HomeMy WebLinkAboutDivision of Public Health Contract #13772
't.
DIVISION OF PUBLIC HEALTH
CONSOLIDATED CONTRACT AGREEMENT
DPH CONTRACT # 13772
Contract Preamble
This Contract Agreement is entered into for the period January 1,2006 through December 31,2006, by and
between the State of Wisconsin represented by its Division ofPubJic Health of the Department of Ilealth 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, hereinafter referred 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 ofthe objectives that it
has agreed to attain within the contract period. A detaUed 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 of the 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. In the 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 $81,195. This amount is contingent upon receipt of sufficient funds by
the Contractor.
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.
Performance LHD w/o CARS Report 12/05
fl
ui
""'
It ')
IV. PAYMENT PROCESS
1. 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.
2. 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 first 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.
V. 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 reports specified in the reporting instructions may result in the Contractor
rendering sanctions pursuant to Section XVI of this contract.
VI. 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 affirmative action
program. Key parts of an affirmative action plan are: (1) a policy statement pledging
nondiscrimination and affirmative action employment, (2) internal and external
dissemination of the policy, (3) assignment of a key employee a,s 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 Affirmative 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 Qftwenty-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 Affmnative Action Requirements (DOA-3021P (R06/96) s. 16765,
Wis. Stats.), page 2. Universities, other states, and local governments, except those of the
Performance LHD w/o CARS Report 12/05
2
~.,
'I
"
,
., ,J
State of Wisconsin who receive state or federal contracts over $25,000, must submit
Affmnative Action Plans in the same manner as other Contractees.
C. In addition, for agreements of twenty-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 Affmnative Action/Civil
Rights Compliance Office, Department of Health and Family Services, One West Wilson
Street, Room 561, PO Box 7850, Madison WI 53707-7850, fortechnical 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, th€:y
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 /Civil
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 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
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.
Performance LHD w/o CARS Report 12/05
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 th'e
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
defmed 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)
The Contractee 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
3
l \
(
l~
complaint proce!1S will be according to the Contractor's standards and the
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 mmors.
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. 11/2003)) 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. 11/2003), 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 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 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.
Performance urn w/o CARS Report 12/05
4
" ,
t ~
VII. SUBCONTRACTS
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 Contractlee
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 terms 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.
VIII. 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 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 Dep~ent, 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 stat,e
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 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 ce9ificate
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.
Performance LHD w/o CARS Report 12/05
5
.~ I
1
, ,
IX. 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 Program Evaluation and Audit Section, Office of Strategic Finance,
Department of Health and Family Services, One West Wilson Street, PO Box 7850, Madison WI
53707-7850.)
2. For Contract Agreements ofless than twenty-five thousand dollars ($25,000), the Contractee shall
at least maintain a simplified double entry bookkeeping system as defmed in the Department's
Accounting Principles and Allowable Cost Policy Manual.
3. The Contractee's accounting system shall allow for accounting oftotal funds included 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 that the Federal government has waived program specific
cost-based reporting requirements for all programs in this Contract Agreement, 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, via the
Web-based Grants and Contracts (GAC) application, 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 undei: paragraph 4 above the Contractee shall
provide the information within ninety (90) days after the end of the contract period. The Contractor
will make the request in writing at least 30 days prior to the specified 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 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
defmitions as defmed in the Department's Accounting Principles and Allowable Cost Policy
Manual.
X. 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
Performance LHD w/o CARS Report 12/05
6
t I
i
. ,
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 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 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.
XI. 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.
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 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-B3 "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-B3 audits; and/or
Performance LHD w/o CARS Report 12/05
7
\ '
",
.;, ':;
. The Provider Agency Audit Guide (P AA 0). All Contractees that 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 w~ich
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. Ifprogram 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 if the
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 copies of the audit report must be sent to the
Contractor at the following address:
Program Evaluation and Audit Section
Office of Strategic Finance
Department of Health and Family Services
PO Box 7850
Madison WI 53707-7850
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 permit appropriate representatives of the
Department and/or the Contractor to have access to the Contractee's records and fmancial
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 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 tha,t do not meet these standards.
Performance LHD w/o CARS Report 12/05
8
(
1 ,
,
.' .~
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 closeout audit 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-B3 and determining major
Federal fmancial 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 iin
conflict with the specific Closeout Audits requirements.
XIII. 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 est~ated, 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 thl~
monies are owed, the expected payment date and other related information. Ifthe liability is in
dispute, the written notice shall contain a discussion offacts 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 ofthis 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.
Performance LHD w/o CARS Report 12/05
9
z '
~
XIV. 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 confmn 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
thjit the Contractee accesses to provide the services under this Contract Agreement.
XV. 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 case load 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.
Performance LHD w/o CARS Report 12105
10
I,
,
. .
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 the 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 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 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, ifit
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 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 Agreement has occurred, or is occurring, it shall demand immediate
correction of continuing non-compliance and it may impose whatever sanctions or remedial measures it
deems necessary to protect the interests of the State. Such sanctions and measures may include
termination ofthe Agreement, suspension of the Agreement as defined in paragraph 2 above, imposing
additional reporting requireme~ts and monitoring of subcontractors and any other measures it deems
appropriate and necessary.
Performance LHD w/o CARS Report 12/05
11
,,\
\
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 submittt:d.
In addition, the Contractor can hold implementation of continuation of this Agreement pending
submittal of this documentation.
XVII. DISPUTE RESOLUTION
If any dispute arises between the Contractor and Contractee under this Contract Agreement, including the
Contractor's fmding 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 fmal review by the Secretary of the
Department of Health and Family Services.
XVIII. INDEMNITY
The Contractor andContractee 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.
XX. CONDITIONS OF THE PARTIES' OBLIGATIONS
1. This Contract Agreement is contingent upon authorization of Wisconsin and United States law, aJtld
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.
XXI. 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.
Performance LHD w/o CARS Report 12/05
12
l ,
\
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 I In such case where a Contractee is eligibll~
for an incentive payment and no longer holds a contrabt 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. The
Contractee shall report, in a manner specified by the Contractor, on how the Contractee expended
these incentive funds.
3. To the extent allowed by law:
. All funding recouped by the Contractor from theContractee 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 cummt
contract period, or returned to the Federal funding agency ofthat 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, except for unearned prepayments (advances). 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, as specified in Section IX.
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 documentation deliverables and risk
conditions.
Performance LHD w/o CARS Report 12/05
13
>
\ '
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.
/- 2 7- ..;?t9,e!:)~
Richarg. A. Wollangk, City M3nager Date
R. Uhrig, City Clerk
Con_'s Aufuoriud Representative '~ 0;10 {. Date
Sheri Johnson, Ph.D~, Administrator and State Health Officer i hereby certify that the necessary provisions
Division of Public Health, Department of Health and Family SeIf'\~ been made to pay the liability which wi\!
accrue under this contract
~Q . '- ,() 0 ~~...../
,...:.... -
-J T
CARS PAYMENT INFORMA nON
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 lD#
Profile lD#
Profile lD#
Profile lD#
Profile lD#
Oshkosh Health Department
472894
31
January 1,2006 through December 31, 2006
$81,195
January through December
155015 Preparedness Amount $19,780
155020 Immunization Amount $13,613
157720 Lead Amount $10,584
159320 Maternal Child Health Amount $29,388
159220 Prevention Amount $7,830
DPH Consolidated Contract # 13772
CFDA #s:
Preparedness
Immunization
MCH
Prevention
93.283
93.268
93.778
93.991
~pPROVED"
I . \
\ \
r-.-~.":
" r~
14
Performance LHD w/o CARS Report 12/05
,
,
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.
12/29/2005 04:\2 PM
DPH Grants and Contracts
.
.
Contract #: 13 772
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2006
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) Contractees 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) Contractees must maintain a central case registry to track follow-up of children with blood lead levels
(BLLs) >lOug/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) Contractees 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) Contractees must build partnerships with local healthcare providers and agencies involved in health, social
services, housing and child care to incorporate lead hazard awareness into encounters with families of
young children or their environments.
B) Contractees 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 agency that distributes
the funds with the goal of addressing lead hazards in the housing stock.
6) A referral network sufficient to assure the accessibility and timely provision of services to address identified public
health care needs.
12/29/2005 04: 12 PM
DPH Grants and Contracts
,
"
Contract #: 13772
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2006
A) Contractees 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) Contractees 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 ordinances.
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 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) Contractees 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) Contractees 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.
12/29/2005 04:12 PM
DPH Grants and Contracts
.
~
Contract#: 13772
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2006
Program: Immunization
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 (VPD) are investigated and controlled as
detailed in the most current edition Wisconsin Disease Surveillance Manual (EPINET), Immunization
programs should maintain regular contact with local required reporters ofVPDs to encourage and assure
prompt reporting.
B) Contractees must annually evaluate immunization delivery and vaccine preventable disease surveillance
systems and improve those systems in their jurisdictions 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 Wisconsin Immunization Program Policies and Procedures and in section 252, HFS 145,
Wis. Admin. Code. Contractees must assure the immunization of children is consistent with Healthy
People 2010 goals.
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 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. Tracking and recall shall be at least bi-monthly
as required by the Program's Policies and Procedures.
B) Contractees' immunization practice must assure the immunization of children, and share children's
immunization records with parents or guardians, schools and day care centers and other healthcare
providers as provided by the Wisconsin School Immunization Law.
4) Informatio~, 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 engage in co~unity 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 healthcare (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.
12/29/2005 04:12 PM
DPH Grants and Contracts
.
~ '
Contract#: 13772
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2006
A) Contractees must develop relationships amo~ public and private healthcare 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
prompt reporting of suspect vaccine preventable diseases. (1) The local public health department (LPHD)
should promote the medical home .concept by referring vaccine recipients to their medical home provider
for subsequent immunizations and coordinate with this medical provider to assure adherence to the
recommended immunization schedule. If no medical home exists, the LPHD must continue to provide
immunization services. (2) Promote the exchange and sharing of immunization data through the use of
immunization registries. (3) The LPHD will assure adequate surveillance, prompt reporting and
epidemiologic follow-up 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 is competent in current immunization program policy and process
information, including that provided through the Centers for Disease Control and Prevention (CDC)
distance learning course and CDC updates.
B) The LPHD will follow the Policies and Procedures Manual developed and distributed by the Wisconsin
Immunization Program unless otherwise agreed upon. The LPHD must have written policies on the proper
handling and storage of state supplied 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 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) LPHDs must assure that parents of children who are on Medical Assistance 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. Only
children who have moved out of the agencies jurisdiction (MOGE) or have failed to respond to 3
remin.?er/recall attempts or their mail has been returned undeliverable may be removed from the cohort for
analysis.
B) LPHDs will 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 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.
12/29/2005 04:12 PM
DPH Grants and Contracts
'<
Contract #: 13772
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2006
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 of the Social Security Act, in their community needs assessment process.
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 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 and youth with special health care needs contact
to receive and disseminate policy and program information provided by the State and Regional CYSHCN
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 Prac1ice:
Mental Health. All programs will be evaluated based on these best practice guidelines. If a 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 and youth 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
12/29/2005 04:12 PM
DPH Grants and Contracts
,
,
Contract #: 13772
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2006
Block Grant, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S.
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 CYSHCN 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) LPHDs that provide maternal and child health prevention and intervention services must have a referral
network. Referral networks may include: healthcare providers including mental health and oral health,
Regional CYSHCN Centers, child care centers, WIC, human or social services, schools, Birth to 3
programs, and other relevant services.
7) Provision of guidance to staff through program and policy manuals and other means sufficient to assure quality heallh
care and cost~effective program administration.
A) There are no separate sub-criterion to this Quality Criteria 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.
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 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 ($0.75 local contribution for every $1.00 federal).
12/29/2005 04:12 I'M
DPH Grants and Contracts
1
.
. .
Contract #: 13772
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2006
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 policymakers 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 of the 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-criterion to this Quality Criteria 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-criterion to this Quality Criteria Category.
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) 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.
B) 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-criterion to this Quality Criteria 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-criterion to this Quality Criteria Category.
7) Provision of guidance to staff through ptogram 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 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
12/29/2005 04:12 PM
DPH Grants and Contracts
Contract #: 13 772
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2006
Program: Public Health Preparedness - CDC
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 agency or consortium by having
their members 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-criterion to this Quality Criteria Category.
3) ~ecord 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-criterion to this Quality Criteria Category.
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 will regularly present to the media, public partners and other stakeholders information on their
agency or consortium and the Public Health Preparedness Program in coordination with DPH program
staff.
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 utilize the Public Health Information Network (pHIN) and the Health Alert Network
(HAN) as appropriate and as these systems develop.
B) Contractees will coordinate with other preparedness programs by assuring representation at the appropriate
meetings, including: (1) Hospital (HRSA) Region, (2) Regional Trauma Advisory Council (RTAC), (3)
Consortia Fiscal Agent, (4) Consortia Program Coordinator, (5) Consortia Training Coordinators, (6)
Consortia Epidemiologist, (7) HAN/PHIN Development, (8) Expert Panel Committees, (9) Local
Emergency Planning Committees (LEPCs).
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-criterion to this Quality Criteria 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-criterion to this Quality Criteria 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
12/29/2005 04:12 PM
DPH Grants and Contracts
"
Contract #: 13772
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2006
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-criterion to this Quality Criteria Category.
12/2912005 04:12 PM
DPH Grants and Contracts
Contract #: 13772
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2006
Program: Public Health Preparedness - CDC
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 agency or consortium by having
their members 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 s~tus.
A) There are no separate sub-criterion to this Quality Criteria Category.
3) ~ecord keepin? 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-criterion to this Quality Criteria Category.
4) Information, education, and outreach programs intended to address known health risks inthe 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 information on their
agency or consortium and the Public Health Preparedness Program in coordination with DPH program
staff.
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 utilize the Public Health Information Network (pHIN) and the Health Alert Network
(HAN) as appropriate and as these systems develop.
B) Contractees will coordinate with other preparedness programs by assuring representation at the appropriate
meetings, including: (1) Hospital (HRSA) Region, (2) Regional Trauma Advisory Council (RTAC), (3)
Consortia Fiscal Agent, (4) Consortia Program Coordinator, (5) Consortia Training Coordinators, (6)
Consortia Epidemiologist, (7) HAN/PHIN Development, (8) Expert Panel Committees, (9) Local
Emergency Planning Committees (LEPCs).
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-criterion to this Quality Criteria 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-criterion to this Quality Criteria 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
12/29/2005 04:12 PM
DPH Grants and Contracts
Contract #: 13772
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: .2006
provided.
A) There are no separate sub-criterion to this Quality Criteria Category.
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-criterion to this Quality Criteria Category.
12/29/2005 04:12 PM
DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II
Program Objectives
(A) Contract Funds, Program/Objective Values, and Other Contract Details
(B) Objective Details
12/2912005 04:12 PM
DPH Grants and Contracts
,
Contract #: 13772
Contract Agreement Addendum: Exhibit II(A)
Agency: Oshkosh Health Department
Contract Year: 2006
Contract Source of Funds
Source
Program
Amount
I Contract Amount I
$19,780
$10,584
$13,613
$29,388
$7,830
Oshkosh
Bioterrorism, Focus A
Oshkosh
Childhood Lead - Consolidated
Oshkosh
Immunization - Consolidated lAP
Oshkosh
Maternal Child Health - Consolidated
Oshkosh
Prevention - Consolidated
$81,195
.
Contract Match Requirements
Program
Amount
Childhood Lead
$0
$0
Immunization
Prevention
$22,041
$0
$0
MCH
Preparedness CDC
Program Sub-Contracts
Program
Sub-Contractee
Sub-Contract Amount
Prevention
None Reported
,
$0
$0
$0
$0
$0
Childhood Lead
None Reported
Immunization
N one Reported
MCH
None Reported
Preparedness CDC
None Reported
12/29/2005 04: 12 PM
DPH Grants and Contracts
,
Contract #: 13772
Contract Agreement Addendum: Exhibit I1(A)
Agency: Oshkosh Health Department
Contract Year: 2006
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.
If the 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 undertaken (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 Oir 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
Administrator may choose to reduce the Contractee's following 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.
12/29/2005 04:12 PM
DPH Grants and Contracts
\.
, .
Contract #: 13772
Contract Agreement Addendum: Exhibit II(A)
Agency: Oshkosh Health Department
Contract Year: 2006
Childhood Lead
Program Total Value $10,584
2
By December 31, 2006, 25 pre- 1 950 housing units located in the city of Oshkosh where children less than 6 years
of age without an elevated blood lead level reside will be assessed using the Wisconsin Childhood Lead Poisoning
Prevention Program Standard for Home Visitation to Address Lead Hazards.
By December 31, 2006, 100% of city of Oshkosh families who are referred for case management of elevated
blood lead levels will receive information regarding Community Development Block Grant and Housing Urban
Development grants,
Immunization
Program Total Value $13,613
2
By December 31, 2006, 90% of children served by the Oshkosh City Health Department Immunization Program
who will be 24-35 months of age as of December 31,2006 will complete their primary immunizations by 35
months of age.
During the contract period, 85% of infants born in the city of Oshkosh who turn three months of age in 2006 will
receive 1 DTaP, 1 Polio, 1 Hib and 1 HepB vaccine by four months of age.
MCH
Program Total Value $29,388
2
By December 31,2006,75 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.
By December 31, 2006, 80% of child care providers who participate in an emergency preparedness inservice
sponsored by the City of Oshkosh Health Department will demonstrate an increase in knowledge related to
emergency preparedness.
By December 31,2006,60 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.
3
Preparedness CDC
Program Total Value $19,780
2
By December 31, 2006, one measurement of preparedness standards conducted for identifying and responding to
chemical, biological, radiological and naturally occurring health threats will be completed for the Oshkosh Health
Department jurisdiction.
By December 31, 2006, assessment and improvement of capabilities for identifying and responding to chemical,
biological, radiological and naturally occurring health threats in the Oshkosh Health Department jurisdiction will
be documented through functional exercise, full-scale exercise, or real event after action reports.
Prevention
Program Total Value $7,830
During the contract period, initiatives that conform to the Healthiest Wisconsin 2010 State Health Plan and are
consistent with the Preventive Health and Health Services Block Grant guidelines will be undertaken by the
Oshkosh Health Department.
Total of Contract Objective Values
01107/2006 04:00 PM
$9,252
$1,332
$8,000
$5,613
$5,388
$4,000
$20,000
$7,780
$12,000
$7,830
$81,195
DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I1(B)
Contract #: 13772 Agency: Oshkosh Health Department
Program: Childhood Lead Poisoning Prevention Objective #: 1 of2
Contract Year: 2006
Objective Value: $9,252
Objective: Primary Details
Objective Statement
By December 31, 2006, 25 pre-1950 housing units located in the city of Oshkosh where children less than 6 years of age without an
elevated blood lead level reside will be assessed using the Wisconsin Childhood Lead Poisoning Prevention Program Standard for
Home Visitation to Address Lead Hazards.
Deliverable Due Date: 01/31/2007
Contract Deliverable (Evidence)
A report to document the housing units in city of Oshkosh that were assessed, to include: 1) address, 2) year the structure was built,
3) activities conducted (i,e., visual assessment, dust wipe samples, lead check swab), 4) sample results, and 5) the information that
was provided to the property owner regarding the presence of lead in the property.
Programs Providing Funds for this Objective
Childhood Lead Poisoning Prevention: $9,252
Agency.Funds for this Objective:
Data Source for Measurement
SPHERE Individual/Household Report to include data from the following screens: (1) Client Information, (2) Contact Information,
including address, pre-1950 housing, and property owner information documented in address comments (if rental property), (3)
Lead Testing, and (4) Lead Health Hazard; or an agency-generated report.
Baseline for Measurement
2005 grant had 7 visits conducted as per the grant objective 2.
Context
Some aspects ofthe Wisconsin Childhood Lead Poisoning Prevention Program Standard for Home Visitation to Address Lead
Hazards can be modified to meet local conditions. However, these essential components must be included: 1) a visit to the home to
provide tead poisoning prevention education and identify potential lead hazards, 2) sampling via dust wipe samples or lead check
swabs that is conducted to document the presence oflead, and 3) the property owner is notified ofthe results of the assessment;
including sample results, and non-abatement measures that can be taken to correct lead hazards.
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.
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
~
I
12/29/2005 04:12 PM
DPH Grants and Contracts
...
Contract Agreement Addendum: Exhibit II(B)
Contract #: 13772 Agency: Oshkosh Health Department
Program: Childhood Lead Poisoning Prevention Objective #: 2 of 2
Contract Year: 2006
Objective Value: $1,332
Objective: Primary Details
Objective Statement
By December 31, 2006, 100% of city of Oshkosh families who are referred for case management of elevated blood lead levels will
receive information regarding Community Development Block Grant and Housing Urban Development grants,
Deliverable Due Date: 0113112007
Contract Deliverable (Evidence)
A report which includes: 1) the number of families referred for case management, 2) who received information regarding the
Community Development Block Grant and Housing Urban Development programs, and 3) who received financial assistance.
Programs Providing Funds for this Objective
Childhood Lead Poisoning Prevention: $1,332
Agency Funds for this Objective:
Data Source for Measurement
A SPHERE report documenting the number of clients who received financial assistance and a written report documenting who
received information regarding financial assistance.
Baseline for Measurement .
In 2005, 7 families were assessed and 6 families were referred and received Community Development Block Grant and Housing
Urban Development funds,
Context
Currently, the Oshkosh Health Division provides case management to all families with children that have a venous blood lead level
of 10 mcu/L. All of these families will be given the information and contact persons for application to these grants.
Input Activities
The Oshkosh Health Division has a written agreement with the City Planning Department which is the Community Development
Block Grant distribution agency. We also have a working relationship with ADVOCAP in Oshkosh which handles the distribution
of Housing Urban Development grants related to lead.
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
~
:=J
12/29/2005 04:12 PM
DPH Grants and Contracts
,
.
Contract Agreement Addendum: Exhibit II(B)
Contract #: 13772
Program: Immunization
Agency: Oshkosh Health Department
Objective #: 1 of 2
Contract Year: 2006
Objective Value: $8,000
Objective: Primary Details
Objective Statement
By December 31,2006,90% of children served by the Oshkosh City Health Department Immunization Program who will be 24-35
months of age as of December 31, 2006 will complete their primary immunizations by 35 months of age.
Deliverable Due Date: 01/31/2007
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 31,2006, and the number of those children who completed their primary
immunizations by 35 months of age,
Programs Providing Funds for this Objective
Immunization: $8,000
Agency Funds for this Objective:
Data Source for Measurement
Agency records and CASA Summary Report of up-to-date, and late-up-to-date immunizations by 35 months of age.
Baseline for Measurement
CASA results indicated 90% of children followed by Oshkosh City Health Department 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 estimate is there are 300 children in this cohort of patients.
Input Activities
Oshkosh City Health Department will be targeting children who are due for their primary immunizations by mailing consent forms
to parents along with our monthly immunization clinic schedules. Oshkosh Health Service Division clinic schedules are also
distributed to all area medical providers and to the Oshkosh Area School System. Immunization dates are inputted in to the
Wisconsin Immunization Registry (WIR). Attend WIR user group meetings to keep informed of updates and changes within the
system. Individual appointments for children's immunizations are also set up as needed. Education, evaluating children's
immunization records, and vaccine administration are implemented at our clinics.
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
~
J
12/29/2005 04:12 PM
DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 13772
Program: Immunization
Agency: Oshkosh Health Department
Objective #: 20f2
Contract Year: 2006
Objective Value: $5,613
Objective: Primary Details
.'
Objective Statement
During the contract period, 85% of infants born in the city of Oshkosh who turn three months of age in 2006 will receive 1 DTaP, 1
Polio, I Hib and 1 HepB vaccine by four months of age.
Deliverable Due Date: 01/31/2007
Contract Deliverable (Evidence)
A report to summarize a statistically valid survey that provides: 1) the total number of children born in the city of Oshkosh who
turned three months of age in 2006, 2) CASA or Wisconsin Immunization Registry generated documentation of the number of those
children who received 1 DTaP, 1 Polio, 1 Hib and 1 HepB vaccine by four months of age, and 3) the number of those children noted
as moved or going elsewhere and those marked as non-responders.
Programs Providing Funds for this Objective
Immunization: $5,613
Agency Funds for this Objective:
Data Source for Measurement
Wisconsin Immunization Registry records.
Baseline for Measurement
New objective, Receiving and recording immunization dates on all children who attend our immunization clinic.
Context
The cohort of children to be analyzed for this objective will be those children born during the period October 1, 2005 through
September 30,2006. Children will be assessed for having at least 1 DTaP, 1 Polio, I Hib and 1 HepB vaccine by four months of
age. Only children who have moved out of the agency's jurisdiction (MOGE) or have failed to respond to three reminder/recall
attempts or their mail has been returned undeliverable may be removed from the cohort for analysis. The goal of this objective is to
help identify patient and system level barriers that place children at risk of not completing their primary series of immunization on
schedule. Access to primary and preventive health services is one of the priorities identified in Wisconsin's State Health Plan,
Healthiest People 2010: A Partnership Plan to Improve the Health of the Public. Children who begin their community-based
immunizations by three months of age are more likely to complete the primary series of 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 HepB
and 1 Varicella by 24 months of age. This objective also addresses the Healthy People 2010: 14-26 goal to "Increase the proportion
of children who participate in fully operational population-based immunization registries" by identifying local gaps in Wisconsin
Immunization Registry.
Input Activities
Checking birth records of children born during October 2005 through September 2006. Keeping in contact with providers and
medical records departments of clinics by checking immunization records. Sending out the Oshkosh Health Division Immunization
Schedule to physicians and families with children who are due for their primary immunizations, Individual appointments are made
for children as needed. Clinic immunization schedules are also sent out in postpartum packets,
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
~
~
12/29/2005 04:12 PM
DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I1(B)
Contract #: 13772 Agency: Oshkosh Health Department
Program: Maternal and Child Health Block Grant Objective #: 2 of 3
Contract Yeal': 2006
Objective Value: $4,000
Objective: Primary Details
Objective Statement
By December 31, 2006, 80% of child care providers who participate in an emergency preparedness inservice sponsored by the City
of Oshkosh Health Department will demonstrate an increase in knowledge related to emergency preparedness.
Deliverable Due Date: 01/31/2007
Contract Deliverable (Evidence)
A report to document the number of child care providers who participated in an Emergency Preparedness inservice sponsored by
the city Of Oshkosh Health Department and demonstrated an increase in knowledge related to emergency preparedness; and a copy
of the tool used to measure the change in knowledge.
Programs Providing Funds for this Objective
Maternal and Child Health Block Grant: $4,000
Agency Funds for this Objective:
Data Source for Measurement
SPHERE Community Report to include the data from the following screens: Community Activity (all appropriate fields) and Health
Teaching Topics and Results.
Baseline for Measurement
The 2005 contract provided an inservice regarding communicable disease for child care providers. At the time of this grant writing,
the inservice has not happened but is scheduled and has approximately 85 child care providers signed up to attend. At the present
time there are approximately 85 child care providers in the city of Oshkosh. Some of these are single providers and some are large
group providers, Because of this, it is difficult to determine an exact number to use as a baseline.
Context
This objective is intended for group activities. Using the 2005 needs assessment survey of child care providers, there were 21 of the
respondents who identified emergency preparedness as a potential need. In the climate today of homeland security, it is important
to assure that our child care providers are ready.
Input Activities
We have obtained an Emergency Preparedness Plan for Childcare Centers plan template from the University of Wisconsin-Madison
police. Using this plan template, we will provide an inservice to assist centers in determining their needs for developing a plan and
how to go about it.
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
=:==J
=:==J
12/29/2005 04:12 PM
DPH Grants and Contracts
,...
,
'"
Contract Agreement Addendum: Exhibit II(B)
Contract #: 13772
Program: Public Health Preparedness - CDC
Agency: Oshkosh Health Department
Objective #: 2 of 2
Contract Year: 2006
Objective Value: $12,000
Objective: Primary Details
Objective Statement
By December 31, 2006, assessment and improvement of capabilities for identifying and responding to chemical, biological,
radiological and naturally occurring health threats in the Oshkosh Health Department jurisdiction will be documented through
functional exercise, full-scale exercise, or real event after action reports,
Deliverable Due Date: 01/31/2007
Contract Deliverable (Evidence)
A completed after action report submitted by December 31, 2006 for functional exercises, full-scale exercises or real events
occurring in 2006. The electronic after action report format from Wisconsin Emergency Management and the federal Office of
Domestic Preparedness Homeland Security Exercise and Evaluation Program will be used to ensure statewide uniformity and
National Incident Management System and National Response Plan compliance. At a minimum, at least one after action report
should be submitted, but submitting any and all completed exercise or real event after action reports is requested. Reports should be
submitted to the agency's consortium coordinator or posted directly to the agency's consortium topic area on the Health Alert
Network.
Programs Providing Funds for this Objective
Public Health Preparedness - CDC: $12,000
Agency Funds for this Objective:
.
Data Source for Measurement
Wisconsin Emergency Management and Homeland Security Exercise and Evaluation Program After Action Report form and
agency records.
Baseline for Measurement '
The Oshkosh Health Department has participated in tabletop exercises in 2003, 2004 and 2005 regarding preparedness activities.
Context
Functional exercises or full-scale exercises should be conducted in collaboration with partner agencies and may be single or multi_
city, county, and tribe exercises. Exercises may be a test of the agency's Public Health Emergens;y Plan/Checklist, Mass Clinic
Plan/Checklist, and/or Pandemic Influenza Plan/Checklist. Per the Homeland Security Exercise and Evaluation Program, a
functional exercise is defined as "single or multi-agency activities designed to analyze and evaluate agency capabilities, multiple
functions and/or sub-functions, or interdependent groups of functions. Functional exercises focus on exercising plans, policies,
procedures, and staffs involved in management, direction, command, and control functions, Events are projected through a scripted
exercise scenario with built-in flexibility that allows updates to drive activity at the management level. Functional exercises are
conducted in a realistic, real-time environment; however, movement of personnel and equipment is simulated," Per the Homeland
Security Exercise and Evaluation Program, a full-scale exercise is defined as "multi-agency, multi-jurisdictional exercises to test
many facets of emergency response and recovery. They include many first responders operating under an Incident Command
System (ICS) or Unified Command System (UCS) to effectively and efficiently respond to, and initiate recovery from, an incident.
A full-scale exercise focuses on implementing and analyzing the plans, policies, and procedures developed in discussion-based
exercises and honed in previous, smaller, operations-based exercises. Events are projected through a scripted exercise scenario that
has built-in flexibility to allow updates to drive activity. The full-scale exercise is conducted in a real-time, stressful environment
that closely mirrors a real event. First responders and resources are mobilized and deployed to the scene where they conduct their
actions as if a real incident had occurred. The full-scale exercise simulates reality by presenting complex and realistic problems
involving operations in multiple functional areas that require critical thinking, rapid problem-solving, and effective responses by
trained personnel in a highly stressful environment."
Input Activities
The Oshkosh Health Department will be participating in a full scale exercise to test the postal services BDS machine, at which time
we will set up and test our dispensing clinic. Also we will be designing an influenza pandemic tabletop exercise specific to our
community.
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract objective.
12/29/2005 04:12 PM
DPH Grants and Contracts
"'.
.
\,
Contract Agreement Addendum: Exhibit II(B)
Contract #: 13772 Agency: Oshkosh Health Department
Program: Maternal and Child Health Block Grant Objective #: 3 of 3
Contract Year: 2006
Objective Value: $20,000
Objective: Primary Details
Objective Statement
By December 31,2006,60 residences located within the city of Oshkosh with children ages birth to 3 years will have a documented
decrease in hazards previouslyjdentified through home safety assessments.
Deliverable Due Date: 01/31/2007
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: $20,000
Agency Funds for this Objective:
Data Source for Measurement
SPHERE IndividuallHousehold Report to include MCH Required Demographic Data and data from the following screens: Home
Safety Assessment, Health Teaching Topics and Results, and Referral and Follow-Up/Results if appropriate.
Baseline for Measurement
As of September 29, 2005, 32 families have been served by the Home Safety/Child Proofing Visits Program.
Context
A Registered Nurse will provide this service, with visits and re-visits to,each residence to promote safety by doing a Home Safety
Assessment. The Wisconsin Division of Public Health Checklist for Home Safety Assessment of Young Children is the tool used
for the home safety assessment. A copy ofthe checklist is left with the parents to assist them -..vith making safety changes as
needed. Hazards found are verbally discussed and documented on assessment form. Some safety devices are also installed during
the visit. A resource and referral guide is given out at visits, along with many safety educational brochures and booklets.
Input Activities
Calls are received from many interested parents requesting a child proofing, home safety visit. Many activities are involved with
this program. The first step is setting up an appointment with the parents. Reminder calls or letters are sent out as needed. Child
proofing products are taken along to the visit and given out as needed. Touring the home and surroundings and checking for any
safety hazards are done during the initial vi~it. Some products are installed by the nurse and clients at the first visit. Educational
brochures and safety pamphlets are given out and discussed with parents. Some ofthe educational material given out include:
Poison Center brochure with number and stickers, WPS emergency numbers, Safety At Your Service booklet; Choking Prevention
and First Aid for Infants and Children. Clients are also educated on the hazards of lead in homes and are encouraged to have their
children tested. The booklet "Protect Your Family From Lead In Your Home" is also given to parents. Lead swab test sticks are
taken in to each home and the parents are instructed on use and testing of any area that has chipping or peeling paint. A
demonstration is given by the nurse and the parents then does the testing. Outlet plug-ins are given out and put in outlets by the
parents and nurse. These are a few of the activities that are performed during the home safety, child proofing visit. The Safety 1st
products are purchased through the company, Safety lst/Dorel Group/Atomic Box Logistics. Other necessary products, such as
baby gates, are purchased at Wal-Mart, Target, K-Mart as needed. Another company that products are purchased through is, One
Step Ahead. Referrals are made to community partners as needed. Many referrals are received from Parent Connection.
Community partners include the Oshkosh Fire Department, Oshkosh Police Department, Parent Connection and Safe Kids, the WIC
office, Human Services, and Winnebago Public Health Department. Community awareness is also implemented by speaking at the
Affinity Mom's Club/Group, and day care centers. Throughout the year, or nurse attends safety events and conferences. Safety
education is provided to children at a Safe Kids event that is held each year in Oshkosh. The nurse educates children on poison
safety and hands out many tools for helping with promoting safety to young children.
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
12/29/2005 04:12 PM
DPH Grants and Contracts
'"
.
'-
Contract Agreement Addendum: Exhibit II(B)
Contract #: 13772
Program: Public Health Preparedness - CDC
Agency: Oshkosh Health Department
Objective #: 1 of2
Contract Year: 2006
Objective Value: $7,780
Objective: Primary Details
Objective Statement
By December 31, 2006, one measurement of preparedness standards conducted for identifying and responding to chemical,
biological, radiological and naturally occurring health threats will be completed for the Oshkosh Health Department jurisdiction.
Deliverable Due Date: 01/31/2007
Contract Deliverable (Evidence)
Completed assessment tool as prescribed by the Centers for Disease Control and Prevention and the Wisconsin Division of Public
Health to establish baseline preparedness standards by December 31, 2006. The assessment tool may be completed via a Health
Alert Network survey.
Programs Providing Funds for this Objective
Public Health Preparedness - CDC: $7,780
Agency Funds for this Objective:
. Data Source for Measurement
Centers for Disease Control and Prevention and Wisconsin Division of Public Health assessment tool and agency records.
Baseline for Measurement
New initiative.
Context
The Centers for Disease Control and Prevention has newly established six preparedness goals of Prevent, DetectJReport,
Investigate, Control, Recover, and Improve. Each goal is accompanied by outcomes and critical tasks. State and city, county, and
tribe progress on accomplishing these tasks are to be monitored using the assessment tool. The Wisconsin Division of Public
Health will add clarifications and comments to Wisconsin-specific tasks measured in the assessment tool. All clarifications and
comments added will be labeled as such to clearly identify the additions from the original Centers for Disease Control and
Prevention text.
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
I None
01/0712006 04:00 PM
DPH Grants and Contracts
..
\.
Contract Agreement Addendum; Exhibit II(B)
Contract #: 13772
Program: Public Health Preparedness - CDC
Agency: Oshkosh Health Department
Objective #: 2 of 2
Contract Year: 2006
Objective Value: $12,000
Objective: Primary Details
Objective Statement
By December 31, 2006, assessment and improvement of capabilities for identifying and responding to chemical, biological,
radiological and naturally occurring health threats in the Oshkosh Health Department jurisdiction will be documented through
functional exercise, full-scale exercise, or real event after action reports.
Deliverable Due Date: 01131/2007
Contract Deliverable (Evidence)
A completed after action report submitted by December 31, 2006 for functional exercises, full-scale exercises or real events
occurring in 2006. The electronic after action report format from Wisconsin Emergency Management and the federal Office of
Domestic Preparedness Homeland Security Exercise and Evaluation Program will be used to ensure statewide uniformity and
National Incident Management System and National Response Plan compliance. At a minimum, at least one after action report
should be submitted, but submitting any and all completed exercise or real event after action reports is requested. Reports should be
submitted to the agency's consortium coordinator or posted directly to the agency's consortium topic area on the Health Alert
Network.
Programs Providing Funds for this Objective
Public Health Preparedness - CDC: $12,000
Agency Funds for this Objective:
.
Data Source for Measurement
Wisconsin Emergency Management and Homeland Security Exercise and Evaluation Program After Action Report form and
agency records.
Baseline for Measurement .
The Oshkosh Health Department has participated in tabletop exercises in 2003, 2004 and 2005 regarding preparedness activities.
Context
Functional exercises or full-scale exercises should be conducted in collaboration with partner agencies and may be single or multi-
city, county, and tribe exercises. Exercises may be a test ofthe agency's Public Health Emergens;y Plan/Checklist, Mass Clinic
Plan/Checklist, and/or Pandemic Influenza Plan/Checklist. Per the Homeland Security Exercise and Evaluation Program, a
functional exercise is defined as "single or multi-agency activities designed to analyze and evaluate agency capabilities, multiple
functions and/or sub-functions, or interdependent groups offunctions. Functional exercises focus on exercising plans, policies,
procedures, and staffs involved in management, direction, command, and control functions. Events are projected through a scripted
exercise scenario with built-in flexibility that allows updates to drive activity at the management level. Functional exercises are
conducted in a realistic, real-time environment; however, movement of personnel and equipment is simulated." Per the Homeland
Security Exercise and Evaluation Program, a full-scale exercise is defined as "multi-agency, multi-jurisdictional exercises to test
many facets of emergency response and recovery. They include many first responders operating under an Incident Command
System (ICS) or Unified Command System (UCS) to effectively and efficiently respond to, and initiate recovery from, an incident.
A full-scale exercise focuses on implementing and analyzing the plans, policies, and procedures developed in discussion-based
exercises and honed in previous, smaller, operations-based exercises. Events are projected through a scripted exercise scenario that
has built-in flexibility to allow updates to drive activity. The full-scale exercise is conducted in a real-time, stressful environment
that closely mirrors a real event. Firstresponders and resources are mobilized and deployed to the scene where they conduct their
actions as if a real incident had occurred. The full-scale exercise simulates reality by presenting complex and realistic problems
involving operations in multiple functional areas that require critical thinking, rapid problem-solving, and effective responses by
trained personnel in a highly stressful environment."
Input Activities
The Oshkosh Health Department will be participating in a full scale exercise to test the postal services BDS machine, at which time
we will set up and test our dispensing clinic. Also we will be designing an influenza pandemic tabletop exercise specific to our
community.
Objective: Ris~ Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract objective.
12/29/2005 04:12 PM
DPH Grants and Contracts
'"
" .
, '
Contract Agreement Addendum: Exhibit II(B)
Contract #: 13772
Program: Public Health Preparedness - CDC
Agency: Oshkosh Health Department
Objective#: 20f2
Conditions of Eligibility for an Incentive
INone
12/29/2005 04:12 PM
Contract Year: 2006
Objective Value: $12,000
~
DPH Grants and Contracts
.. "'l
~
~
/'
./
Contract Agreement Addendum: Exhibit II(B)
Contract #: 13772 Agency:
Program: Preventive Health and Health Services
Block Grant
Oshkosh Health Department
Objective #: I of 1
Contract Year: 2006
Objective Value: $7,830
Objective Statement
During the contract period, initiatives that conform to the Healthiest Wisconsin 2010 State Health Plan and are consistent with the
Preventive Health and Health Services Block Grant guidelines will be undertaken by the Oshkosh Health Department.
Deliverable Due Date: 01/31/2007
Contract Deliverable (Evidence)
A report to document Prevention-related initiatives undertaken by the Oshkosh Health Department and the results achieved.
Programs Providing Funds for this Objective
Preventive Health and Health Services Block Grant: $7,830
Agency Funds for this Objective:
Data Source for Measurement
Agency report.
Baseline for Measurement
In 2002, 408 thermometers were collected through the mercury collection program. The trail map will be a new initiative.
Context
Oshkosh Health Division plans to use Prevention funds for 2006 to provide 2 community-based programs. The first program will be
a return of the mercury recovery program that was instituted 2 years ago. However, instead of limiting the collection to small
thermometers, we will open it up to other forms of mercury such as home thermometers. The second program will be to identifY,
map, and develop educational pamphlets related to walking trails within the city limits.
Input Activities.
The mercury program will be accomplished by using the media to notify the community of the time period when mercury will be
collected. The trail program will be developed by identifying a variety of regions in the city where walking trails can be
determined. Mileage and routes will be determined and a pamphlet developed that will be provided to health related communi~y
g..oups such as the Oshkosh Recreation Department, The Oshkosh Senior Center, and the YMCA.
Objective: Risk Profile
Objective: Primary Details
Accountability Targets
Accountability targets are not applicable or were not determined for this contract objective.
Conditions of Eligibility for an Incentive
I None
~
12/29/2005 04:12 PM
DPH Grants and Contracts