HomeMy WebLinkAboutDivision of Public Health #14656
Jim Doyle
Governor
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Kevin R. Hayden
Secretary
State of Wisconsin
DIVISION OF PUBLIC HEALTH
1 WEST WILSON STREET
POBOX 2659
MADISON WI 53,701-2659
608.266-1251
FAX: 608.267-2832
TTY: 888-701-1253
dhfs.wisccmsin.gov
Department of Health and Family Services
January 23,2007
TO:
Paul Spiegel, Oshkosh Health Department
FROM:
Janice Lipsey, Office of Operati
RE:
Consolidated Contract Agreem
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Enclosed is your agency's fully executed 2007 Division of Public Health Contract Agreement for
Consolidated Contract #14656.
Exhibits I and II for this contract are included.
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The Contractor will not make payments in excess of the Conttact Agreement amounts, with the exception of
performance-based incentive funds pursuant to Section XXI.
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 he
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.,.,r, 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 ofa key employee as the equal opportunity
officer, (4) a workforce analysis that identifies job classifications where there is an under
representation of women, minorities, and persons with disabilities, (5) goals must be
directed to achieving a balanced workforce, specific and measurable, having an
implementation target date between six months and two years, and having a plan of action
or description of procedures to implement the goals, (6) revision of employment practices
to ensure that they do not have discriminatory effects, and (7) establishment of internal
monitoring and reporting systems to regularly measure progress.
B. An 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 of twenty-five (25)
or more employees as of the award date, unless the Contractee is exempt by criteria listed
in the Wisconsin Office of Contract Compliance, Department of Administration's
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Instruction for Vendors Affirmative Action Requirements (DOA-3021P (R06/96) s. 16765,
Wis. Stats.), page 2. Universities, other states, and local governments, except those ofthe
State of Wisconsin who receive state or federal contracts over $25,000, must submit
Affirmative 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 Affirmative Action/Civil Rights
Compliance Office, Department of Health and Family Services, One West Wilson Street,
Room 561, PO Box 7850, Madison WI 53707-7850, for technical assistance on Equal
Opportunity .
Civil Rights Compliance
A. For agreements for the provision of services to clients, the Contractee must comply with
Civil Rights requirements. Contractees with an annual workforce oflessthan twenty-five
(25) employees, regardless of contract amount, and Contractees with contracts of less than
$25,000 are not required to submit a Civil Rights Compliance Action Plan, however, they
must submit a Civil Rights Compliance Letter of Assurance. Contractees with an annual
workforce of twenty-five (25) employees or more and contract agreements of $25,000 or
more shall submit a written Civil Rights Compliance Plan which covers a three-year period
within fifteen (15) working days of the award date of the agreement or contract.
B. The Contractee assures that it has submitted to the Contractor's Affirmative Action /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.
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(~
basis of race, color, national origin, sexual orientation, religion, sex, disability or
age. This policy covers eligibility for and access to service delivery, and
treatment in all programs and activities. All employees of the Contractee are
expected to support goals and programmatic activities relating to
nondiscrimination in service delivery.
2) No otherwise qualified person shall be excluded from employment, be denied the
benefits of employment or otherwise be subjected to discrimination in
employment in any manner or team of employment on the basis of age, race,
religion, sexual orientation, color, sex, national origin or ancestry, disability (as
defined in Section 504 and the American with Disability Act of 1990); or
association with a person with a disability, arrest or conviction record, marital
status, political affiliation, or military participation, unfair honesty testing and
genetic testing, and use or non-use of lawful products outside of working hours..
All employees of the Contractee are expected to support goals and rogrammatic
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
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complaint process 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 intetpretation
of services if needed. The Contractee shall not request intetpretation services
from family members, friends and minors.
4) The Contractee agrees to comply with the Contractor's guidelines in the State of
Wisconsin Department of Workforce Developmentand Department of Health and
FamilyServices, 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 staffwith 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 nOIl-Englishspeaking 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.
VII. SUBCONTRACTS
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1. The Contractee may subcontract all or part of this Contract Agreement as agreed to during contract
n.egotiation. The Contractor reserves the right of approval for any subcontracts and the Contractee
shall report information relating to subcontracts to the Contractor. A change in a subcontractor or a
change from direct service provision to a subcontract may only be executed with the prior written
approval of the Contractor. In addition, Contractor approval may be required regarding the terms
and conditions of the subcontracts, and the subcontractors selected. Approval of the subcontractors
will be withheld if the Contractorreasonably believes that the intended subcontractor will not be a
respOIlsible provider in terms of services provided, objectives to be attained, or required quality
criteria.
2. The Contractee retaip.s 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 arid 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
I. 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 Cmporation
(hereinafter FDIC) insurance coverage. Any balance exceeding FDIC coverage must be collaterally
secured.
2. The Contractee shall conduct all procurement transactions in a manner that provides maximum open
and free competition.
3. The Contractee shall not engage the services of any person or persons concurrently employed by the
State of Wisconsin, including any Department, commission or board thereof, to provide services
relating to this Contract Agreement without the written consent of the employer of such person or
persons and ofthe Contractor.
4. This Contract Agreement is voidable if the Contractee is a state public official, a member of a state
public official's immediate family, or an organization in which the official or immediate family
member owns or controls at least 10% of the outstandlng 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 cmporation other than a Wisconsin cmporation, it must
demonstrate prior to providing services under this Contract Agreement that it possesses a certificate
of authority from the Wisconsin Secretary of State, and must have, and continuously maintain, a
registered agent, and otherwise conform to all requirements of Chapters 180 and 181, Wisconsin
Statutes, relating to foreign corporations.
6. The Contractee agrees that funds provided under ,this Contract Agreement shall be used to
supplement or expand the Contractee's current public health service efforts, not to replace or allow
for the release of available local (Contractee) funds for alternative uses. If the Contractor
determines that local funds supporting public health services or funds under this Agreement have
been released for alternative uses (supplanting), the Contractee may be subject to a proportionate
reduction in funding under this Agreement in the current or subsequent contract year.
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
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a substantial business reas~n f~~h~ging its accounti~g peri~-- .
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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 defined in the Department's
Accounting Principles and Allowable Cost Policy Manual.
3. The Contractee's accounting system shall allow for accounting of total funds 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. Ifprogram specific cost information is requested under 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;'
willlimii the breakdownofthe 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 IIla~c4 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 meetthe Department's allowable cost
defmitions as defined 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 ofthis.contract. During the contract period, the
accounting period may only be changed with prior written approval from the Contractor. The
Contractor may approve a change in accounting period only if the Contractee has a substantial,
verifiable business reason for changing the accounting period and agrees to submit a closeout audit,
as defined in section (XII, 8), within 90 days after the first day of the new 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.
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B. T~e 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:
Office of Audit
Division of Management and Technology
Wisconsin Department of Health and Family Services
1 West Wilson Street
P.O. 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 financial
statements as necessary to review Contractee's compliance with the Federal and State requirements
for the use of the funding.
7. Failure to Comply with the Requirements of this Section: In the event that the Contractee fails to
have an appropriate audit performed or fails to provide a complete audit report to the Contractor
within the specified timeframes, in addition to applying one or. more of the sanctions available in
Section XVI of this contract, the Contractor may:
A. Conduct an audit or arrange for an independent audit of the Contractee and charge the cost
of completing the audit to the Contractee;
B. Charge the Contractee for all loss of Federal or State aid or for penalties assessed to the
Contractor because the Contractee did not submit a complete audit report within the
required timeframe; and/or
C. Disallow the cost of audits that do not meet these standards.
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.
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If any dispute arises between the Contractor and Contractee under this Contract Agreement, including the
Contractor's finding of non-compliance and imposition of sanctions or remedial measures, the following
process will be the exclusive administrative review.
I. The Contractor's and Contractee's Contract Administrators will attempt to resolve the dispute, in
coordination with the Division of Public Health Regional Office Director and appropriate program
staff within the Division.
2. If the dispute cannot be resolved by the Contract Administrators, the Contractee may ask for review
by the Administrator of the Division of Public Health.
,
3. If the dispute is still not resolved, the Contractee may request a final review by the Secretary of the
Department of Health and Family Services.
XVIII. INDEMNITY
The Contractor and Contractee agree they shall be responsible for any losses or expenses (including costs,
damages, and attorney's fees) attributable to the acts or omissions of their officers, employees or agents.
XIX. SURETY BOND
The Contractor may require the Contractee to have a surety bond. The surety bond shall be in force for the
period of the Contract Agreement and shall be a reasonable amount to be determined by the Contractor.
XX. CONDITIONS OF THE PARTIES' OBLIGATIONS
1. This Contract Agreement is contingent upon authorization of Wisconsin and United States law, and
any material amendment or repeal of the same affecting relevant funding or authority of the
Contractor shall serve to revise or terminate this Agreement, except as further agreed to by the
parties hereto.
2. The Contractor and Contractee understand and agree that no clause, term or condition of this
Contract Agreement shall be construed to supersede the lawful powers or duties of either party.
3. It is understood and agreed that the entire Contract Agreement between the parties is contained
herein, except for those matters incorporated herein by reference, and that this Agreement
supersedes all oral agreements and negotiations between the parties relating to the subject matter
thereof.
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.
2. The Contractor may make these incentive awards at its discretion based on the amount of available
incentive funding and the terms of agreement with the Federal agency(s) as to the distribution of
such incentive funding. The awards will be made during the subsequent contract year via an
adjustment (increase) in the monthly CARS payment. In such case where a Contracteeis eligible
for an incentive payment and no longer holds a contract agreement with the Contractor, the
Contractor will make a separate payment to the Contractee. The incentive funds must be expended
by the Contractee within the subsequent contract or calendar year and can not be diverted outside of
the set of programs defined by this Contract Agreement or used for supplanting purposes. 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:
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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 oftre two signature dates.
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Date
1/~Y/()7
Date ( <
Contractor's Authorized e tat" e
Sheri Johnson, Ph.D., Admi istr tor and State Health Officer
Division of Public Health, rtment of Health and Family Services
CARS PAYMENT INFORMATION
The information below is used by the Department's Bureau of Fiscal Services, CARS Unit to facilitate the processing and
recording of payments made under this Contract Agreement.
Agency Name
Agency Number
Agency Type
Contract Period
Contract Amount
Agency Fiscal Year
Profile ID#
Profile ID#
Profile ID#
Profile ID#
Profile ID#
DPH Contract # 14656
CFDA #s:
Bioterrorism
Immunization
Prevention
MCH
Oshkosh Health Department
472894
41
January 01, 2007 through December 31,2007
$84,794.00
January I to December 31
155015 Bioterrorism, Focus A
155020 Immunization - Consolidated lAP
157720 Childhood Lead - Consolidated
159220 Prevention - Consolidated
159320 Maternal Child Health - Consolidated
$19,780.00
$15,059.00
$10,883.00
$8,502.00
$30,570.00
Amount
Amount
Amount
Amount
Amount
93.283
93.268
93.994
93.994
APPROVED
~
CITY ATTORNE
OSHKOSH. WISCONSIN
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
pmposes 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
~a .
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-133 "Audits of States, Local Governments and Nonprofit
Organizations," which applies only to Contractees that expend $500,000 from all federal
funding sources (this grant and other grants, direct or indirect, from this Contractor or another)
during a Contractee's fiscal year.
. The State Single Audit Guidelines (SSAG), which are applicable to local governments having
A-133 audits; and/or
. The Provider Agency Audit Guide (PAAG). All Contractees that do not meet the requirements
of the SSAG shall have audits in conformance with the P AAG.
3. Reporting Package: The Contractee shall submit to the Contractor a reporting package which
includes the following:
A. Financial statements and other audit schedules and reports required for the type of audit
applicable to the Contractee.
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B. The Contractee shall ensure that its auditor contacts the Contractor prior to beginning the
audit. The Contractor, or its representative, shall have the opportunity to review the
planned audit program, request additional compliance or internal control testing and attend
any conference between the Contractee and the auditor. Payment of increased audit costs,
as a result of the additional testing requested by the Contractor, is the responsibility of the
Contractee.
C. The Contractor may require a closeout audit that meets the audit requirements specified in
XII, 2. above. In addition, the Contractor may require that the auditor annualize revenues
and expenditures for the purposes of applying OMB Circular A-133 and determining major
Federal financial assistance programs. This information shall be disclosed in a note to the
schedule of Federal awards.
D. All other provisions in the Audit Requirements section apply to Closeout Audits unless in
conflict with the specific Closeout Audits requirements.
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 estimated, the unit of
government to which the monies are owed, the expected payment date and other related
information.
2. The COIitractee shall notify the Contractor, in writing, within thirty (30) days of the date payment
was due, of any past due payment in excess of five hundred dollars ($500), or when total past due
liabilities to anyone or more vendors exceed one thousand dollars ($1000), related to the operation
of this Contract Agreement for which the Contractor has reimbursed or will reimburse the
Contractee. The written notice shall include the amount(s) owed, the reason the monies are owed,
the due date, the amount of any penalties or interest, known or estimated, the vendor to which the
monies are owed, the expected payment date and other related information. If the liability is in
dispute, the written notice shall contain a discussion of facts related to the dispute and the
information on steps being taken by the Contractee to resolve the dispute.
3. The Contractor may require written assurance at the time of entering into this Contract Agreement
that the Contractee has in force and will maintain for the course of this Agreement employee
dishonesty bonding in a reasonable arnount 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 fmancial 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.
XIV. RECORDS
I. 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 ofrecords and programs, insofar as is permitted by State and[
Federal law, by representatives of the Contractor and its authorized agents, and Federal agencies, iin
order to confirm the Contractee's compliance with the specifications of this Contract Agreement.
Performance LOO w/o CARS Report 12/05 9
)"
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 I above. Upon the Contractor's
request, at the expiration of the Contract Agreement, the Contractee will transfer at no cost to the
Contractor, records regarding the individual recipients who received services from the Contractee
under this Agreement. The transfer of records includes transfer of any record, regardless of media,
if that is the only method under which records were maintained. -
4. The Contractee and its subcontractors shall comply with all State and Federal confidentiality laws
concerning the information in both the records it maintains and in any of the Contractor's records
that 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 reductionin 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 3D-day written notice by either
party.
3. Revision of this Contract Agreement may be made by mutual agreement. The revision will be
effective only when the Contractor and Contractee attach an addendum or amendment to this
Agreement, which is signed by the authorized representatives of both parties, except in
circumstances in which increased caseload or grant award amount, where such increase infunds is
for the same pmpose 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. Ifthe 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 Contracltor
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.
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
Performance LHD w/o CARS Report 12/05
10
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, if it reasonably believes that the non-compliance will continue or will reoccur.
4. TheContractee 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 identifiedin
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 iit
deems necessary to protect the interests of the State. Such sanctions and measures may include
termination of the Agreement, suspension of the Agreement as defined in paragraph 2 above, imposing
additional reporting requirements and monitoring of subcontractors and any other measures it deems
appropriate and necessary.
6. If audits are not submitted when due, the Contractor may take action pursuant to Section XII of this
Contract Agreement.
7. If required program deliverables or other required information or reports, other than audits, are not
submitted when due, the Contractor may withhold all payments that otherwise would be paid the
Contractee under this Contract Agreement until such time as the reports and information are submitted.
In addition, the Contractor can hold implementation of continuation of this Agreement pending
submittal of this documentation.
XVII. DISPUTE RESOLUTION
Performance LHD w/o CARS Report 12/05
11
Performance LHD w/o CARS Report 12/05
12
. All funding recouped by the Contractor from the Contractee shall be held by the
Contractor in a fund designated for use within the program area associated with the
recoupment action.
. . These funds may be used to award other Contractees who have exceeded their objectives
in that program, general funding of the program area to all Contractees via formula in the
next contract period, general funding of the program for all Contractees during the current
contract period, or returned to the Federal funding agency of that program.
These funds cannot be used by the Contractor for their own operational costs.
4. If at the end of the contract year, the Contractee has attained its contract objectives and is in
compliance with the quality criteria, it may retain any unspent funds from this Contract Agreement
not expended during the contract year, 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 documeritation deliverables and risk
conditions.
Performance LOO w/o CARS Report 12/05
13
,.....--.--~T~~
CITY ATTORNEY
OSHKOSH, WISCONSIN
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.
01123/2007 10: 17 AM
DPH Grants and Con~racts
Contract #: 14656
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2007
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 Statutes ch. 254,
WI Administrative Rule HFS 181, WI Administrative Rule HFS 163, and the practice standards presented
in the Wisconsin Childhood Lead Poisoning Prevention & Control Handbook and in Managing Elevated
Blood Lead Levels Among Young Children (CDC, 2002).
B) Contractees must assure the availability and accessibility of blood lead screening tests for children ages 0-5
years who are 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):> 10 mg/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, and
primary prevention. 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 health care 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 childrenin the community.
C) If the Contractee serves a community receiving entitlement funds, to accept the funding available to those
communities, it 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
01/23/2007 10:17 AM
DPH Grants and Contracts
,I
........
Contract #: 14656
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2007
health care needs.
A) Contractees must assess needs and provide and monitor referrals for supportive services as needed to
families of lead 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 has access to,an~
knowledgeable of, and in compliance with the Wisconsin Childhood Lead
Poisoning Prevention & Control Handbook for Local Health Departments, the Wisconsin Blood Lead
Screening Guidelines, Managing Elevated Blood Lead Levels Among Young Children (CDC, 2002), state
statutes, administrative rules, and local ordinances.
8) Financial management practices sufficient to assure accurate eligibility determination, appropriate use of state and
federal fund~, 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 other funding sources for service provision to childn~n
who are eligible for third party payment, except when doing so is demonstrated to not be 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 oflead poisoned children, successful and timely completion oflead
hazard reduction orders, community lead poisoning education, prevention and control efforts.
01/23/2007 10:17 AM
DPH Grants and Contracts
Contract #: 14656
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2007
Program: Immunization
Program Quality Criteria
I) Assessment and surveillance of public health to identify community needs and to support systematic, competent program
planning and sound policy development with activities focusedat 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 formally evaluate immunization delivery and vaccine preventable disease
surveillance systems and improve those systems in their jurisdictions
where needed.
C) Contractees must work in collaboration with the Wisconsin Immunization Program to increase the use of
existing electronic data collection systems for vaccine record keeping and vaccine preventable disease data
systems.
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 Manual 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 conducted at kast
bi-monthly as required by the Wisconsin Policies and Procedures Manual for Immunizations.
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) 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 engage in community partnerships to identify and address the needs of high-risk
populations, reduce racial and ethnic health disparities, 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.
01/23/2007 10:17 AM
DPH Grants and Contracts
Contract #: 14656
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2007
A) Contractees must coordinate immunization services with local child Q.ealthcare (service) providers: e.g..,
WIC projects, Medical Assistance programs, and other local public health programs to assess the
immunization status of, and referral and/or provision of immunization services to under-immunized
children.
6) A referral network sufficientto assure the accessibility and timely provision of services to address identified public
health care needs.
A) Contractees must develop relationships among public and private healthcare providers to facilitate aCCI~SS
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, and the use of the WIR or a registry capable of interfacing with the WIR.
B) The local health department (LHD) 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. Ifno medical home exists, the
LHD must continue to provide immunization services.
C) LHDs should promote the exchange and sharing of immunization data using immunization registries.
D) The LHD will assure adequate surveillance, prompt reporting and epidemiologic follow-up of vaccine
preventable diseases. When prompt reporting of a vaccine preventable disease does not occur, the LPHD
will formally address the issue with the reporting agency to assure that reports are made according to the
latest EPINET Manual.
7) Provision of guidance to staffthrough 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 processes,
including that provided through the Centers for Disease Control and Prevention (CDC) distance learning
course and CDC updates.
B) The LHD will follow the Wisconsin Policies and Procedures Manual for Immunizations developed and
distributed by the Wisconsin Immunization Program, unless otherwise agreed upon. The LHD 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.
01/23/2007 10:17 AM
A) Billing for payment of childhood immunization services is not required under this section,
B) LHDs 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.
Administration fees cannot be mandatory and clients must be informed that failure to pay the
administration fee or make a donation does not preclude them from receiving state-supplied vaccine. This
DPH Grants and Contracts
Contract #: 14656
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2007
information must be added to immunization advertising materials used by the LHD. The message must be
given to the client in a way and in a language the client understands.
9) Data collection, analysis, and reporting to assure program outcome goals are met or to identify program management
problems that need to be addressed.
01/23/2007 10:17 AM
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 agency's jurisdiction may be removed from the cohort for analysis.
B) LHDs will utilize the WIR for immunization level data analysis.
DPH Grants and Contracts
Contract #: 14656
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2007
Program: Maternal and Child Health Block Grant
Program Quality Criteria
I) 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 in their
community needs assessment process, as required by Title V of the Social Security Act.
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 in the
organization and delivery of services: I) Wisconsin Medicaid Prenatal Care Coordination Services
Handbook and related Medicaid Updates, 2) Family Planning Reproductive Health Standards ofPractilce, ,
3) Bright Futures: Guidelines for Health Supervision ofInfants, Children and Adolescents, Second Edition,
4) Caring for Our Children: National Health and Safety Performance Standards Guidelines for Out-of-
Home Child Care Programs: Second Edition, 2002, 5) Bright Futures in Practice: Oral Health, 6) Bright
Futures in Practice: Physical Activity, 7) Bright Futures in Practice: Nutrition, Second Edition, 8) Bright
Futures in Practice: Mental Health. All programs will be evaluated based on these best practice guidelines.
If a local health department (LHD) 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
01/2312007 10:17 AM
DPH Grants and Contracts
Contract #: 14656
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2007
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) LHDs 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 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 thirdcparty 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 Rec()rd 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).
0112312007 10:17 AM
DPH Grants and Contracts
Contract #: 14656
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2007
Program: Public Health Preparedness - CDC
Program Quality Criteria
I) 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,
B) Contractees will annually conduct public health preparedness exercises and revise and update public h,~alth
preparedness plans based on completed Exercise After Action Reports.
C) Competency-based education of public health workers, clinicians, and others critical to emergency
response should be planned and implemented based on needs identified through assessments and/or
evaluations of performance. Contractees are required to continue to support preparedness education and
training activities needed to successfully achieve targeted outcomes and preparedness goals.
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 support public health response functions in the context of the National Incident
Management System (NIMS). In accordance with HSPD-5, NIMS provides a consistent approach for
federal, state, tribal and local governments to work together effectively and efficiently to prepare for,
prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity. As a
condition of receiving Public Health Emergency Preparedness cooperative agreement funds, Contract<::es
agree to adopt and implement NIMS. In accordance with the eligibility and allowable uses of the
cooperative agreement, Contractees are encouraged to direct FY 2006 funding towards activities necessary
to implement NIMS.
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) 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 and the Health Alert Network as
appropriate and as these systems develop.
B) Contractees will coordinate with other preparedness programs by participating in state, regional, tribal, and
local public health preparedness meetings.
01123/2007 10:17 AM
DPH Grants and Contracts
Contract #: 14656
Contract Agreement Addendum: Exhibit I
Agency: Oshkosh Health Department
Contract Year: 2007
C) Contractees will contribute to the development of a statewide system for public health emergency response
that is coordinated, consistent and efficient.
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 staffthrough 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
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.
01/2312007 10:17 AM
DPH Grants and Contracts
/lilY'
Contract Agreement Addendum: Exhibit II
Program Objectives
(A) Contract Funds, Program/Objective Values, and Other Contract Details
(B) Objective Details
01/23/2007 10:17 AM
DPH Grants and Contracts
-'l!!/
Contract #: 14656
Contract Agreement Addendum: Exhibit II(A)
Agency: Oshkosh Health Department
Contract Year: 2007
Contract Source of Funds
Source
Program
Amount
I Contract Amount I
$19,780
$10,883
$15,059
$30,570
$8,502
Oshkosh
Bioterrorism, Focus A
Oshkosh
Childhood Lead - Consolidated
Oshkosh
Immunization - Consolidated lAP
Oshkosh
Maternal Child Health - Consolidated
Oshkosh
Prevention - Consolidated
$84,794
Contract Match Requirements
Program
Amount
Childhood Lead
$0
$0
Immunization
Prevention
$22,928
$0
$0
MCH
Preparedness CDC
Program Sub-Contracts
Program Sub-Contractee
Childhood Lead None Reported
Immunization None Reported
,
MCH N one Reported
Preparedness CDC None Reported
Prevention N one Reported
Sub.Contract Amount
$0
$0
$0
$0
$0
01/23/2007 10:17 AM
DPH Grants and Contracts
Contract #: 14656
Contract Agreement Addendum: Exhibit II(A)
Agency: Oshkosh Health Department
Contract Year: 2007
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, iftaken, 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 develop~:d
and implemented. If a pattern of ongoing objective attainment failure is documented in a program area or across an agency's
contracts for two or more years, the Division of Public Health Administrator may reduce the following year's contract by some or all
of the value amount assigned to the objectives that were not achieved. If this happens, a mutually agreed-upon improvement plan will
developed and implemented to reinstate the funding in future years.
Non-performance is defined as no effort to accomplish an objective.
Ifthe Contractor determine~ 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.
01123/2007 10:17 AM
DPH Grants and Contracts
Contract #: 14656
Contract Agreement Addendum: Exhibit II(A)
Agency: Oshkosh Health Department
Contract Year: 2007
Childhood Lead
Program Total Value $10,883
2
By December 31, 2007, all children with capillary or venous blood lead levels >= 10 mcg/dL who reside in City
of Oshkosh will receive follow-up services according to the guidelines in the Wisconsin Childhood Lead
Poisoning Prevention and Control Handbook and Wisconsin Statute 254.
By December 31, 2007, 100% of families within the City of Oshkosh with required lead hazard reduction orders
will be referred to the CDBG (Community Development Block Grant) and HUD (Department of Housing and
Urban Development) for potential funding.
Immunization
Program Total Value $15,059
By December 31, 2007, 90% of infants born to families residing in the City of Oshkosh Health Department
jurisdiction who turn three months of age during the contract year will have received I DTaP, I Polio, I Hib and I
Hepatitis B vaccine by three months of age,
MCR
Program Total Value $30,570
2
By December 31, 2007, 65 residences located within the City of Oshkosh, with children ages birth to 4 years will
have a documented decrease in hazards previously identified through home safety assessments.
By December 31, 2007, 75 children ages birth through 8 years from City of Oshkosh will be properly positioned
in a child car passenger seat system as demonstrated by their parent or caregiver.
Preparedness CDC
Program Total Value $19,780
2
By December 31, 2007, a work plan to improve local public health performance capability based on results of the
2006 completed Centers for Disease Control and Prevention Performance Measure Assessment will be
implemented by the Oshkosh Health Department.
By December 31, 2007, a Personal Protective Equipment (PPE) policy and procedure for public health staff to
respond in a public health emergency will be implemented by the Oshkosh Health Department.
By December 31, 2007, four (4) tiers of redundant, interoperable communication systems will be assured by the
Oshkosh Health Department for their agency.
By December 31, 2007, a plan for improvement will be implemented for all deficiencies identified in the
Wisconsin Local Strategic National Stockpile (SNS) Assessment of Oshkosh Health Department.
December 31,2007, the Wisconsin Electronic Disease Surveillance System (WEDSS) will be implemented within
the jurisdiction of the Oshkosh H~alth Department.
By December 31, 2007, outreach education to local health care providers on the importance of reporting non-
communicable reportable conditions will increase the epidemiology capacity of the Oshkosh Health Department.
3
4
5
6
Prevention
Program Total Value $8,502
During the contract period, initiatives that conform to the Healthiest Wisconsin 20 I 0 State He(llth Plan and are
consistent with the Preventive Health and Health Services Block Grant guidelines will be undertaken by the
Oshkosh City Health Department.
Total of Contract Objective Values
$9,571
$1,312
$15,059
$25,000
$5,570
$3,300
$3,296
$3,296
$3,296
$3,296
$3,296
$8,502
$84,794
0112312007 10:17 AM
DPH Grants and Contracts
III
Contract Agreement Addendum: Exhibit II(B)
Contract #: 14656 Agency: Oshkosh Health Department
Program: Childhood Lead Poisoning Prevention Objective #: I of 2
Contract Year: 2007
Objective Value: $9,571
Objective: Primary Details
Objective Statement
By December 31, 2007, all children with capillary or venous blood lead levels >= 10 mcg/dL who reside in City of Oshkosh will
receive follow-up services according to the guidelines in the Wisconsin Childhood Lead Poisoning Prevention and Control
Handbook and Wisconsin Statute 254.
Deliverable Due Date: 01131/2008
Contract Deliverable (Evidence)
A report to document: I) all children with capillary or venous blood lead levels >= 10 mcg/dL who reside in the City of Oshkosh, 2)
their blood lead levels, and 3) the number of these children for whom and the type of follow-up services that were provided to that
child and family. For evaluation purposes, those children whose families have moved from the jurisdiction or are non-responsive to
outreach can be removed from this cohort,
Programs Providing Funds for this Objective
Childhood Lead Poisoning Prevention: $9,571
Agency Funds for this Objective:
Data Source for Measurement
For Elevated Blood Lead Level Cases: SPHERE IndividuallHousehold Report to include data from the following screens: I) Lead
Testing, including test date, result, and provider, 2) Lead Health Hazard, and 3) Case Management for Wisconsin Childhood Lead
Program: or an agency-generated report, For Blood Lead Levels of 10-19 mcg/dL: SPHERE IndividuallHousehold Report to
include data from the following screens: 1) Lead Testing-including test date, result, and provider, and 2) Health Teaching Topic
Environmental Lead Exposure: or an agency-generated report.
Baseline for Measurement
. In 2006, the City of Oshkosh has had II cases of elevated lead levels (levels of venous 10 mcg/dL or higher) in their area. All cases
receive case management services according to the Wisconsin Childhood Lead Program guidelines,
Context
At a minimum, the families of children with capillary or venous blood lead levels drawn by public and private providers with a
value between 10-19 mcgldL will be contacted by phone and/or provided written materials. The local health department will assure
a confirmatory test ofthe capillary draw and follow-up venous testing according to the "Wisconsin Childhood Lea<i; Poisoning
Prevention & Control Handbook (2002)". Children with blood lead levels that meet the elevated blood lead level definition as
defined by Wisconsin Statute 254 will receive case management services for lead poisoning.
Input Activities
Oshkosh Health Division provides case management for all confirmed blood lead levels of IOmcg/dL or higher. This includes a
home visit where education is given to the family and the source oflead contamination is identified by a certified lead inspector.
The City of Oshkosh has a lead ordinance that requires owners of residences remediate if a child with lead poisoning is identifiied as
living in that residence, We will continue to meet the requirements of that ordinance.
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract period.
Conditions of Eligibility for an Incentive
Inone
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0] 123/2007 10: 17 AM
DPH Grants and Contracts
'"
Contract Agreement Addendum: Exhibit II(B)
Contract #; 14656 Agency; Oshkosh Health Department
Program; Childhood Lead Poisoning Prevention Objective #: 2 of 2
Contract Year: 2007
Objective Value; $:1,312
Objective: Primary Details
Objective Statement
By December 31, 2007, 100% of families within the City of Oshkosh with required lead hazard reduction orders will be referred to
the CDBG (Community Development Block Grant) and BUD (Department of Housing and Urban Development) for potential
funding,
Deliverable Due Date: 01/31/2008
Contract Deliverable (Evidence)
A report which includes: I) the number of families referred for case management, 2) who was referred to the CDBG and HUD for
potential funding, 3) who received financial assistance.
Programs Providing Funds for this Objective
Childhood Lead Poisoning Prevention: $1,312
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
recieved information regarding financial assistance,
Baseline for Measurement
Currently in 2006, we have had 8 assessed and referred and 4 have received funding through CDBG and/or BUD funds.
Context
Currently, the Oshkosh Health Department provides case management to all families with children that havea venous confirmed
blood lead level of 10 mcg/dL. All of these families will be referred to the CDBGand HUD programs for application to these
grants.
Input Activities
The Oshkosh Health Department 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(Advocacy Community Action Program)in
Oshkosh which handles the distribution of HUD grants related to lead,
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this' cOl'ltnict period.
Conditions of Eligibility for an Incentive
INone.
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01123/2007 10:17 AM
DPH Grants and Conb:acts
'"
Contract Agreement Addendum: Exhibit II(B)
Contract #: 14656
Program: Immunization
Agency: Oshkosh Health Department
Objective #: I of I
Contract Year: 2007
Objective Value: $15,059
Objective: Primary Details
Objective Statement
By December 31, 2007, 90% of infants born to families residing in the City of Oshkosh Health Department jurisdiction who tum
three months of age during the contract year will have received I DTaP, 1 Polio, I Hib and 1 Hepatitis B vaccine by three months
of age.
Deliverable Due Date: 01/31/2008
Contract Deliverable (Evidence)
A Wisconsin Immunization Registry generated, population-based report to document: I) the number of children in the (insert name)
Health Department jurisdiction who tumed three months of age in 2007,2) the number of those children who received 1 DTaP, 1
Polio, 1 Hib, 1 Hepatitis B by three months of age, 3) the number of those children marked as moved or going elsewhere, and 4) the
number of those children marked as non-responders.
Programs Providing Funds for this Objective
Immunization: $15,059
Agency Funds for this Objective:
Data Source for Measurement
Wisconsin Immunization Registry.
Baseline for Measurement
Context
Children will be assessed for having at least I DTaP, I Polio, I Hib and 1 Hepatitis B vaccine by three months of age. Only
children who have moved out of the agency's jurisdiction may be removed from the cohort for analysis.
Input Activities
Checking all birth records of children bom in the City of Oshkosh during October 2006 through September 2007. Locating these
children on the Wisconsin Immunization Registry and checking immunization dates. Children that do not have a record or are
behind schedule, are sent a reminder letter to attend our immunization clinic orto receiveilllmunizations at a private provider. Calls
to parents and medical records departments of clinics are also performed to get current immunization dates for children's records.
Our Oshkosh Health Division Immunization Schedule is sent out to physicians and families with children who are due for their
primary immunizations. Individual appointments are also made for children as needed. Immunization awareness is also attained
through the local newspaper, information given out at local community events, and also briefly discussed with parents during home
visits, CASA inputting of immunization data and reports generated as needed for statistal data.
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract period.
Conditions of Eligibility for an Incentive
I none
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01/23/2007 10:17 AM
DPH Grants and Contracts
II
Contract Agreement Addendum: Exhibit II(B)
Contract #: ,14656 Agency: Oshkosh Health Department
Program: Maternal and Child Health Block Grant Objective #: I of 2
Contract Year: 2007
Objective Value: $25,000
Objective: Primary Details
Objective Statement
By December 31, 2007, 65 residences located within the City of Oshkosh, with children ages birth to 4 years will have a
documented decrease in hazards previously identified through home safety assessments.
Deliverable Due Date: 01/31/2008
Contract Deliverable (Evidence)
A report to document, per residence (household), the number and types of corrections made for hazards identified through home
safety assessments.
Programs Providing Funds for this Objective
Maternal and Child Health Block Grant: $25,000
Agency Funds for this Objective:
Data Source for Measurement
SPHERE Individual/Household Report to include MCH Required Demographic Data and data from the following screens: Home
Safety Assessment, Health Teaching Topics and Results, and Referral and Follow-Up/Results if appropriate.
Baseline for Measurement
As of September 15,2006,40 families have been served by the nurse at the Oshkosh Health Services Division, providing education
on Home Safety and Child Proofing.
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 HotIl.e Safety Assessment of Young Children is the tool used
for the Home Safety Assessment. A copy of the checklIst is left with the parentis to assist them with making safety changes as
needed. Hazards found are verbally discussed and documented on the assessment form. Many safety products are left with parentis
to install and some are installed during visit per nurse and/or client. A resource and referral guide is given out at visits, along with
many educational brochures and booklets on safety in the home and community,
Input Activities
See context for overview. Listed activities inclu4e:Calls rece:iyed and placed to interested parentis. Setting up appointments,
touring the homes and surrounding area and checking for safety hazards and potential problems. Checking smoke alarms, looking
for any evidence of lead paint, by observing chipping, peeling paint. Instructional education is given by nurse to teach parentis to
test for lead in the home as needed Giving out safety products to assist with child proofing in the home. Some products are installed
by nurse on the first visit. Educational brochures and s(ifety pamphlets are given out and discussed with parentis, Purchasing Safety
1 st products through the company of Safety 1 stlDorel Groupl Atomic Box Logistics. Other necessary products purchased as baby
gates, smoke alarms and needed child proofing products when stock runs out, are purchased at local stores as Target, Wal-Mart,
Menards and Baby Depot. Working with community partners as Parent Connection, Safe Kids, Oshkosh Police Department and
Fire Department, WIC office, Affinity Mom's Group and Toddler Club. Attending conferences regarding childhood safety. Also
attending local events as Back to School Fair, and Safety Fairs. Every year teaching safety to young children is accomplished
through a Safety City Event sponsored by the Oshkosh Police Department. Safety awareness is started in the home and brought out
in to the community by the benefits of providing this program. The Home Safety Child Proofing Program has grown in awareness
and necessity; that we provide education and knowledge to all parentis, grandparentls, families, to keep all of our children safe.
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract period.
Conditions of Eligibility for an Incentive
I none.
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01/23/2007 10:17 AM
DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 14656 Agency: Oshkosh Health Department
Program: Maternal and Child Health Block Grant Objective #: 2 of 2
Contract Year: 2007
Objective Value: $5,570
Objective: Primary Details
Objective Statement
By December 31, 2007, 75 children ages birth through 8 years from City of Oshkosh will be properly positioned in a child car
passenger seat system as demonstrated by their parent or caregiver.
Deliverable Due Date: 01/31/2008
Contract Deliverable (Evidence)
A report to document the number of children ages birth through 8 years from City of Oshkosh who were properly positioned in a
child car passenger seat system by their parents or other caregivers.
Programs Providing Funds for this Objective
Maternal and Child Health Block Grant: $5,570
Agency Funds for this Objective:
Data Source for Measurement
SPHERE IndividuallHousehold Report to include MCH Required Demographic Data and data from the following screen: Child
Passenger Safety Seat.
Baseline for Measurement
The 2006 objective was contracted for 75 children, However, in 2007 we seek to meet the increased need required by the change of
the Booster seat law.
Context
The City of Oshkosh Health Division will provide designated individual assessment, installation and instruction services to families
with one or more children in the selected age group. We do employ certified staff in our program. We will be using the Safe Kids
form, along with an addendum specifically to meet the required additional MCH program data the agency must also collect and
report. To count toward this objective, a pregnant woman instructed on child passenger safety seat installation must return with the
baby after the baby is born to document proper positioning. It is when the baby is documented with proper positioning, that this
child is to be counted within the number of children served by this objective.
Input Activities
This is an ongoing objective that is providing car seat information and education in collaboration with Fox Valley Safe Kids,
Winnebago County Health, Town of Menasha and City of Men ash a and Neenah. We work along with the WIC program to provide
low cost car seats to low income residents. This program has been in effect as a collaborative effort since 2005.
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract period,
Conditions of Eligibility for an Incentive
INone.
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01/23/2007 ]0;]7 AM
DPH Grants and Con~:acts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 14656
Program: Public Health Preparedness - CDC
Agency: Oshkosh Health Department
Objective #: 1 of 6
Contract Year: 2007
Objective Value: $3,300
Objective: Primary Details
Objective Statement
By December 31, 2007, a work plan to improve local public health performance capability based on results ofthe 2006 completed
Centers for Disease Control and Prevention Performance Measure Assessment will be implemented by the Oshkosh Health
Department.
Deliverable Due Date: 01/31/2008
Contract Deliverable (Evidence)
An agency summary report to include a work plan implemented by the agency to improve local capability based on the results of
the 2006 completed Centers for Disease Control and Prevention Perfonuance Measure Assessment.
Programs Providing Funds for this Objective
Public Health Preparedness - CDC: $3,300
Agency Funds for this ObjeCtive:
Data Source for Measurement
Agency records and Centers for Disease Control Performance Measures.
Baseline for Measurement
New initiative.
Context
The Centers for bisease Control and Prevention have identifiedPerfOJ:l1}al1c~ .Measllr~sfor therllbli~ H~~~thr~7paredne~s Program,
Local Public Health Departments (LPHD's) and Tribes will have completed an assessment on the metrics by December 31, :2006.
Based on the assessment results, LPHD's and Tribes are to develop a plan with strategies to implement to improve their local public
health performance capability. Each strategy should have one or more activities identified for implementation to support the plan.
The intent of this objective is for the score at the next evaluation to show improvement and to reflect the strategies implemented and
changes made in 2007.
Input Activities
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for thiscontiad period,
Conditions of Eligibility for an Incentive
INone.
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01/23/2007 10:17 AM
OPB Grants and ConDracts
Contract Agreement Addend'Um: Exhibit II(B)
Contract #: 14656
Program: Public Health Preparedness - CDC
Agency: Oshkosh Health Department
Objective #: 2 of 6
Contract Year: 2007
Objective Value: $3,296
Objective: Primary Details
Objective Statement
By December 31, 2007, a Personal Protective Equipment (PPE) policy and procedure for public health staff to respond in a public
health emergency will be implemented by the Oshkosh Health Department.
Deliverable Due Date: 01/31/2008
Contract Deliverable (Evidence)
An agency report documenting the quantity and type ofPPE purchased and the training dates/times/locations for public health staff
on the use ofPPE. A copy ofPPE policy/procedure.
Programs Providing Funds for this Objective
Public Health Preparedness - CDC: $3,296
Agency Funds for this Objective:
Data Source for Measurement
Agency records.
Baseline for Measurement
New initiative.
Context
Local Public Health departments/tribes should have a stockpile ofPPE for public health staff for contact tracing, mass clinics, and
or any other public health emergency. Local public health departments/tribes should assess what PPE they have (if any), purchase
PPE, and train staff on PPE use. Refer to DPH provided Algorithm, Northwoods Template, PPE PolicylProcedure.
Input Activities
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract period.
Conditions of Eligibility for an Incentive
INone.
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01/2312007 10:17 AM
DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 14656
Program: Public Health Preparedness - CDC
Agency: Oshkosh Health Department
Objective #: 3 of 6
Contract Year: 2007
Objective Value: $3,296
Objective: Primary Details
Objective Statement
By December JI, 2007, four (4) tiers of redundant, interoperable communication systems will be assured by the Oshkosh Health
Department for their agency.
Deliverable Due Date: 0 I /31 /2008
Contract Deliverable (Evidence)
An agency report to include a summary of the 4 tiers of redundant communication equipment used and or purchased
dates/times/locations of training, and a list of any exercises conducted to test use of the equipment.
Programs Providing Funds for this Objective
Public Health Preparedness - CDC: $3,296
Agency Funds for this Objective:
Data Source for Measurement
Agency Records.
Baseline for Measurement
New initiative.
Context
In accordance with directives from both the FY ~005 HRSA and CDC Cooperative Agreements, each hospital and local health
department (LHD/tribe) is to have communications redundancy based on the State Communication Expert Panel Recommendations.
Local public health departments/tribes should coordinate with local emergency management and other preparedness partners to
assure the 4 tiers of redundancy and purchase and train staff on the use of equipment as needed: landline telephones, VHF /UHF
radio, satellite telephone, amateur (HAM) radio.
Input Activities
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract period.
Conditions of Eligibility for an Incentive
I none. ,
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0]/2312007 10:17 AM
DPH Grants and Contracts
~
Contract AgreementAddendum: Exhibit II(B)
Contract #: 14656
Program: Public Health Preparedness - CDC
Agency: Oshkosh Health Department
Objective #: 4 of 6
Contract Year: 2007
Objective Value: $3,296
Objective: Primary Details
Objective Statement
By December 31, 2007, a plan for improvement will be implemented for all deficiencies identified in the Wisconsin Local Strategic
National Stockpile (SNS) Assessment of Oshkosh Health Department.
Deliverable Due Date: 01/31/2008
Contract Deliverable (Evidence)
An agency report to include the completed Wisconsin Local SNS Assessment Tool, local improvement plan and summary of
changes implemented.
Programs Providing Funds for this Objective
Public Health Preparedness - CDC: $3,296
Agency Funds for this Objective:
Data Source for Measurement
Agency records.
Baseline for Measurement
New initiative.
Context
As a part of the overall initiative for Wisconsin to be approved by the Centers for Disease Control and Prevention as Green for
receiving, staging, storing, and distributing the Strategic National Stockpile, local jurisdictions are required to complete and submit
the SNS Local Assessment tothe Division of Public Health. Meeting SNS requirements is concurrent with national priorities for
surge capacity and mass prophylaxes.
Input Activities
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract period.
Conditions of Eligibility for an Incentive
INone.
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01/23/2007 10:17 AM
DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 14656
Program: Public Health Preparedness - CDC
Agency: Oshkosh Health Department
Objective #: 5 of 6
Contract Year: 2007
Objective Value: $3,296
Objective: Primary Details
Objective Statement
December 31,2007, the Wisconsin Electronic Disease Surveillance System (WEDSS) will be implemented within the jurisdictJion
of the Oshkosh Health Department.
Deliverable Due Date: 01/31/2008
Contract Deliverable (Evidence)
Areport generated through the audit system within WEDSS showing agency use ofWEDSS, specifically the submission of case
reports of notifiable conditions to DPH using WEDSS.
Programs Providing Funds for this Objective
Public Health Preparedness - CDC: $3,296
Agency Funds for this Objective:
Data Source for Measurement
Agency Records.
Baseline for Measurement
New initiative.
Context
Implementation of the WED~S system at the local/tribal agency will provide timely information for epidemiology from laboratories
and healthcare providers, and facilitate communication and data sharing. Recommended input activities include: participation in
WEDSS planning sessions, provision of feedback through established channels regarding preparation for and implementation of
WEDSS, preparation of an agency training and data conversion plan with the WEDSS manager, determination of a start date within
the agency for WEDSS implementation, participation in training, assist and participate in data conversions (if needed).
Input Activities
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract period.
Conditions of Eligibility for an Incentive
INone.
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01123/2007 10:17 AM
DPH Grants and Contracts
t'
Contract Agreement Addendum: Exhibit II(B)
Contract #: 14656
Program: Public Health Preparedness - CDC
Agency: Oshkosh Health Department
Objective #: 6 of 6
Contract Year: 2007
Objective Value: $3,296
Objective: Primary Details
Objective Statement
By December 31, 2007, outreach education to local health care providers on the importance of reporting non-communicable
reportable conditions will increase the epidemiology capacity of the Oshkosh Health Department.
Deliverable Due Date: 01/31/2008
Contract Deliverable (Evidence)
An agency report summarizing the methods used, dates provided, organizations and number of staff participating in outreach
education to local health care providers to increase the reporting of non-communicable reportable conditions.
Programs Providing Funds for this Objective
Public Health Preparedness - CDC: $3,296
Agency Funds for this Objective:
Data Source for Measurement
Agency records.
Baseline for Measurement
New initiative.
Context
Epidemiologic capacity is critical to local public health preparedness, Educating local healthcare providers about reporting of non-
communicable reportable conditions will enhance communities to respond to all health threats.
Input Activities
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract period.
Conditions of Eligibility for an Incentive
I None.
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01/23/2007 10:17 AM
DPH Grants and Contracts
~, i'
Contract Agreement Addendum: Exhibit II(B)
Contract #: 14656 Agency:
Program: Preventive Health and Health Services
Block Grant
Oshkosh Health Department
Objective #: 1 of I
Contract Year: 2007
Objective Value: $8,502
Objective: Primary Details
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 City Health Deparfu1el1t.
Deliverable Due Date: 01/31/2008
Contract Deliverable (Evidence)
A report to document Prevention-related initiatives undertaken by the Oshkosh Health Division and the results achieved.
Programs Providing Funds for this Objective
Preventive Health and Health Services Block Grant: $8,502
Agency Funds for this Objective:
Data Source for Measurement
Agency report
Baseline for Measurement
This is a new objective for our community,
Context
Oshkosh Health Division plans to use Prevention funds for 2007 to work with Winnebago County Health Department in a
household drug collection. This will be an effort done with the assistance of both health departments, a local pharmacy, the drug
MEG unit, and the local disposal unit.
Input Activities
This program will be accompanied by a development of an informational brochure that can be distributed to the local senior centers,
pharmacies, senior day cares, and any other identifed groups that might be a potential participant in this endeavor. There will be
outreach to the local newpapers and other media if necessary. A collection day will be determined though a meeting of the involved
parties.
Objective: Risk Profile
Accountability Targets
Accountability targets are not applicable or were not determined for this contract period.
Conditions of Eligibility for an Incentive
INone.
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01/23/2007 10:17 AM
DPH Grants and Contracts