HomeMy WebLinkAboutDivision of Public Health-DPH/05
't{
DIVISION OF PUBLIC HEALTH
CONSOLIDATED CONTRACT AGREEMENT
. DPH CONTRACT # 13007
Contract Preamble
This Contract Agreement is entered into for the period January 1, 2005 through December 31, 2005, 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 Health Department, whose principal business address is
215 Church Street, PO Box 1130, Oshkosh WI 54902-1130, hereinafterreferred to as Contractee. .
The Contractee 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 Contract Agreement should be sent to an address different from the
Contractee address noted 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. A detailed description of the objectives to be attained and
the documentation associated with that attainment is part of this Contract Agreement as listed in Exhibits I
and II, which are attached to this Agreement. 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.
II.
CONTRACT ADMINISTRATION
The Contractor's Contract Administrator is Konnie Brown.ofthe Division of Public Health, whose
principal business address is 200 North Jefferson, Suite 511, Green Bay WI .54301-5123. The telephone
number of the Contractor's Contract Administrator is (920) 448-5222. In the event its Contract
Administrator is unable to administer this Contract Agreement, the Contractor will contact the Contractee
and designate a new Contract Administrator.
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. lnthe event its 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 Contract
Agreement, an amount not to exceed $78,608. This amount is contingent upon receipt of sufficient funds
by the Contractor.
The Contractor will nòt maid: payments in excess of the Contract Agreement amounts, with the exception
of performance-based incentive funds pursuant to Section XXI. .
,.
Revised 10/04 CC-LPHD
L.
tf~
IV.
v.
VI.
,
PAYMENT PROCESS
1.
2.
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 achievement of Contract Agreement objectives as determined by the
Contractor. In these situations, the Contractor can make reductions in the monthly 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 II of this Contract
Agreement. 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 report~ specified in the reporting instructions may result in the Contractor
rendering sanctions pursuant to Section XVI of this Contract Agreement.
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 Compliance
Affirmative Action Plans
A.
An Affirmative Action Plan is a written document that details. an affITIDative action
program. Key parts of an affirmative action plan ar.e: (1) a policy statement pledging
nondiscrimination and affirmative action employment, (2) internal and external
dissemination of the policy, (3) assignment of a key employee as the equal opportunity
officer, (4) a workforce analysis that identifies job classifications where there is an under
representation of women, minorities, and persons with disabilities, (5) goals must be
directed to achieving a balanced workforce, specific and measurable, having an
implementation target date between six months and two years, and having a plan of action
or description of procedures to implement the goals, (6) revision of employment practices
to ensure that they do not have discriminatory effects, and (7) establishment of internal
monitoring and reporting systems to regularly measure progress.
B.
An AffITIDative Action Plan is required from a Contractee who receives a contract from
the Contractor in the amount of $25,000 or more and who has a workforce of twenty-five
(25) or more employees as of the award date, unless the Contractee is exempt by criteria
listed in the Wisconsin Office of Contract Compliance, Department of Administration's
Instruction for Vendors AffITffiative Action RequIrements (DOA-3021P (R06/96) s.
16765, Wis. Stats.), page 2. Universities, other states, and local governments, except
Revised 10/04 CC-LPHD
2
{~
.. .)
t L..
.,
Revised 10/04 CC-LPHD
} ~)~-:éPoJ MJ
those of the State of Wisconsin who receive state or federal contracts over $25,0/00, / j (
must submit AffIrmative Action Plans in the same manner as other Contractees.
C.
In addition, for agreements oftwenty-five thousand ($25,000) or more, regardless of
workforce size, the 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. Contractees are to contact the Department of Affirmative
Action/Civil Rights Compliance Office, Department of Health and Family Services, One
West Wilson Street, Room 561, PO Box 7850, Madison WI 53707-7850, for technical
assistance on Equal Opportunity.
Civil Rights Compliance
A.
For agreements for the provision of services to clients, the Contractee must comply with
Civil Rights requirements. Contractees with an annual workforce of less than twenty-five
(25) employees, regardless of contract amount, and Contractees with contracts of less than
$25,000 are not required to submit a Civil Rights Compliance Action Plan, however, they
must submit a Civil Rights Compliance Letter of Assurance. Contractees with an annual
workforce of twenty-five (25) employees or more and contract agreements of $25,000 or
more shall submit a written Civil Rights Compliance Plan which covers a three-year
period within fifteen (15) working days of the award date of the agreement or contract.
B.
The Contractee assures that it has submitted to the Contractor's Affirmative Action ICivil
Rights Compliance Office a current copy of its three-year Civil Rights Compliance Action
Plan for meeting Equal Opportunity Requirements under Title VI and VII of the Civil
Rights Act of 1964, Section 503 and 504 ofthe 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
. American with Disabilities Act (ADA) of 1990, and the Wisconsin Fair Employment Act.
If the Plan was reviewed and approved during the previous year, a plan update must be
submitted for this Contract Agreement period.
1)
No otherwise qualified person shall be excluded from participation in, be denied
the benefits of, or otherwise be subjected 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 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 from employment, be denied the
benefits of employment or otherwise be subjected to discrimination in
employment in any manner or team of employment on the basis of age, race,
religion, sexual orientation, color, sex, national origin or ancestry, disability (as
defined in Section 504 and the American with Disability Act of 1990), or
association with a person with a disability, arrest or conviction record, marital
status, political affiliation, or military participation, unfair honesty testing and
genetic testing, and use or non-use of lawful products outside of working hours.
All employees of the Contractee are expected to support goals and programmatic
activities relating to non-discrimination in employment.
3)
TheContractee shall post the Equal Opportunity Policy, the name of the Equal
Opportunity Coordinator and the Limited English Proficiency Coordinator, and
the discrimination complaint process in conspicuous places available to
applicants and clients of services, and applicants for employment and employees.
The complaint process will be according to the Contractor's standards and the
3
¡;" ;A
t \ 1!.
j
Revised 10/04 CC-LPHD
Contractee shall post the complaint process notice translated into the major
primary languages of the limited English Proficient (LEP) participants in their
service area. The notice will announce the availability of free oral interpretation
of services if needed. The Contractee shall not request interpretation services
from family members, friends and minors.
4)
The Contractee agrees to comply with the Contractor's guidelines in the State of
Wisconsin Department of Workforce Development and Department of Health
and Family Services, Affirmative Action, Equal Opportunity, Limited English
Proficiency and Civil Rights Compliance Plan for Profit and Non-Profit Entities
DWSD-14045 (R. 1112003» or subsequent revisions.
5)
Requirements herein stated apply to any subcontracts or grants. The Contractee
has primary responsibility to take constructive steps, as per the State of
Wisconsin Department of Workforce Development and Department of Health
and Family Services, Affirmative Action, Equal Opportunity, Limited English
Proficiency and Civil Rights Compliance Plan for Profit and Non-Profit Entities
DWSD-14045 (R. 1112003), to ensure the compliance of its subcontractors.
However, where the Contractor has a direct contract with another Contractee's
subcontractor, the Contractee need not obtain a Subcontractor or Subgrantee
Civil Rights Compliance Plan or monitor that subcontractor.
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 grantees according to guidelines in the State
of Wisconsin Department of Workforce Development and Department of Health
and Family Services, Affirmative Action, Equal Opportunity and Limited
English Proficiency, Civil Rights Compliance Plan for Profit and Non-Profit
Entities, DWSD- 14045 (R. 11/2003). The Contractee agrees to comply with
Civil Rights monitoring reviews; including the examination of records and
relevant files maintained by Contractee, as well as interviews with staff, clients,
and applicants for services, subcontractors, providers, 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,
implementing and monitoring corrective action plans that result from complaint
investigations or monitoring efforts. .
C.
The Contractee agrees that it will: (1) hire staff with special translatión or sign language
skills andlor 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 complaints or appeals; (3) train staff in human 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 materials in languages
and formats appropriate to the needs of the client population.
4
.\
! L
f< .~
\ ~
VII.
VIII.
A
SUBCONTRA CTS
1.
The Contractee may subcontract all or part of this Contract Agreement as agreed to during contract
negotiation. 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, 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.
2.
The Contractee retains responsibility for fulfillment of all terins and conditions of this Contract
Agreement when it enters into sub-contractual agreements and will be subject to enforcement of all
the terms and conditions of this Agreement.
3.
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.
GENERAL PROVISIONS
1.
Any payments of monies to the Contractee by the Contractor for services provided under this
Contract Agreement shall be deposited in a bank with Fedenil 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 Agreement 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 fàmily
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 Wis. 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 the 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 authority from the Wisconsin Secretary of State, and must have, and continuously
maintain, 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 or 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. .
Revised 10/04 CC-LPHD
5
,
!<.
... )
l ,t
IX.
x.
;!
ACCOUNTING REQUIREMENTS
1.
For Contract 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'
Accounting Principles and Allowable Cost Policy Manual, available upon request from the
Contract Administrator or from the Office of Program Review and Audit, Department of Health
and Family Services, One West Wilson Street, PO Box 7850, Madison WI 53707-7850.)
2.
For Contract 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
Accounting Principles and Allowable Cost Policy Manual.
3.
The Contractee's accounting system shall allow for accounting of total funds i~c1uded in this
Contract Agreement, and document that contract funds were not diverted outside of such set of
programs. Diversion outside of the set of programs included in this 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 thatJhe 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, the Contractor will not request this information 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 lllatch 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 Agreement are
not required for contract payment purposes.
8.
Nothing in this Section precludes the Contractee from keeping such information as needed for its
internal management purposes.
9.
Expenditures of funds from this Contract Agreement must meet the Department's allowable cost
definitions as defined in the Department's Accounting Principles and 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 in the CARS Payment Information section of 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 closeout
audit, as defined in section (XII, 8), within 90 days after the first day of the new accòunting period.
Revised 10/04 CC-LPHD
6
(
1.>
f ~;
XI.
XII.
cJ,
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 Contract 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 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.
PROPERTY MANAGEMENT REQUIREMENTS
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 Contract
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 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 use, and to authorize others to use, such materials. Any discovery or invention arising
out of, or developed in the course of work aided by this Agreement, shall be promptly and fully
reported to the Contractor. .
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 performed in accordance with auditing standards generally
accepted in the United States of America, s.46.036, Wis. Stats., Government Auditing Standards,
and other provisions in this Contract Agreement. 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 $500,000 from all federal
funding sources (this grant and other grants, direct or indirect, from this Contractor or another)
during a Contractee's fiscal year.
.
The State Single Audit Guidelines (SSAG), which are applicable to local governments having
A-133 audits; andlor .
.
The Provider Agency Audit Guide (PAAG). All Contractees that do not meet the requirements
ofthe SSAG shall have audits in conformance with the PAAG.
Revised 10/04 CC-LPHD
7
.
, .
i -~T
--1.
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.
The Management Letter (or similar document conveying auditor's comments issued as a
result of the audit) or written assurance that a Management Letter was not issued with the
audit report.
c.
Management responses/corrective action plan for each audit issue identified in the audit.
D.
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: (a) within nine months of the end of the Contractee's fiscal year ifthe
Contractee is a local government, or (b) within 180 days of the end of the Contractee' s fiscal year
for non-governmental Contractee agencies. Two copi~s of the audit report must be sent to the
Contractor at the following address:
Program of Evaluation and Audit Section
Office of Strategic Finance
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 firm, the Contractee shall
authorize its auditor to provide access to work papers, reports, and other måterials 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
(or 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 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 timeframe; and/or
C.
Disallow the cost of audits that do not meet these standards.
Revised 10/04 CC-LPHD
8
,
J'
r:,
XIII.
¿.
8.
Closeout Audits:
A.
A specific audit of an accounting period of less than twelve (12) months is required when
an 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 audit may be waived by the
Contractor upon written request from the Contractee, except when the agreement is
terminated for cause. The required c1oseoutaudit may not be waived when an 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.
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 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
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' Compensation, Unemployment 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 monies 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 monies are
owed, the due date, the amount of any penaltieS or interest, known or estimated, 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 ássurance at the time of entering into this Contract Agreement
that the Contractee has in force and will maintain for the course of this Agreement employee
dishones~y 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 Exclpded 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.
Revised 10/04 CC-LPHD
9
\
. '
"'
~ "
XIV.
xv.
,1
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 audit, dispute or litigation, 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 confirm the Contractee's compliance with the specifications of this Contract 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 paragraph 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
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 theContractee accesses to provide the services under this Contract Agreement.
AGREEMENT REVISIONS AND/OR TERMINATION
1.
The Contractee agrees to re-negotiate with the Contractor this Contract 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.
.
.
Failure to agree to a re-negotiated Contract Agreement under these circumstances is cause for the
Contractor to terminate this Agreement.
2.
This Contract Agreement can be terminated for any reason by a 30-day written notice by either
party.
3.
Revision of this Contract 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
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 Contract Agreement.
5.
If the Contractor finds it necessary to terminate this Contract 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 Agreement, associated with failure to
attain program objectives or the failure to maintain quality criteria.
Revised 10/04 CC-LPHD
10
,
¡ ,
~ ~'.
XVI.
..
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 th~ CARS 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 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 Contract Agreement may be considered cause for revision,
suspension or termination of this Agreement. Suspension includes withholding part or all of the
payments 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 Agreement and any
other measure that suspends the Contractee's participation in the Agreement if the Contractor
deterqrines 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 Contract 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 implementation period, the
Contractee is found to still be out of compliance, the Contractor may, at its sole discretion, 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 ofthe 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 Agreement
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 Agreement
5.
If the Contractor determines that non-compliance with other requirements (not stated in Exhibit I or
Exhibit II) in this Contract Agreementhas occurred, or is occurring, it shall demand immediate
correction of continuing non-compliance and it may impose whatever sanctions or remedial measures it
deems neçessary 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.
Revised 10/04 CC-LPHD
11
,
» '
r "
XVII.
~
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 payments that otherwise would be paid the
Contractee under this Contract Agreement until such time as the reports and information are submitted.
In addition, the Contractor can hold implementation of continuation of this Agreement pending
submittal of this documentation.
DISPUTE RESOLUTION
If any dispute arises between the Contractor and Contractee under this Contract 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 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 may request a final review by the Secretary of the
Department of Health and Family Services.
XVIII. 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 Contract 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
Contract Agreement shall be construed to supersede the lawful powers or duties of either party.
3.
It is understood and agreed that the entire Contract 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
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 an Incentive Payment, the
Contractee may be eligible to receive performance-based incentive funds if such funds are
available as determined by the Contractor.
Revised 10/04 CC-LPHD
12
.
"
f .'
XXII
"
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 monthly CARS 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 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 Agreement. These retained funds cannot be diverted outside of
the scope of this 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.
CONTRACT RENEWAL OPTIONS
This contract can be renewed on an annual basis for up to two (2) one-yeár 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 documentation deliverables and risk
conditions.
Revised 10/04 CC-LPHD
13
,
'.
¡ è,
.~
XXIII 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 Agreement (or
addendum) exceeds sixty. (60) days inclusive of the two signature dates.
7;//¡~~
~fE~'ÂRbs ~~tIIOOttdA~'ffi{~seeïfye MANAGER
PAM~LA R. UBRIG,
/ 4/d (b~/I')
Contractor's Authorized Representative .!
Herb H. Bostrom, Interim Administrator, Division of Public Health
Department of Health and Family Services I hereby certify that the necessary provisions
s to orm: have been made to pay the liability which will
accrue under this contract.
~I,~£Q~~
//J/vr-
Date
Oshkosh, WI
CARS PAYMENT INFORMATION
The information below is used by the Department's Bureau of Fiscal Services, CARS Unitto facilitate the processing and
recording of payments made under this Contract Agreement.
Agency Name Oshkosh Health Department
Agency Number 472894
Agency Type 21
Contract Period January 1,2005 through December 31,2005
Contract Amount $78,608
Agency Fiscal YearJanuary through December
Profile ID#
Profile ID#
Profile ID#
Profile ID#
Profile ID#
155015
155020
157720
159320
159220
Bioterrorism
Immunization
Lead
Maternal Child Health
Prevention
Amount
Amount
Amount
Amount
Amount
$18,246
$13,725
$7,996
$29,047
$9,594
DPH Consolidated Contract # 13007
CFDA #s:
Bioterrorism
Immunization
MCH
Prevention
93.283
93.268
93.994
93.991
Revised 10/04 CC-LPHD
14
"
t ..
Contract Agreement Addendum: Exhibit I
Program Quality Criteria
Generally high program quality criteria for the delivery of quality and qost-effective administration of
health care programs have been, and will continue to be, required in each public health program to be
operated under the tenns of this contract.
This Exhibit contains only applicable quality criteria for this contract.
11/22/2004 07:00 PM
DPH Grants and Contracts
,
..
{ ...
.,'
Contract #: 13007
Contract AgreementAddendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2005
Program: Bioterrorism CDC Planning & Readiness
Program Quality Criteria
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 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,
culturally competent, and consistent with the best practices; and delivery of public health programs for communities for
the improvement of health status.
A) There are 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 infonnation.
A) There are no separate sub-criteria to this Quality Criterion Category.
4) Infonnation, 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 will regularly present to the media, public partners and other stakeholders infonnation on their
consortium and the Public Health Preparedness Program in coordination with DPH Focus Area F staff and
the Preparedness Program Speaker's Bureau.
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) Contractees will coordinate with other preparedness programs by assuring representation at the appropriate
following meetings:.1) Hospital (HRSA) Region, 2) Regional Trauma Advisory Council (RTAC), 3) Joint
CDC/HRSA Advisory Committee, 4) Consortia Fiscal Agent Meetings, 5) Consortia Program Coordinator
Meetings, 6) Consortia Training Coordinators, 7) State Public Health Epidemiologist Network, 8) Expert
Panel Committees, 9) Local Emergency Planning Committees (LEPCs).
B) Contractees will utilize the Public Health Infonnation Network (PHIN) and the Health Alert Network
(HAN) as appropriate and as these systems develop.
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 Quality Criterion Category.
8) Financial management practices sufficient to assure accurate eligibility detennination, 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
11/22/2004 07:00 PM
DPH GrantS and Contracts
.,
t ~
Contract #: 13007
provided.
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
A) There are no separate sub-criteria to this Quality Criterion Category.
Contract Year: 2005
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) There are no separate sub-criteria to this Quality Criterion Category.
I i/22/2004 07:00 PM
DPH Grants and Contracts
f -
~.
Contract #: 13007
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2005
Program: Childhood Lead Poisoning Prevention
Program Quality Criteria
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) 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 a 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) Contractees must provide services that support the elimination of 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.
B) Contractees must assure the availability and accessibility of blood lead screening tests for children ages 0-5
years at high risk of lead poisoning.
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) Contractee must maintain a central case registry to track follow-up of children with BLLs of at least lO
ug/dL and of properties where a lead hazard investigation was performed, including interventions and
outcomes.
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) Contractee must provide information within 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.
B) Contractee must provide information, consultation and technical assistance to assure that treatment of
children with lead poisoning is efficient and effective, and to assure that lead safe environments are
available to children in the community.
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 age~cy that distributes
the funds with the goal of addressing lead hazards in the housing stock.
6) Areferral network sufficient to assure the accessibility and timely provision of services to address identified public
health care needs.
11122/2004 07:00 PM
DPH Grants and Contracts
'. ,..
Contract #: 13007
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health DepartmeI].t
Contract Year: 2005
A)Contractee must assess needs and provide and monitor referrals for supportive services as needed to
families oflead poisoned children.
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) Contractee must assure that local childhood lead poisoning prevention program staff have access to, are
knowledgeable of, 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.
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) Contractee must pursue third party payment and/or other funding sources for service provision to children
who are eligible for third party payment except when doing so is demonstrated not cost effective.
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; community lead poisoning education, prevention and control efforts.
B) Contractee must submit forms and documents to the Wisconsin Childhood Lead Poisoning Prevention
Program (DPH477IA, B, C, D) by the specified deadlines as stated in the WCLPPP Handbook.
ll/2212004 07:00 PM
DPH Grants and Contracts
i '"
Contract #: 13007
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2005
Program: Immun,ization
Program Quality Criteria
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 assure reported vaccine preventable diseases are investigated and controlled as detailed in
the Wisconsin Disease Surveillance Manual (EPINET), Immunization programs should contact local
required reporters to encourage prompt reporting,
B) Contractees must annually evaluate their local immunization delivery and vaccine preventable disease
surveillance systems and improve these systems where needed.
2) Delivery of public health services to citizens by qualified health professionals in.a 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) Contractees must assure the delivery of immunization services in a safe, effective, and efficient manner as
detailed in the ImmunizationProgram Policies and Procedures and in section 252, HFS 145, Wis, Admin.
Code. Contractees must assure the immunization of children is consistent with Healthy People 20 I 0 goals.
3) Record keeping for individual focused services that assures documentation and tracking of'dient health care needs,
response to known health care problems on a timely basis, and confidentiality of client information.
A) Contractees must use the Wisconsin Immunization Registry (WIR) or an electronic immunization data
system that links. with the WIR. The data system must have a tracking and recall function to identify
children whose immunization records are behind schedule.
B) Contractees' immunization practice must assure the immunization of children, and share children s
immunization records with schools and 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 decision making by those at risk and to affect policy and environmental changes at
the community level.
A) Contractees must promote community 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 assure that identified public health needs are addressed in a comprehensive, cost-
effective manner across programs and throughout the community.
A) Contractees must coordinate immunization services with local child health care (service) providers; e.g.,
WIC 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 care providers to facilitate access
by children and families to immunization services. Contractees should work with these providers to assure
that current immunization guidelines are followed. These relationships should also be used to promote the
11/22/2004 07:00 PM
DPH Grants and Contracts
í ..'
Contract #: 13007
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2005
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 ofthe prompt reporting of all suspect
cases of vaccine preventable diseases.
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) Contractees will ensure program staff are competent in current immunization program policy and process
information including that provided through t~e Centers for Disease Control and Prevention (CDC)
distance learning course and CDC updates.
B) The local health department must have written policies on the proper handling and storage of state supplied
vàccrne. 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 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) Billing 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 (MA)
will not be charged a vaccine administration fee or be requested to make a donation for vaccine or vaccine
related services.
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) 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 will utilize the CDC Clinic Assessment Software Application (CASA)
for immunization level data analysis.
C) The deliverable for all objectives dealing wid;! immunization level assessments utilizing CASA will include
a written summary report and a copy of the CASA data diskette. The data diskette should be sent to the
Regional Office Immunization Program Advisor.
11/22/2004 07:00 PM
DPH Grants and Contracts
1 -¡¡¡.
Contract #: 13007
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2005
Program: Maternal and Child Health Block Grant
Program Quality Criteria
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 include a maternal and child health needs assessment, at least every five years as required
by Title V ofthe Social Security Act, in their community needs assessment process.
2) Delivery of public health services tò citizens by qualified health professionals in a 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) 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 information provided by the State.
C) Contractees must designate a staff person as the children with special health care needs contact to receive
and disseminate policy and program information provided by the State and Regional CSHCN Centers.
D) The Contractee must assure quality by utilizing one or more of the following documents as guidance for
best practice in the organization and delivery of services: 1) Guidance Manual 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 Practice: 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. If 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 confidential 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) All materials for public distribution 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.
] 1/22/2004 07:00 PM
DPH Grants and CO¡1tracts
.
..
,,..
Contract#: 13007
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2005
Department of Health and Human Services."
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) Contractees must have a mechanism in place to assure coordination with the Regional CSHCN Centers.
B) Contractees must coordinate maternal and child health programs with other community health programs.
6) A referral network sufficient to assure the, accessibility and timely provision of services to address identified public
health care needs.
A) Local health departments that provide maternal and child health 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, WIC, 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) Contractees must 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 oflast 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 all Title V
MCH Block grant funds. .
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) 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 ($0.7Slocal contribution for every $1.00 federal).
1l!22/2004 07:00 PM
DPH Grants and Contracts
j ..
Contract #: 13007
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2005
Program: Preventive Health and Health Services Block Grant
Program Quality Criteria
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) Involvement of key policy makers and the general public in the development of comprehensive public
health plans. .
B) Development and implementation of a plan to address issues related to access to high priority public health
services for every member ofthe community.
2) Delivery of public health services to citizens by qualified health professionals in a 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) There are 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 oùtreach programs intended to address known health risks in the general and certain target
populations to encourage appropriate decision making by thosç: 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 preventive activities.
Note: All materials produced with PHHS Block Grant funds must include 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 accuràte 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) Program-specific data collection, analysis, and reporting to assure program outcome goals are met or to
11/22/2004.07:00 PM
DPH Grants and Contracts
I
..
, ¡oJ
~
Contract #: 13007
Contr3¡ct Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2005
identify program management problems that need to be addressed.
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) There are no separate sub-criteria to this Quality Criterion Category.
,;
11/22/2004 07:00 PM
DPH Grants and Contracts
l
".
;~ ,¡
Contract Agreement Addendum: Exhibit II
Program Objectives
(A) Contract Funds, Program/Objective Values, and Other Contract Details
(B) Objective Details
11/22/2004 07:00 PM
DPH Grants and Contracts
k
>'
~ "
Contract #: 13007
Source
Oshkosh
Oshkosh
Oshkosh
Oshkosh
Oshkosh
.-,
Contract Agreement Addendum: Exhibit II(A)
Agency: Oshkosh Health Department
Program
Contract Source of Funds
Bioterrorism, Focus A
Childhood Lead - Consolidated
Immunization - Consolidated lAP
Maternal Child Health - Consolidated
Prevention - Consolidated
Program
Contract Match Requirements
Bioterror CDC Focus A
Childhood Lead
Immunization
MCH
Prevention
Amount
$0
$0
$0
$21,785
$0
Program
BioterrorCDC Focus A
Childhood Lead
Immunization
MCH
Prevention
11/22/2004 07:00 I'M
Sub-Contractee
None Reported
None Reported
None Reported
None Reported
None Reported
Contract Amount
Program Sub-Contracts
Amount
$18,246
$7,996
$13,725
$29,047
$9,594
$78,608
Contract Year: 2005
Sub-Contract Amount
$0
$0
$0
$0
$0
DPH Grants and Contracts
~
'.
Contract #: 13007
Contract Agreement Addendum: Exhibit II(A)
Agency: Oshkosh Health Department
Contract Year: 2005
Other Contract Information
The format of an objective's Risk Profile can be either: 1) a grid to correlate definitions of percentage attainment and the related
recoupment based on the objective's value, 2) accountability target(s), or 3) non-specific as to definitions of attainment and
recoupment, or accountability.
An accountability target is defined as an action that, if taken, should lead to the accomplishment of an objective.
Ifthe Contractor determines an objective has not been attained, there will be: 1) recoupment based on the stipulated correlation to
percentage attainment, or 2) a review under:taken (by the Contractee's Health Officer and Division of Public Health Regional Office
and Central Office staff) to determine that either no further action is necessary or a technical assistance plan needs to be developed
and implemented. If a pattern of ongoing objective attainment failure is documented in a program area or across an agency's
contracts for two or more years, the Division of Public Health Administrator may reduce the following year's contract by some or all
of the value amount assigned to the objectives that were not achieved. If this happens, a mutually agreed-upon improvement plan will
developed and implemented to reinstate the funding in future years.
Non-performance is defined as no effort to accomplish an objective.
If the Contractor determines there is non-performance against a particular program objective; the Division of Public Health
Adniinistrator may choose to reduce the Contractee's followirig year's allocation in that program by an amount less than or equal to
. .,
the value assigned to that objective. Correspondingly, a mutually agreed-upon improvement plan will be developed and implemented
to reinstate the funding in future years.
11/22/2004 07:00 PM
DPH Grants and Contracts
Q
. '. F ,
Contract #: 13007
Contract Agreement Addendum: Exhibit II(A)
Agency: Oshkosh Health Department
Contract Year: 2005
Bioterror CDC Focus A
Program Total Value $18,246
By December 31, 2005, all Fox Valley Public Health Preparedness Consortium member agency requirements
related to the accomplishment of the public health preparedness objectives will be met by the Oshkosh Health
Department.
Childhood Lead
Program Total Value $7,996
2
By December 31,2005, the City of Oshkosh Board of Health will have signed a proclamation to take a leadership
role in promoting age-appropriate blood lead testing among Oshkosh children.
By December 31,2005,7 pre-1978 housing units located in the City of Oshkosh where children less than 6 years
with no blood lead test on record, children less than 6 years without an elevated blood level or pregnant women
reside will be assessed using the Wisconsin Childhood Lead Poisoning Prevention Program Standards for Home
Visitation to Address Lead Hazards.
Immunization
Program Total Value $13,725
2
By December 31, 2005, 90% of children served by the Oshkosh City Health Department Immunization Program
who will be 24-35 months of age as of December 31,2005 will complete their primary immunizations by 35
months of age. .
By December 31, 2005, two private health care providers located in the City of Oshkosh will receive Wisconsin
Immunization Registry training. .
MCR
Program Total Value $29,047
By December 31,2005,80% of the child care or day care workers who participate in a communicable disease
inservice sponsored by the City of Oshkosh Health Department will demonstrate an increase in knowledge related
to communicable disease... ,
2
By December 31, 2005, 65 residences located within the City of Oshkosh with children ages birth to 3 years will
have a documented decrease in hazards previously identified through home safety assessments.
By December 31,2005, 60. children ages birth through 8 years from the City of Oshkosh will be properly
positioned in a child car passenger seat system as demonstrated by their parent or caregiver.
3
Prevention
Program Total Value $9,594
2
By December j 1, 2005, one strategy will be implemented to address child passenger safety needs of children by
developing a partnership with the City of Oshkosh and community partners in Winnebago County.
By December 31,2005, the City of Oshkosh Board of Health will receive a completed Day Care Center Needs
Assessment as developed by the City of Oshkosh Health Department and its community partners.
Total of Contract Objective Values
11/22/2004 07:00 PM
$18,246
. $5,437
. $2,559
$11,725
$2,000
$4,000
$20,047
$5,000
$4,500
$5,094
$78,608
DPH Grants and Contracts
,
'"
~
'. J.,
Contract Agreement Addendum: Exhibit II(B)
Contract #: 13007 Agency: Oshkosh Health Department
Program: Bioteuorism CDC Planning & Readiness Objective #: I of I
Contract Year: 2005
Objective Value: $18,246
Objective: Primary Details
Objective Statement
By December 31,2005, all Fox Valley Public Health Preparedness Consortium member agency requirements related to the
accomplishment of the public health preparedness objectives will be met by the Oshkosh Health Departinent.
Deliverable Due Date: 01/31/2006
Contract Deliverable (Evidence)
A report to stipulate the degree of participation by the Oshkosh Health Department in the effort to achieve the public health
preparedness consortium contract objectives.
Programs Providing Funds for this Objective
Bioterrorism CDC Planning & Readiness: $18,246
Agency Funds for this Objective:
Data Source for Measurement
A template for the required Deliverable report will be provided by the Division of Public Health.
Baseline for Measurement
The degree of participation in the achievement of the 2004 public health preparedness consortium contract objectives.
Context ,
Eight required objectives must be completed by both the consortia and local agency members. There are two required objectives for
each of the four preparedness capacities: emergency response, epidemiology, communication, and training. In addition, two
template objectives must be mutually selected by the consortia and its member agencies for each of the four capacities, i.e., eight
total template objectives. No less than two member agencies must collaborate on a selected template objective and the results must
be shared with all member agencies. . All member agencies are encouraged, but not required, to collaborate on the selected template
objectives. Template objectives cannot be chosen ifthe related work is already completed.
Input Activities
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract objective.
Conditions of Eligibility for an Incentive
INone
11122/2004 07:00 PM
DPH Grants and Contracts
)
" .' "
Contract Agreement Addendum: Exhibit II(B)
Contract #: 13007 Agency: Oshkosh Health Department
Program: Childhood Lead Poisoning Prevention Objective #: 1 of 2
Contract Year: 2005
Objective Value: $5,437
Objective: Primary Details
Objective Statement
By December 31,2005, the City of Oshkosh Board of Health will have signed a proclamation to take a leadership role in promoting
age-appropriate blood lead testing among Oshkosh children. . .
Deliverable Due Date: 01/31/2006
Contract Deliverable (Evidence)
A proclamation signed by the City of Oshkosh Board of Health stating their support for age-appropriate blood lead testing among
children in Oshkosh. .
Programs Providing Funds for this Objective
Childhood Lead Poisoning Prevention: $5,437
Agency Funds for this Objective:
Data Source for Measurement
Survey and analysis of same.
Baseline for Measurement
It has been at least 5 years since a survey related to lead screening has been done with Oshkosh physicians.
Context
The City of Oshkosh has a high percentage of homes built prior to 1978. The children who reside in these homes aré at high risk of
exposure due to deteriorated paint. It is imperative that children be tested to ascertain if they have been lead poisoned.
Input Activities
The Health Department will develop and implement a childhood blood lead testing survey for the pediatricians and family practice
providers within the City of Oshkosh that primarily provide services to children. The completed surveys will be analyzed and the
infonnation received will be presented to the City of Oshkosh Board of Health.
Objective: Risk Profile
Accountability Targets
Targeted accountability stages will be: 1) design and implement survey, 2) report to the Board of Health on survey outcomes, and 3)
educate physicians on age-appropriate blood lead testing.
Conditions of Eligibility for an Incentive
I None
11/22/2004 07:00 PM
DPH Grants and Contracts
j.
~"
Contract Agreement Addendum: Exhibit II(B)
Contract #: 13007 Agency: Oshkosh Health Department
Program: Childhood Lead Poisoning Prevention Objective #: 2 of2
Contract Year: 2005
Objective Value: $2,559
Objective: Primary Details
Objective Statement
By December 31,2005,7 pre-1978 housing units located in the City of Oshkosh where children less than 6 years with no blood lead
test on record, children less than 6 years wÏthòut an elevated blood level or pregnant women reside will be assessed using the
Wisconsin Childhood Lead Poisoning Prevention Program Standards for Home Visitation to Address Lead Hazards.
Deliverable Duè Date: 01/3112006
Contract Deliverable (Evidence)
A report to include documentation of the housing units assessed, year built, type of sampling results and number of property owners
contacted.
Programs Providing Funds for this Objective
Childhood Lead Poisoning Prevention: $2,559
Agency Funds for this Objective:
Data Source for Measurement
Agency report or SPHERE generated report.
Baseline for Measurement
January through September 2004,20 home visits have been conducted.
Context
Children residing in pre-l 978 buildings are at high risk of exposure to lead due to deteriorated lead-based paint.
Input Activities
The Wisconsin Childhood Lead Poisoning Prevention Program Standards for Home Visitation to Address Lead Hazards will be
utilized to address the target groups of children less than 6 years of age with no blood lead test on record or children less than 6
years of age without an elevated blood lead level or pregnant women.
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract objective.
Conditions of Eligibility for an Incentive
I None
] ]/22/2004 07:00 PM
DPH Grants andCon1racts
~\
-
, ,
'.
Contract Agreement Addendum: Exhibit II(B)
Contract #: 13007
Program: Immunization
Agency: Oshkosh Health Department
Objective #: 1 of 2
Contract Year: 2005
Objective Value: $11,725
Objective: Primary Details
Objective Statement
By December 31, 2005, 90% of children served by the Oshkosh City Health Department Immunization Program who will be 24-35
months of age as of December 31, 2005 will complete their primary immunizations by 35 months of age.
. Deliverable Due Date: 01/31/2006
Contract Deliverable (Evidence)
A report to include documentation of the number of children served by the Oshkosh City Health Department Immunization Program
who were 24-35 months of age as of December 31, 2005, and the number of those children who completed their primary
immunizations by 35 months of age.
Programs Providing Funds for this Objective
Immunization: $11,725
Agency Funds for this Objective:
Data Source for Measurement
Agency records and CASA Summary Report of late-up-to-date immunizations by 35 months of age.
Baseline for Measurement
In 2004, CASA results indicated 90% of children followed by Oshkosh City Health DepartÍnent completed their primary
immunizations.
Context
Children will be assessed for their completion of the 4 DTaP, 3 polio, 1 MMR,3 Hib, 3 HepB immunization series by 35 months of
age. The estimatds there are 300 children in this cohort of patients. As of June 2004, 90% of children (or approximately 175) who
were served by the Oshkosh City Health Department completed their primary immunizations.
Input Activities
Oshkosh City Health Department will be targeting children who are due for their primary immunizations by mailing consent fonns
to parents along with ~ur monthly immunization clinic schedules. Another way we target families with young children is by sending
clinic schedules out in our postpartum packets and handing out at child safety home visits. Oshkosh Health Service Division clinic
schedules are also distributed to all area medical providers and to the Oshkosh Area School System. Education, evaluating
children's'immunization records, and vaccine administration are implemented at our clinics. We will continue to input
immunizations in the Wisconsin Immunization Registry (WIR), and attend WIR user group meetings to keep infonned of current
updates and changes within the system. Individual appointments for children's immunizations are also set up as needed. We will
continue to attend the Immunization Coalition meetings as a member to receive current updates and infonnation on new
immunization data from phannaceutical representatives.
Objective: Risk Profùe
Accountability Targets
Accountability targets are not applicable or were not detenninetl for this contract objective.
Conditions of Eligibility for an Incentive
INone
11/22/2004 07:00 PM
DPH Grants and Contracts
:
Contract Agreement Addendum: Exhibit II(B)
Contract #: 13007 Agency: Oshkosh Health Department
Program: Maternal and Child Health Block Grant Objective #: 2 00
Contract Year: 2005
Objective Value: $20,047
Objective: Primary Details
Objective Statement
By December 31,2005,65 residences located within the City of Oshkosh with children ages birth to 3 years will have a
. documented decrease in hazards previously identified through home safety assessments.
Deliverable Due Date: 01/31/2006
Contract Deliverable (Evidence)
A report to document, by residence (household), the corrections made for hazards identified through home safety assessments.
Programs Providing Funds for this Objective
Maternal and Child Health Block Grant: $20,047
Agency Funds for this Objective:
Data Source for Measurement
SPHERE Individual/Household Report to include MCH Required Demographic Data and data from the following screens: Injury
Prevention Assessment OR Home Safety Assessment of Young Children; Health Teaching Topics and Results; and Referral and
Follow-Up/Results if appropriate.
Baseline for Measurement
As of September 24, 2004, 50 families have been served by the Home Safety Child Proofing Visits Program.
Context
A grant-funded Registered Nurse will visit and revisit each residence and do the home safety assessment. The Wiscónsin Division
of Public Health Checklist for Home Safety Assessment of Young Children is used for visits. A copy of the checklist is left with
parents to make changes as needed. Hazards found are verbally discussed and written on assessment form. .Some safety devices are
. also installed during the visit. Referrals are given as needed. A resource and referral guide is also handed out at these visits.
Community awareness is established by distributing home safety brochures to community partner such as: New Parent, WIC and
Oshkosh pediatric physicians. By being involved in this program for a few years, -input received from parents and needed changes
within the program have evolved. By evaluating and assessing many homes, it has been found that the quality and extent of
products given out to parents has increased and also the time needed at each visit has lengthened due to the teaching and total
assessment of each home. The Health Department has found that many homes do not have a working smoke alarm. Instructions on
the use of a smoke alarm, setting up the alarm and teaching of the importance of the alarm is all a part of the visit along with other
assessments. Client awareness and testing for lead is also assessed in each home. This program continues to grow and expand.
Input Activities
Reminder calls to set up times of visits and revisits are sent out as needed. Completing the home safety checklist as we tour the
home and its surroundings and checking for hazards including lead testing. Education on safety issues and pamphlets are handed
out, which include: poison control numbers and stickers, car seat safety, First Aid/CPR, emergency numbers from Wisconsin Public
Service. Installation of products that do not require a screwdriver. City of Oshkosh Health Department will make referrals to
community partners as needed and attend safety events and conferences. Community awareness is also implemented by speaking at
the Mom's Club and at a local grandparent's group. All products are purchased through Safety Ist/Dord Group and Wal-Mart. Also
purchase a few products from One Step Ahead. Grant nurse works with community partners, which includes the Oshkosh Fire
Department, New Parent Program, the Oshkosh Police Department, and Safe Kids.
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract objective.
Conditions of Eligibility for an Incentive
I None
11/22/2004 07:00 PM
DPH Grants and Contracts