HomeMy WebLinkAbout2009 consolidated grant fundsJANUARY 13, 2009 09 -03 RESOLUTION
(CARRIED 7 -0 LOST LAID OVER WITHDRAWN )
PURPOSE: APPROVAL OF AGREEMENT WITH STATE DIVISION OF
PUBLIC HEALTH TO ACCEPT 2009 CONSOLIDATED GRANT
FUNDS
INITIATED BY: DEPARTMENT OF COMMUNITY DEVELOPMENT/
HEALTH SERVICES DIVISION
BE IT RESOLVED by the Common Council of the City of Oshkosh that the
proper City officials are hereby authorized and directed to approve and accept a
consolidated grant from the State of Wisconsin Division of Public Health for public
health nursing related activities.
BE IT FURTHER RESOLVED by the Common Council of the City of Oshkosh
that the proper City officials are hereby authorized and- directed to execute any and all
documents and assurances required by the State of Wisconsin Division of Public Health
for purposes of same.
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TO: Honorable Mayor and Members of the Common Council
FROM: Paul Spiegel
Health Director
DATE: December 20, 2008
RE: Consolidated Contract Agreement 2009
BACKGROUND
Council is being asked to authorize the City to enter into an agreement with the Division of Public
Health of the Department of Health Services that will enable the Health Services Division to receive
funding for the period of January 1, 2009 through December 31, 2009.
The Health Services Division has received similar funding for at least ten years that has been utilized
to increase immunization rates of children, provide home safety assessments to families with children
under the age of five, operate a car seat check program, offer medication take back events, provide
case management to children with elevated blood lead levels and other health related projects.
In the coming year the Division will be granted $63,608. During this grant cycle we will continue to
work on increasing immunization rates of children, case manage lead poisoned children, provide home
safety inspections, organize medication take back events, and participate in the annual community
health and safety fair.
ANALYSIS
This is an annual noncompetitive grant opportunity for the city to provide additional services to the
citizens that would not normally be able to be offered. This grant funds two part-time public health
nurses that provide the services to meet the grant objectives that are negotiated with the State.
FISCAL IMPACT
The activities that are proposed to be undertaken will enable the Division to offer the community
additional programs and/or services. By tapping available grant funds the City does not have to utilize
its budget resources for these programs and/or services
RECOMMENDATION
Council is being asked to authorize the City to enter into the above grant agreement.
Ap roved Approved,
son i ey City Manager
Director, mmunity Development
DIVISION OF PUBLIC HEALTH
CONTRACT AGREEMENT
DPH CONTRACT #16626
Contract Preamble
This Contract Agreement is entered into for the period January 1, 2009 through December 31, 2009, by and
between the State of Wisconsin represented by its Division of Public Health of the Department of Health Services,
whose principal business address is One West Wilson Street, PO Box 2659, Madison WI 53701 -2659, hereinafter
referred to as Contractor, and Oshkosh Health Department, whose principal business address is 215 Church Street,
PO Box 1 130, Oshkosh WI 54902 -1130, hereinafter referred to as Contractee.
The Contractee address above is the address to which payments shall be mailed. If any legal notices required to be
sent to the Contractee in the execution of this Contract Agreement should be sent to an address different from the
Contractee address noted above, that address should be provided below:
Whereas, the Contractor wishes to purchase services from the Contractee as it is authorized to do by Wisconsin law;
and Whereas, the Contractee is engaged in furnishing the desired services; Now, therefore, the Contractor and the
Contractee agree as follows:
I. SERVICES TO BE PROVIDED
The Contractee agrees to provide services consistent with the purposes and conditions of the objectives that it
has agreed to attain within the contract period. A detailed description of the objectives to be attained and the
documentation associated with that attainment is part of this Contract Agreement as listed in Exhibits I and 1I,
which are attached to this Agreement. The Contractee also agrees to provide to the Contractor documentation
(as agreed to in negotiations with the Contractor) of the attainment of those objectives no later than 30 days
after the end of the contract period or as specified in Exhibit I1.
II. CONTRACT ADMINISTRATION
The Contractor's Contract Administrator is Susan Nelson of the Division of Public Health, whose principal
business address is 200 North Jefferson Street, Suite 511, Green Bay WI 54301 -5123. The telephone
number of the Contractor's Contract Administrator is (920) 448 -5265. In the event its Contract Administrator
is unable to administer this Contract Agreement, the Contractor will contact the Contractee and designate a
new Contract Administrator.
The Contractee's Contract Administrator is Paul Spiegel, whose principal business address is 215 Church
Street, PO Box 1130, Oshkosh WI 54902 -1130. The telephone number of the Contractee's Contract
Administrator is (920)236-5031, In the event its Contract Administrator is unable to administer this
Contract Agreement, the Contractee will contact the Contractor and designate a new Contract Administrator.
III. PAYMENT LIMIT
The Contractor agrees to pay the Contractee in accordance with the terms and conditions of this Contract
Agreement, an amount not to exceed $63,608. This amount is contingent upon receipt of sufficient funds by
the Contractor.
The Contractor will not make payments in excess of the Contract Agreement amounts, with the exception of
performance -based incentive funds pursuant to Section XXI.
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IV. PAYMENT PROCESS
1. Payments will be made on a monthly basis. The Contractee will receive one month's estimated
operating expenses of the total contract amount each month unless Contractee has failed to maintain
quality criteria or proposed progress towards achievement of Contract Agreement objectives as
determined by the Contractor. In these situations, the Contractor can make reductions in the monthly
payment pursuant to Section XVI.
2. All payments shall be released by the Department on the last business day before the fifth day of the
month for municipalities, or the last business day of each month for non - municipalities, with the
exception that the payment that would normally be released on the last working day of June shall be
released instead on the first working day of July. Checks will be mailed to the Contractee's principal
business address unless the Contractee requests, in writing, subject to approval, that the Department
mail the checks to a different address.
V. PROGRAM REPORTING
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 11.
2. Failure to submit the reports specified in the reporting instructions may result in the Contractor
rendering liquidated damages pursuant to Section XVI of this contract.
VI. STATE AND FEDERAL RULES AND REGULATIONS
The Contractee agrees to meet State and Federal laws, rules and regulations, and program policies
applicable to this Contract Agreement.
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.
Affirmative Action Plan/Civil Rights Compliance
Affirmative Action Plans
A. An Affirmative Action Plan is a written document that details an affirmative action
program. Key parts of an affirmative action plan are: (1) a policy statement pledging
nondiscrimination and affirmative action employment, (2) internal and external
dissemination of the policy, (3) assignment of a key employee 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 Instruction
for Vendors Affirmative Action Requirements (DOA -3021P (R06/96) s. 16765, Wis.
Stars.), page 2. Universities, other states, and local governments, except those of the State
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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 Services, One West Wilson Street, Room 561, PO Box 7850,
Madison WI 53707 -7850, for technical assistance on Equal Opportunity.
Civil Rights Compliance
A. For agreements for the provision of services to clients, the Contractee must comply with
Civil Rights requirements. Contractees with an annual workforce of less than twenty-five
(25) employees, regardless of contract amount, and Contractees with contracts of less than
$25,000 are not required to submit a Civil Rights Compliance Action Plan, however, they
must submit a Civil Rights Compliance Letter of Assurance. Contractees with an annual
workforce of twenty -five (25) employees or more and contract agreements of $25,000 or
more shall submit a written Civil Rights Compliance Plan which covers a three -year period
within fifteen (15) working days of the award date of the agreement or contract.
B. The Contractee assures that it has submitted to the Contractor's Affirmative Action /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 the
basis of race, color, national origin, sexual orientation, religion, sex, disability or
age. This policy covers eligibility for and access to service delivery, and treatment
in all programs and activities. All employees of the Contractee are expected to
support goals and programmatic activities relating to nondiscrimination in service
delivery.
2) No otherwise qualified person shall be excluded from employment, be denied the
benefits of employment or otherwise be subjected to discrimination in employment
in any manner or team of employment on the basis of age, race, religion, sexual
orientation, color, sex, national origin or ancestry, disability (as defined in Section
504 and the American with Disability Act of 1990), or association with a person
with a disability, arrest or conviction record, marital status, political affiliation, or
military participation, unfair honesty testing and genetic testing, and use or non-
use of lawful products outside of working hours. All employees of the Contractee
are expected to support goals and 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 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
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the limited English Proficient (LEP) participants in their service area. The notice
will announce the availability of free oral interpretation of services if needed. The
Contractee shall not request interpretation services from family members, friends
and minors.
4) The Contractee agrees to comply with the Contractor's guidelines in the State of
Wisconsin Department of Workforce Development and Department of Health
Services, Affirmative Action, Equal Opportunity, Limited English Proficiency and
Civil Rights Compliance Plan for Profit and Non - Profit Entities DWSD -14045 (R.
11/2003)) or subsequent revisions.
5) Requirements herein stated apply to any subcontracts or grants. The Contractee
has primary responsibility to take constructive steps, as per the State of Wisconsin
Department of Workforce Development and Department of Health 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
Services, Affirmative Action, Equal Opportunity and Limited English Proficiency,
Civil Rights Compliance Plan for Profit and Non -Profit Entities, DWSD- 14045
(R. 11/2003). The Contractee agrees to comply with Civil Rights monitoring
reviews, including the examination of records and relevant files maintained by
Contractee, as well as interviews with staff, clients, and applicants for services,
subcontractors, providers, and referral agencies. The reviews will be conducted
according to Department procedures. The Contractor will also conduct reviews to
address immediate concerns of complainants.
7) The Contractee agrees to cooperate with the Contractor in developing,
implementing and monitoring corrective action plans that result from complaint
investigations or monitoring efforts.
C. The Contractee agrees that it will: (1) hire staff with special translation or sign language
skills and /or provide staff with special translation or sign language skills training, or find
qualified persons who are available within a reasonable period of time and who can
communicate with limited or non - English speaking or speech or hearing- impaired clients at
no cost to the client; (2) provide aids, assistive devices and other reasonable
accommodations to the client during the application process, in the receipt of services, and
in the processing of complaints or appeals; (3) train staff in human relations techniques,
sensitivity to persons with disabilities and sensitivity to cultural characteristics; (4) make
programs and facilities accessible, as appropriate, through outstations, authorized
representatives, adjusted work hours, ramps, doorways, elevators, or ground floor rooms,
and Braille, large print or taped information for the visually or cognitively impaired; (5)
post and /or make available informational materials in languages and formats appropriate to
the needs of the client population.
VII. SUBCONTRACTS
The Contractee may subcontract all or part of this Contract Agreement as agreed to during contract
negotiation. The Contractor reserves the right of approval for any subcontracts and the Contractee
shall report information relating to subcontracts to the Contractor. A change in a subcontractor or a
change from direct service provision to a subcontract may only be executed with the prior written
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approval of the Contractor. In addition, Contractor approval may be required regarding the terms
and conditions of the subcontracts, and the subcontractors selected. Approval of the subcontractors
will be withheld if the Contractor reasonably believes that the intended subcontractor will not be a
responsible provider in terms of services provided, objectives to be attained, or required quality
criteria.
The Contractee retains responsibility for fulfillment of all terms and conditions of this Contract
Agreement when it enters into sub - contractual agreements and will be subject to enforcement of all
the terms and conditions of this Agreement.
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
Any payments of monies to the Contractee by the Contractor for services provided under this
Contract Agreement shall be deposited in a bank with Federal Deposit Insurance Corporation
(hereinafter FDIC) insurance coverage. Any balance exceeding FDIC coverage must be collaterally
secured.
The Contractee shall conduct all procurement transactions in a manner that provides maximum open
and free competition.
The Contractee shall not engage the services of any person or persons concurrently employed by the
State of Wisconsin, including any Department, commission or board thereof, to provide services
relating to this Contract Agreement without the written consent of the employer of such person or
persons and of the Contractor.
This Contract Agreement is voidable if the Contractee is a state public official, a member of a state
public official's immediate family, or an organization in which the official or immediate family
member owns or controls at least 10% of the outstanding equity, voting rights, or outstanding
indebtedness and failed to make the written disclosure required under sec. 19.45 Wis. Stats. This
disclosure is required to be made to the State of Wisconsin Government Accountability Board, 44
East Mifflin Street, Suite 601, Madison WI 53703, [Telephone (608) 266 - 8123].
If the Contractee or any subcontractor is a corporation other than a Wisconsin corporation, it must
demonstrate prior to providing services under this Contract Agreement that it possesses a certificate
of authority from the Wisconsin Secretary of State, and must have, and continuously maintain, a
registered agent, and otherwise conform to all requirements of Chapters 180 and 181, Wisconsin
Statutes, relating to foreign corporations.
6. The Contractee agrees that funds provided under this Contract Agreement shall be used to
supplement or expand the Contractee's current public health service efforts, not to replace or allow
for the release of available local ( Contractee) funds for alternative uses. If the Contractor determines
that local funds supporting public health services or funds under this Agreement have been released
for alternative uses (supplanting), the Contractee may be subject to a proportionate reduction in
funding under this Agreement in the current or subsequent contract year.
IX. ACCOUNTING REQUIREMENTS
For Contract Agreements of twenty-five thousand dollars ($25,000) or more, the Contractee shall
maintain a uniform double entry, full accrual accounting system and a financial management
information system in accordance with Generally Accepted Accounting Principles. (See DHS'
Allowable Cost Policy Manual, available upon request from the Contract Administrator or from the
Audit Section, Division of Enterprise Services, Department of Health Services, One West Wilson
Street, PO Box 7850, Madison WI 53707- 7850.)
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For Contract Agreements of less than twenty -five thousand dollars ($25,000), the Contractee shall at
least maintain a simplified double entry bookkeeping system as defined in the Department's
Allowable Cost Policy Manual.
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. If program 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;
will limit the breakdown of the information to what is required by the Contractor's funding sources
and; will only request the information as of the end of the contract period for the full contract period.
6. The Contractee shall reconcile costs and match to expenses recorded in the Contractee's accounting
or simplified bookkeeping system on an ongoing and periodic basis. The Contractee agrees that
reconciliation will be completed at least quarterly, will be documented, and supplied to the
Contractor upon request. The Contractee shall retain the reconciliation documentation in accordance
with the record retention requirement specified in Section XIV.
7. Monthly submittals of expenditure reports on the use of funds within this Contract Agreement are
not required for contract payment purposes.
8. Nothing in this Section precludes the Contractee from keeping such information as needed for its
internal management purposes.
Expenditures of funds from this Contract Agreement must meet the Department's allowable cost
definitions as defined in the Department's Allowable Cost Policy Manual.
X. CHANGES IN ACCOUNTING PERIOD
The Contractee's accounting records are maintained on a fiscal year basis, beginning on the date
indicated in the CARS Payment Information section of this contract. During the contract period, the
accounting period may only be changed with prior written approval from the Contractor. The
Contractor may approve a change in accounting period only if the Contractee has a substantial,
verifiable business reason for changing the accounting period and agrees to submit a closeout audit,
as defined in section (XII, 8), within 90 days after the first day of the new 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.
A change in accounting period shall not relieve the Contractee of reporting or audit requirements of
this Contract Agreement. An audit meeting the requirements of this Agreement shall be submitted
within 90 days after the first day of the start of the new accounting period for the short accounting
period and within 180 days of the close of the new accounting period for the new period. For
purposes of determining audit requirements, expenses and revenues incurred during the short
accounting period shall be annualized.
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XI. PROPERTY MANAGEMENT REQUIREMENTS
1. Property insurance coverage will be provided by the Contractee for fire and extended coverage of
any equipment funded under this Contract Agreement which the Contractor retains ownership of,
and which is in the care, custody and control of the Contractee.
2. The Contractor shall have all ownership rights in any hardware funded under this Contract
Agreement or supplied by the Contractor and in any software or modifications thereof and associated
documentation designed, developed or installed as a result of this Agreement. The Contractee is
responsible for keeping all of Contractor's property secure from theft, damage or other loss.
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
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 PAAG.
Reporting Package: The Contractee shall submit to the Contractor a reporting package which
includes the following:
A. Financial statements and other audit schedules and reports required for the type of audit
applicable to the Contractee.
B. The Management Letter (or similar document conveying auditor's comments issued as a
result of the audit) or written assurance that a Management Letter was not issued with the
audit report.
C. Management responses /corrective action plan for each audit issue identified in the audit
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D. If program specific cost -based information is needed, the Contractor may require it as part
of the reporting package.
4. Submitting the Reporting Package: The Contractee shall submit the required reporting package to
the Contractor either: (a) within nine months of the end of the Contractee's fiscal year 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:
Attn: Audit Section
Division of Enterprise Services
Wisconsin Department of Health Services
PO Box 7850
Madison WI 53707 -7850
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.
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 liquidated damages
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.
Closeout Audits:
A. A specific audit of an accounting period of less than twelve (12) months is required when
an agreement is terminated for cause, when the Contractee ceases operations or when the
Contractee changes its accounting period (fiscal year). The purpose of the audit is to
closeout the short accounting period. The required closeout audit may be waived by the
Contractor upon written request from the Contractee, except when the agreement is
terminated for cause. The required closeout audit may not be waived when an agreement is
terminated for cause.
B. The Contractee shall ensure that its auditor contacts the Contractor prior to beginning the
audit. The Contractor, or its representative, shall have the opportunity to review the planned
audit program, request additional compliance or internal control testing and attend any
conference between the Contractee and the auditor. Payment of increased audit costs, as a
result of the additional testing requested by the Contractor, is the responsibility of the
Contractee.
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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
The Contractee shall notify the Contractor in writing, within thirty (30) days of the date payment was
due of any past due liabilities to the Federal Government, State Government or their agents for
income tax withholding, FICA, Workers' Compensation, Unemployment Compensation,
garnishments or other employee related liabilities, Sales Tax, Income Tax of the Contractee, or other
monies owed. The written notice shall include the amount(s) owed, the reason the monies are owed,
the due date, the amount of any penalties or interest, known or estimated, the unit of government to
which the monies are owed, the expected payment date and other related information.
2. The Contractee shall notify the Contractor, in writing, within thirty (30) days of the date payment
was due, of any past due payment in excess of five hundred dollars (5500), or when total past due
liabilities to any one 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.
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 amount to be determined by the Contractor.
4. The Contractee certifies that neither the Contractee organization nor any of its principals are
debarred, suspended, or proposed for debarment for Federal financial assistance (e.g., General
Services Administration's List of Parties Excluded from Federal Procurement and Non - Procurement
Programs). The Contractee further certifies that potential sub- recipients, contractors, or any of their
principals are not debarred, suspended or proposed for debarment.
XIV. RECORDS
The Contractee shall maintain such records (in either written or electronic form) as required by State
and Federal law and as required by program policies. Records shall be retained for no less than the
retention period specified in law or policy. Records for periods which are under audit or subject to
dispute or litigation must be retained until the audit, dispute or litigation, and any associated appeal
periods, have ended.
2. The Contractee will allow inspection of records and programs, insofar as is permitted by State and
Federal law, by representatives of the Contractor and its authorized agents, and Federal agencies, in
order to confirm the Contractee's compliance with the specifications of this Contract Agreement.
3. The Contractee agrees to retain and make available to the Contractor all program and fiscal records
in accordance with the retention period specified in paragraph 1 above. Upon the Contractor's
request, at the expiration of the Contract Agreement, the Contractee will transfer at no cost to the
Contractor, records regarding the individual recipients who received services from the Contractee
under this Agreement. The transfer of records includes transfer of any record, regardless of media, if
that is the only method under which records were maintained.
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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
The Contractee agrees to re- negotiate with the Contractor this Contract Agreement or any part
thereof in such circumstances as:
• Increased or decreased volume of services as required by the Contractor;
• Changes required by State and Federal law or regulations, or court action; or,
• Increase or reduction in the monies available affecting the substance of this Agreement.
Failure to agree to a re- negotiated Contract Agreement under these circumstances is cause for the
Contractor to terminate this Agreement.
2. This Contract Agreement can be terminated for any reason by a 30 -day written notice by either
party.
3. Revision of this Contract Agreement may be made by mutual agreement. The revision will be
effective only when the Contractor and Contractee attach an addendum or amendment to this
Agreement, which is signed by the authorized representatives of both parties, except in
circumstances in which increased caseload or grant award amount, where such increase in funds is
for the same purpose as originally agreed upon, the Agreement may be amended by a unilateral
amendment made by the Contractor.
4. The Contractee shall notify the Contractor whenever it is unable to provide the required quality or
quantity of services required. Upon such notification, the Contractor shall determine whether such
inability will require revision or termination of this Contract Agreement.
5. If the Contractor finds it necessary to terminate this Contract Agreement prior to the stated
expiration date for reason other than non - performance by the Contractee, payment by the Contractor
shall cease upon termination. Termination of the contract does not nullify the recoupment of funds
by the Contractor, per the negotiated Agreement, associated with failure to attain program objectives
or the failure to maintain quality criteria.
XVI. NON- COMPLIANCE, LIQUIDATED DAMAGES AND REMEDIAL MEASURES
If the Contractor determines, after notice to the Contractee and opportunity to respond, that the
Contractee:
Is out of compliance with the program quality criteria as listed in Exhibit I, the Contractor may
withhold part or all of the Contractee's funding at a level deemed appropriate by the Contractor as
defined in paragraph 3 below.
Has not attained the negotiated objective(s) as listed in Exhibit II, the Contractee shall refund the
amount designated in Exhibit II under Risk Profile. Recoupments will be collected during the
subsequent contract year via an adjustment (decrease) in the CARS monthly payment. In such case
where a Contractee is subject to recoupment and no longer holds a Contract Agreement with the
Contractor, the Contractor will issue an invoice to be paid by the Contractee.
The Contractor may also, at its sole discretion, effectuate such refunds by withholding money from future
payments due the Contractee at any time during or after the contract period or may recover such funds by
any other legal means.
2. Failure to comply with any part of this Contract Agreement may be considered cause for revision,
suspension or termination of this Agreement. Suspension includes withholding part or all of the
payments that otherwise would be paid the Contractee under this Agreement, temporarily having others
perform, and receive reimbursement for, the services to be provided under this Agreement and any other
Performance LHD w/o CARS Report 7/08 10
measure that suspends the Contractee's participation in the Agreement if the Contractor determines it is
necessary to protect the interests of the State.
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.
The Contractee shall provide within 30 days after the end of the contract period (or by the date specified
in Exhibit II) to the Contractor via the Contract Administrator, the documentation specified in Exhibit II
relating to attainment or failure to attain the objectives agreed to in this Contract Agreement. If any
objective is not attained, the Contractor will determine, at its sole discretion, the proportion of non -
attainment and will recoup from the Contractee an amount as defined by the Risk Profile identified in
Exhibit II. Any degree of non - attainment, as judged by the sole discretion of the Contractor, shall be used
by the Contractor in determining the conditions of any continuation of this Agreement.
If the Contractor determines that non - compliance with other requirements (not stated in Exhibit I or
Exhibit 11) in this Contract Agreement has occurred, or is occurring, it shall demand immediate
correction of continuing non - compliance and it may impose whatever liquidated damages or remedial
measures it deems necessary to protect the interests of the State. Such liquidated damages 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
If any dispute arises between the Contractor and Contractee under this Contract Agreement, including the
Contractor's finding of non - compliance and imposition of liquidated damages or remedial measures, the
following process will be the exclusive administrative review.
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.
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.
If the dispute is still not resolved, the Contractee may request a final review by the Secretary of the
Department of Health Services.
Performance LHD w/o CARS Report 7/08 11
XVIII. FINAL REPORT DATE
The due date of the final fiscal report shall be ninety (90) days after the Contract Agreement period
ending date.
Expenses incurred during the Contract Agreement period but reported later than ninety (90) days
after the period ending date will not be recognized, allowed or reimbursed under the terms of this
Grant Agreement.
XIX. 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.
XX. 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.
XXI. CONDITIONS OF THE PARTIES' OBLIGATIONS
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.
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.
XXII. SPECIAL PROVISIONS
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.
The Contractor may make these incentive awards at its discretion based on the amount of available
incentive funding and the terms of agreement with the Federal agency(s) as to the distribution of
such incentive funding. The awards will be made during the subsequent contract year via an
adjustment (increase) in the monthly CARS payment. In such case where a Contractee is eligible for
an incentive payment and no longer holds a contract agreement with the Contractor, the Contractor
will make a separate payment to the Contractee. The incentive funds must be expended by the
Contractee within the subsequent contract or calendar year and can not be diverted outside of the set
of programs defined by this Contract Agreement or used for supplanting purposes. The Contractee
shall report, in a manner specified by the Contractor, on how the Contractee expended these
incentive funds.
To the extent allowed by law:
All funding recouped by the Contractor from the Contractee shall be held by the Contractor
in a fund designated for use within the program area associated with the recoupment action.
These funds may be used to award other Contractees who have exceeded their objectives in
that program, general funding of the program area to all Contractees via formula in the next
Performance LHD w/o CARS Report 7/08 12
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.
If at the end of the contract year, the Contractee has attained its contract objectives and is in
compliance with the quality criteria, it may retain any unspent funds from this Contract Agreement
not expended during the contract year, except for unearned prepayments (advances). However, those
funds must be expended in the current contract year or the contract year immediately following and
their use must fall within the program boundaries established under this Agreement. These retained
funds cannot be diverted outside of the scope of this Agreement, the Local Public Health
Department's budget, or used to supplant local public health tax levy levels. These funds shall be
retained in a non - lapsing account for the sole use of the Local Public Health Department; these funds
may not lapse to the general fund. The Contractee shall report how these funds were utilized, as
specified in Section IX.
XXII. CONTRACT RENEWAL OPTIONS
This contract can be renewed on an annual basis for up to two (2) one -year extensions with the mutual
agreement of both the Contractor and Contractee. The objectives to be attained by program will be re-
negotiated each year by the Contractor and Contractee, as well as documentation deliverables and risk
conditions.
XXIII REQUIRED MATCH REPORTING
The Contractee agrees to report required Maternal and Child Health match on the DMT -855 form (CARS
Expenditure Report by Profile). The Contractee also agrees to use the Divison of Public Health electronic
Grants and Contracts (GAC) System to report required match. Match reports are due no later than ninety (90)
days past the end date of the contract period.
Profile 9193002- MCH General
Profile #193001 - MCH Reproductive Health (only)
Performance LHD w/o CARS Report 7/08 13
XXIV. TIMELY CONTRACT SIGNING
This Contract Agreement becomes null and void if the time between the earlier dated signature and the later
dated signature of the Contractee's and Contractor's Authorized Representative on this Agreement (or
addendum) exceeds sixty (60) days inclusive of the two signature dates.
CARS PAYMENT INFORMATION
Cont 's Authorized Representat' e
Date
"ark A RTlof City Ma a e
Oshkosh Health Department
' n
472894
Agency Type
rF) mela R.
Ubrig, City Clerk
January 1, 2009 through December 31, 2009
Contract Amount
Contractors Authorized Representative
Date
Thomas Sieger, Deputy Administrator
157720 Childhood Lead Amount $9,717
Division of Public Health, Department of Health Services
155020 Immunization Amount $15,071 _
Profile ID#
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
Oshkosh Health Department
Agency Number
472894
Agency Type
960
Contract Period
January 1, 2009 through December 31, 2009
Contract Amount
$63,608
Agency Fiscal Year January through December
Profile ID#
157720 Childhood Lead Amount $9,717
Profile ID#
155020 Immunization Amount $15,071 _
Profile ID#
159320 Maternal Child Health Amount $30,535
Profile ID#
159220 Prevention Amount $8,285
DPH Contract #
16626
CFDA #s:
Immunization
93.268
MCH
93.994
Prevention
93.994
Contract Agreement Addendum: Exhibit I
Program Quality Criteria
Generally high program quality criteria for the delivery of quality and cost - effective administration of
health care programs have been, and will continue to be, required in each public health program to be
operated under the terms of this contract.
This Exhibit contains only applicable quality criteria for this contract.
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
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
(Environmental Health), WI Administrative Rule HFS 181 (Reporting of Blood Lead Test Results), WI
Administrative Rule HFS 163 (Certification for the Identification, Removal and Reduction of Lead -Based
Paint Hazards), 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 to one or more target audiences within the community about lead
hazards, lead hazard reduction methods, primary prevention of lead poisoning, and blood lead testing 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 their activities with, or services
to, families living in pre -1978 housing.
B) Contractees must provide information, consultation and technical assistance to health care providers or
other programs to assure that treatment of children with lead poisoning is efficient and effective, and to
assure that lead -safe environments are available to children with lead poisoning.
C) If the Contractee serves a community receiving HUD Community Development Block Grant (CDBG)
funds, in order to accept the additional lead program formula allocation, it must establish and maintain a
relationship with the local housing agency that distributes the CDBG funds in order to increase the
12/03/2008 10:50 AIM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
availability of lead -safe housing within the community.
6) A referral network sufficient to assure the accessibility and timely provision of services to address identified public
health care needs.
A) Contractees must assess the need for, and provide referrals for, supportive services 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 have access to, are
knowledgeable of, and in compliance with the Wisconsin Childhood Lead
Poisoning Prevention & Control Handbook for Local Health Departments, the Wisconsin Blood Lead
Screening Guidelines, Managing Elevated Blood Lead Levels Among Young Children (CDC, 2002), state
statutes, administrative rules, and/or local ordinances.
8) Financial management practices sufficient to assure accurate eligibility determination, appropriate use of state and
federal funds, prompt and accurate billing and payment for services provided and purchased, accurate expenditure
reporting, and, when required, pursuit of third -party insurance and Medical Assistance Program coverage of services
provided.
A) Contractees must pursue third party payment and/or other funding sources for service provision to children
who are eligible for third party payment, except when doing so is demonstrated 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 the adequacy of blood lead testing
for children enrolled in WIC, timely follow -up of lead poisoned children, timely completion of lead hazard
reduction work, and community lead poisoning prevention education.
B) Contractee must submit the following forms and documents to the Wisconsin Childhood Lead Poisoning
Prevention Program by the specified deadlines as stated in the WCLPPP Handbook. These forms are
available on the Lead -Safe Wisconsin website, at: www.dhfs.wi.gov /lead.
a) Nursing Case Management Report (DPH 4771 A)
Nursing Closure Report (DPH 4771B)
Property Investigation Report (DPH 4771 C)
Property Investigation Closure Report (DPH 4771D)
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Program: Immunization
Program Quality Criteria
1) Assessment and surveillance of public health to identify community needs and to support systematic, competent program
planning and sound policy development with activities focused at both the individual and community levels.
A) Contractees must assure reported vaccine preventable diseases (VPD) are investigated and controlled as
detailed in the most current edition Wisconsin Disease Surveillance Manual (EPINET). Immunization
programs should maintain regular contact with local required reporters of VPDs to encourage and assure
prompt reporting. Contractees should solicit the help of the Immunization Program when needed to help
assure that an adequate system is in place to report and investigate vaccine preventable disease (VPD).
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
population -based 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 least bi- monthly as required by the Wisconsin "Policies and Procedures Manual for
Immunization Programs ".
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.
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
5) Coordination with related programs to assure that identified public health needs are addressed in a comprehensive, cost-
effective manner across programs and throughout the community.
A) Contractees must coordinate immunization services with local child healthcare (service) providers: e.g.,
WIC projects, Medical Assistance programs, and other local public health programs to assess the
immunization status of, refer, and provide immunization services to under - immunized children.
6) A referral network sufficient to assure the accessibility and timely provision of services to address identified public
health care needs.
A) Contractees must develop relationships among public and private healthcare providers to facilitate access
by children and families to immunization services. Contractees should work with these providers to assure
that current immunization guidelines are followed.
These relationships should also be used to promote the prompt reporting of suspect vaccine preventable
diseases, and the use of the WIR or a registry capable of interfacing with the WIR. As follows in
paragraphs B and C:
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. If no 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 staff through program and policy manuals and other means sufficient to assure quality health
care and cost - effective program administration.
A) Contractees will ensure program staff is competent in current immunization program policy and 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; as well as
Immunization Policy Memos issues periodically from the Immunization Program and posted on the Health
Alert Network (HAN). 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.
A) Billing for payment of childhood immunization services is not required under this section.
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
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
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.
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.
C) LHDs and Tribes will assure staff competence with the WIR system. LHD and Tribal staff must attend at
least one of the 2 or more annual Regional WIR User Group Meetings. Attendance at these meetings is
necessary for staff to maintain a thorough working knowledge of the functionality of the WIR.
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Program: Maternal and Child Health Block Grant
Program Quality Criteria
1) Assessment and surveillance of public health to identify community needs and to support systematic, competent program
planning and sound policy development with activities focused at both the individual and community levels.
A) Contractees must include a maternal and child health needs assessment at least every five years as required
by Title V of the Social Security Act, in their community needs assessment process.
2) Delivery of public health services to citizens by qualified health professionals in a manner that is family centered,
culturally competent, and consistent with the best practices; and delivery of public health programs for communities for
the improvement of health status.
A) Contractees must assure that maternal and child health services are delivered and supervised by qualified
staff as required by the activity or service being delivered.
B) Contractees must designate a staff person as the maternal and child health contact to receive, disseminate,
and respond to policy and program information provided by the State.
C) Contractees must designate a staff person as the children and youth with special health care needs contact
to receive and disseminate policy and program information provided by the State and Regional CYSHCN
Centers.
D) The Contractee must assure quality by utilizing one or more of the following documents as guidance in the
organization and delivery of services: 1) Wisconsin Medicaid Prenatal Care Coordination Services
Handbook and related Medicaid Updates, 2) Family Planning Reproductive Health Standards of Practice,
3) Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents, Third 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
public health department (LPHD) wants to use an alternate, but comparable document, the State of
Wisconsin Maternal and Child Health Program must approve it.
E) Contractees must integrate the MCH Five Guiding Principles in MCH programs, services and systems: 1)
Family- Centered Care, 2) Cultural Competence, 3) Community-wide Leadership, 4) Health Promotion and
Resiliency, and 5) Outreach and Needs Assessment.
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 22 years old, including children and youth with special health care needs and
their families in the maternal and child health population.
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
B) All materials for public distribution developed by a Contractee with Title V MCH Block Grant funds must
identify the funding source on the publication as follows: "Funded in part by the MCH Title V Services
Block Grant, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S.
Department of Health and Human Services."
5) Coordination with related programs to assure that identified public health needs are addressed in a comprehensive, cost-
effective manner across programs and throughout the community.
A) Contractees must have a mechanism in place to assure coordination with the Regional CYSHCN Centers.
B) Contractees must coordinate maternal and child health programs with other community health programs.
6) A referral network sufficient to assure the accessibility and timely provision of services to address identified public
health care needs.
A) LPHDs that provide maternal and child health prevention and intervention services must have a referral
network. Referral networks may include: healthcare providers including mental health and oral health,
Regional CYSHCN Centers, child care centers, WIC, human or social services, schools, Birth to 3
programs, tribal agencies 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 third -party insurance and Medical Assistance Program coverage of services
provided.
A) Contractees must seek other available funding sources, as Title V MCH Block Grant is payer of last resort.
B) Contractees must bill the Wisconsin Medical Assistance (Medicaid) 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 and report through GAC and CARS system as described in the contract.
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 using
SPHERE (Secure Public Health Electronic Record Environment) as defined within the objective's Data
Source for Measurement.
B) Contractees will comply with year -end program reporting requirements set by the State of Wisconsin MCH
Program including documentation of 75% match ($0.75 local contribution for every $1.00 federal) and
report through GAC and CARS system as described in the contract.
C) An agency narrative as defined by MCH end -of -year reporting requirements must be submitted by each
agency receiving MCH /Title V funding including MCH, CYSHCN, EIDP -LHD, and FP /RH. This agency
report will assist in demonstrating the comprehensiveness of the MCH work (both funded and unfunded
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
by these dollars) being done by agencies across the state.
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Program: Preventive Health and Health Services Block Grant
Program Quality Criteria
1) Assessment and surveillance of public health to identify community needs and to support systematic, competent program
planning and sound policy development with activities focused at both the individual and community levels.
A) Involvement of key policymakers and the general public in the development of comprehensive public
health plans.
B) Development and implementation of a plan to address issues related to access to high priority public health
services for every member of the community.
2) Delivery of public health services to citizens by qualified health professionals in a manner that is family centered,
culturally competent, and consistent with the best practices; and delivery of public health programs for communities for
the improvement of health status.
A) There are no separate sub - criterion to this Quality Criteria Category.
3) Record keeping for individual focused services that assures documentation and tracking of client health care needs,
response to known health care problems on a timely basis, and confidentiality of client information.
A) There are no separate sub - criterion to this Quality Criteria Category.
4) Information, education, and outreach programs intended to address known health risks in the general and certain target
populations to encourage appropriate decision making by those at risk and to affect policy and environmental changes at
the community level.
A) Provision of public information and education, and /or outreach activities focused on high -risk populations
that increase awareness of disease risks, environmental health risks, and appropriate preventive activities.
B) All materials produced with PHHS Block Grant funds must include the following statement: "This
publication was made possible by the PHHS Block Grant from the Centers for Disease Control."
5) Coordination with related programs to assure that identified public health needs are addressed in a comprehensive, cost-
effective manner across programs and throughout the community.
A) There are no separate sub - criterion to this Quality Criteria Category.
6) A referral network sufficient to assure the accessibility and timely provision of services to address identified public
health care needs.
A) There are no separate sub - criterion to this Quality Criteria Category.
7) Provision of guidance to staff through program and policy manuals and other means sufficient to assure quality health
care and cost - effective program administration.
A) Provision of written policy and program information about the current guidelines, standards, and
recommendations for community and/or clinical preventive care.
8) Financial management practices sufficient to assure accurate eligibility determination, appropriate use of state and
federal funds, prompt and accurate billing and payment for services provided and purchased, accurate expenditure
reporting, and, when required, pursuit of third -party insurance and Medical Assistance Program coverage of services
provided.
A) Program - specific data collection, analysis, and reporting to assure program outcome goals are met or to
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
identify program management problems that need to be addressed.
9) Data collection, analysis, and reporting to assure program outcome goals are met or to identify program management
problems that need to be addressed:
A) There are no separate sub - criterion to this Quality Criteria Category
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II
Program Objectives
(A) Contract Funds, Program/Objective Values, and Other Contract Details
(B) Objective Details
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(A)
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Contract Match Requirements
Program Amount
Childhood Lead $0
Immunization $0
MCH $22,901
Prevention $0
Contract Source of Funds
Source
Program
Amount
Oshkosh
Childhood Lead - Consolidated
$9,717
Oshkosh
Immunization - Consolidated IAP
$15,071
Oshkosh
Maternal Child Health - Consolidated
$30,535
Oshkosh
Prevention - Consolidated
$8,285
Contract Amount
$63,608
Contract Match Requirements
Program Amount
Childhood Lead $0
Immunization $0
MCH $22,901
Prevention $0
12/03/2008 10:50 AM DPH Grants and Contracts
Program Sub - Contracts
Program
Sub- Contractee
Sub - Contract Amount
Childhood Lead
None Reported
$0
Immunization
None Reported
$0
MCH
None Reported
$0
Prevention
None Reported
$0
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(A)
Contract #: 16626 Agency: Oshkosh Health Department
Contract Year: 2009
Childhood Lead Program Total Value $9,717
1 Environmental Lead Hazard Investigation at a Blood Lead Level of 10mcg /dL or greater Objective:
$9,717
By December 31, 2009, 11 environmental lead hazard investigations will be completed on the primary residences
and pertinent secondary properties of children with venous blood lead levels greater than or equal to 10
micrograms per deciliter who reside in (The City of Oshkosh.
Immunization Program Total Value $15,071
1 By December 31, 2009, 79% of children residing in the City of Oshkosh jurisdiction, who turn 24 months of age
$15,071
during the contract year will complete 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hepatitis B and 1 Varicella vaccination
by their second birthday.
MCH Program Total Value $30,535
1 By December 31, 2009, outcome measures will be evaluated on all children ages birth through seven years from
$6,250
The City of Oshkosh who are properly positioned in a child safety seat as demonstrated by their parent or
caregiver.
2 By December 31, 2009, 40 residences located within City of Oshkosh with children ages birth to 4 years will have
$14,285
a documented decrease in hazards previously identified through home safety assessments.
3 By December 31, 2009, 3 strategies to create environments that support and promote healthy eating, daily
$10,000
physical activity and a healthy weight for school aged children and their families, will be implemented by the City
of Oshkosh Health Division /Best For Kids Partnership.
Prevention Program Total Value $8,285
1 By December 31, 2009, two strategies to prevent or ameliorate environmental health hazards through household
$5,285
drug collection events will be implemented by the The Oshkosh Health Department(s) in collaboration with
community partners.
2 By December 31, 2009, outcomes of injury prevention focused strategy(ies) for children aged 4 -7 and their
$3,000
families, will be reported by the Oshkosh Health Department in collaboration with community partners.
Total of Contract Objective Values
$63,608
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Program: Childhood Lead Poisoning Prevention Objective #: 1 of 1 Objective Value: $9,717
Objective: Primary Details
Objective Statement
Environmental Lead Hazard Investigation at a Blood Lead Level of l0mcg/dL or greater Objective:
By December 31, 2009, 11 environmental lead hazard investigations will be completed on the primary residences and pertinent
secondary properties of children with venous blood lead levels greater than or equal to 10 micrograms per deciliter who reside in
(The City of Oshkosh.
Deliverable Due Date: 01/31/2010
Contract Deliverable (Evidence)
A report to document: 1) the number of children with a blood lead level greater than or equal to 10 micrograms per deciliter; and 2)
the number of associated environmental lead hazard investigations that were completed. 3) A report of the number of children with
lead levels of 8 or 9mcg/dl and how many agree to investigations.
Programs Providing Funds for this Objective
Childhood Lead Poisoning Prevention: $9,717
Agency Funds for this Objective:
Data Source for Measurement
An agency - generated report.
Baseline for Measurement
In 2007 13 lead investigations occured. Currently for 2008, our number of investigations has dropped to 4. It is impossible to
predict how many elevations we may encounter for 2009.
Context
Acceptable value for this objective is up to $800 per environmental lead hazard investigation. The most important factor in
managing childhood lead poisoning is reducing the child's exposure to lead. CDC recommends that public health agencies
investigate the child's primary residence and secondary properties, e.g., a child care facility, to identify and reduce the lead hazards
to prevent further exposure and reduce the child's blood lead level (Managing Elevated Blood Lead levels Among Young Children,
CDC, March 2002). When notified that a child has a blood lead level of l0mcg/dL or greater, the public health agency will conduct
an environmental lead hazard investigation using the procedure outlined in Chapter 9 of the'Wisconsin Childhood Lead Poisoning
Prevention & Control Handbook (2002).' An environmental lead hazard investigation includes a risk assessment of the property,
issuance of work orders to address the identified lead hazards, and a clearance report indicating that the hazards have been
controlled. The amount of money used for this objective is currently over the alloted $800 per visit. However, our program is
currently looking at an increase in expenses through increases in payroll and milage. We would also like to offer an investigation
for families with children that have lead levels of 8mcg /dl or 9mcg /dl and keep records regarding how many of these families agree.
Input Activities
None required.
Objective: Risk Profile
Percent of Objective Accomplished
Corresponding Percentage Recoupment
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Program: Immunization Objective #: 1 of 1 Objective Value: $15,071
Objective: Primary Details
Objective Statement
By December 31, 2009, 79% of children residing in the City of Oshkosh jurisdiction, who turn 24 months of age during the contract
year will complete 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hepatitis B and 1 Varicella vaccination by their second birthday.
Deliverable Due Date: 01/31/2010
Contract Deliverable (Evidence)
A Wisconsin Immunization Registry (WIR) generated population based standard benchmark report documenting the number of
children in City of Oshkosh jurisdiction who turned 24 months of age in 2009. Reports should be run with a 45 day buffer to ensure
that all updated data has been received by the WIR. Include a report of the accountability targets and the progress achieved
including the activities and interventions conducted, and list the barriers that may have been identified if this objective was not met.
Programs Providing Funds for this Objective
hmmunization: $15,071
Agency Funds for this Objective:
Data Source for Measurement
Wisconsin Immunization Registry Records.
Baseline for Measurement
The 2007 end of year population based standard benchmark report will be used to determine the baseline for the 2009 population
based objective. For the baseline the following parameters will be used to run the benchmark report (see attachment of WIR
Benchmark Report for correct report options to select children 24 months of age for 4:3:1:3:3:1 vaccinations):
* Birthdate Range: 01/01/2005 through 12/31/1005
* Evaluation Date: 01/01/2008
Run Date: 02/15/2008 Baseline measurement of 76 %, per report noted from DHS Contract Administrator.
Context
Children will be assessed for having 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hepatitis B and 1 Varicella vaccination by 24 months of
age. Progress towards reaching 90% will be measured using a WIR Benchmark report. Only children who have moved out of the
agency's jurisdiction may be removed from the cohort for analysis. Accountability targets are strongly recommended for all
agencies. Accountability targets must be at or above the Quality Criteria standards. It is encouraged to consult with the
Immunization Program advisor.
Guidelines for determining increase needed for progress towards 2010 goals:
If Current baseline is, then % Increase in baseline required:
* <50 %, 10% Above Baseline
* 50 - 59 %, 5% Above Baseline
* 60 - 69%,4% Above Baseline
70 - 79 %, 3% Above Baseline
* 80 - 85 %, 2% Above Baseline
* 86 - 89 %, 1% Above Baseline
* > 90 %, Maintain
Agencies should consult with their Regional Immunization Program Advisor for assistance in determining activities and
interventions that will help them achieve the required increase for their population assessment.
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 16626
Program: Immunization
Agency: Oshkosh Health Department Contract Year: 2009
Objective #: I of 1 Objective Value: $15,071
Input Activities
Access to primary and preventive health services is one of the priorities identified in Wisconsin's State Health Plan, 'Healthiest
People 2010: A Partnership Plan to Improve the Health of the Public.'
Agencies are expected to follow children through completion of on -time primary immunizations. Agency activities shall include
monitoring for receipt of all recommended childhood vaccines. Please do not change an address for a client unless you have the
correct current address.
In addition, through this objective LHD's will work to address the 'Healthy People 2010: 14 -26' goal to "Increase the proportion of
children who participate in fully operational population -based Immunization registries" by identifying local gaps in WIR coverage.
The Wisconsin Immunization Program recommends a minimum of 3 attempts to personally contact a responsible party.
Reminder /recall activity is not listed in a particular order and we suggest you use the method that is the most successful for your
community:
* Contacting parents of infants without immunization histories,
* Reminder /recall,
* Follow -up interventions to complete series,
* Tracking,
* Sharing information with area physicians,
* Requesting that information is entered into the WIR,
* Coordination of immunization services with other LHD programs.
Additional interventions /activities are in an addendum to the Immunization Program Boundary Statement. These are suggested
interventions /activities that LHD's may want to consider in order to achieve this objective.
These activities are addressed in the boundary statement: "...The local health department will assure the development and
maintenance of a community-wide immunization infrastructure necessary to raise immunization levels and prevent vaccine
preventable diseases such as diphtheria, tetanus, ...and hepatitis B."
Objective: Risk Profile
Percent of Objective Accomplished
ding Percentage Recoupment
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Program: Maternal and Child Health Block Grant Objective #: 1 of 3 Objective Value: $6,250
Objective: Primary Details
Objective Statement
By December 31, 2009, outcome measures will be evaluated on all children ages birth through seven years from The City of
Oshkosh who are properly positioned in a child safety seat as demonstrated by their parent or caregiver.
Deliverable Due Date: 01/31/2010
Contract Deliverable (Evidence)
A SPHERE report and an analysis of data collected in SPHERE as defined within the Data Source for Measurement and narrative
report to document: 1) the number of children ages birth through seven years from The City of Oshkosh who were properly
positioned in a child car passenger seat system by their parents or other caregivers; and 2) number of expecting parents who receive
instruction on proper installation of child safety seat.
Programs Providing Funds for this Objective
Maternal and Child Health Block Grant: $6,250
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:
Intervention: Screening, Sub - Intervention: Child Passenger Safety Seat (child) and Child Passenger Safety Seat (pregnant woman).
If using the SafeKids form, the agency must also collect and report additional MCH Program required data; that is, the birth date
and race of the child and health care coverage information.
Baseline for Measurement
The 2008 contract objective was to assure that 60 children within the City of Oshkosh were properly fitted. We are on target to
reach this objective. These numbers do not reflect the number of pregnant women and fathers to be who we have assisted in
assuring that their carseats are ready for their new baby at birth.
Context
This objective is a continuation of a multi - departmental group that works together to meet the needs of families throughout the Fox
Valley (Winnebago County) area. We will continue to work with these departments and continue working with the Winnebago
County WIC program to especially identify low income families that may need to obtain low cost car seats. These families are
given the opportunity to purchase carseats at the "at cost" level rather than retail cost. We also do community events that are
available to the general population as statistics show that income level does not necessarily assure that the seat installation is
correct.
During the contract, it is estimated that at least 50 children will be properly positioned in a child safety seat as demonstrated by their
parent or caregiver. Acceptable value range for this objective is $50 -$125 per child. All MCH quality criteria apply to this
objective.
This objective is for local health department programs that provide designated individual assessment, installation and instruction
services on child passenger safety to families with one or more children in the selected age group. Expecting parents who receive
instruction on child passenger safety seat installation should be encouraged to return with the baby after the baby is born to
document proper positioning. In SPHERE there is a Child Passenger Safety Seat screen (pregnant woman) where you can document
the instruction provided prior to birth. The new child safety seat law requires that children must be in a car seat until they reach the
age of four years and in a booster seat until they reach the age of eight years.
Input Activities
Our group which includes The City of Oshkosh Health, Winnebago Health, City of Neenah Health, City of Menasha Health, Safe
Kids Fox Valley, and Winnebago WIC will continue to hold two scheduled car seat events monthly. Also, we will participate in
community events within Winnebago County. Currently we have 3 NHTSA Certified Seat Technicians on staff and one Senior
Checker.
Objective: Risk Profile
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Program: Maternal and Child Health Block Grant Objective #: 1 of 3 Objective Value: $6,250
Percent of Objective Accomplished
0% 10% 1 20% 30% 1 40% 1 50% 1 60% 70% 1 80% 1 85% 1 90% 1 95% 1 100%
Corresponding Percentage Recoupment
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
12/0312008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Program: Maternal and Child Health Block Grant Objective #: 2 of 3 Objective Value: $14,285
Objective: Primary Details
Objective Statement
By December 31, 2009, 40 residences located within 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: 01/31/2010
Contract Deliverable (Evidence)
A SPHERE report and an analysis of data collected in SPHERE as defined within the Data Source for Measurement and narrative
report to document: 1) the number of residence (household) assessed using the home safety assessment tool and 2) the number and
types of corrections made for hazards identified through home safety assessments per residence (household).
Programs Providing Funds for this Objective
Maternal and Child Health Block Grant: $14,285
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:
Intervention: Screening, Sub - Intervention: Home Safety Assessment (all appropriate fields); Intervention: Health Teaching, Sub -
Intervention: Topics relevant to services provided under this objective and Results; Intervention: Referral and Follow -up, Sub -
Intervention: Type /place(s) and outcome(s).
Baseline for Measurement
32 homes have been assessed as of October 31,2008.
Context
Acceptable value range for this objective is $125 -$250 for one annual assessment per household. Additional funds may be used to
purchase safety items to correct hazards, but detail must be provided in input activities to justify this cost. All questions in the Home
Safety Assessment must be answered to count toward the total number of households completed. All MCH Quality Criteria apply
to this objective.
The Home Safety Assessment screen is available in SPHERE. For ease of use, the assessment is available in a PDF printable form
that can be filled out during the visit. The Home Safety Assessment was developed by representatives from local health departments
and staff within the state MCH program and is based on national as well as international research.
Input Activities
[Describe the health department's plan to assure family has information to correct areas of concern, what support or products may
be available from health department staff to assist the family, and the follow up provided for each household assessed to determine
what hazards are corrected. Specify the staff who will provide the home safety assessment; for example, Public Health Nurse,
Public Health Educator, or trained volunteer. If you have a community partner who will provide correction materials, please
identify them, or state if you will use MCH funds to purchase correction materials. ]
These listed activities are required but are not intended to be all encompassing. Additional activities can be described. The Grant
Registered Nurse will provide the service of visiting and assessing the individual homes. Every visit is followed by a re -visit to
meet with the family and look at safety changes that were made in the home. The Sphere Home Safety Assessment Guide is used as
the assessment tool to assess each home environment.Additional hours are spent with the promotion of The Home Safety Program
by sending out brochures to all new families, speaking at the Affinity Mom's Group, Head Start, and at a Grandparents Group. Also
brochures are taken to community offices and private providers offices. A large assortment of child - proofing products are purchased
through the MCH grant to assist families in need to child proof their homes. Baby gates and smoke alarms are a great need in the
community and are furnished and set -up per the Grant Nurse. Approximate time spent with each family is 8 -10 hours. Conferences
are also attended for education and training on injury prevention.
Objective: Risk Profile
Percent of Objective Accomplished
0% 1 10% 1 20% 30% 1 40% 1 50% 1 60% 1 70% 1 80% 1 85% 1 90% 1 95% 100%
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Program: Maternal and Child Health Block Grant Objective #: 2 of 3 Objective Value: $14,285
Corresponding Percentage Recoupment
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Program: Maternal and Child Health Block Grant Objective #: 3 of 3 Objective Value: $10,000
Objective: Primary Details
Objective Statement
By December 31, 2009, 3 strategies to create environments that support and promote healthy eating, daily physical activity and a
healthy weight for school aged children and their families, will be implemented by the City of Oshkosh Health Division/Best For
Kids Partnership.
Deliverable Due Date: 01/31/2010
Contract Deliverable (Evidence)
A SPHERE report and an analysis of data collected in SPHERE as defined within the Data Source for Measurement to document:
The Best For Kids partnership will focus on providing hands on activities, demonstrations and educational learning times and
activities for primarily school aged children, focusing on ages 4 -12 years old; families and younger children will also receive
educational materials and have the opportunity to learn about nutrion, exercise and healthy choices, through educational
materials,scheduled events and mailings.
Programs Providing Funds for this Objective
Maternal and Child Health Block Grant: $10,000
Agency Funds for this Objective:
Data Source for Measurement
SPHERE System Report to include data from the following screens: System Activity (all appropriate fields including the population
focus or jurisdiction and strategies /outcomes documented in the Results /Outcome field) and appropriate Intervention(s): Coalition
Building, Community Organizing, Collaboration, or Policy Development, Sub - Intervention: healthy eating, weight and physical
activity.
Baseline for Measurement
Grant Nurse organized and formed a partnership focused on implementing healthy changes for children. Health and Safety Expo
Event was coordinated and the First Year of event attracted 560 families, with children aged 2 -12 years old participating in
children's healthy activities.
Context
Acceptable value range for this objective is up to $3,000 per strategy. All MCH Quality Criteria apply to this objective. The Grant
Nurse from the City of Oshkosh will be promoting the growth of our partnership and working on goals with the group.The
partnership will focus on health and safety of children and families, by increasing awareness of healthy choices, providing access to
healthy foods, and increasing opportunities for physical activity through the implementation of environmental changes. the City of
Oshkosh Grant Nurse and partnership will focus on establishing these changes at the yearly Health and Safety Expo Event, and at
the Oshkosh schools and/or After School Programs.
Chosen strategies must support the implementation of the Wisconsin Nutrition and Physical Activity State Plan, which provides a
framework to address obesity, improve nutrition and increase physical activity. The Plan serves as a guide for all partners who are
planning and implementing initiatives for the prevention and management of obesity. The strategies are primarily evidence -based
or promising strategies and will impact the related health priority areas of Healthiest Wisconsin 2010: Adequate and Appropriate
Nutrition; Overweight, Obesity and Lack of Physical Activity. Additionally, at -risk of overweight and overweight is a state and
national MCH performance measure. For more information and the Nutrition and Physical Activity State Plan and evidence -based
strategies go to: http: // dhfs. wisconsin. gov / health /physicalactivity /index.htm.
Allowable focus areas include:
* Implementation of goal(s) or objectives detailed in the local nutrition and physical activity coalitions strategic /action plan.
* Increase opportunities for physical activity through the implementation of environmental and/or policy change strategies based on
the results of community audits /assessments. Examples include Safe Routes to Schools, Active Community Environments, and
Complete the Streets.
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Program: Maternal and Child Health Block Grant Objective #: 3 of 3 Objective Value: $10,000
* Increase access to fruits and vegetables or healthy foods and beverages through the implementation of environmental and/or policy
change strategies based on community audits /assessments. Examples include Fruit and Vegetable Audit Tool and Nutrition
Environment Measures Survey (NEMS).
* Establishment of childcare, school or community gardens through the Got Dirt? Garden Initiative.
* Assist schools in meeting the criteria for the Governor's School Health Award.
* Assist pre- school and /or childcare centers in implementing the "Color Me Healthy" program on physical activity and healthy
eating.
All strategies chosen as part of this objective must include a policy and/or environmental change component. Educational activities,
events or campaigns alone are not acceptable for this objective.
The Nutrition and Physical Activity Program is available to provide technical assistance for choosing and implementing evidence -
based obesity prevention strategies. The Program also has various assessment tools, resource kits, evidence -based strategy
summaries and curriculum available.
1 nput Activities
[Include a brief description of the focus area chosen and clearly identify the strategies that will be implemented. Complete a brief
online survey on the policy and environmental changes made during the contract year. The information will be used measure
progress on the Wisconsin Nutrition and Physical Activity State Plan.]
These listed activities are required but are not intended to be all encompassing. Additional activities can be described. A
partnership has been formed and we will approach other community businesses /agencies to come on board and join with us in
promoting healthy behavior changes. The first strategy will be setting up goals for this year. We will be assessing and planning
goals for this year, looking at evaluating previous year and progressing forward. We also will be making our partnership stonger by
getting marketing materials to promote our mission and have uniformity. A second strategy will be to outreach to the schools and
school systems to provide education, demonstrations and activities promoting healthy lifestyles, exercise, nutritional information ,
and assist in preparing healthy snacks, either at an after school program or during a health/fitness class. A third strategy is to again
be on the steering committee and coordinate and plan our yearly Health and Safety Expo Event to be held in the month of October.
We plan the childrens activity area, which promotes exercise and participation in demonstrations that work on making a healthy
snack. We also provide education to children and families, along with giving out education materials. We evaluate each child
participating by asking them questions relating to nutrition and the activity that they are performing. We are looking for a behavior
change and making better cchoices for their health and safety. This is a day long event with the focus of providing safety tips of all
areas, and education on health.
Objective: Risk Profile
Percent of Objective Acco
Corresponding
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Program: Preventive Health and Health Services Objective #: 1 of 2 Objective Value: $5,285
Block Grant
Objective: Primary Details
Objective Statement
By December 31, 2009, two strategies to prevent or ameliorate environmental health hazards through household drug collection
events will be implemented by the The Oshkosh Health Department(s) in collaboration with community partners.
Deliverable Due Date: 01/31/2010
Contract Deliverable (Evidence)
DELIVERABLE DUE DATE: 01/15/2010.
An Agency Report to document: environmental health hazard prevention or remediation strategies implemented and the outcomes,
the population focus, number of individuals affected by the initiative, and identification of the community partners.
Programs Providing Funds for this Objective
Preventive Health and Health Services Block Grant: $5,285
Agency Funds for this Objective:
Data Source for Measurement
Use of questionnaire and poundage reports from the company responsible for disposal,
Baseline for Measurement
The spring event held in Oshkosh this 2008 grant cycle was very successful, We collected over 900 pounds of medications as well
as over 11,000 units of controlled substances and 4 pounds of mercury. All of these substances were not disposed of improperly
thus possibly leading to contamination of our local environment. Current numbers of our Fall event have not been tabulated as yet.
Context
The City of Oshkosh Health Division has participated in household drug collection events for the last several years. This has been
done in collaboration with the Winnebago County Health Department, The Winnebago County Solid Waste Department, the
Winnebago County Sheriffs Department and private pharmacies. These events have been very successful and we would like to
continue to offer this to the community until a more permanent solution to the disposal problem is in place
Input Activities
Oshkosh Health Division will again participate in a household drug collection event in collaboration with the above named partners.
This will be done at least twice during the year and will be advertised in the local papers, websites, and local newsletters. A
questionnaire will be given to identify the locale of the participant, their age range and the estimated amount of medication they are
bringing.
Objective: Risk Profile
Percent of Objective Acco
Cor
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
12/03/2008 10:50 AM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract #: 16626 Agency: Oshkosh Health Department Contract Year: 2009
Program: Preventive Health and Health Services Objective #: 2 of 2 Objective Value: $3,000
Block Grant
Objective: Primary Details
Objective Statement
By December 31, 2009, outcomes of injury prevention focused strategy(ies) for children aged 4 -7 and their families, will be
reported by the Oshkosh Health Department in collaboration with community partners.
Deliverable Due Date: 01/31/2010
Contract Deliverable (Evidence)
DELIVERABLE DUE DATE: 01/15/2010.
An Agency Report, or SPHERE report, to document: injury prevention strategies implemented and the outcome(s), the population
focus, number of individuals affected by the initiative, and identification of the community partners.
Programs Providing Funds for this Objective
Preventive Health and Health Services Block Grant: $3,000
Agency Funds for this Objective:
Data Source for Measurement
Health Department records.
Baseline for Measurement
250 children attended and participated in Safety City in 2008. Safety City received recognition for this event.
Context
The City of Oshkosh Health Division is involved with a program that focuses on injury prevention. The city will provide safety
education; regarding bike and pedestrian safety, poison safety, fire safety, etc. along with other city partners, during a 5 -7 week
Safety City event during the summer. Safety City targets children and their caregivers and families.
Input Activities
The Grant Nurse is involved with Safety City along with many other partners /sponsors as the Police Department, Fire Department,
etc. to provide all aspects of teaching and promoting safety to our families with young children. We provide many opportunities of
learning and activities to educate the children about being safe in their environment. Demonstrations and interaction with the
children and caregivers is provided;movies on safety topics are shown, educational worksheets and color sheets are given out to
practice on, also a pre- and post test is used for evaluation.
Objective: Risk Profile
Percent of Objective
Corr
Corresponding Potential Recoupment Amounts
Definition of Percent
Conditions of Eligibility for'an Incentive
12/0312008 10:50 AM DPH Grants and Contracts