received age appropriate immunizations. 90% Accomplishment 11/04/2003 09,46 PM DPH Gran" and Cont<ac" Conditions of Eligibility for an Incentive ¡None Objective Staternent By December 31, 2004, 65 City of Oshkosh residents with childten ages birth to 3 will eliminate 4 safetyhazards in their home. Deliverable Due Date: 01/31/2005 Programs Providing Fundsfor'this Objective Maternal and Child Health -Block Grant: $21,000 Agency Funds for this Objective: Data Source for Measurement SPHERE IndividuaiIHousehold report to include MCH Required Demographic Data and data from the following screens: Injury Prevention Assessment, Health Teaching Topics and Results, and Referral and Follow-up if appropriate. Summary of families serv.ed with hazards found and corrections made on pre and post assessment form. Baseline for Measurement . As of September 18, 2003, 48 families have been served by the home safety program. Context A grant funded nurse will visit each residence. New families are referred to the home safety program each year. Referrals are received from Public Health Nurses, New Parent Program, WIC, etc. New families are visited each year and continued contact with these families and parents are made to promote an open line for communication and education on safety issues as they arise. A written home safety checklist is filled out for each visit, aloI\g with identifying hazards in each room of the home. Two to 5 safety devices are installed at the first visit, a.wri.tten improvement plan is left with client, and changes are reviewed at a follow-up èontact. This has been an ongoing program that is growing in popularity. Advocacy with community partners and previons clients having referred their family and friends has made this a community effort in promoting safety for all our children. Input Activities City of Oshkosh Health Department will provide instruction, safety products and brochures. All safety products are purchased through Safety 1st and Wal-Mart. Some of the brochures used include the Poison Center number and stickers, Home Safety CheckJist, Gun Safety, and Fire Safety and Prevention. Education on lead poisoning is also being addressed by health department staff. The health department staff conduct an assessment for lead at each home visit. Health department staff will be working with community partners, which include the Oshkosh Fire Department, New Parent Program, the Oshkosh Police Department, and Safe Kids. Families are referred to commnnity resources which may assist the family in providing the safest environment for their children. Community awareness is implemented by speaking at the Mom's Club and at a local grandparents group. Continuing education for health department staff regarding new recommendations, related health concerns, and policy wil1 take place. Objective: Risk Profile Percent of Objective Accomplished I 0% I 10% I 20% I 30% I 40% I 50% I 60% I 70% 80% I 85% I 90% I 95% I 100% I Corresponding Percentage Recoupment I 100% I 90% I 80% I 70% I 60% I 50% I 40% I 30% I 20% I 15% I 10% I 5% 0% Corresponding Potential Recoupment Amounts I $21,000 I $18,900 I $16,800 I $14,700 I $12,600 I $10,500 I $8,400 I $6,300 I $4,200 I $3,150 I $2,100 I Definition of Percent Accornplished 0% Accomplishment No Oshkosh residents with children ages birth to 3 eliminated 4 safety hazards in their home. 10% Accomplishment 7 Oshkosh residents with children ages birth to 3 eliminated 4 safety hazards in their home. 20% Accomplishment 13 Oshkosh residents with children ages birth to 3 eliminated 4 safety hazards in their home. 30% Accomplishment $1,050 I $0 11/04/2003. 09A6 PM DPH Grants and Con',,"ct' 20 Oshkosh residents with children ages birth to 3 eliminated 4 safety hazards in their home. 40% Accomplishment 26 Oshkosh residents with children ages birth to 3 eliminated 4 safety hazards in their home. 50% Accomplishment 33 Oshkosh residents with children ages birth to 3 eliminated 4 safety hazards in their home. 60% Accomplishment 39 Oshkosh residents with children ages birth to 3 eliminated 4 safety hazards in their home. 70% Accomplishment 46 Oshkosh residents with children ages birth to 3 eliminated 4 safety hazards in their home. 80% Accomplishment 52 Oshkosh residents with children ages birth to 3 eliminated 4 safety hazárds in their home. 85% Accomplishment 55 Oshkosh residents with children ages birth to 3 eliminated 4 safety hazards in their home. 90% Accomplishment 59 Oshkosh residents with children ages birth to 3 eliminated 4 safety hazards in their home. 95% Accomplishment 62 Oshkosh residents with children ages birth to 3 eliminated 4 safety hazards in their home. 100% Accomplishment 65 Oshkosh residents with children a es birth to 3 eliminated 4 safet hazards in their home. Conditions of Eligibility for an Incentive The agency may be eligible for an incentive payment if70 Oshkosh residents with children ages birth to 3 eliminated 4 safety hazards in their home. 11/04/2003 09,46 PM Objective Statement . By December 31, 2004, 40 parents or other caregivers of children ages birth through 8 years from the City of Oshkosh will demonstrate the proper installation of a child care passenger seat system. DeliverableDueDate: 01/3112005 Contract Deliverable (Evidence) . A report to document the number of parents or other caregivers of children ages birth through 8 years from the City of Oshkosh who demonstrated the proper installation ora child car passenger seat system. Prograrns Providing Funds for this Objective Maternal and Child Health -Block Grant: $3,000 Agency Funds for this Objective: Data Sonrce for Measurement Sphere IndividuallHousehold Report to include MCH Required Demographic Data and data from the following screens: Injury Prevention Assessment and Health Teaching Topics and Results. Baseline for Measurement , As of September 2003,30 car seat checks have been completed. In addition, 2 large community events with Fox Valley Safe Kids have been implemented. . Context This objective is for local health department programs that provide designated individual assessment, installation and instruction services to families with one or more children in the selected age group. Input Activities By providing an ongoing car seat inspection service, the health department provides the community with a regularly scheduled opportunity to assure that a new car seat is installed correctly or that their child is properly fitted to the correct seat. This will assure a higher level of compliance community-wide. In cooperation with Fox Valley Safe Kids, families that are unable to afford a new seat will be provided one at cost or free depending on their financial circumstances. Objective: Risk Profile Corresponding Potential Recoupment Amounts I $3,000 I $2,700 I $2,400 I $2,100 I $1,800 I $1,500 I $1,200 I $900 I $600 I $450 I $300 I $150 I Definition of Percent Accornplished 0% Accornplishment No parents or other caregivers of children ages birth through 8 years from the City of Oshkosh demonstrated the proper installation of a child care passenger seat system. . 10% Accomplishment 4 parents or other caregivers of children ages birth through 8 years from the City of Oshkosh demonstrated the proper installation of a child care passenger seat system. 20% Accomplishment 8 parents or other caregivers of children ages birth through 8 years from the City of Oshkosh demonstrated the proper instaIlation of a child care .passenger seat system. . . . 30% Accomplishment 12 parents or other caregivers of children ages birth through 8 years from the City of Oshkosh demonstrated the pioper instaIlation of a child care passenger seat systern. 40% Accomplishment 16 parents or other caregivers of children ages birth through 8 years from the City of Oshkosh demonstrated the proper installation of a child care passenger seat system, $0 ll/04/2003 09,46 PM DPH O"n" and Con'",ts 50% Accomplishment , ' " ' . , 20 parents or other caregivers of childrenagesbirth through Ii years from the City of Oshkosh demOnstrated the proper installation of a child care passenger seat system. 60% Accomplishment , 24 parents or other caregivers of children ages birth through 8' years from the City of Oshkosh demonstrated the proper installation of a child care passenger seat system. 70% Accomplishment ... ... .' 28 parents or other caregivers of ëhildren ages birth through 8' years from the City of Oshkosh demonstrated the proper installation of a child care passenger seat system. 80% Accomplishment , , . 32 parents or other caregivers of children ages birth through 8 years from the City of Oshkosh demonstrated the proper installation of a child care passenger seat system. 85% Accomplishment 34 parents or other caregivers of children ages birth through 8 years from the City of Oshkosh demonstrated the proper installation of a child care passenger seat system. 90% Accomplishment 36 parents or other caregivers of children ages birth through 8 years from the City of Oshkosh demonstrated the proper installation of a child care passenger seat system. 95% Accomplishment 38 parents or other caregivers of children ages birth through 8 years from the City of Oshkosh demonstrated the proper installation of a child care passenger seat system. 100% Accomplishment 40 parents or other caregivers of children ages birth through 8 years from the City of Oshkosh demonstrated the proper installation of a child care assen er seat s stem. Conditions of Eligibility for an Incentive The agency may be eligible for an incentive payment if45 parents or other caregivers of children ages birth through 8 years from the City of Oshkosh demonstrated the proper installation of a child care passenger seat system. 11/04/2003 09A6 PM Context , ' This project, in cooperation with a child care center in Oshkosh, continues to address the need to increase activity levels of the general population as identified in the Healthy People 2010: National Health Promotion and Disease Prevention Objectives. This addresses physical activity guidelines set forth from the National Association for Sport and Physical Education, and the need for physical activity set forth in the publication Bright Futures in Practice: Physical Activity. Physical fitness should begin from birth. By beginning a program in the early years,.it is hopéd that activity can become a règular part of a healthy lifestyle as the child grows and matures. It is also known that parental or guardian involvement and encouragement can positively influence a child to be more active. The Oshkosh Health Department has been working with child care centers since 1995. They have been strengthening this association through many educational and supportive activities. This win be a continuation of a program called "Kids Are Active" where a pòlicy and curriculum for 3-4 year olds has begun in 2003. The Oshkosh Health Department will use the Bright Futures in Practice: Physical Activity, as wen as the guidelines from The National Association for Sport and Physical Education and other resources to 'continue to develop this physical activity program. As of September 2003, a physical activity policy and curriculum for 3-4 year olds has been written. The physical activity policy and curriculum for 3-4 year olds will be implemented in October 2003. Input Activities The Oshkosh City Health Department will provide technical assistance to the day care center to develop a curriculum for 1-2 year oJds, as well as maintain the physical activity policy and curriculum for 3-4 year olds. This may include getting approval from any governing board and working closely with the program administrators on relevant physical activity issues and concerns. The grant nurse will work with the day care staff to develop a tracking and reward system for the 1-2 year old classroom to monitor the activities that each chil¡j participates in. The grant nurse will also continue to work with the day care staff of the 3-4 year olds to maintain the tracking and reward system. Training of staff will be provided as needed regarding activity, safety concerns, health concerns and use of "desired outcomes" or goals to evaluate developmental milestonesand formulate physical activity plans. Parents will be involved by being provided with educational materials about physical activity and children: We will also provide parents with a copy of their child's assessments, which will be conducted periodicaUy. Objective: Risk Profile Percent of Objective Accomplished f 0% I 10% I 20% ~ 90% f 95% f 100% I Corresponding Percentage Recoupment f1O0%fI00%1100%fI00%1~ 15% 10% Corresponding Potential Recoupment Amounts -. f $6,550 f $6,550 I $6,550 f $6,550 I. $6,550 I $6,550 ~ 11/04/2003 09,46 PM Definition of Percent Accomplished 0% Accomplishment Nothing accomplished. 70% Accomplishment Oshkosh Health Department provided technical assistance to one City of Oshkosh child care center serving more than 40 children. 85% Accomplishment One City of Oshkosh child care center serving more than 40 children developed a policy which includes órgánizecÏ physical activity for children ages ]-2. . 100% Accomplishment One City of Oshkosh child care center serving more than 40 children developed and instituted a curriculum that includes Of"anized h sical activit for children a es 1-2. Conditions of Eligibility for an Incentive ¡None tII0412003 09A6 PM èontext , , The City of Oshkosh currently employs 744 people. According to the HealthY People 2010 Objectives, a major barrier of physical activity is time. The 10,000 Step Program operates under the premise that individuals can accumulate increased physical activity as part of their everyday living with results of benefiting their health. This is a program to assist those who work or who are family members of Oshkosh City employees to achieve an increased level of physical activity. This program is meant to assess the feasibility of conducting a 10,000 Step program on a community"wide level. Input Activities ;, . The 10,000 Step Program will be adapted for City of Oshkosh employees and their families. The City of Oshkosh Health Department will partner with the Planning Division to develop mapped walking routes and the Oshkosh Employee Wellness Group. A tool will be developed to assess baseline physical activity levels and post activity levels. A tracking system will also be developedfor the participants. Analysis of participant progress will be performed. The participants will receive education about beginning and maintaining a walking program. Participants with be provided incentives for their participation in the 10,000 Step program. i Objective: ~isk Profile Percent of Objective Accomplished I 0% 1 10% I 20% 1 30% 1 40% I 50% 1 60% 1 70% 80% I 85% 1 90% 1 95% 1 100% 1 Corresponding Percentage Recoupment 1100% 1 90% 1 80% 1 70% 1 60% I 50% 1 40% 1 30% 1 20% I 15% Corresponding Potential Recoupment Amounts 1 $9,585 1 $8,626 I $7,668 1 $6,709 1 $5,751 I $4,792 1 $3,834 1 $2,875 1 $1,917 1 $1,437 1 $958 1 $479 1 Definition of Percent Accornplished 0% Accomplishment , No City of Oshkosh City or family members of employees completed a 10,000 Step Program for a 4 month time period: 10% Accomplishment ' 3 City of Oshkosh City or family members of employees completed a 10,000 Step Program for a 4 month time period. 20% Accomplishment 6 City of Oshkosh City or family members of employees completed a 10,000 Step Program for a 4 month time period. 30% Accomplishment 9 City of Oshkosh City or family members of employees completed a 10,000 Step Program for a 4 month time period. 40% Accomplishment 12 City of Oshkosh City or family members of employees completed a 10,000 Step Program for a 4 month time period. 10% 1 5% 0% $0 11/04/2003 09,46 PM DPH Gmnts and Cont<ac" 50% Accomplishment 15 City of Oshkosh City or family members of employees completed a 10,000 Step Program for a 4 month time period. 60% Accomplishment . 18 City of Oshkosh City or family members of employees completed a 10,000 Step Program for a 4 month time period. 70% Accomplishment 21 City of Oshkosh City or family members of employees completed a 10,000 Step Program for a 4 month time period. 80% Accomplishment 24 City of Oshkosh City or family members of employees completed a 10,000 Step Program for a 4 month time period. 85% Accomplishment ' 26 City of Oshkosh City or family members of employees completed a 10,000 Step Program for a 4 month time period. 90% Accomplishment ' 27 City of Oshkosh City or family members of employees completed a 10,000 Step Program for a 4 month time period. 95% Accomplishment 29 City of Oshkosh City or family members of employees cornpleted a 10,000 Step Program for a 4 month time period. 100% Accomplishment 30 Cit of Oshkosh Citor famil members of em 10 ees com leted a 10,000 Ste Proaram for a 4 month time eriod. Conditions of Eligibility for an Incentive The agency may be eligible for an incentive payment if 40 City of Oshkosh employees or family members of employees completed a 10,000 Step Program for a 4 month time pêriod. 11/0412003 09,46 PM DIVISIO. N OF P~LIC HEALTH CONTRACT ~GREEMENT PUBLIC HEALTH PREPAREDNESS DPH CONTRACT # 12762 Contract Prearnble This Agreement is entered into for the period Janllary 1, 2004 through December 31, 2004, by and between the State of Wisconsin represented by its Division of Public Health of the Department of Health and Family Services, whose principal business address is One West Wilson Street, PO Box 2659, Madison WI 53701-2659, hereinafter referred to as Contractor, and Oshkosh Pnblic Health Department, whose principal business address is 215 Church Street, Oshkosh, WI 54902-1130, hereinafter referred to as Contractee. The Contactee address above is the address to which payments shall be mailed. If any legal notices required to be sent to the Contractee in the execution of.this Agreement should be sent to an address different frorn the Contractee address above, that address should be provided below: Whereas, the Contractor wishes to purchase services from the Contractee as it is authorized to do by Wisconsin law; and whereas, the Contractee is engaged in furnishing the desired services; now, therefore, the Contractor and the Contractee agree as follows: I, SERVICES TO BE PROVIDED The Contractee agrees to provide services consistent with the purposes and conditions of the objectives that it has agreed to attain within the contract period. The Contractee also agrees to provide to the Contractor documentation (as agreed to in negotiations with the Contractor) of the attainment of those objectives no later than 30 days after the end of the contract period or as specified in Exhibit II. A detailed description of the objectives to be attained and the documentation associated with that attainrnent is part of this Agreement as listed in Exhibits I and II, which are attached to this Agreement. II. CONTRACT ADMINISTRATION The Contractor's contract administrator is Dennis Tornczyk of the Division of Public Health, whose princiPâl business address is One West Wilson Street, PO Box 2659, Madison WI 53701-2659. The telephone number of the Contractor's Contract Administrator is (608) 266-3128. In the event that the Contrâct Administrator is unable to administer this Contract Agreement, Contractor will contact the Contractee and designate a new Contract Administrator. The Contractee's Contract Administrator is Palll Spiegel, whose principal business address is 215 Church Street, Oshkosh, WI 54902-1130. The telephone number of the Contractee's Contract Administrator is (920) 236-5034. In the event that the Contract Administrator is unable to administer this Contract Agreement, the Contractee will contact the Contractor and designate a new Contract Administrator. III. PAYMENT LIMIT The Contractor agrees to pay the Contractee in accordance with the terms and conditions of this Agreement, an amount not to exceed $100,910. This amount is contingent upon receipt of sufficient funds by the Contractor(s). The Contractor will not make payments in excess of the Contract Agreement amounts, with the exception of performance-based incentive funds pursuant to Section XXI. Rev¡,ed 12/03 HRSA P<epa<edne" LPHD Pi"al Agen' ", . V. VI. IV. PAYMENT PROCESS I. Payments will be made on a rnonthly basis. The Contractee will receive one-twelfth (1112) of the total contract amount each month unless Contractee has failed to maintain quality criteria or proposed progress towards achievement of Contract objectives as deternrined by the Contractor. In these situations the Contractor can make reductions in the monthly payment pursuant to Section XVI. 2. Al1 payments shal1 be released by the Department on the last business day before the fifth day of the month for municipalities, or the last business day of each rnonth for non-rnunicipalities, with the exception that the payment that would normal1y be released on the last working day of June shall be released instead on the first working day of July. Checks wil1 be mailed to the Contractee's principal business address unless the Contractee requests, in writing, subject to approval, that the Departrnent rnail the checks to a different address. PROGRAM REPORTING I. The Contractee shall cornply with the program reporting requirements of the Contractor as specified below and/or as stated in Exhibits I and II. The required reports shall be forwarded to the Contractor's Contract Administrator according to the schedule specified below and/or as specified in Exhibits I and II. 2. The Contractee shall assist the State in the development of future grant proposals including developing funding formulas, submitting estimated future budget needs for their Pubhc Health Preparedness Consortiurn, and participating in the writing of future federal grant proposals as requested. 3. The Contractee shal1 post all relevant and related consortium rneeting agendas, minutes, progress reports, plans, drills and other relevant bioterrorisrn information on the Health Alert Network (HAN) within the appropriate security levels. 4. The Contractee and its Public Health Preparedness Consortium members shal1 complete al1 consortia-related state assessrnents and evaluation by the specified due date as required by CDCIHRSA and agreed to by DPH and the statewide CDCIHRSA Advisory Committee. 5. Failure to submit the reports specified in the reporting instructions rnay result in the Contractor rendering sanctions pursuant to Section XVI of this contract. STATE AND FEDERAL RULES AND REGULATIONS I. The Contractee agrees to meet state and federal laws, rules and regulations, and program policies applicable to this Contract Agreement. 2. The Contractee agrees to comply with Public Law 103-227, also known as the Pro-Children Act of 1994, which prohibits tobacco smoke in any portion of a facility owned or leased or contracted for by an entity which receives federal funds, either directly or through the State, for the purpose of providing services to children under the age of 18. 3. Affirmative Action Plan/Civil Rights Compliance Affirmative Action Plans A. For Agreements of twenty-five thousand ($25,000) or more, Contractee shall submit a written Affirmative Action (AA) Plan, which may cover a two-year period. Contractees with an annual work force of less than twenty-five employees and Contractees who are governrnental entities are excluded from the requirement to submit an AA Plan. Revised 12103 HRSA Pcepacedne" LPHD Fi,cal Agent 2 \-} , B. "Affirmative Action Plan" is a written document that details an affirmative action program. Key parts of an affirmative action plan are: (I) a policy statement pledging nondiscrimination and affirrnative action employment, (2) internal and external' dissemination of the policy, (3) assignrnent of a key employee as the equal opportunity officer, (4) a work force analysis that identifies job classifications where representation of women, minorities and the disabled is deficient, (5) goals and timetables that are specific and measurable and that are set to correct deficiencies and to reach a balanced work force, (6) revision of employment practices to ensure that they do not have discriminatory effects, and (7) establishment of internal monitoring and reporting systems to measure progress regularly. c. In addition, for Agreements of ten thousand ($10,000) or more, regardless of work force size, Contractee shall conduct, keep on file, and update annually, a separate and additional accessibility self-evaluation of all programs and facilities, including employment practices for compliance with ADA regulations, unless an updated self- evaluation under Section 504 of the Rehabilitation Act of 1973 exists which meets the ADA requirements. Contrac.tees are to contact the Departrnent's Affirmative Action/Civil Rights Compliance Office, Department of Health and Family Services, I W. Wilson Street, Room 672, P.O. 7850, Madison WI 53707-7850, for technical assistance on Equal Opportunity. Civil Rights Cornpliance A. For Agreements for the provision of services to clients, the Contractee must comply with Civil Rights requirements. Contractees with an annual work force ofless than ten ernployees, regardless of Agreernent amount, and Contractees with Agreements less than $10,000 are not required to submit a Civil Rights Cornpliance Action Plan, but must, at a minimum, subrnit Civil Rights Compliance Assurances. For Agreements of $1 0,000 or more, Contractee shall submit a written Civil Rights Compliance (CRC) Action Plan, which may cover a two-year period. B. The Contractee assures that it has submitted to the Contractor's Affirmative Action/Civil Rights Compliance Office a current copy of its two-year Civil Rights Compliance Action Plan for Meeting Equal Opportunity Requirements under Title VI and VII of the Civil Rights Act of 1964, Sections 503 and 504 of the Rehabilitation Act of 1973, Title VI and XVI of the Public Health Service Act, the Age Discrimination in Employment Act of 1967, the Age Discrimination Act of 1975, the Omnibus Reconciliation Act of 1981, the Arnericans with Disabilities Act (ADA) of 1990, and the Wisconsin Fair Employment Act. If a Plan was reviewed and approved during the previous year, a plan update must be submitted for this Agreement period. 1) No otherwise qualified person shall be excluded frorn participation in, be denied the benefits of, or otherwise be subject to discrimination in any manner on the basis of race, color, national origin, sexual orientation, religion, sex, disability or age. This policy covers eligibility for and access to service delivery, and treatment in all programs and activities. All ernployees of the Contractee are expected to support goals and programmatic activities relating to nondiscrimination in service delivery. 2) No otherwise qualified person shall be excluded from employment, be denied the benefits of employment or otherwise be subject to discrimination in employment in any manner or term of employment on the basis of age, race, religion, sexual orientation, color, sex, national origin or ancestry, handicap (as defined in Section 504 and the Americans with Disabilities Act), arrest or conviction record, marital status, political affiliation, or military participation. All employees are expected to support goals and programmatic activities relating to non-discrimination in employment. Revi,ed 12/03 HRSA Preparedne" LPHD Fi"al Agent ,. , , . 3) The Contractee shall post the Equal Opportunity Policy, the name of the Equal Opportunity Coordinator and the discrimination cornplaint process in conspicuous places available to applicants and clients of services, and appiicants for ernployment and employees. The complaint process will be according to Contractor standards and made available in languages and formats understandable to applicants, clients and employees. The Contractor will continue to provide appropriate translated prograrn brochures and forms for distribution. 4) The Contractee agrees to comply with the Contractor's guidelines in the Civil Rights Compliance Standards and a Resource Manual for Equal Opportunity in Service Delivery and Employment for the Wisconsin Department of Health and Family Services, its Service Providers and their Subcontractors (October 1997 Edition). 5) Requirements herein stated apply to any subcontracts or contracts. The Contracteè has prirnary responsibility to take constructive steps, as per the CRC Standards and Resource Manual, to ensure the compliance of its subcontractors. However, where the Contractor has a direct contract with another Contractee, the Contractee need not obtain a Subcontractor or Subcontractee Civil Rights Compliance Action Plan or monitor that Subcontractee. 6) The Contractor will monitor the Civil Rights Compliance of the Contractee. The Contractor will conduct reviews to ensure that the Contractee is ensuring compliance by its subcontractors or Contractees according to guidelines in the CRC Standards and Resource Manual. The Contractee agrees to comply with Civil Rights monitoring reviews, including the examination of records and relevant files maintained by the Contractee, as well as interviews with staff, clients, applicants for services, subcontractors, Contractees, and referral agencies. The reviews will be conducted according to Department procedures. The Contractor will also conduct reviews to address immediate concerns of complainants. 7) The Contractee agrees to cooperate with the Contractor in developing, implernenting and monitoring corrective action plans that result frorn complaint investigations or monitoring efforts. c. The Contractee agrees that it will: (1) hire staff with special translation or sign language skills and/or provide staff with special translation or sign language skills training, or find qualified persons who are available within a reasonable period of time and who can communicate with lirnited- or non-English speaking or speech- or hearing-impaired clients at no cost to the client; (2) provide aids, assistive devices and other reasonable accommodations to the client during the application process, in the receipt of services, and in the processing of complaint or appeals; (3) train staff in hurnan relations techniques, sensitivity to persons with disabilities and sensitivity to cultural characteristics; (4) make programs and facilities accessible, as appropriate, through outstations, authorized representatives, adjusted work hours, ramps, doorways, elevators, or ground floor rooms, and Braille, large print or taped information for the visually or cognitively impaired; (5) post and/or make available informational rnaterials in languages and forrnats appropriate to the needs of the client population. Vll. SUBCONTRACTS I. The Contractee may subcontract all or part of this Agreement as agreed to during the contract negotiation session(s). The Contractor reserves the right of approval for any subcontracts and the Contractee shall report information relating to subcontracts to the Contractor. A change in a subcontractor or a change frorn direct service provision to a subcontract may only be executed with the prior written approval of the Contractor. In addition, the Contractor approval may be required Revised 12/03 HRSA P<eparedne8' LPHD Fi,cal Agen' 4 ,. , VIII. IX. regarding the terms and conditions of the subcontracts, and the subcontractors selected. Approval of the subcontractors will be withheld if the Contractor reasonably believes that the intended subcontractor will not be a responsible provider in terms of services provided, objectives to be attained, or required quality criteria. 2. The Contractee retains responsibility for fulfillment of all terms and conditions of this Agreement when it enters into sub-contractual Agreements and will be subject to enforcement of all the terms and conditions of this Contract Agreement. 3. Recoupment of Contractor payments to the Contractee for failure to comply with either the attainment of contract objectives or the rnaintenance of quality criteria by either the Contractee or its subcontractor(s) will be rnade from the Contractee. GENERAL PROVISIONS 1. Any payrnents of monies to the Contractee by the Contractor for services provided under this Contract Agreement shall be deposited in a bank with Federal Deposit Insurance Corporation (hereinafter FDIC) insurance coverage. Any balance exceeding FDIC coverage must be collaterally secured. . 2. The Contractee shall conduct all procurement transactions in a manner that provides maximum open and free competition. 3. The Contractee shall not engage the services of any person or persons concurrently employed by the State of Wisconsin, including any Department, commission or board thereof, to provide services relating to this Contract Agreernent without the written consent of the employer of such person or persons and of the Contractor. 4. This Contract Agreement is voidable if the Contractee is a state public official, a member of a state public official's immediate family, or an organization in which the official or immediate family member owns or controls at least 10% of the outstanding equity, voting rights, or outstanding indebtedness and failed to make the written disclosure required under sec. 19.45 Stats. This disclosure is required to be made to the State of Wisconsin Ethics Board, 44 East Washington Avenue, Suite 601, Madison WI 53703-2800, [Telephone (608) 266-8123]. 5. If Contractee or any subcontractor is a corporation other than a Wisconsin corporation, it must demonstrate prior to providing services under this Contract Agreement that it possesses a certificate of authorìty from the Wisconsin Secretary of State, and must have, and continuously rnaintain, a registered agent, and otherwise conform to all requirements of Chapters 180 and 181, Wisconsin Statutes, relating to foreign corporations. ' 6. The Contractee agrees that funds provided under this Contract Agreement shall be used to supplement/expand the Contractee's current public health service efforts, not to replace or allow' for the release of available local (Contractee) funds for alternative uses. If the Contractor determines that local funds supporting public health services or funds under this Agreement have been released for alternative uses (supplanting), the Contractee may be subject to a proportionate reduction in funding under this Agreement in the current or subsequent contract year. ACCOUNTING REOUIREMENTS 1. For Agreements of twenty-five thousand dollars ($25,000) or more, the Contractee shall maintain a uniform double entry, full accrual accounting system and a financial management information system in accordance with Generally Accepted Accounting Principles. (See DHFS Allowable Cost Policy Manual, available upon request from Contract Administrator or from the Office of Program Review and Audit, Department of Health and Family Services, 1 West Wilson Street, PO Box 7850, Madison WI 53707-7850.) Revised 12/03 HRSA P,eparedne" LPHD Fiscal Agent x. 2. For Agreements of less than twenty-five thousand dollars ($25,000), the Contractee shall at least maintain a simplified double entry bookkeeping system as defined in the Department's Allow~ble Cost Policy Manual. 3. The Contractee's accounting system shall allow for accounting of total funds included in this Agreement, and document that contract funds were not diverted outside of such set of programs. Diversion outside of the set of programs included in the Agreement will be subject to recoupment. 4. As an innovation involving federal funds, the Department is in the process of securing federal Agreement to the accounting reforms in this contract. Until such time as the Contractee receives final written notice from the Contractor that the Federal Government has waived program specific cost-based reporting requirements for all programs, the Contractee shall maintain sufficient information within their accounting records to provide cost-based information by program. The Contractee shall provide this information to the Contractor electronically upon request for statewide reconciliation, however, this information will not be requested by the Contractor unless necessary to support the claiming of federal funds. 5. If program specific cost information is requested under paragraph 4 above, the Contractor will make the request in writing at least 30 days prior to the due date for such information; will limit the breakdown of the information to what is required by the Contractor's funding sources and; will only request the information as of the end of the contract period for the full contract period. 6. The Contractee shall reconcile costs and match to expenses recorded in the Contractee's accounting or simplified bookkeeping system on an ongoing and periodic basis. The Contractee agrees that reconciliation will-be completed at least quarterly, will be documented, and supplied to the Contractor upon request. The Contractee shall retain the reconciliation documentation in accordance with the records retention requirernent specified in Section XIV. 7. Monthly submittals of expenditure reports on the use of funds within this contract are not required for contract payment purposes. 8. Nothing in this Section precludes the Contractee from keeping such inforrnation as needed for internal management purposes. 9. Expenditures of funds from this contract must meet the Department's allowable cost definitions as defined in the Department's Allowable Cost Policy Manual. CHANGES IN ACCOUNTING PERIOD 1. The Contractee's accounting records are maintained on a fiscal year basis, beginning on the date indicated on the CARS Payrnent Information form attached to this contract. During the contract period, the accounting period may only be changed with prior written approval from the Contractor. The Contractor may approve a change in accounting period only if the Contractee has a substantial, verifiable business reason for changing the accounting period and agrees to submit a close-out audit, as defined in section (XII, 8), within 90 days after the first day of the new accounting period. 2. Proof of Internal Revenue Service approval shall be considered verification that the Contractee has a substantial business reason for changing its accounting period. 3. A change in accounting period shall not relieve the Contractee of reporting or audit requirements of this Agreernent. An audit meeting the requirements of this Agreement shall be submitted within 90 days after the first day of the start of the new accounting period for the short accounting period and within 180 days of the close of the new accounting period for the new period. For purposes of determining audit requirements, expenses and revenues incurred during the short accounting period shall be annualized. Revi,ed 12103 HRSA Pœpa<edne" LPHD Fi,cal Agen' 6 ,. , XI. XII. PROPERTY MANAGEMENT REQUIREMENTS I. Property insurance coverage will be provided by the Contractee for fire and extended coverage of any equipment funded under this Contract Agreernent which the Contractor retains ownership of, and which is in the care, custody and control of the Contractee. 2. The Contractor shall have all ownership rights in any hardware funded under this Agreement or supplied by the Contractor and in any software or modifications thereof and associated documentation designed, developed or installed as a result of this Contract Agreement. The Contractee is responsible for keeping all of Contractor's property secure from theft, damage or other loss. 3. The Contractee agrees that if any materials are developed under this Contract Agreement, the Contractor shall have a royalty-free, non-exclusive, and irrevocable right to reproduce, publish or otherwise lise, and to authorize others to use, such rnaterials. Any discovery or invention arising out of, or developed in the course of work aided by this Contract Agreernent, shall be promptly and fully reported to the Contractor. AUDIT REOUIREMENTS I. Requirement to Have an Audit: Unless waived by the Contractor, the Contractee shall submit an annual audit to the Contractor if the total amount of annual funding provided by the Contractor (from any and all of its Divisions taken collectively) through this and other contracts is $25,000 or more. In determining the amount of annual funding provided by the Contractor, the Contractee shall consider both: (a) funds provided through direct contracts with the Contractor; and (b) funds from the Contractor passed through another agency which has one or rnore contracts with the Contractee. 2. Audit requirements: The audit shall be performed in accordance with generally accepted auditing standards, s.46.036, Wis. Stats., Government Auditing Standards, and other provisions in this contract. In addition, the Contractee is responsible for ensuring that the audit complies with other standards that may be applicable depending on the type of Contractee and the nature and amount of financial assistance received from all sources: Federal OMB Circular A-133 "Audits of States, Local Governments and Nonprofit Organizations," which applies only to Contractees that expend $300,000 frorn all federal funding sources (this contract and other contracts, direct or indirect, frorn this Contractor or another), during a Contractee's fiscal year. State Single Audit Guidelines (SSAG), which are applicable to local governments having A- 133 audits; and/or Provider Agency Audit Guide (PAAG). All Contractees who do not meet the requirements of the SSAG shall have audits in conformance with the PAAG. 3. Reporting package: The Contractee shall submit to the Contractor a reporting package which includes the following: A. Financial statements and other audit schedules and reports required for the type of audit applicable to the Contractee. B. Summary schedule of prior year findings and the status of addressing these findings. c. The Management Letter (or similar docurnent conveying auditor's comments issued as a result of the audit) ill written assurance that a Management Letter was not issued with the audit report. Revised 12/03 HRSA Preparedne" LPHD Fi,ca1 Agen' D. Managernent responses/corrective action plan for each audit issue identified in the audit. E. If program specific cost-based information is needed, the Contractor may require it as part of the reporting package. 4. Submitting the Reporting Package: The Contractee shall submit the required reporting package to the Contractor either: (1) within nine months of the end of the Contractee's fiscal year if the Contractee is a local government; or (2) within 180 days of the end of the Contractee's fiscal year for non-governmental Contractee agencies. Two copies of the audit report rnust be sent to the Contractor at the following address: Office of Program Review and Audit Department of Health and Family Services PO Box 7850 Madison WI 53707-7850 Telephone: (608) 266-2924 5. Access to auditor's work papers: When contracting with an audit firrn, the Contractee shall authorize its auditor to provide access to work papers, reports, and other materials generated during the audit to the appropriate representatives of the Department. Such access shall include the right to obtain copies of the work papers and computer disks, or other electronic media, upon which records/ working papers are stored. 6. Access to Contractee records: The Contractee shall permit appropriate representatives of the Department and/or the Contractor to have access to the Contractee's records and financial statements as necessary to review Contractee's compliance with the federal and state requirements for the use of the funding. 7. Failure to comply with the requirements of this section: In the event that the Contractee fails to have an appropriate audit perforrned or fails to provide a complete audit report to the Contractor within the specified timeframes, in addition to applying one or more of the sanctions available in Section XVI of this contract, the Contractor may: A. Conduct an audit or arrange for an independent audit of the Contractee and charge the . cost of completing the audit to the Contractee; B. Charge the Contractee for all loss of Federal or State aid or for penalties assessed to the Contractor because the Contractee did not submit a complete audit report within the required time frarne; and/or C. Disallow the cost of audits that do not meet these standards. 8. Close-out Audits: A. A contract specific audit of an accounting period of less than twelve (12) months is required when a Contract Agreement is terminated for cause, when the Contractee ceases operations or when the Contractee changes its accounting period (fiscal year). The purpose of the audit is to closeout the short accounting period. The required closeout contract specific audit rnay be waived by the Contractor upon written request from the Contractee, except when the Contract Agreement is terminated for cause. The required closeout audit may not be waived when a Contract Agreement is terminated for cause. B. The Contractee shall ensure that its auditor contacts the Contractor prior to beginning the audit. The Contractor, or its representative, shall have the opportunity to review the planned audit program, request additional compliance or internal control testing and attend any conference between the Contractee and the auditor. Payment of increased audit costs, as a result of the additional testing requested by the Contractor, is the responsibility of the Contractee. Revj,ed 12/03 HRSA Pæpaædne" LPHD Fi".t Agent XIII. XIV. C. The Contractor may require a closeout audit that meets the audit requirements specified in XII, 2 above. In addition, the Contractor may require that the auditor annualize revènues and expenditures for the purposes of applying OMB Circular A- 133 and detennining major Federal financial assistance programs. This information shall be disclosed in a note to the schedule of Federal awards. D. All other provisions in the Audit Requirements section apply to Closeout Audits unless in conflict with the specific Closeout Audits requirements. OTHER ASSURANCES 1. The Contractee shall notify the Contractor in writing, within thirty (30) days of the date payment was due of any past due liabilities to the Federal government, State government or their agents for income tax withholding, FICA, Workers' Cornpensation, Unemployrnent Compensation, garnishments or other employee related liabilities, Sales Tax, Income Tax of the Contractee, or other monies owed. The written notice shall include the amount(s) owed, the reason the monies are owed, the due date, the amount of any penalties or interest, known or estimated, the unit of government to which the moniès are owed, the expected payment date and other related information. 2. The Contractee shall notify the Contractor, in writing, within thirty (30) days of the date payment was due, of any past due payment in excess of five hundred dollars ($500), or when total past due liabilities to anyone or more vendors exceed one thousand dollars ($1000), related to the operation of this Contract Agreement for which the Contractor has reimbursed or will reimburse the Contractee. The written notice shall include the amount(s) owed, the reason the rnonies are owed, the due date, the amount of any penalties or interest, known or estimated, the vendor to which the rnonies are owed, the expected payment date and otber related information. If the liability is in dispute, the written notice shall contain a discussion of facts related to the dispute and the information on steps being taken by the Contractee to resolve the dispute. 3. The Contractor may require written assurance at the time of entering into this Contract Agreement that the Contractee has in force and will maintain for the course of this Contract Agreement employee dishonesty bonding in a reasonable amount to be detenrrined by the Contractor. 4. The Contractee certifies that neither the Contractee organization nor any of its principals are debarred, suspended, or proposed for debarment for federal financial assistance (e.g., General Services Administration's List of Parties Excluded frorn Federal Procurement and Non- Procurement Programs). The Contractee further certifies that potential sub-recipients, contractors, or any of their principals are not debarred, suspended or proposed for debarment. RECORDS 1. The Contractee shall maintain such records (in either written or electronic form) as required by State and Federal law and as required by program policies. Records shall be retained for no less than the retention period specified in law or policy. Records for periods which are under audit or subject to dispute or litigation must be retained until the auditldisputellitigation, and any associated appeal periods, have ended. 2. The Contractee will allow inspection of records and programs, insofar as is permitted by State and Federal law, by representatives of the Contractor and its authorized agents, and Federal agencies, in order to confirrn the Contractee's compliance with the specifications of this Agreement. 3. The Contractee agrees to retain and make available to the Contractor all program and fiscal records in accordance with the retention period specified in section 1 above. Upon the Contractor's request, at the expiration of the Contract Agreement, the Contractee will transfer at no cost to the Contractor, records regarding the individual recipients who received services from the Contractee Rev¡,ed 12103 HRSA Preprn:edne" LPHD Fiscal Agent 9 xv. XVI. under this Agreement. The transfer of records includes transfer of any record, regardless of media, if that is the only method under which records were maintained. 4. The Contractee and its subcontractors shall comply with all state and federal confidentiality laws concerning the information in both the records it maintains and in any of the Contractor's records that the Contractee accesses to provide the services under this Agreement. AGREEMENT REVISIONS AND/OR TERMINATION 1. The Contractee agrees to renegotiate with the Contractor this Agreement or any part thereof in such circurnstances as: Increased or decreased volume of services as required by the Contractor; Changes required by State and Federal law or regulations, or coùrt action; or, Increase or reduction in the monies available affecting the substance of this Agreernent. Failure to agree to a renegotiated Agreernent under these circumstances is cause for the Contractor to terminate this Agreement. 2. This Agreement can be terminated for any reason by a 30-day written notice by either party. 3. Revision of this Agreement may be made by mutual agreement The revision will be effective only when the Contractor and Contractee attach an addendum or amendment to this Agreement, which is signed by the authorized representatives of both parties, except in circumstances in which increased caseload or grant award amount, where such increase in funds is for the same purpose as originally agreed upon, the agreement may be amended by a unilateral arnendment made by the Contractor. 4. The Contractee shall notify the Contractor whenever it is unable to provide the required quality or quantity of services required. Upon such notification, the Contractor shall determine whether such inability will require revision or termination of this Agreement. 5. If the Contractor finds it necessary to terminate this Agreement prior to the stated expiration date for reason other than non-performance by the Contractee, payment by the Contractor shall cease upon termination. Termination of the contract does not nullify the recoupment of funds by the Contractor per the negotiated Agreernent associated with failure to attain program objectives or the failure to maintain quality criteria. NON-COMPLIANCE. SANCTIONS AND REMEDIAL MEASURES 1. If the Contractor determines, after notice to the Contractee and opportunity to respond, that the Contractee: Is out of compliance with the program quality criteria as listed in Exhibit I, the Contractor may withhold part or all of the Contractee's funding at a level deemed appropriate by the Contractor as defined in paragraph 3 below. Has not attained the negotiated objective(s) as listed in Exhibit II, the Contractee shall refund the amount designated in Exhibit II under Risk Profile. Recoupments will be collected during the subsequent contract year via an adjustment (decrease) in the monthly payment. In such case where a Contractee is subject to recoupment and no longer holds a Contract Agreement with the Contractor, the Contractor will issue an invoice to be paid by the Contractee. The Contractor may also, at its sole discretipn, effectuate such refunds by withholding money from future payments due the Contractee at any time during or after the contract period or rnay recover such funds by any other legal rneans. 2. Failure to comply with any part of this Agreement may be considered cause for revision, suspension or termination of this contract Agreement. Suspension includes withholding part or all of the payments Revised 12103 HRSA Preparedne'5 LPHD Fiscal Agen' 10 XVII. that otherwise would be paid the Contractee under this Agreement, temporarily having others perform, and receive reimbursement for, the services to be provided under this Agreernent and any other measure that suspends the Contractee's participation in the Agreement if the Contractor determinès it is necessary to protect the interests of the State. 3. The Contractee shall provide written notice to the Contractor of all instances of non-compliance with the terms of program quality criteria associated with this Agreement by itself or its subcontractors. Notice shall be given as soon as practicable but in no case later than 15 days after the Contractee became aware, or should have been aware, of the non-compliance. Non-Cornpliance can also be determined by the Division of Public Health regional office Contract Administrator through on-site inspection or desk review of documentation. The written notice shall include information on reason(s) for and effect(s) of the non-compliance. The Contractee shall provide the Contractor with a plan to correct the non-compliance and a timetable for the implementation of that plan to correct. The plan to correct must be approved by the Contractor. If at the end of the implementation period, the Contractee is found to still be out of compliance, at its sole discretion, the Contractor may take whatever action it deems necessary to protect the interests of the State, including withholding part or all of the Contractee's funding, if it reasonably believes that the non-compliance will continue or will reoccur. 4. The Contractee shall provide within 30 days after the end of the contract period (or by the date specified in Exhibit II) to the Contractor via the Contract Administrator, the documentation specified in Exhibit II relating to attainment or failure to attain the objectives agreed to in this contract. If any objective is not attained, the Contractor will determine, at its sole discretion, the proportion of non- attainment and will recoup from the Contractee an amount as defined by the risk profile identified in Exhibit II. Any degree of non-attainment as judged by the sole discretion of the Contractor, shall be used by the Contractor in determining the conditions of any continuation of this Contract Agreement. 5. If the Contractor determines that non-compliance with other requirements (not stated in Exhibit I or Exhibit II) in this Agreement has occurred, or is occurring, it shall demand immediate correction of continuing non-compliance and it rnay irnpose whatever sanctions or remedial measures it deems necessary to protect the interests of the State. Such sanctions and measures may include termination of the Agreement, suspension of the Agreement as defined in paragraph 2 above, imposing additional reporting requirements and monitoring of subcontractors and any other measures it deems appropriate and necessary. 6. If audits are not submitted when due, the Contractor may take action pursuant to Section XII of this Contract Agreement. 7. If required program deliverables or other required information or reports, other than audits, are not submitted when due, the Contractor may withhold all payrnents that otherwise would be paid the Contractee under this Agreement until such time as the reports and inforrnation are subrnitted. In addition, the Contractor can hold implementation of continuations of this contract pending submittal of this documentation. DISPUTE RESOLUTION If any dispute arises between the Contractor and Contractee under this Agreement, including the Contractor's finding of non-compliance and imposition of sanctions or remedial measures, the following process will be the exclusive administrative review. 1. The Contractor's and Contractee's Contract Adrninistrators will attempt to resolve the dispute, in coordination with the Division of Public Health Regional Office Director and appropriate program staff within the Division. 2. If the dispute cannot be resolved by the Contract Administrators, the Contractee may ask for review by the Administrator of the Division of Public Health. 3. If the dispute is still not resolved, the Contractee may request a final review by the Secretary of the Department of Health and Family Services. Revi'ed 12/03 HRSA Pœpaœdne" LPHD Fi".l Agen' 11 XVTII. INDEMNITY XIX. xx. XXI. The Contractor and Contractee agree they shall be responsible for any losses or expenses (including costs, damages, and attorney's fees) attributable to the acts or omissions of their officers, employees or agents. SURETY BOND The Contractor may require the Contractee to have a surety bond. The surety bond shall be in force for the period of the Contract Agreement and shall be a reasonable amount to be determined by the Contractor. CONDITIONS OF THE PARTIES' OBLIGATIONS 1. This Agreernent is contingent upon authorization of Wisconsin and United States law, and any rnaterial amendment or repeal of the same affecting relevant funding or authority of the Contractor shall serve to revise or terminate this Agreement, except as further agreed to by the parties hereto. 2. The Contractor and Contractee understand and agree that no clause, term or condition of this Agreement shall be construed to supersede the lawful powers or duties of either party. 3. It is understood and agreed that the entire Agreement between the parties is contained herein, except for those matters incorporated herein by reference, and that this Agreement supersedes all oral agreernents and negotiations between the parties relating to the subject matter thereof. SPECIAL PROVISIONS 1. If the Contractor determines that the Contractee has exceeded the agreed upon program objective(s) to the level specified in Exhibit II, Conditions for Incentive Payment, the Contractee may be eligible to receive performance-based incentive funds if such funds are available as determined by the Contractor. 2. The Contractor may make these incentive awards at its discretion based on the amount of available incentive funding and the terms of agreement with the Federal agency(s) as to the distribution of such incentive funding. The awards will be rnade during the subsequent contract year via an adjustment (increase) in the monthly payment. In such case where a Contractee is eligible for an incentive payment and no longer holds a Contract Agreement with the Contractor, the Contractor will make a separate payment to the Contractee. The incentive funds must be expended by the Contractee within the subsequent contract or calendar year and can not be diverted outside of the set of programs defined by this Contract Agreement or used for supplanting purposes. 3. To the extent allowed by law, all funding recouped by the Contractor from the Contractee shall be held by the Contractor in a fund designated for use within the program area associated with the recoupment action. These funds may be used to award other Contractees who have exceeded their objectives in that program, general funding of the program area to all Contractees via formula in the next contract period, general funding of the program for all Contractees during the current contract period, or returned to the Federal funding agency of that prograrn. These funds cannot be used by the Contractor for their own operational costs. 4. If at the end of the contract year, the Contractee has attained its contract objectives and is in compliance with the quality criteria, it may retain any unspent funds from this Contract Agreement not expended during the contract year. However, those funds rnust be expended in the current contract year or the contract year immediately following and their use must fall within the program boundaries established under this Contract Agreernent. These retained funds can not be diverted outside of the scope of this Contract Agreement, the Local Public Health Department's budget, or used to supplant local public health tax levy levels. These funds shall be retained in a non-lapsing account for the sole use of the Local Public Health Department; these funds may not lapse to the general fund. The Contractee shall report how these funds were utilized upon request of the Contractor. Revi,ed 12/03 HRSA Pœparedness LPHD Fi,cal Agen' 12 XXII CONTRACT RENEWAL OPTIONS This contract can be renewed on an annual basis for up to two (2) one-year extensions with the mutual Agreement of both the Contractor and Contractee. The objectives to be attained by program will be re- negotiated each year by the Contractor and Contractee as well as docurnentation deliverables and risk conditions. Revised 12/03 HRSA P<ep:u:edne" LPHD F"cal Agen' ]3 xxm TIMELY CONTRACT SIGNING This Contract Agreement becomes null and void if the time between the earlier dated signature and the later dated signature of the Contractee's and Contractor's Authorized Representative on this Agreernent (or addendum) exceeds sixty (60) days inclusive of the two signature dates. Contractor's Authorized Representative Thomas E. Alt, Interim Administrator, Divisio 0 Department of Health and Family Services Date blic Health CARS PAYMENT INFORMATION The information below is used by the Department's Bureau of Fiscal Services, CARS Unit to facilitate the processing and recording of payments made under this Contract Agreement. Agency Name Agency Number Agency Type Contract Period Contract Amount Agency Fiscal Year Oshkosh Public Health Department 472894 11 January 1,2004 through December 31, 2004 $100,910 January I through December 31 ProfileID# 155172 Amount $100,910 Program Name: HRSA - Hospital Public Health Preparedness DPH Contract # 12762 Revi,w 12/03 HRSA Preparedness LPHD Fi,cal Agen' 14 Contract Agreement Addendum: Exhibit I Program Quality Criteria Generally high program quality criteria for the delivery of quality and cost-effective administration of health care programs have been, and will continue to be, required in each public health program to be operated under the terms of this contract. This Exhibit contains only applicable quality criteria for this contract. 01121/2004 01,41 PM DPH G"n" 'nd Contract, Contract#: 12762 Contract Agreement Addendum: Exhibit I Agency: Oshkosh Health Department Contract Year: 2004 No Applicable Quality Criteria 01/21/2004 01,41 PM DPH GrantS 'nd Contract, " Contract Agreement Addendum: Exhibit II Program Objectives (A) Contract Funds and Program/Objective Values (B) Objective Details 0112112004 01,41 PM DPH Gmnts and Con'mots . ' , .. Contract #: 12762 Agency: Oshkosh Health Department Contract Agreement Addendum: Exhibit II(A) Contract Year: 2004 Contract Source of Funds Sonrce Program Oshkosh Amount Bio-terrorism, Hospital Assess & Plan $100,910 I Contract Amount I $100,910 Contract Match Requirements Program Amount Bioterror HRSA Hospital Prepare $0 Contract Amount: $100,910 Program Sub-Coutractee Program Sub-Contracts Bioterror HRSA Hospital None Reported Prepare 0112112004 01,41 PM Sub-Contract Amount $0 DPH G"n" and Con'"cts .. Contract Agreement Addendum: Exhibit II(A) Contract#: 12762 Agency: Oshkosh Health Department Contract Year: 2004 Bioterror HRSA Hospital Prepare Program Total Value $100,910 2 By December 31, 2004, primary and affiliate members of the Region Six Hospital Bioterrorism Preparedness Planning Team will document their ability to manage surge capacity during a public health threat or emergency. By December 31, 2004, primary and affiliate members of the Region Six Bioterrorism Preparedness Planning Team will complete an exercise to test the State of Wisconsin Hospital Bioterrorism Preparedness Plan through participation in the 2nd Annual State of Wisconsin Bioterrorism Preparedness Exercises. $95,910 $5,000 Total of Contract Objective Values $100,910 0112112004 OL41 PM DPH Gmn" and Con""" ~ Contract Agreement Addendum: Exhibit II(B) Contract #: 12762 Agency: Oshkosh Health Department Program: Bioterrqrism HRSA Hospital Preparedness Objective #, I of 2 Contract Year: 2004 Objective V~lue: $95,910 Objective: Primary Details Objective Stntement By December 31, 2004, primary and affiliate members of the Region Six Hospital Bioterrorism Preparedness Planning Team will document their ability to manage surge capacity during a public health threat or emergency. Deliverable Due Date: 01131/2005 Contract Deliverable (Evidence) A completed Deliverables Checklist One and accompanying documentation delivered to the Wisconsin Division of Public Health, Hospital Bioterrorism Preparedness Program. Programs Providing Funds for this Objective Bioterrorism HRSA Hospital Preparedness: $95,910 Agency Funds for this Objective: Data Source for Measurement Region Six Hospital Bioterrorism Preparedness Planning Team records. Baseline for Measurement This is a new initiative so baseline data will be established during the contract year. Context The Region Six Hospital Bioterrorism Preparedness Team (TEAM) will be better prepared to respond to bioterrorism, outbreaks of infectious disease, and other public health threats and emergencies as part of an overall post-event preparedness strategy to manage surge capacity by completing infrastructure enhancements represented by the Health Research and Services Administration (HRSA) FFY 2003 Contract Deliverables Checklist. The Contract Deliverables Checklist One is intended to address the Benchmarks of the FFY03 funding from HRSA to implement a response to a bioterrorist event, infectious disease outbreaks and other public health threats and emergencies involving mass casualties. These Contract Deliverables have been designed so they can be accomplished given the limited funds available per region. FFY03 is, for the purposes of this Contract, equivalent to calendar year 2004. The Contract Deliverables Checklist One outlines all the activities that are to be implemented by the hospital members of the Region Six TEAM. This will allow the TEAM to accomplish the FFY03 Benchmarks to best prepare for a regional response in a mass casualty event. Meeting these Benchmarks is dependent, in part, upon recommendations from State Expert Panels due to the TEAM no later than September 30, 2004. What follows in this Context section, and is completed in the Input Activities Section for this contract, is an itemization of the Benchmarks and the number of deliverables (in parenthesis) for the Benchmark. Critical Benchmark #1 (number of deliverables = I): Develop and maintain a financial accounting system capable of tracking expenditures by priority area, by critical benchmark, and by funds allocated to hospitals and other health care entities. Critical Benchmark #2-1 (number of deliverables = 7): Establish a system that allows the triage, treatment and disposition of 500 adult and pediatric patients per 1,000,000 population with acute illness or trauma requiring hospitalization from a biological, chemical, radiological or explosive terrorist incident. Critical Benchmark #2-2 (number of deliverables = 2): Upgrade or maintain airborne infectious disease isolation capacity to have at least one negative pressure, HEPA-filtered isolation facility per awardee, to be placed in accord with the findings of the awardee's needs assessments. Such facilities must be able to support the initial evaluation and treatment of 10 adult and pediatric patients at a time, having a clinical contagious syndrome suggestive of smallpox, plague or hemorrhagic fever, prior to movement to a definitive isolation facility. Critical Benchmark #2-3 (this is FYI: number of deliverables = 0): Establish a response system that allows the immediate deplóyment of 250 or more additional patient care personnel per 1,000,000 population in urban areas, and 125 or more additional patient care personnel per 1,000,000 of population in rural areas, that would meaningfully increase hospital patient care surge capacity. Critical Benchmark #2-4 (number of deliverables = 2): Develop a system that allows the credentialing and supervision of clinicians not normally working in facilities responding to a terrorist incident. Critical Benchmark #2-5 (number of deliverables = 1): Establish local or regional systems whereby pharmacies based in hospitals or otherwise participating in the local or regional health care response plan have surge capacity to provide pertinent pharmaceuticals in response to bioterrorism or other public health emergencies. Critical Benchmark #2-6 (this is FYI: number of deliverables = 0): Ensure adequate personal protective equipment (PPE) to protect 250 or more health care personnel per 1,000,000 population in urban areas, and 125 or more health care personnel per 1,000,000 population in rural areas during a biological, chemical or radiological incident. Input Activities Critical Benchmark #2-7 (number of deliverables = I): Ensure that adequate portable or fixed decontamination systems exist for managing 500 adult and pediatric patients and health care workers per 1,000,000 population who have been exposed to biological, chemical or radiological agents. Critical Benchmark #2-8 (number of deliverables = 2): Establish a system that provides for a graded range of acute psycho-social interventions and longer-term mental health services to 5,000 adult and pediatric clients and 0112112004 01,41 PM DPH Gran" and Comrac" Contract Agreement Addendum: Exhibit II(B) Contract#: 12762 Program: Bioterrorism HRSA Hospital Preparedness Agency: Oshkosh Health Department Objective #: 1 of 2 Contract Year: 2004 Objective Valne: $95,910 health care workers per 1,000,000 population exposed to a biological, chemical, radiological or explosive terrorist incident. Benchmark #2-9 (number of deliverables ; 3): Enhance statewide trauma care capacity to be able to respond to a mass casualty incident due to terrorism. This plan should ensure the capability of providing trauma care to at least 50 severely injured adult and pediatric patients per million of population per day. Critical Benchmark #2-10 (number of deliverables ; 2): Establish a secure and redundant communications system that ensures connectivity during a terrorist incident between health care facilities and state and local health departments. Critical Benchmark #3 (number of deliverables; I): Develop a mutual aid plan for upgrading and deploying EMS units in jurisdictions they do not normally cover in response to a mass casualty incident due to terrorism. This plan must ensure the capability of providing EMS coverage for at least 500 adult and pediatric patients per 1,000,000 population per day. Critical Benchmark #4-1 (this is FYI: number of deliverables; 0): Implement a hospital laboratory program that is coordinated with currently funded CDC laboratory capacity efforts, and which provides rapid and effective hospital laboratory services responding to terrorism and other public health emergencies. Critical Benchmark #4-2 (number of deliverables; 1): Enhance the capability of rural and urban hospitals, clinics, emergency medical services systems and poison control centers to report syndromic and diagnostic data that is suggestive of terrorism to their associated local and state health departments on a 24-hour-a-day, 7-day-a- week basis. Benchmark #5 (number of deliverables; I): Develop education and training programs for adult and pediatric hospital, outpatient and pre-hospital health care professionals responding to a terrorist incident. Critical Benchmark #6 (this is FYI: number of deliverables; 0): As part of a written evaluation strategy of the awardee's program, conduct at least one bioterrorism disaster exercise in the jurisdiction during FY 2003 that covers a large-scale epidemic scenario affecting both adults and children. Calendar year 2003 Contract Deliverables deferred to calendar year 2004 contract: (number of deliverables; 3). Objective: Risk Profile Percent of Objective Accomplished 1 0% 1 10% 1 20% I 30% 1 40% 50% I 60% 1 70% 1 80% 1 85% I 90% 1 95% 100% 1 Corresponding Percentage Recoupment 1 100% 1 90% 1 80% 1 70% I 60% I 50% 1 40% 1 30% 1 20% 1 15% I 10% 1 5% Corresponding Potential Recoupment Amounts I $95,910 I $86,3191 $76,7281 $67,1371 $57,5461 $47,9551 $38,3641 $28,7731 $19,1821 $14,3861 $9,591 1 $4,795 1 $0 Definition of Percent Accomplished 0% Accomplishment None of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 10% Accomplishment Less than 12 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 20% Accomplishment 17 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 30% Accomplishment 18 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 40% Accomplishment 19 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 50% Accomplishment 20 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 60% Accomplishment 21 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 70% Accomplishment 22 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 80% Accomplishment 23 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 85% Accomplishment 24 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 90% Accomplishment 25 of the Deliverables referenced in the Context section and Input Activities section for this objective were accomplished. 0% 01121/2004 01:41 PM DPH Gmn" and Conn""