HomeMy WebLinkAboutDivision of Public Health/DPH Contract @17935 DIVISION OF PUBLIC HEALTH
CONTRACT AGREEMENT
DPH CONTRACT#17395
Contract Preamble
This Contract Agreement is entered into for the period January 1,2010 through December 31,2010,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 1130,Oshkosh, WI 54902-1130,hereinafter referred to as Contractee.
The Contractee address above is the address to which payments shall be mailed. If any legal notices required to be
sent to the Contractee in the execution of this Contract Agreement should be sent to an address different from the
Contractee address noted above,that address should be provided below:
Whereas,the Contractor wishes to purchase services from the Contractee as it is authorized to do by Wisconsin law;
and whereas,the Contractee is engaged in furnishing the desired services;now,therefore,the Contractor and the
Contractee agree as follows:
I. SERVICES TO BE PROVIDED
The Contractee agrees to provide services consistent with the purposes and conditions of the objectives that it
has agreed to attain within the contract period.A detailed description of the objectives to be attained and the
documentation associated with that attainment is part of this Contract Agreement as listed in Exhibits I and II,
which are attached to this Agreement. The Contractee also agrees to provide to the Contractor documentation
(as agreed to in negotiations with the Contractor)of the attainment of those objectives no later than 30 days
after the end of the contract period or as specified in Exhibit II.
II. CONTRACT ADMINISTRATION
The Contractor's Contract Administrator is Susan Nelson,of the Division of Public Health,whose principal
business address is 200 North Jefferson Street, Suite 511,Green Bay,WI 54301. The telephone number of
the Contractor's Contract Administrator is(920)448-5231. 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 Mark Ziemer,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)232-5302. 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$68,529. This amount is contingent upon receipt of sufficient funds by
the Contractor.
The Contractor will not make payments in excess of the Contract Agreement amounts,with the exception of
performance-based incentive funds pursuant to Section XXI.
Performance LHD w/o CARS Report 6/09
IV. PAYMENT PROCESS
A. 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.
B. 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
A. The Contractee shall comply with the program reporting requirements of the Contractor as specified
during the negotiation process and as stated in Exhibits I and II of this Contract Agreement. The required
reports shall be forwarded to the Contractor's Contract Administrator according to the schedule as specified
in Exhibits I and II.
B. 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
A. The Contractee agrees to meet State and Federal laws,rules and regulations,and program policies
applicable to this Contract Agreement.
B. 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.
C. Affirmative Action Plan
1. 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.
2. 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-3021 P(R06/96)s. 16765, Wis. Stats.),page 2. Universities,other
states,and local governments, except those of the State of Wisconsin who receive state or federal
contracts over$25,000,must submit Affirmative Action Plans in the same manner as other
Contractees.
Performance LHD w/o CARS Report 6/09 2
3. 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.
D. Civil Rights Compliance
1. 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.
2. 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.
3. 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.
4. No otherwise qualified person shall be excluded from employment,be denied the benefits of
employment or otherwise be subjected to discrimination in employment in any manner or team of
employment on the basis of age,race,religion,sexual orientation, color,sex,national origin or
ancestry,disability(as defined in Section 504 and the American with Disability Act of 1990),or
association with a person with a disability,arrest or conviction record,marital status,political
affiliation, or military participation,unfair honesty testing and genetic testing,and use or non-use of
lawful products outside of working hours. All employees of the Contractee are expected to support
goals and programmatic activities relating to non-discrimination in employment.
5. 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 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.
6. 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.
Performance LHD w/o CARS Report 6/09 3
7. 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.
8. 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.
9. The Contractee agrees to cooperate with the Contractor in developing, implementing and
monitoring corrective action plans that result from complaint investigations or monitoring efforts.
E. 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.PRIVACY AND CONFIDENTIAL INFORMATION
A. The Contractee shall not use Confidential Information for any purpose other than the limited purposes set
forth in this Contract, and all related and necessary actions taken in fulfillment of the obligations thereunder.
The Contractee shall hold all Confidential Information in confidence, and shall not disclose such Confidential
Information to any persons other than those directors,officers,employees,and agents("Representatives")
who have a business-related need to have access to such Confidential Information in furtherance of the
limited purposes of this Contract and who have been apprised of, and agree to maintain,the confidential
nature of such information in accordance with the terms of this Contract.
B. Contractee shall institute and maintain such security procedures as are commercially reasonable to
maintain the confidentiality of the Confidential Information while in its possession or control including
transportation,whether physically or electronically.
C. Contractee shall ensure that all indications of confidentiality contained on or included in any item of
Confidential Information shall be reproduced by Contractee on any reproduction,modification,or translation
of such Confidential Information. If requested by the State,Contractee shall make a reasonable effort to add a
proprietary notice or indication of confidentiality to any tangible materials within its possession that contain
Confidential Information of the State,as directed.
D. If requested by the State,Contractee shall return or destroy all Individually Identifiable Health
Information and Personally Identifiable Information it holds upon termination of this Agreement
Performance LHD w/o CARS Report 6/09 4
E. Definitions used herein:
1. "Confidential Information"means all tangible and intangible information and materials accessed
or disclosed in connection with this Agreement, in any form or medium(and without regard to
whether the information is owned by the State or by a third party),that satisfy at least one of the
following criteria: (i)Personally Identifiable Information;(ii)Individually Identifiable Health
Information;(iii)non-public information related to the State's employees, customers,technology
(including data bases,data processing and communications networking systems),schematics,
specifications,and all information or materials derived therefrom or based thereon;or(iv)
information designated as confidential in writing by the State.
2. "Individually Identifiable Health Information"means information that relates to the past,
present,or future physical or mental health or condition of the individual,or that relates to the
provision of health care in the past,present or future,and that is combined with or linked to any
information that identifies the individual or with respect to which there is a reasonable basis to
believe the information can be used to identify the individual.
3. "Personally Identifiable Information" means an individual's last name and the individual's first
name or first initial, in combination with and linked to any of the following elements, if the element
is not publicly available information and is not encrypted, redacted,or altered in any manner that
renders the element unreadable: (a)the individual's Social Security number;(b)the individual's
driver's license number or state identification number; (c)the number of the individual's financial
account, including a credit or debit card account number, or any security code,access code,or
password that would permit access to the individual's financial account; (d)the individual's DNA
profile; or(e)the individual's unique biometric data, including fingerprint,voice print,retina or iris
image,or any other unique physical representation, and any other information protected by state or
federal law.
VIII. SUBCONTRACTS
A. The Contractee may subcontract all or part of this Contract Agreement as agreed to during contract
negotiation. The Contractor reserves the right of approval for any subcontracts and the Contractee shall
report information relating to subcontracts to the Contractor. A change in a subcontractor or a change from
direct service provision to a subcontract may only be executed with the prior written approval of the
Contractor. In addition, Contractor approval may be required regarding the terms and conditions of the
subcontracts, and the subcontractors selected. Approval of the subcontractors will be withheld if the
Contractor reasonably believes that the intended subcontractor will not be a responsible provider in terms of
services provided,objectives to be attained,or required quality criteria.
B. 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.
C. 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.
IX. GENERAL PROVISIONS
A. 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.
B. The Contractee shall conduct all procurement transactions in a manner that provides maximum open and
free competition.
C. 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
Performance LHD w/o CARS Report 6/09 5
this Contract Agreement without the written consent of the employer of such person or persons and of the
Contractor.
D. 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].
E. 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.
F. 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.
X. ACCOUNTING REQUIREMENTS
A. 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.)
B. 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.
C. 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.
D. 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.
E. 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.
F. 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
Performance LHD w/o CARS Report 6/09 6
•
Contractee shall retain the reconciliation documentation in accordance with the record retention requirement
specified in Section XIV.
G. Monthly submittals of expenditure reports on the use of funds within this Contract Agreement are not
required for contract payment purposes.
H. Nothing in this Section precludes the Contractee from keeping such information as needed for its internal
management purposes.
I. 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.
XI. CHANGES IN ACCOUNTING PERIOD
A. 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.
B. Proof of Internal Revenue Service approval shall be considered verification that the Contractee has a
substantial business reason for changing its accounting period.
C. 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.
XII.PROPERTY MANAGEMENT REQUIREMENTS
A. 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.
B. 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.
C. 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.
XIII. AUDIT REQUIREMENTS
A. 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.
B. 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, issued by
Performance LHD w/o CARS Report 6/09 7
the U.S. Government Accountability Office;and the Department of Health Services Audit Guide
(www.ssag.state.wi.us).
1. The audit shall also comply with the requirements in OMB Circular A-133 "Audits of States,
Local Governments,and Non-Profit Organizations" if the agency meets the criteria for needing a
federal single audit.
C. Reporting Package: The Contractee shall send to the Contractor a reporting package which includes the
following:
1. Financial statements and other audit schedules and reports required for the type of audit
applicable to the Contractee.
2. 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.
3. Management responses/corrective action plan for each audit issue identified in the audit.
D. Sending the Reporting Package: The Contractee shall send one copy of the required reporting package to
the Contractor either: (a)within nine(9)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. Reports sent to DHS may be in either paper or electronic pdf format. Paper copies of
audit reports may be sent to the following address:
Attn: DHS Auditors
Division of Enterprise Services
Department of Health Services
1 West Wilson Street, Room 627
PO Box 7850
Madison WI 53707-7850
Reports in pdf format may be sent to DHS Auditors at the following email address:
DHSAuditors @Wisconsin.gov
E. 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.
F. 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.
G. 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:
1. Conduct an audit or arrange for an independent audit of the Contractee and charge the cost of
completing the audit to the Contractee;
2. 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
3. Disallow the cost of audits that do not meet these standards.
H. Closeout Audits:
Performance LHD w/o CARS Report 6/09 8
1. 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.
2. 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.
3. 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.
4. All other provisions in the Audit Requirements section apply to Closeout Audits unless in
conflict with the specific Closeout Audits requirements.
XIV. OTHER ASSURANCES
A. 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.
B. The Contractee shall notify the Contractor, in writing,within thirty(30)days of the date payment was
due,of any past due payment in excess of five hundred dollars($500),or when total past due liabilities to 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.
C. 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.
D. 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.
XV.RECORDS
A. 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.
Performance LHD w/o CARS Report 6/09 9
B. 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.
C. 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.
D. 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.
XVI. AGREEMENT REVISIONS AND/OR TERMINATION
A. The Contractee agrees to re-negotiate with the Contractor this Contract Agreement or any part thereof in
such circumstances as:
1. Increased or decreased volume of services as required by the Contractor;
2. Changes required by State and Federal law or regulations,or court action; or,
3. 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.
B. This Contract Agreement can be terminated for any reason by a 30-day written notice by either party.
C. 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.
D. 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.
E. 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.
XVI1. NON-COMPLIANCE,LIQUIDATED DAMAGES AND REMEDIAL MEASURES
A. If the Contractor determines,after notice to the Contractee and opportunity to respond,that the
Contractee:
1. 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.
Performance LHD w/o CARS Report 6/09 10
2. 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.
B. Failure to comply with any part of this Contract Agreement may be considered cause for revision,
suspension or termination of this Agreement. Suspension includes withholding part or all of the payments
that otherwise would be paid the Contractee under this Agreement,temporarily having others perform, and
receive reimbursement for,the services to be provided under this Agreement and any other measure that
suspends the Contractee's participation in the Agreement if the Contractor determines it is necessary to
protect the interests of the State.
C. 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.
D. 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.
E. If the Contractor determines that non-compliance with other requirements(not stated in Exhibit I or
Exhibit II)in this Contract Agreement has occurred,or is occurring, it shall demand immediate correction of
continuing non-compliance and it may impose whatever 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.
F. If audits are not submitted when due,the Contractor may take action pursuant to Section XII of this
Contract Agreement.
G. 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.
XVIII. DISPUTE RESOLUTION
Performance LHD w/o CARS Report 6/09 1 1
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.
A. 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.
B. 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.
C. If the dispute is still not resolved,the Contractee may request a final review by the Secretary of the
Department of Health Services.
XIX. FINAL REPORT DATE
A. The due date of the final fiscal report shall be ninety(90)days after the Contract Agreement period
ending date.
B. 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.
XX.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.
XXI. 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.
XXII. CONDITIONS OF THE PARTIES' OBLIGATIONS
A. 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.
B. 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.
C. 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.
XXIII. SPECIAL PROVISIONS
A. 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.
B. 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
Performance LHD w/o CARS Report 6/09 12
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.
C. To the extent allowed by law:
1. 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.
2. These funds may be used to award other Contractees who have exceeded their objectives in that
program,general funding of the program area to all Contractees via formula in the next contract
period,general funding of the program for all Contractees during the current contract period, or
returned to the Federal funding agency of that program.
These funds cannot be used by the Contractor for their own operational costs.
D. 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.
XXIV. CONTRACT RENEWAL OPTIONS
This contract can be renewed on an annual basis for up to two(2)one-year extensions with the mutual
agreement of both the Contractor and Contractee.The objectives to be attained by program will be re-
negotiated each year by the Contractor and Contractee,as well as documentation deliverables and risk
conditions.
Performance LHD w/o CARS Report 6/09 13
XXV. 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.
Contractee's Authorized epre entative
11 Lco)
Date
„,,,it .rte a
s W, n �,, 64 l) Dpi lac)
Contractor`s Au o' `ative Date
Seth Foldy, MD,
State Health Officer and Administrator
Division of Public Health
Department of Health Services
CARS PAYMENT INFORMATION
The information below is used by the Department's Bureau of Fiscal Services, CARS Unit to facilitate the processing
and recording of payments made under this Contract Agreement.
Agency Name Oshkosh Health Department
Agency Number 472894
Agency Type 060
Contract Period January 1,2010 through December 31,2010
Contract Amount $68,529
Profile ID# 157720 Childhood Lead Amount$11,330
Profile ID# 155020 Immunization Amount$14,943
Profile ID# 159320 Maternal Child Health Amount$33,480
Profile ID# 159220 Prevention Amount$8,776
DPH Contract# 17395
CFDA#s:
Immunization 93.268
MCH 93.994
Prevention 93.991
Performance LHD w/o CARS Report 6/09 14
Contract Agreement Addendum: Exhibit I
Program Quality Criteria
Generally high program quality criteria for the delivery of quality and cost-effective administration of
health care programs have been,and will continue to be,required in each public health program to be
operated under the terms of this contract.
This Exhibit contains only applicable quality criteria for this contract.
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
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 prevalence and risk factors.
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 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 mcg/dL and of properties where a lead hazard investigation was performed, including
findings,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)Contractee that serves a community receiving HUD Community Development Block Grant(CDBG)funds,
in order to accept the additional WCLPPP formula allocation,establish and maintain a relationship with the
local housing agency that distributes the CDBG funds in order to increase the availability of lead-safe
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
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)Contractee 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.dhs.wi.gov/lead.
a)Nursing Case Management Report(DPH 4771A)
Nursing Closure Report(DPH 4771B)
Property Investigation Report(DPH 4771C)
Property Investigation Closure Report(DPH 4771D)
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
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(e.g.,implementation of the Wisconsin Electronic Disease Surveillance System(WEDSS)).
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 according to the ACIP
recommendations. 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 HFS 144(section 252).
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.
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
•
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
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.
A referral network sufficient to assure the accessibility and timely provision of services to address
identified public health care needs. These relationships should also be used to promote the prompt
reporting of suspect vaccine preventable diseases,and the use of the WIR or an information system capable
of passing data to the WIR.RECIN is the only other registry. The majority of data transfer comes from
EMR systems.
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 as required by the vaccines for Children(VFC)Program. 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
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
provided.
A)Billing for payment of childhood immunization services is not required under this section.
B)LHDs must assure that parents of children who are on Medical Assistance will not be charged a vaccine
administration fee or be requested to make a donation for vaccine or vaccine related services.
Administration fees cannot be mandatory and clients must be informed that failure to pay the
administration fee or make a donation does not preclude them from receiving state-supplied vaccine.This
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.
DPH Grants and Contracts
01/26/2010 12:32 PM
Contract Agreement Addendum: Exhibit I
•
Contract#: 17395 Agency:A Oshkosh Health Department Contract Year: 2010
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.
DPH Grants and Contracts
01/26/2010 12:32 PM
Contract Agreement Addendum: Exhibit I
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
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
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
by these dollars)being done by agencies across the state.
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
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.
C)Identification of the scientific basis(evidence base)for the intervention.
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)Provision of public information and education and/or outreach activities should utilize strategies that have a
scientific basis(best-practices)for delivery methods to assure maximum impact on the selected population.
C)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
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit I
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
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
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
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II
Program Objectives
(A)Contract Funds,Program/Objective Values,and Other Contract Details
(B)Objective Details
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(A)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Contract Source of Funds
Source Program Amount
Oshkosh Childhood Lead-Consolidated 511,330
Oshkosh Immunization-Consolidated IAP $14,943
Oshkosh Maternal Child Health-Consolidated $33,480
Oshkosh Prevention-Consolidated $8,776
Contract Amount $68,529
Contract Match Requirements
Program Amount
Childhood Lead $0
Immunization $0
MCH $25,110
Prevention $0
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
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(A)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Childhood Lead Program Total Value$11,330
1 Template Objective 3 -By December 31,2010,environmental lead hazard investigations will be completed on $7,721
100%of the primary residences and pertinent secondary properties associated with children with venous blood
lead levels 10 micrograms per deciliter or greater who reside in the City of Oshkosh
2 Template Objective 2-By December 31,2010, 15 pre-1950 housing units or childcare sites located in City of $2,250
Oshkosh where children less than 6 years of age without an elevated blood lead level reside or attend day care
will be assessed using the Wisconsin Childhood Lead Poisoning Prevention Program Standard for Home-
/Childcare Site-based Intervention to Address Lead Hazards.
3 Template Objective 5 -By December 31,2010,5 contractors,rental property owners or maintenance staff from $1,359
Oshkosh Health Division will demonstrate knowledge of lead-safe work practices through completion of a course
conducted by a certified training provider.
Immunization Program Total Value$14,943
1 By December 31,2010, 79%children residing in the City of Oshkosh jurisdiction who turn 24 months of age $14,943
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$33,480
1 By December 31,2010,4 strategies to create environments that support and promote healthy eating,daily $12,000
physical activity and a healthy weight for school aged children and their families,will be implemented by the
City of Oshkosh Health Division and Best for Kids Partnership.
2 By December 31,2010,follow-up assessments will show a documented decrease in home hazards previously $14,480
identified by the Division of Public Health Home Safety Assessment Tool,in City of Oshkosh Health Division's
households with young children.
3 Template Objective 11 -By December 31,2010,outcomes of a pedestrian safety program to prevent pedestrian- $2,500
related injury to children will be reported by the Oshkosh Health Department in collaboration with community
partners.
4 Template Objective 8 -By December 31,2010,outcomes from the implementation of a crib education program to $4,500
support safe infant sleep practices will be analyzed by the City of Oshkosh Health Department in collaboration
with community partners.
Prevention Program Total Value$8,776
1 Template Objective 4-By December 31,2009, outcomes of injury prevention focused strategy(ies)for children $8,776
aged 4-7 and their families,will be reported by the Oshkosh Health Department in collaboration with community
partners.
Total of Contract Objective Values $68,529
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Childhood Lead Poisoning Prevention Objective#: 1 of 3 Objective Value: $7,721
Objective: Primary Details
Objective Statement
Template Objective 3 -By December 31,2010,environmental lead hazard investigations will be completed on 100%of the primary
residences and pertinent secondary properties associated with children with venous blood lead levels 10 micrograms per deciliter or
greater who reside in the City of Oshkosh
Deliverable Due Date: 01/31/2011
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.
Programs Providing Funds for this Objective
Childhood Lead Poisoning Prevention: $7,721
Agency Funds for this Objective:
Data Source for Measurement
An agency-generated report.
Baseline for Measurement
To date in 2009,eight children with blood lead levels greater than 10 mcg per deciliter have received environmental investigations
and follow-up.Required.Number of children with a blood lead level greater than or equal to 10 micrograms per deciliter and
number of associated environmental lead hazard investigations completed in 2008 or year-to-date in 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 environmental investigations be
conducted in housing where a child with a venous blood lead level of 10 mcg/dL or greater lives,where the child spends a
significant amount of time, secondary residences, and other areas where the child(or other children)may be exposed to lead
hazards(e.g.,in buildings with more than one housing unit,conduct inspection not only in the elevated blood lead child's residence,
but also in adjacent units where children could be at risk) (see Program Announcement CDC-RFA-EH06-602.) When notified that
a child has a blood lead level of 10mcg/dL or greater,the public health agency will conduct an early intervention environmental
lead hazard investigation,using the procedure outlined in Chapter 9 of the"Wisconsin Childhood Lead Poisoning Prevention&
Control Handbook(2002)."This early intervention 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.
Input Activities
None required.
Objective: Risk Profile
Percent of Objective Accomplished
0% 10% 20% 30% 40% 50% 60% 70% 80% 85% 90% 95% 100%
Corresponding Percentage Recoupment
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Childhood Lead Poisoning Prevention Objective#: 2 of 3 Objective Value: $2,250
Objective: Primary Details
Objective Statement
Template Objective 2 -By December 31,2010, 15 pre-1950 housing units or childcare sites located in City of Oshkosh where
children less than 6 years of age without an elevated blood lead level reside or attend day care will be assessed using the Wisconsin
Childhood Lead Poisoning Prevention Program Standard for Home-/Childcare Site-based Intervention to Address Lead Hazards.
Deliverable Due Date: 01/31/2011
Contract Deliverable(Evidence)
For each property assessed,the"Standards for Home Visitation to Address Lead Hazards Documentation" form may be completed.
This form is found in the Wisconsin Childhood Lead Poisoning Prevention Program Standard for Home/Childcare Site-based
Intervention to Address Lead Hazards resource kit. It contains these required deliverables: 1)property address;2)year the structure
was built;3)activities conducted,i.e., lead poisoning education,visual assessment and intervention guidance,sampling via dust
wipes or lead check swabs,and demonstration of cleaning techniques;4)results of dust wipe samples or lead check swabs;and 5)
date information was provided to the property owner regarding the presence of lead in the property.
Programs Providing Funds for this Objective
Childhood Lead Poisoning Prevention: $2,250
Agency Funds for this Objective:
Data Source for Measurement
The"Standards for Home Visitation to Address Lead Hazards Documentation" form contains all the required information for this
objective. Completed forms are sufficient as the data source for measurement; an agency-generated report is also acceptable.
Baseline for Measurement
Required.Number of pre-1950 housing or childcare sites assessed in 2008 or year-to-date in 2009 This is a new initiative.
Context
Acceptable value for this objective is up to S150 per housing unit or childcare site. The protocol to be followed is the Wisconsin
Childhood Lead Poisoning Prevention Program Standard for Home/Childcare Site-based Intervention to Address Lead Hazards.
The following essential components must be included: 1)a visit to the home to provide lead poisoning prevention education and
identify potential lead hazards; 2) sampling via dust wipe samples or lead check swabs to document the presence of lead;and 3)
notifying the property owner of the results of the home assessment,including results of dust wipe samples or lead check swabs,and
non-abatement measures that can be taken to correct lead hazards.
This objective entails using the standard with one or more target audiences. Target audiences are families whose primary residence
or childcare site was built before 1950. For pregnant women residing in pre-1950 housing,the Home/Childcare Site-based
Intervention Standard can be incorporated into a perinatal care coordination or newborn visitation program,or into Medicaid
Prenatal Care Coordination services.A resource kit is available by calling the Wisconsin Childhood Lead Poisoning Prevention
Program(WCLPPP)at(608)266-5817. Materials to support this objective may also be available, including infant bibs, lead check
swabs and HEPA vacuums.Dust-wipe samples can be analyzed at the State Laboratory of Hygiene and billed to the Basic
Agreement(fee exempt). WCLPPP staff is available to conduct orientation on the Home/Childcare Site-based Intervention
Standard.
Input Activities
None required.
Objective: Risk Profile
Percent of Objective Accomplished
0% 10% 20% 30% 40% 50% 60% 70% 80% 85% 90% 95% 100%
Corresponding Percentage Recoupment
Corresponding Potential Recoupment Amounts
01/26/2010 12:32 PM DPI-I Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Childhood Lead Poisoning Prevention Objective#: 2 of 3 Objective Value: $2,250
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
01/26/2010 12:32 PM DPI-1 Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Childhood Lead Poisoning Prevention Objective#: 3 of 3 Objective Value: $1,359
Objective: Primary Details
Objective Statement
Template Objective 5 -By December 31,2010,5 contractors,rental property owners or maintenance staff from Oshkosh Health
Division will demonstrate knowledge of lead-safe work practices through completion of a course conducted by a certified training
provider.
Deliverable Due Date: 01/31/2011
Contract Deliverable(Evidence)
A report to document: 1)the number of contractors,rental property owners or maintenance staff who gained knowledge of lead-safe
work practices, as evidenced by successful completion of a post-test;and 2)the name of the certified training provider that
conducted the lead-safe work practices course.
Programs Providing Funds for this Objective
Childhood Lead Poisoning Prevention: $1,359
Agency Funds for this Objective:
Data Source for Measurement
An agency-generated report; or SPHERE System Report,including information from the following screens: (1)System Activity-all
required fields,including audience focus and documentation of additional information in the Results/Outcome field,and(2)Health
Teaching Topic Environmental Lead Exposure.
Baseline for Measurement
Required.Number of certified trainees in 2008 or year-to-date 2009. This is a new initiative.
Context
Acceptable value for this objective is up to$260 per anticipated course attendee. This standardized 8-hour,lead-safe work practices
training course must be conducted by a certified training provider. The training components include: 1)health effects of lead
poisoning;2)regulations regarding lead-based paint;3)preparing the worksite;4)non-abatement lead hazard control activities; and
5)clean-up and disposal. Successful completion of the course requires a score of at least 70%on a post-test given by the certified
training provider.
The lack of contractors,property owners or maintenance staff who are trained in lead-safe work practices can be a significant
barrier to increasing the availability of lead-safe housing.This objective seeks to increase local capacity to correct lead hazards in
old housing and to prevent inadvertent lead poisoning due to unsafe renovation,remodeling or lead hazard control activities.
Input Activities
None required. I am working with the Planning Division to inform contractors that conduct work in their rehab program about the
availability of training.
Objective: Risk Profile
Percent of Objective Accomplished
0% 10% 20% 30% 40% 50% 60% 70% 80% 85% 90% 95% 100%
Corresponding Percentage Recoupment
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Immunization Objective#: 1 of 1 Objective Value: $14,943
Objective: Primary Details
Objective Statement
By December 31,2010,79%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: 01/31/2011
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 2010.Reports should be run with a 45 day buffer to ensure
that all updated data has been received by the WIR.If object not met,Include a report of the accountability targets and the progress
achieved including the activities and interventions conducted,include any barriers that may have been identified.
Programs Providing Funds for this Objective
Immunization: $14,943
Agency Funds for this Objective:
Data Source for Measurement
Wisconsin Immunization Registry Records.
Baseline for Measurement
The baseline for measurement from 2008 is 79%. The 2008 end of year population based standard benchmark report will be used to
determine the baseline for the 2010 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: 01/01/2006 through 12/31/2006
Evaluation Date: 01/01/2009
Run Date: After 02/15/2009
Context
Children will be assessed using the standard benchmark report 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 unless you can prove that a
child has moved out of your jurisdiction you can not remove them from your cohort.. 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:
2008 Calendar Year Baseline Required Increase
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
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Immunization Objective#: 1 of 1 Objective Value: $14,943
i1'90%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.
Input Activities
Tracking individuals age birth to 2 years old amd the progress of receiving current immunizations to complete the series of primary
immunizations.Reminder recalls sent out to parents,to keep children up to date on immunizations. Sharing and requesting
information from area physicians.Contacting parents by telephone or mailings for children without immunization histories and
needed immunization dates. Inputting immunization data in to WIR.Due to the the HIB dose schedule change and the shortage of
this vaccine,we may anticipate difficulty reaching this goal for the objective.
Objective: Risk Profile
Percent of Objective Accomplished
0% 10% 20% 30% 40% 50% 60% 70% 80% 85% 90% 95% 100%
Corresponding Percentage Recoupment
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Maternal and Child Health Block Grant Objective#: 1 of 4 Objective Value: $12,000
Objective: Primary Details
Objective Statement
By December 31,2010,4 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 and Best
for Kids Partnership.
Deliverable Due Date: 01/31/2011
Contract Deliverable(Evidence)
A SPHERE report and an analysis of data collected in SPHERE as identified in the Data Source for Measurement to document: 1)
the number of strategies implemented,2)a description of the impact of each strategy and each of its related interventions,and 3)the
outcome of each strategy, all documented in the Results/Outcome box in the SPHERE System Activity.
Programs Providing Funds for this Objective
Maternal and Child Health Block Grant: $12,000
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
The City of Oshkosh Health Division along with community partners is meeting and working on a Community Health Improvement
Plan which has showed a need for forcusing on obesity and health,exercise and nutrition in our community. The goal and focus on
educating elementary children on healthy eating and exercise may decrease the incidence of children becoming overweight later in
life.Following the guidance and format that is used in the Wisconsin Nutrition and Physical Activity State Plan. In 2009,the Best
For Kids Partnership grew from 6 members in 2008,to 12 community partners at the end of 2009.The focus was on education of
healthy eating and exercise which took place at an after school program at one elementary school,which runs for the entire school
year. A yearly community event is also held which brings together many community sponsors and requires many organizational
meetings by the committee to develope and coordinate this community wide event.The event drew approximately 200 children and
family members.
Context
Acceptable value range for this objective is up to$3,000 per strategy.All MCH Quality Criteria apply to this objective.
A strategy is defined as a framework for action designed to achieve a particular goal. This objective focuses on systems strategies.
The focus is not directly on individual behavior changes for community changes,but on the system changes that impact health
outcomes. A systems focused-practice changes organizations,policies, laws,and power structures.
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://dhs.wisconsin.gov/health/physicalactivity/index.htm.
Allowable strategies include:
-Implementation of goal(s)or objectives detailed in the local nutrition and physical activity coalition's strategic/action plan.
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Maternal and Child Health Block Grant Objective#: 1 of 4 Objective Value: $12,000
-Increase opportunities for physical activity through the implementation of environmental and/or policy change strategies based on
the results of community audits/assessments using the Active Community Environments Resource Kit
(http://dhs.wisconsin.gov/health/physicalactivity/index.htm.).
-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.
-Assist child care centers in implementing the "Ten Steps to a Breastfeeding Friendly Child Care
Centeri,(http://dhs.wisconsin.gov/health/physicalactivity/index.htm).
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,Physical Activity and Obesity 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. Contact Mary Pesik at 608-267-3694 or mary.pesik @dhs.wisconsin.gov.
Input Activities
(Agency should provide the specific strategy and SHPERE Intervention for as many strategies and interventions being supported in
the following format):
1.Strategy#1 -Implementation of goals and objectives by the Best For Kids Partnership.
A.coalition building,community collaboration and organizing.Monthly to quarterly meetings will be held focusing on setting goals
for this year.Planning,organizing,promoting community awareness by producing marketing materials and displaying in schools
and community and retail places and enviroment. Educational and promotional materials will focus on health,safety,exercise and
nutrition.Also Best For Kids will be designing a brochure to promote their mission in the schools and community that promotes
health,excercise and nutrition.
2.Strategy#2-Increasing opportunities for physucal activity at local schools through implementation of environmental changes.
A. 2 local schools may have the opportunity to receive this dance/exercise program to be taught at the after school program.
Education and Awareness of excercise. Children will be educated on the importance of excercise and healthy eating. The children
will participate in a dance/exercise class provided by the training of skilled dance/exercise instructors. They will also will be given
educational materials to take home and share with family members. Soame of the children also have the opportunity to also perform
what they have learned at a Health and Safety Event.A yearly Health and Safety Expo will be held either at a school or community
faciliy,which provides education,hands on activities and demos provided by community partners,which all promote;health, safety
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Maternal and Child Health Block Grant Objective#: 1 of 4 Objective Value: $12,000
,healthy nutrition and exercise .This event is open to the whole community,children and families.
Objective: Risk Profile
Percent of Objective Accomplished
0% 10% 20% 30% 40% 50% 60% 70% 80% 85% 90% 95% 100%
Corresponding Percentage Recoupment
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
01/26/2010 12:32 PM DPH Grants and Contracts
• Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Maternal and Child Health Block Grant Objective#: 2 of 4 Objective Value: $14,480
Objective: Primary Details
Objective Statement
By December 31,2010,follow-up assessments will show a documented decrease in home hazards previously identified by the
Division of Public Health Home Safety Assessment Tool,in City of Oshkosh Health Division's households with young children.
Deliverable Due Date: 01/31/2011
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 and follow-ups per residence(household). 3)The
number and type of referrals provided to families to assist them in making hazard corrections.
Programs Providing Funds for this Objective
Maternal and Child Health Block Grant: $14,480
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
During the contract period it is estimated that 40 households will receive a Home Safety Assessment and follow-up. To date 35
Home Safety assessments have been done in 2009. There has been a great response from previous clients and the community in
response to continuing this service,and the need in the community to reach out and provide safety products that are not easily
assessible to certain clients. Many client referrals are from Parent Connection and WIC.Mom's clubs and Day Care Centers have
also requested the service of the nurse providing education on injury prevention and safety to their moms and families. With all the
safety topics and notices on recalls,there needs to be a continued effort to provide safety education and assistance at homes as
needed and requested.
Context
Acceptable value range for this objective is$125-$250, for an initial assessment and follow-up within six months,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.Required follow-ups must be completed within six months of the
initial assessment in order to be tracked in the SPHERE system and linked to the initial assessment.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
Registered Nurse from the Health Department will provide the services of visiting each home and assessing the individual homes
and providing follow-up visits.Also the RN will be providing education on injury prevention and home safety at Mom's Club and
other parent and familiy meetings. The Sphere Home Safety Assessment Guide is used as the assessment tool to assess each home
environment.
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit 11(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Maternal and Child Health Block Grant Objective#: 2 of 4 Objective Value: $14,480
A large assortment of child proofing products are purchased through the MCH grant to assist families in need to child proof their
homes and to use to make safety corrections.
Many families are in the need of baby gates,smoke alarms,and especially carbon monoxide detectors: which was absent at 98%of
homes.Many other products are purchased for the clients and families and are used to correct potential hazards in the home.
Educational materials are also given at each household and gone over.Promotional and educational materials are taken to
community partners and displayed.A brochure on the Home Safety and Child Proofing Program has been distributed through-out
the city.
Objective: Risk Profile
Percent of Objective Accomplished
0% 10% 20% 30% 40% 50% 60% 70% 80% 85% 90% 95% 100%
Corresponding Percentage Recoupment
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Maternal and Child Health Block Grant Objective#: 3 of 4 Objective Value: $2,500
Objective: Primary Details
Objective Statement
Template Objective 11 -By December 31,2010, outcomes of a pedestrian safety program to prevent pedestrian-related injury to
children will be reported by the Oshkosh Health Department in collaboration with community partners.
Deliverable Due Date: 01/31/2011
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: implementation of a pedestrian safety program in Winnebago County to include identification of community
partners and activities to create a pedestrian safe environment.
Programs Providing Funds for this Objective
Maternal and Child Health Block Grant: $2,500
Agency Funds for this Objective:
Data Source for Measurement
SPHERE Community Report to include data from the following screens: Community Activity(all appropriate fields including the
audience focus and results documented in the Results/Outcomes field) and Intervention: Health Teaching, Sub-Intervention:
Pedestrian Related(with results).
Baseline for Measurement
If this is a new objective for this agency and there is insufficient or no data available, state"Baseline data will be established during
the contract year for this new objective." This is a new objective for 2010.
Context
Acceptable value range for this objective is up to $2,500 to support a pedestrian safety program.All MCH Quality Criteria apply to
this objective.Pedestrian safety programs provide education and issue awareness concerning pedestrian safety by hosting high
visibility school-based events,documenting risks to pedestrians around schools and high-risk intersections,and the improvement of
pedestrian environments for children. The Safe Kids Walk this Way program
(www.usa.safekids.org/wtw/),partnering with FedEx Express, is one resource that hosts national walk to school days and leads
year-round school-and community-based safety committees to improve pedestrian environments for children.Health Departments
are encouraged to collaborate with community partners such as hospitals,businesses and service organizations to identity funding
sources to support educational and awareness programs. The Wisconsin Safe Routes to School program also provides support for
safer walking and biking travel for children and may be a valuable resource in developing a program
(www.dot.state.wi.us/localgov/aid/saferoutes.htm).
Input Activities
[Identify community partners.Identify a funding source to host educational programs,events,and pedestrian environment
improvements(MCH dollars, donations,grants).Implement a pedestrian safety program to include education,awareness events,
and pedestrian environment improvements.]
These listed activities are required but are not intended to be all encompassing.Additional activities can be described. The nurse
will be working and collaborating with the crime prevention officer from OPD ,and other community partners involved with the
Safe Routes to School Program.
Objective: Risk Profile
Percent of Objective Accomplished
0% 10% 20% 30% 40% 50% 60% 70% 80% 85% 90% 95% 100%
Corresponding Percentage Recoupment
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Maternal and Child Health Block Grant Objective#: 4 of 4 Objective Value: $4,500
Objective: Primary Details
Objective Statement
Template Objective 8-By December 31,2010,outcomes from the implementation of a crib education program to support safe
infant sleep practices will be analyzed by the City of Oshkosh Health Department in collaboration with community partners.
Deliverable Due Date: 01/31/2011
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 implementation of a crib education program in the City of Oshkosh ,and to include: 1)Identification of the
community partners including any policy changes implemented within their respective organizations(i.e.hospitals,daycares etc.),
2)implementation or support of a crib education program for individuals/families and 3)the total number of families served and the
number of cribs distributed.
Programs Providing Funds for this Objective
Maternal and Child Health Block Grant: $4,500
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 audience
focus and results documented in the Results/Outcomes field); and appropriate Intervention(s): Collaboration,Community
Organizing,or Health Teaching, Sub-Intervention: Infant Safe Sleep Practices(with results if appropriate).
Baseline for Measurement
Insert a brief statement indicating the rationale for why the particular MCH priority area was selected and include data as available.
If this is a new objective for this agency and there is insufficient or no data available, state"Baseline data will be established during
the contract year for this new objective." This is a new objective for City of Oshkosh in 2010. City of Oshkosh Health Department
identified via their home safety assessment visit program that families were without cribs,or safe cribs or infant slept with parents.
Context
Acceptable value range for this objective is up to$3,000 to support a crib education program plus$65 per crib if purchased by the
health department. All MCH Quality Criteria apply to this objective.
National crib education programs provide educational materials and access to low cost portable cribs to help reduce the risk of
injury and death of infants due to unsafe sleep environments. The Cribs for Kids program(www.cribsforkids.org)is one resource
that provides standardized educational materials,Graco Pack N Play cribs and other resources for individuals and families. The
Infant Death Center of Wisconsin(414-266-2743)can provide additional information and technical assistance to support
implementation of crib education programs. Health Departments are encouraged to collaborate with community partners such as
hospitals,businesses and service organizations to identity funding sources to purchase cribs and incorporate safe sleep messages
into other community practices. MCH funds may also be used to purchase new,portable cribs.
Input Activities
[Include a brief description of your program,which should include implementation of consistent safe sleep policies within diverse
community organizations,education and crib distribution to individuals and families,and follow-up services to assure safe infant
sleep practices. In this description,please identify the community partners involved and the funding source(s)that will be used to
purchase new,portable cribs.]
These listed activities are required but are not intended to be all encompassing. Additional activities can be described. Educational
materials and cribs will be given to all clients in the City of Oshkosh as needed. Approximately 22 cribs will be purchased.MCH
funds will be used as the funding source to provide needed cribs for the safety of the child.
Objective: Risk Profile
Percent of Objective Accomplished
0% 10% 20% 30% 40% 50% 60% 70% 80% 85% 90% 95% 100%
Corresponding Percentage Recoupment
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Maternal and Child Health Block Grant Objective#: 4 of 4 Objective Value: $4,500
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
01/26/2010 12:32 PM DPH Grants and Contracts
Contract Agreement Addendum: Exhibit II(B)
Contract#: 17395 Agency: Oshkosh Health Department Contract Year: 2010
Program: Preventive Health and Health Services Objective#: 1 of 1 Objective Value: $8,776
Block Grant
Objective: Primary Details
Objective Statement
Template Objective 4-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: 01/31/2011
Contract Deliverable(Evidence)
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: $8,776
Agency Funds for this Objective:
Data Source for Measurement
Health Department records.
Baseline for Measurement
Baseline for measurement: 225 children were served in 2009. Prior testing of the childrens knowledge on poison safety showed
61%,after instruction and education, 92%of children were able to identify poisons and assist their families in keeping a safe
enviroment.
Context
Activities focus on the jurisdiction.Implementing strategies is based upon the completion of an identified needs assessment
and development and implementation of a plan to address issues.Develop strategic alliances with community based organizations
and other groups that are working to improve the health status of the jurisdiction. Infrastructure should include expertise in the
focus area. All Prevention Quality Criteria apply.
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
These listed activities are required but are not intended to be all encompassing.Additional activities can be described.
The grant nurse is involved with Safety City along with many other partners/sponsors including the Police Department and Fire
Department to provide all aspects of teaching and promoting safety to families with young children.The agency provides 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,and a pre-and post test is used for evaluation.
Objective: Risk Profile
Percent of Objective Accomplished
0% 10% 20% 30% 40% 50% 60% 70% 80% 85% 90% 95% 100%
Corresponding Percentage Recoupment
Corresponding Potential Recoupment Amounts
Definition of Percent Accomplished
Conditions of Eligibility for an Incentive
01/26/2010 12:32 PM DPH Grants and Contracts