HomeMy WebLinkAboutDoc 384 - IGA - State Funding for Health SvcsDeschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 -Fax (541) 385-3202 -www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of July 3, 2013
DATE: June 28, 2013
FROM: Nancy Mooney, Contract Specialist, Deschutes County Health Services, 322-7516
TITLE OF AGENDA ITEM:
Consideration of Board Signature of Document #2013-384, Intergovernmental Financial Agreement Award
#142008 between the Local Public Health Department and the Oregon Health Authority for the financing of Local
Public Health Services for fiscal year 2013-2015.
PUBLIC HEARING ON THIS DATE? No.
BACKGROUND AND POLICY IMPLICATIONS:
OHA is at the forefront of lowering and containing costs, improving quality and increasing access to health care
in order to improve the lifelong health of Oregonians. In the public sector, OHA will consolidate most of the
state's health care programs, including Public Health, the Oregon Health Plan (OHP), HealthyKids Connect,
employee benefits and public-private partnerships. This will give the state greater purchasing and market
power to begin tackling issues with costs, quality, lack of preventive care and health care access. In both the
public and the private sector, OHA will be working to fundamentally improve how health care is delivered and
paid for, but because poor health is only partially due to lack of medical care, OHA will also be working to
reduce health disparities and to broaden the state's public health focus. Ultimately, OHA is charged with
delivering a plan to the Legislature to ensure that all Oregonians have access to affordable health care.
The individual public health programs represented in this Intergovernmental Agreement, range from disease
prevention and maternal child health to school based health centers, women, infants and children (WIC),
bioterrorism preparedness, Safe Drinking Water Program and family planning. Each grant will have an
associated set of Program Assurances which are the service and quality performance expectations connected
with the delivery of the various components of the program itself. The funding attached to this two-year
agreement is for year 13-14. Next spring, funding for year 14-15 will be provided by an amendment to this
agreement.
FISCAL IMPLICATIONS:
Maximum funding reimbursement for specific Program Elements for year 13-14 is $2,604,741
RECOMMENDATION & ACTION REQUESTED:
Approval and signature of Document #2013-384, Intergovernmental Financial Agreement Award #142008 between
the Local Public Health Dept. and the Oregon Health Authority is requested.
ATTENDANCE: Scott Johnson, Department Director
DISTRIBUTION OF DOCUMENTS:
E-mail (connie.thies@state.or.us) or fax 503-373-7889: 1) Signature page -sign and date the signature page (page
3), 2) Contractor Tax Identification Form, 3) Document Return Statement; executed documents to Nancy Mooney,
Contract Specialist
DESCHUTES COUNTY DOCUMENT SUMMARY
(NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be
on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board
agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be returned to
the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the
County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form
electronically to the Board Secretary.)
Please complete all sections above the Official Review line.
Date: June 27,2013
Department: 1 Health Services, Public Health Division .1
Contractor/Supplier/Consultant Name: 1 Oregon Health Authority 1
Contractor Contact: I Connie Thies, Office of Contracts &Procurements 1
Contractor Phone #: I 503-373-7889 1
Type of Document: Intergovernmental Agreement #142008
Goods and/or Services: The attached IGA between the Oregon Health Authority and Deschutes
County outlines the program descriptions and funding for Deschutes County's Public Health
Division for fiscal year 2013-2015.
Background & History: The Oregon Health Authority (OHA) was created by the 2009 Oregon
legislature to bring most health-related programs in the state into a single agency to maximize its
purchasing power; the attached Intergovernmental Agreement (#142008) outlines the services and
financing for fiscal year 2013-2015.
aHA is at the forefront of lowering and containing costs, improving quality and increasing access to
health care in order to improve the lifelong health of Oregonians. In the public sector, aHA will
consolidate most of the state's health care programs, including Public Health, the Oregon Health
Plan (OHP), HealthyKids Connect, employee benefits and public-private partnerships. This will give
the state greater purchasing and market power to begin tackling issues with costs, quality, lack of
preventive care and health care access. In both the public and the private sector, OHA will be
working to fundamentally improve how health care is delivered and paid for, but because poor
health is only partially due to lack of medical care, OHA will also be working to reduce health
disparities and to broaden the state's public health focus. Ultimately, OHA is charged with
delivering a plan to the Legislature to ensure that all Oregonians have access to affordable health
care.
The individual public health programs represented in this Intergovernmental Agreement, range
from disease prevention and maternal child health to school based health centers, women,
infants and children (WI C), bioterrorism preparedness, Safe Drinking Water Program and family
planning. Each grant will have an associated set of Program Assurances which are the service
and quality performance expectations connected with the delivery of the various components of
the program itself. The funding attached to this two-year agreement is for year 13-14. Next
spring, funding for year 14-15 will be provided by an amendment to this agreement.
Agreement Starting Date: I July 1! 2013 I Ending Date: I June 30, 2015
Annual Value or Total Payment: I $2,604,741 FY13-15. I
6/27/2013
Check all that apply:
D RFP, Solicitation or Bid Process
D Informal quotes «$150K)
[2J Exempt from RFP, Solicitation or Bid Process (specify -see DCC §2.37)
Funding Source: {Included in current budget? [2J Yes D No
If No, has budget amendment been submitted? DYes D No
Is this a Grant Agreement providing revenue to the County? Yes [2J No
Special conditions attached to this grant:
Deadlines for reporting to the grantor:
If a new FTE will be hired with grant funds, confirm that Personnel has been notified that
it is a grant-funded position so that this will be noted in the offer letter: DYes D No
Contact information for the person responsible for grant compliance: Name:
Phone#:D
Departmental Contact and Title: I Nancy Mooney, Contract Specialist
Phone #: I 541-322-7516 I
Department Director Approval: ---~~--t-=--~----
Date
Distribution of Document: e-mail (connie.thi s@state.or.us) or fax 503-373-7889: 1)
Signature page -sign and date the signature page (page 3),2) Contractor Tax
Identification Form, 3) Document Return Statement; executed documents to Nancy
Mooney, Contract Specialist
Official Review:
County Signature Required (check one): D BOCC D Department Director (if <$25K)
D Administrator (if >$25K but <$150K; if >$150K, BOCC Order No. ____-')
Legal Review Date
Document Number =20.;:;..1.:...;:3,....-.=..38.;:;..4-'--_______
6/27/2013
Nancy Mooney
From: Eric Mone
Sent: Thursday, June 27, 2013 10:52 AM
To: Nancy Mooney; Thomas Kuhn
Subject: RE: Public Health OHA agreement FY13-15, legal counsel has a question and I think you
have the answer
The contract language is fine as is PE 50 for Safe Drinking Water. It is very similar language and
funding as the previous contract.
Thanks, Nancy.
Eric
-----Original Message----
From: Nancy Mooney
Sent: Thursday, June 27,2013 8:43 AM
To: Eric Mone; Thomas Kuhn
Subject: RE: Public Health OHA agreement FY13-15, legal counsel has a question and I think you
have the answer
Importance: High
Hi Eric,
Just checking in about your review of the Program Element for Drinking Water.
Tom,
I need an answer to Mark's question, " ...out of curiosity, is it our intention to actively enforce the
provisions of the Oregon Indoor Clean Air Act, ORS 433? Exhibit D suggests that we will be doing
so."
If I can get this back today, I will try to get Scott's signature and then take downtown for execution
tomorrow. Otherwise, it will all have to wait until I return on July 8th.
Thank you!
Nancy Mooney
Contract Specialist
541-322-7516 phone
541-322-7565 fax
Deschutes County Health Services
2577 NE Courtney Drive
Bend, OR 97701
1
Nancy Mooney
From:
Sent:
To:
Subject:
Thomas Kuhn
Wednesday, June 26, 2013 11:50 AM
Nancy Mooney
RE: LPHA 142008--State contract FY13-15, please approve for your program elements
Hi Nancy,
I affirm that I have read the Oregon Health Authority 2013-15 contract in its entirety, that we can
accept/accomplish the required work and that signing this document is recommended.
I've read the document and approve the Statement of Work as it is set forth in this agreement.
Please await Eric's response in regards to legal if you have not received it yet. Thanks.
Sincerely,
Tom Kuhn, M.S.Ed.
Deschutes County Health Services
Community Health Program Manager
2577 NE Courtney Dr.
Bend, OR 97701
Ph:(541) 322-7410
Fax: (541) 322-7465
thomask@deschutes.org
-----Original Message----
From: Nancy Mooney
Sent: Monday, June 17, 20131:16 PM
To: Thomas Kuhn; Eric Mone
Subject: FW: LPHA 142008--State contract FY13-15, please approve for your program elements
Importance: High
Tom/Eric,
The attached agreement is pending your approval. This is the agreement that outlines our program
elements and funding FY13-15. The Drinking Water Program is PE 50, Page 108 through 117.
Please review and approve for your applicable program element descriptions and funding. Feel free
to contact me if you have questions.
Thank you!
Nancy Mooney
Contract Specialist
541-322-7516 phone
541-322-7565 fax
Nancy Mooney
From: Kate Moore
Sent: Wednesday, June 12, 2013 5:11 PM
To: Nancy Mooney
Subject: RE: LPHA 142008--State contract FY13-15, please approve for your program elements
With exception of WIC assurances (want to have Laura review too upon return from vacation Mon)
I affirm that I have read this document in its entirety, that we can accept/accomplish the required work
and that signing this document is recommended. I've read the document and approve the Statement
of Work as it is set forth in this agreement. Kate Moore
-----Original Message----
From: Nancy Mooney
Sent: Tuesday, June 11, 20138:51 AM
To: Thomas Kuhn; Kate Moore; Eric Mone
Cc: Sandy Ringer
Subject: LPHA 142008--State contract FY13-15, please approve for your program elements
Importance: High
Hello,
Attached is the contract we have been waiting for. This is the agreement that outlines our program
elements and funding FY13-15.
Eric, I see the Drinking Water Program is PE 50, Page 108 through 117.
Everyone, please review and approve for your applicable program element descriptions and funding.
Feel free to contact me if you have questions.
Happy reading everyone and thank you!
Nancy Mooney
Contract Specialist
541-322-7516 phone
541-322-7565 fax
Deschutes County Health Services
2577 NE Courtney Drive
Bend, OR 97701
-----Original Message----
From: THIES Connie [mailto:connie.thies@state.or.us]
1
Nancy Mooney
From: Laura Spaulding
Sent: Thursday, June 13, 2013 9:36 AM
To: Kate Moore; Nancy Mooney
Subject: RE: LPHA 142008--State contract FY13-15, please approve for your program elements
No changes. Looks accurate. Thank you.
Is
Laura Spaulding, RON
WIC Coordinator
Accreditation Coordinator
Deschutes County Health Services
2577 NE Courtney Dr.
Bend, OR 97701
541.322.7450
Our Mission: To promote and protect the health and safety of our community.
CONFIDENTIALITY STATEMENT:
This e-mail, including attachments, may include Protected Health Information or otherwise
confidential, or legally privileged information, and may be used only by the person or entity to which it
is addressed or the individuals designated to view such information per HIPAA regulations. If the
reader of this e-mail is not the intended recipient or his or her authorized agent, the reader is hereby
notified that any dissemination, distribution or copying of this e-mail is prohibited. If you have received
this e-mail in error, please notify the sender by replying to this message and delete this e-mail
immediately.
-----Original Message----
From: Kate Moore
Sent: Wednesday, June 12,20135:10 PM
To: Laura Spaulding; Nancy Mooney
Subject: FW: LPHA 142008--State contract FY13-15, please approve for your program elements
Importance: High
Laura-please look at WIC program assurances to see if any change-thanks Kate
-----Original Message----
From: Nancy Mooney
Sent: Tuesday, June 11,20138:51 AM
To: Thomas Kuhn; Kate Moore; Eric Mone
Cc: Sandy Ringer
Subject: LPHA 142008--State contract FY13-15, please approve for your program elements
Importance: High
Hello,
Attached is the contract we have been waiting for. This is the agreement that outlines our program
elements and funding FY13-15.
1
Nancy Mooney
From: Thomas Kuhn
Sent: Thursday, June 27, 2013 9:14 AM
To: Nancy Mooney
Subject: RE: Public Health OHA agreement FY13-1S, legal counsel has a question and I think you
i+nSkler -to
have the answer
fVlCtrk:: s aU.(..,<;-+. ~Y\
Hi Nancy, ~
Yes, through our Tobacco Control program, we are enforcing the Oregon Indoor Clean Air Act. Dave
Visiko initiates this work following the receipt of smoking complaints and follows the steps outlined in
Exhibit D.
-Tom
-----Original Message----
From: Nancy Mooney
Sent: Thursday, June 27,20138:43 AM
To: Eric Mone; Thomas Kuhn
Subject: RE: Public Health OHA agreement FY13-15, legal counsel has a question and I think you
have the answer
Importance: High
Hi Eric,
Just checking in about your review of the Program Element for Drinking Water.
Tom,
I need an answer to Mark's question, " ...out of curiosity, is it our intention to actively enforce the
provisions of the Oregon Indoor Clean Air Act, ORS 433? Exhibit D suggests that we will be doing
so."
If I can get this back today, I will try to get Scott's signature and then take downtown for execution
tomorrow. Otherwise, it will all have to wait until I return on July 8th.
Thank you!
Nancy Mooney
Contract Specialist
541-322-7516 phone
541-322-7565 fax
Deschutes County Health Services
2577 NE Courtney Drive
Bend, OR 97701
1
CONFIDENTIAL
Contractor Tax Identification Information
For Accounting Purposes Only
June 10,2013
Deschutes County Health Services
Attn: Scott Johnson
2577 NE Courtney Drive
Bend, OR 97701
Re: Document #: 142008
The State of Oregon requires contractors to provide their Federal Employer Identification
Number (FEIN) or Social Security Number (SSN). This information is requested pursuant to
ORS 305.385 and OAR 125-246-0330(2). Social Security numbers provided pursuant to this
section will be used for the administration of state, federal and local tax laws. The State of
Oregon may report this information to the Internal Revenue Service (IRS). Contractors must
keep this information current at all times. Contractors are required to notify the State of Oregon
contract administrator within 10 business days if this information changes. The State of Oregon
reserves the right to ask contractors to update this information at any time during the document
term.
Business Name (tax filing):~1s~ ~"'i O'S<e'esoO
Billing Address: 1::.00 I\)W \AD " ~t:"Ct
City: '&rd State: ofZ. Zip: if 9-=10 I
Phone: :H/:322"=tSCC>
FEIN: q3"'~CO;2Ql9~
SSN: 1iI
Please return this completed form to:
Connie Thies
Department of Human Services
Office of Contracts and Procurement
250 Winter St NE
Salem, OR 97301
connie.thies@state.or.us
Phone: (503) 945-6372
Fax: (503) 373-7889
CP 385: CTn Form, Rev. 11/11
DHS SHARED SERVICES)n2t;!~"tm.", ] [ealth
of Human Services Office of Contracts and Procurement Authority
John A. Kitzhaber, MD, Governor 250 Winter St NE, Room 306
Salem, OR 97301
Voice: (503) 945-5818
FAX: (503) 373-7889
DOCUMENT RETURN STATEMENT
June 10,2013
Re: Document #: 142008, hereinafter referred to as "Document."
Please complete the following statement and return it along with the completed
signature page and the Contractor Data and Certification page and/or Contractor Tax
Identification Information form (if applicable).
Important: If you have any questions or find errors in the above referenced Document,
please contact the contract specialist, Phil McCoy at (503) 945-5868.
(Name) (Title)
received a copy of the above referenced Document, between the State of Oregon,
acting by and through the Department of Human Services, the Oregon Health Authority,
and Deschutes County Health Services, bye-mail from Connie Thies on June 10, 2013.
On ________, I signed the electronically transmitted Document without
(Date)
change. I am returning the completed signature page and Contractor Data and
Certification page and/or Contractor Tax Identification Information form (if applicable)
with this Document Return Statement.
(Authorizing Signature) (Date)
---~""REVIEWED
LEGAL COlJN
In compliance with the Americans with Disabilities Act, this document is available in
alternate formats such as Braille, large print, audiotape, oral presentation and electronic
format. To request an alternate format, please send an e-mail to dhs
oha.publicationrequest@state.or.us or call 503-378-3486, and TTY at 503-378-3523.
AGREEMENT #142008
OREGON HEALTH AUTHORITY
2013-2015 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF PUBLIC HEALTH SERVICES
This Oregon Health Authority 2013-2015 Intergovernmental Agreement for the Financing of
Public Health Services (the "Agreement") is between the State of Oregon acting by and through its
Oregon Health Authority ("OHA") and Deschutes County Health Services, the entity designated,
pursuant to ORS 431.375(2), as the Local Public Health Authority for Deschutes County ("LPHA").
RECITALS
WHEREAS, ORS 431.375 authorizes OHA and LPHA to collaborate and cooperate in
providing for basic public health services in the state, and in maintaining and improving public health
services through county or district administered public health programs;
WHEREAS, ORS 431.250 and 431.380 authorize OHA to receive and disburse funds made
available for public health purposes;
WHEREAS, LPHA has established and proposes, during the term of this Agreement, to operate
or contract for the operation of public health programs in accordance with the policies, procedures, and
administrative rules ofOHA;
WHEREAS, LPHA has requested financial assistance from OHA to operate or contract for the
operation of LPHA's public health programs;
WHEREAS, OHA is willing, upon the terms and conditions of this Agreement, to provide
financial assistance to LPHA to operate or contract for the operation of LPHA's public health
programs.
NOW, THEREFORE, in consideration of the foregoing premises and other good and valuable
consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto agree
as follows:
2013-2015 INTERGOVERNMENTAL AGREEMENT F'OR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE I OF 167 PAGES
142008 PGM -DESCHUTES COUNTY .
DC 2013· 384 DC
AGREEMENT
1. Effective Date and Duration. This Agreement is effective on July 1, 2013. Unless terminated
earlier in accordance with its terms, this Agreement shall terminate on June 30, 2015.
2. Agreement Documents, Order of Precedence. This Agreement consists of the following
documents:
This Agreement without Exhibits
Exhibit A Definitions
Exhibit B Program Element Descriptions
Exhibit C Financial Assistance Award and Revenue and Expenditure Reporting Forms
Exhibit D Special Terms and Conditions
Exhibit E General Terms and Conditions
Exhibit F Standard Terms and Conditions
Exhibit G Required Federal Terms and Conditions
Exhibit H Required Provider Contract Provisions
Exhibit I Provider Insurance Requirements
In the event of a contlict between two or more of the documents comprising this Agreement,
the language in the document with the highest precedence shall control. The precedence of
each of the documents comprising this Agreement is as follows, listed from highest precedence
to lowest precedence: this Agreement without Exhibits, Exhibit A, Exhibit F, Exhibit E,
Exhibit C, Exhibit D, Exhibit B, Exhibit G, Exhibit H, and Exhibit I.
3. Vendor or Sub-Recipient Determination and CFDA Numbers. Vendor or Sub-Recipient
determination is listed at Exhibit A "Definitions". Related federal policy and procedures are
referenced in Exhibit G "Required Federal Terms and Conditions", paragraph 8. "Audits".
Catalog of Federal Domestic Assistance (CFDA) #(s) of federal funds to be paid through this
Agreement are listed at Exhibit A, paragraph 16. "Program Element".
201J-2015INTERGOVERNMENTAL AGRUMENT FOR THE FINANCING Of' PUBLIC HEALTH SERVICES PAGE 2 Of' 167 PAGES
142008 PGM -DESCHUTES COt'NTY
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the
dates set forth below their respective signatures.
4. SIGNATURES.
STATE OF OREGON ACTING BY AND THROUGH ITS OREGON HEALTH AUTHORITY (OHA)
By:
Name: Thomas G. Eversole
Title: Administrator, Center for Public Health Practice
Date:
DESCHUTES COUNTY ACTING BY AND THROUGH ITS DESCHUTES COUNTY HEALTH SERVICES
(LPHA)
By:
Name: Alan Unger, Chair
Deschutes County Board of Commissioners
Title:
Date:
DEPARTMENT OF JUSTICE -APPROVED FOR LEGAL SUFFICIENCY
Approved by D. Kevin Carlson, Senior Assistant Attorney General on May 21, 2013. Copy of
approval on file at OHA, OC&P .
REVIEWED:
OFFICE OF CONTRACTS & PROCUREMENT
By:
Name: Phillip G. McCoy, OPBC, OCAC
Title: Contract Specialist
Date:
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF Pt;BLlC HFALTH SERVICFS PAGE 3 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
OREGON HEALTH AUTHORITY
2013-2015 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF PUBLIC HEALTH SERVICES
EXHIBIT A
DEFINITIONS
As used in this Agreement, the following words and phrases shall have the indicated meanings.
Certain additional words and phrases are defined in the Program Element Descriptions. When a word
or phrase is defined in a particular Program Element Description, the word or phrase shall not
necessarily have the ascribed meaning in any part of the Agreement other than the particular Program
Element Description in which it is defined.
1. "Agreement" means this 2013-2015 Intergovernmental Agreement for the Financing of Public
Health Services.
2. "Agreement Settlement" means OHA's reconciliation, after termination of this Agreement, of
amounts OHA actually disbursed to LPHA under this Agreement with amounts that OHA is
obligated to pay to LPHA under this Agreement based on allowable expenditures as properly
reported to OHA in accordance with this Agreement. OHA reconciles disbursements and
payments on an individual Program Element basis.
3. "Allowable Costs" means the costs described in OMB Circular A-87 except to the extent such
costs are limited or excluded by other provisions of this Agreement, whether in the applicable
Program Element Descriptions, the Special Terms and Conditions, the Financial Assistance
Award, or otherwise.
4. "Claims" has the meaning set forth in Section 2 of Exhibit F.
5. "Conference of Local Health Officials" or "CLHO" means the Conference of Local Health
Officials created by ORS 431.330.
6. "OHA" means the Oregon Health Authority of the State of Oregon.
7. "Federal Fnnds" means all funds paid to LPHA under this Agreement that OHA receives from
an agency, instrumentality or program ofthe Federal Government of the United States.
8. "Financial Assistance Award" or "FAA" means the description of financial assistance set
forth in Exhibit C, as such Financial Assistance A ward may be amended from time to time.
9. "Grant Appeals Board" has the meaning set forth in Exhibit E. Section 1.c.iii.(B)(ii.)(a).
10. "LPHA" has the meaning set forth in the first paragraph of this Agreement.
11. "LPHA Client" means, with respect to a particular Program Element service, any individual
who is receiving that Program Element service from or through LPHA.
2013-2015INTERGOYERNMENTAL AGREEMENT FOR <£HE FINANCING OF PUBLIC HEALTH SERVICES PAGE 4 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
12. Medicaid" means federal funds received by OHA under Title XIX of the Social Security Act.
13. "Misexpenditure" means money disbursed to LPHA by OHA under this Agreement and
expended by LPHA that:
a. Is identified by the Federal Government as expended contrary to applicable statutes,
rules, OMB Circulars or any other authority that governs the permissible expenditure of
such money, for which the Federal Government has requested reimbursement by the
State of Oregon and whether in the form of a federal determination of improper use of
federal funds, a federal notice of disallowance, or otherwise; or
b. Is identified by the State of Oregon or OHA as expended in a manner other than that
permitted by this Agreement, including without limitation, any money expended by
LPHA, contrary to applicable statutes, rules, OMB Circulars or any other authority that
governs the permissible expenditure of such money; or
c. Is identified by the State of Oregon or OHA as expended on the delivery of a Program
Element service that did not meet the standards and requirements of this Agreement
with respect to that service.
14. "Provider" has the meaning set forth in Section 4 of Exhibit E. As used in a Program Element
Description and elsewhere in this Agreement where the context requires, Provider also includes
LPHA if LPHA provides services described in the Program Element directly.
15. "Provider Contract" has the meaning set forth in Section 4 of Exhibit E.
16. "Program Element" means anyone of the following services or group of related services as
described in Exhibit B, whose costs are covered in whole or in part with financial assistance
that OHA pays to LPHA pursuant to this Agreement: [this section continues next page.]
2013·2015 INTERGOVERNMENTAL AGREEMENT .'OR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 5 OF 167 PAGES
142008 PGM· DESCHUTES COUNTY
2013-2015 PROGRAM ELEMENTS (PE)
PE NUMBER AND TITLE
• SUB-ELEMENT(S)
FUND
TYPE
FEDERAL AGENCY I
GRANT TITLE
CFDA#
PE 01 State Support for Public Health GF N/A N/A
• PE 01 Accreditation Mini Grants FF
CDC I Strengthening Public
Health Infrastructure for Improved
Health Outcomes
93.507
PE 02 City Readiness Initiative (CRI) FF
CDC I Public Health Preparedness
and Response for Bioterrorism 93.069
PE 03 Tuberculosis Case Management GFFF
CDC I Project Grants and
Cooperative Agreements for
Tuberculosis Control Program
93.116
PE 05 Health Impact Assessment (HIA) FF CDC I Environmental Public
Health and Emergency Response 93.070
PE 07 mv Prevention Services GFFF CDC I HlV Prevention Activities
for Health Departments 93.940
PE 08 Ryan White Case Management GFOF
FF
HRSA I HIV Care Formula Grants 93.917
PE 08 Ryan White Support Services • GFOF
FF
HRSA I HIV Care Formula Grants 93.917 .
PE 10 Sexually Transmitted Disease (STD) GF50%
FF 50%
CDC I HIV Prevention Activities
for Health Departments 93.940
PE 11 Climate Change and Public Health
Program: Building Capacity to Address the Public
Health Impacts of Climate Change at the Local
Level
FF
CDC I Environmental Public
Health and Emergency Response 93.070
PE 12 Public Health Emergency Preparedness
(PHEP) FF CDC I Public Health Preparedness
and Response for Bioterrorism 93.069
PE 13 Tobacco Prevention and Education
Program (TPEP) OF N/A N/A
PE 15 Healthy Communities (HC) OFFF
CDC I Investigations & Technical
Assistance; Environmental Public
Health & Emergency Response
93.283;
93.070
PE 19 Program Desigu and Evaluation Services
(PDES) (see sub-element detail)
• PE 19 PDES HIV Medical Monitoring
Project OF FF CDC I HIV/AIDS Surveillance 93.944
PE 19 PDES BRFSS Data Weighting • OFFF CDC I Health Care
SurveillancelHealth Statistics 93.745
• PE 19 PDES Coordinated School Health,
Return on Investment Project OF N/A N/A
• PE 19 PDES Evaluation of OR Prescription
Drug Monitoring Project OF N/A N/A
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING Ot" PUBLIC HEALTH SERVICES PAGE 6 OF 167 PAGES
142008 PGM -DESCHUTES CotlNTY
2013-2015 PROGRAM ELEMENTS (PE)
PE NUMBER AND TITLE
• SUB-ELEMENT(S)
FUND
TYPE
FEDERAL AGENCY I
GRANT TITLE CFDA#
• PE 19 PDES Falls Prevention Program
Evaluation FF
DHHS/CDC I Injury Prevention &
Control Research & State &
Community Based Programs
93.136
PE 20 Statewide Lead Line FF
EPAffSCA I Title IV State Lead
Grants Certification of Lead
Based Paint Professionals
66.707
PE 25 Metro Area Pertussis Surveillance
(MAPS) FF CDC I Investigations & Technical
Assistance 93.283
~EIP HAl Projects (Multnomah Co. only) FF CDC I ARRA Preventing
Healthcare-Associated Infections 93.717
PE 40 FIlS WIC FF
USDA I Special Supplemental
Nutrition Program for Women,
Infants and Children
10.557
• PE 40 FHS WIC Peer Counseling FF
USDA I Special Supplemental
Nutrition Program for Women,
Infants and Children
10.557
PE 41 FIlS Reproductive Health Services FF DHHS I Family Planning Services 93.217
PE 42 FIlS Maternal and Child Health Services
Title V Flexible Funds FF HRSA / Maternal & Child Health
Block Grant to the States 93.994
• PE 42 FHS Maternal and Child Health
Services Title V Child & Adolescent Health FF HRSA I Maternal & Child Health
Block Grant to the States 93.994
• PE 42 FHS Maternal and Child Health
Services Oregon MothersCare FF HRSA I Maternal & Child Health
Block Grant to the States 93.994
• PE 42 FHS Maternal and Child Health
Services Perinatal GF GF N/A N/A
• PE 42 FHS Maternal and Child Health
Services CAH GF GF N/A N/A
• PE 42 FHS Maternal and Child Health
Services Babies First! GF N/A N/A
PE 43 FIlS Immunization Services GF, FF CDC I Immunization Cooperative
Agreements 93.268
PE 43 FHS Immunization Affordable Care •
Act (AAC) FF
CDC I PPHF 2012 -AAC
Capacity Building Assistance to
Strengthen PHIP
93.539
PE 44 FIlS School-Based Health Centers GF N/A N/A
PE 47 Linking Actions for Unmet Needs in
Child Health Project (LAUNCH) FF
DHHS/SAMHSA I Linking
Actions for Unmet Needs in
Children
93.243
PE 48 Personal Responsibility Education
Program (PREP) FF DHHS / ACA PREP 93.092
PE 50 Safe Drinking Water (SDW) Program FF, OF
EPA I Public Water System
Supervision Grant; Drinking
Water State Revolving Funds
Capitalization Grant
66.432;
66.468
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142008 PGM -DESCHUTES COUNTY
17. "Program Element Description" means the description of the group of services falling within
a Program Element, as set forth in Exhibit B.
18. "Underexpenditure" means money disbursed to LPHA by OHA under this Agreement that
remains unexpended by LPHA at Agreement termination.
19. "Vendor" or "Sub-Recipient" are terms which pertain to the accounting and administration of
federal funds awarded under this Agreement. In accordance with the State Controller's Oregon
Accounting Manual, policy 30.40.00.102, OHA determines that for the purposes of this
Agreement, LPHA is a Sub-Recipient.
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OREGON HEALTH AUTHORITY
2013·2015 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF PUBLIC HEALTH SERVICES
EXHIBITB
PROGRAM ELEMENT DESCRIPTIONS
Program Element #01: State Support for Public Health (SSPH)
1. Purpose of State Support for Public Health Services (SSPH). State Support for Public
Health (SSPH) funds awarded to LPHA must only be used in accordance with and subject to
the requirements and limitations set forth below to operate a Communicable Disease control
program in LPHA's service area that includes the following components: (i) epidemiological
investigations that report, monitor and control Communicable Disease, (ii) diagnostic and
consultative Communicable Disease services, (iii) early detection, education, and prevention
activities to reduce the morbidity and mortality of reportable Communicable Diseases, (iv)
appropriate immunizations for human and animal target populations to control and reduce the
incidence of Communicable Diseases, and (v) collection and analysis of Communicable
Disease and other health hazard data for program planning and management.
2. Definitions Specific to SSPH
a. Communicable Disease: A disease or condition, the infectious agent of which may be
transmitted from one person or animal to another person, either by direct contact or
through an intermediate host, vector or inanimate object, and that may result in illness,
death or severe disability.
b. Conference of Local Health Officials ("CLHO") Standards for Communicable
Disease Control or CLHO Standards for Communicable Disease Control:
Minimum standards for local health department services for the control of
Communicable Diseases as adopted by the Conference of Local Health Officials
(CLHO) in June 2008, available online at: ...
http://public.healthoregongovIProviderPartnerResourcesILocalHealthDepartmentRes
ourcesIDocumentsIRESOURCESI2008%20v%201I%20with%20adminstrator%20MINI
MUM%20STANDARDS%20HEALTH%20DEPTCombined903.pd{
... and the Oregon Health Authority in accordance with ORS 431.345 and OAR 333
Division 14.
3. Standards for Program Operations.
a. LPHA must operate its Communicable Disease program in accordance with the CLHO
Standards for Communicable Disease Control and the Requirements and Standards for
the Control of Communicable Disease set forth in ORS Chapters 431,432,433 and 437
and OAR Chapter 333, Divisions 12,17,18, 19 and 24, as such statutes and rules may
be amended from time to time.
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h. As part of its Communicable Disease control program, LPHA must, within its service
area, investigate the outbreak of Communicable Diseases, institute appropriate
Communicable Disease control measures, and submit required information regarding
the outbreak to OHA as prescribed in OHA CD Investigative Guidelines available at:
http://public.health.oregon.gov/DISEASESCONDITIONS/COMMUNICABLEDISEASEI
REPORTINGCOMMUNICABLEDISEASEIPageslindex.aspx
4. Reporting Requirements. LPHA must complete and submit to OHA, no later than August 25
of each fiscal year, an Oregon Health Authority Public Health Division Expenditure and
Revenue Report.
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Program Element #03 -Tuberculosis Services
1. Description. ORS 433.006 and Oregon Administrative Rule 333-019-0000 assign responsibility
to LPHA for Tuberculosis ("TB") investigations and implementation of TB control measures
within LPHA's service area. The funds provided under this Agreement for this Program Element
may only be used, in accordance with and subject to the requirements and limitations set forth
below, as supplemental funds to support LPHA's TB investigation and control efforts. The funds
provided under this Agreement for this Program Element are not intended to be the sole funding
for LPHA's TB investigation and control program.
2. Definitions Specific to TB Services.
B. Active TB Disease: TB disease in an individual whose immune system has failed to
control his or her TB infection and who has become ill with active TB disease, as
determined in accordance with the Centers for Disease Control and Prevention's (CDC)
laboratory or clinical criteria for active TB and based on a diagnostic evaluation of the
individual.
b. Appropriate Therapy: Current TB treatment regimens recommended by the CDC, the
American Thoracic Society, the Academy of Pediatrics, and the Infectious Disease
Society of America.
c. Associated Cases: Additional cases of TB disease discovered while performing a
contact investigation.
d. B-waiver Immigrants: Immigrants or refugees screened for TB prior to entry to the U.S.
and found to have TB disease or latent TB infection.
e. Case: A case is an individual who has been diagnosed by a health care provider, as
defined in OAR 333-017-0000, as having a reportable disease, infection, or condition,
as described in OAR 333-018-0015, or whose illness meets defining criteria published
in OHA's Investigative Guidelines.
f. Cohort Review: A systematic review of the management of patients with TB disease
and their contacts. The "cohort" is a group of TB cases counted (confirmed as cases)
over 3 months. The cases are reviewed 6-9 months after being counted to ensure they
have completed treatment or are nearing the end. Details of the management and
outcomes of TB cases are reviewed in a group with the information presented by the
case manager.
g. Contact: An individual who was significantly exposed to an infectious case of active
TB disease.
h. Directly Observed Therapy (DOT): LPHA staff (or other person appropriately
designated by the county) observes an individual with TB disease swallowing each dose
of TB medication to assure adequate treatment and prevent the development of drug
resistant TB.
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i. Evaluated (in context of contact investigation): A contact received a complete TB
symptom review and tests as described in OHA's Investigative Guidelines.
j. Interjurisdictional Transfer: A TB suspect, case or contact transferred for follow-up
evaluation and care from another jurisdiction either within or outside of Oregon.
k. Investigative Guidelines: Department guidelines, dated as of January 2012, which are
incorporated herein by this reference are available for review at
http://public.health.oregon.gov/DiseasesConditions/CommunicableDiseaselTuberculosi
sIDocumentslinvestigativeguide.pdf.
I. Latent TB Infection (L TBl): TB disease in a person whose immune system is keeping
the TB infection under control. LTBI is also referred to as TB in a dormant stage.
m. Medical Evaluation: A complete medical examination of an individual for tuberculosis
including a medical history, Ehysical examination, TB skin test or interferon gamma
release assay (QuantiFERON -TB Gold In-Tube test or T-SPOT®.TB test), chest x-ray,
and any appropriate bacteriologic/histologic examinations.
n. Suspected Case: A suspected case is an individual whose illness is thought by a health
care provider, as defined in OAR 333-017-0000, to be likely due to a reportable disease,
infection, or condition, as described in OAR 333-018-0015, or whose illness meets
defining criteria published in OHA's Investigative Guidelines. This suspicion may be
based on signs, symptoms, or laboratory findings.
o. TB Case Management: Dynamic and systematic management of a case of TB where a
person, known as a case manager, is assigned responsibility for the management of an
individual TB case to ensure completion of treatment. TB Case Management requires a
collaborative approach to providing and coordinating health care services for the
individual. The case manager is responsible for ensuring adequate TB treatment,
coordinating care as needed, performing contact investigations and following infected
contacts through completion of treatment, identifying barriers to care and implementing
strategies to remove those barriers.
3. Procedural and Operational Requirements.
a. LPHA must include the following minimum TB services in its TB investigation and
control program if that program is supported in whole or in part with funds provided
under this Agreement, as defined above and further described below and in OHA's
Investigative Guidelines.
b. Tuberculosis Case Management Services. LPHA's TB Case Management Services must
include the following minimum components:
i. LPHA must investigate and monitor treatment for each case and suspected case of
active TB disease identified by or reported to LPHA whose residence is in LPHA's
jurisdiction, to confirm the diagnosis of TB and ensure completion of adequate
therapy.
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ii. LPHA must require individuals who reside in LPHA's jurisdiction and who LPHA
suspects of having active TB disease, to receive appropriate medical examinations
and laboratory testing to confirm the diagnosis of TB and response to therapy,
through the completion of treatment. LPHA must assist in arranging the laboratory
testing and medical examination, as necessary.
iii. LPHA must provide medication for the treatment of TB to all individuals who
reside in LPHA's jurisdiction and who have TB but who do not have the means to
purchase TB medications or for whom obtaining or using identified means is a
barrier to TB treatment compliance. LPHA must monitor, at least monthly and in
person, individuals receiving medication(s) for adherence to treatment guidelines,
medication side effects, and clinical response to treatment.
iv. LPHA must develop a plan to ensure patient adherence with TB treatment
guidelines for each individual within LPHA's jurisdiction identified by or reported
to LPHA as having active TB disease. This plan should include the use of DOT for
the majority of patients. If DOT will not be used, other methods to ensure patient
adherence with treatment guidelines must be utilized and documented (e.g. monthly
pill counts or other). Evidence of patient adherence (such as DOT records) must be
documented in each individual's chart.
v. DOT Guidelines: DOT is the standard of care for the treatment ofTB. Virtually all
cases of active TB disease should be treated via DOT. If DOT is not utilized, the
LPHA may be asked to justify to Department why DOT was not used for that
particular individual.
The clinical indications and socioeconomic factors listed below are strong indicators
that DOT is necessary to ensure adequate treatment of the individual and to prevent
acquired drug resistant TB. Patients with the following risk factors must be on DOT.
If patients with any of the below circumstances will not be on DOT for any reason
during their course of treatment, OHA must be contacted and a plan to ensure
compliance discussed.
a.) Clinical indications which require DOT include:
(i.) HIV and TB co-infection
(ii.) Reactivation ofTB disease or history of previous TB treatment
(iii.) MDR-TB
(iv.) Smear positivity
(v.) Cavitary disease
(vi.) History of drug and alcohol abuse within the last 6 months
(vii.) Evidence of severe malnourishment with BMI <18.5
(viii.) Patient < 18 years old
b.) Socioeconomic factors which require DOT include:
(i.) Homelessness
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(ii.) History of failure to arrive for clinic appointments and/or noncooperation
with LPHA interventions and/or history of non-adherence with
prescribed medical therapy (TB or other)
(iii.) Presence of child/children or immunocompromised individual in the
household
(iv.) Resident of a congregate setting such as jail, long term care facility,
group home or homeless shelter.
(v.) Patient unable to self-administer medications due to mental, physical, or
emotional impairments
(vi.) Patient shows poor understanding of TB diagnosis, or non-acceptance of
diagnosis. Consider level of understanding especially carefully for
patients with low literacy and/or low levels of English proficiency.
c.) Patients not on DOT initially must start DOT if any ofthe following occur:
(i.) Slow sputum culture conversion (culture still positive> 2 months after
treatment started)
(ii.) Slow clinical improvement or clinical deterioration while on TB therapy
(iii.) Adverse reaction to TB medications
(iv.) Significant interruptions in therapy due to non-adherence
vi. LPHA may assist the patient in completion of treatment by utilizing the below
methods. Methods to ensure adherence should be documented.
a.) Proposed interventions for assisting the individual to overcome obstacles to
treatment adherence (e.g. assistance with transportation).
b.) Proposed use of incentives and enablers to encourage the individual's
compliance with the treatment plan.
vii. With respect to each case ofTB within LPHA'sjurisdiction that is identified by or
reported to LPHA, LPHA shall perform a contact investigation to identify contacts,
associated cases and source of infection. The LPHA must evaluate all located
contacts, or confirm that all located contacts were advised of their risk for TB
infection and disease.
The LPHA must offer or advise each located contact identified with TB infection or
disease, or confirm that all located contacts were offered or advised, to take
appropriate therapy and shall monitor each contact who starts treatment through the
completion of treatment (or discontinuation of treatment).
viii. If LPHA receives in-kind resources under this agreement in the form of medications
for treating TB, LPHA shall use those medications to treat individuals for TB. In
the event of a non-TB related emergency (i.e. meningococcal contacts), with
notification to TB Program, the LPHA may use these medications to address the
emergent situation.
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ix. The LPHA will present TB cases through participation in the quarterly cohort
review. If the LPHA is unable to present the TB case at the designated time, other
arrangements shall be made in collaboration with OHA.
x. The LPHA will accept Class B waivers and inter jurisdictional transfers for
evaluation and follow-up, as appropriate for LPHA capabilities.
4. Reporting Obligations and Periodic Reporting Requirements. LPHA shall prepare and
submit the following reports to OHA:
a. LPHA shall notify OHA's TB Program of each case or suspected case of active TB
disease identified by or reported to LPHA no later than 5 business days within receipt of
the report (OR -within 5 business days of the initial case report), in accordance with
the standards established pursuant to OAR 333-018-0020. In addition, LPHA shall,
within 5 business days of a status change of a suspected case of TB disease previously
reported to OHA, notify OHA of the change. A change in status occurs when a
suspected case is either confirmed to have TB disease or determined not to have TB
Disease. The LPHA shall utilize OHA's "TB Disease Case Report Form" for this
purpose. After a case of TB disease has concluded treatment, case completion
information shall be sent to OHA's TB Program utilizing the "TB Disease Case Report
Form" within 5 business days of conclusion of treatment.
b. LPHA shall submit the "TB Contact Investigation Form" to OHA's TB Program or
enter contacts into the Orpheus database in accordance with the time lines described in
the instructions for the reporting forms designated by OHA for this purpose. Contact
investigations are not required for strictly extrapulmonary cases. Consult with local
medical support as needed.
5. Performance Measures. If LPHA uses funds provided under this agreement to support its TB
investigation and control program, LPHA shall operate its program in a manner designed to
achieve the following national TB performance goals by 2015:
a. For patients with newly diagnosed TB for whom 12 months or less of treatment is
indicated, 93.00/0 will complete treatment within 12 months.
b. For TB patients with positive acid-fast bacillus (AFB) sputum-smear results, 100.0%
(of patients) will be elicited for contacts.
c. For contacts of sputum AFB smear-positive TB cases, 93.0% will be evaluated for
infection and disease.
d. For contacts of sputum AFB smear-positive TB cases with newly diagnosed latent TB
infection (L TBI), 88.0% will start treatment.
e. For contacts of sputum AFB smear-positive TB cases that have started treatment for
newly diagnosed L TBI, 79.0% will complete treatment.
f. For TB cases in patients ages 12 years or older with a pleural or respiratory site of
disease, 950/0 will have a sputum culture result reported.
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Program Element #07: DIV Prevention Services
1. Description. Funds provided under this Agreement for this Program Element may only be
used, in accordance with and subject to the requirements and limitations set forth below, for the
following services and appropriate costs associated with the delivery of these services:
a. Confidential and anonymous HIV counseling, testing and referral services, including
rapid HIV testing;
b. Other HIV prevention services with evidence of effectiveness to identified priority
populations in LPHA's service area; and
c. Structural activities that facilitate the delivery of HIV prevention services to priority
populations in the LPHA's service area.
Priority populations for service focus in Oregon are identified in the current HIV Prevention
Comprehensive Plan. Funds awarded under this Agreement may only be expended on services
included in the LPHA's HIV Prevention Program Model Plan that has been approved by the
OHA HIV Prevention Program, with a focused emphasis on services for the priority
popUlations identified in the plan.
2. Definitions Specific to DIV Prevention Services.
a. CDC: Federal Centers for Disease Control and Prevention.
b. CLHOIHIV: Conference of Local Health OfficialslHIV subcommittee of CLHO
Executive.
c. Client Focused Counseling: A counseling technique used in HIV Counseling, Testing,
and Referral Services that usually consists of (i) a personalized risk assessment
counseling session that encourages the individual to identify, understand, and
acknowledge the behaviors and circumstances that put the individual at risk for HIV,
explores previous attempts to reduce risk, identifies successes and challenges in these
efforts and culminates, in most cases, in a commitment from the individual to adopt at
least one risk reduction behavior, and (ii) a second counseling session in which the
counselor discusses the HIV test results, explores how the individual may have
implemented the risk reduction behavior the individual committed to in the first session,
identifies with the individual additional risk reduction behaviors he/she may also adopt,
and makes any appropriate referrals. When using HIV rapid testing technology, there
may be only one client centered counseling session.
d. Clinical Laboratory Improvement Amendments or CLlA: Federal legislation that
governs the licensing of laboratories. A CLiA certificate of waiver allows laboratories
to perform simple laboratory tests.
e. Community Review Panel (alkla Program Review Panel): A panel comprised of
community members and established in accordance with CDC guidelines which are
available for review at http://www.cdc.gov/od/pgo/formslhiv.htm. that reviews and
201J..201SINTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PuBUC HEALTH SERVICES PAGE 16 OF 167 PAGES
142008 PGM -DESCHt:TES COUNTY
approves for appropriateness the HIV prevention informational materials that are
distributed in the counties in which LPHA provides HIV prevention services. Review
panels may be convened by OHA or the LPHA.
f. Comprehensive Prevention with Positives:
i. Linkages to care and treatment and interventions to improve retention in care and
treatment for people living with HIV
ii. Behavioral interventions and other risk reduction services for HIV positive
individuals and their sexual or needle sharing partners to reduce the likelihood of
HIV transmission
iii. Interventions to prevent mother-to-child HIV transmission
iv. Referral to other medical and social services, such as substance abuse and mental
health services
v. Support and/or facilitate voluntary testing for hepatitis, TB and other STDs and
Partner Services accordingly
g. Culturally Appropriate: Characteristic of services provided to clients with diverse
values, ethnicities, sexual orientations, beliefs and behaviors that include, as necessary,
the tailoring of delivery methods to meet client's social, cultural and linguistic needs
h. HIV Counseling, Testing, and Referral Services or CTRS: An HIV prevention service,
which includes client focused counseling, obtaining a blood or oral fluid specimen on
which to conduct an HIV test, and referral and linkage to other appropriate services.
i. HIV Prevention Program Model Plan: The plan that describes the HIV Counseling,
Testing and Referral Services, other HIV prevention services, and structural activities
that LPHA intends to deliver with funds provided under this Agreement for this
Program Element. Each program plan includes a specific engagement plan for
communities of color and also includes anti-stigma approaches and activities for
priority populations.
j. Partner-Counseling and Referral Services or PCRS: A systematic approach to
notifYing sex and needle-sharing partners of HIV-infected persons of their possible
exposure to HIV. PCRS assists exposed partners to early access to individualized
counseling, HIV testing, medical evaluation, treatment, and other prevention services.
k. Preliminary Positive: A result from a Rapid HIV Test that indicates HIV antibodies are
in the blood of the person tested. A preliminary positive test result must be followed up
with a traditional serum or oral fluid HIV test to determine if the individual is actually
infected with HIV.
I. Rapid HIV Test: An FDA-approved HIV test that yields negative or preliminary
positive test results within a short time period (less than 30 minutes) after processing
specimen.
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m. Structural activities: Activities that remove barriers to the delivery of HIV prevention
services in the LPHA service area. (Examples include working with police to support
harm reduction services to injection drug users, working with Department of
Transportation officials to support outreach activities in road rest areas, etc.)
n. Sub-contractor: A provider offering services pursuant to a subcontract of the LPHA for
the purposes of providing HIV Prevention services to a targeted population.
3. Procednral and Operational Reqnirements.
a. Staffing Requirements and StaffOualifications.
i. HIV Counseling, Testing and Referral Services. All individuals providing HIV
Counseling, Testing and Referral Services supported in whole or part with funds
provided under this Agreement must have received baseline training in the
essentials of HIV prevention which includes client focused counseling techniques,
HIV transmission basics, risk reduction messages, provision for making effective
referrals and linking people to care, and a general orientation to the priority
popUlations in Oregon. If staff is providing Rapid HIV Tests appropriate training in
methods and in rapid HIV counseling and testing according to CDC HIV CTRS
guidelines must be ensured. In addition, contractors should plan on attending these
trainings after updates to the curricula have been made by the CDC and as
reasonably requested by the OHA HIV Prevention Program. To ensure that the
skills acquired during baseline training are employed during CTR services, the OHA
HIV Prevention Program reserves the right to shadow contractors during at least one
CTR session within a triennial review period. Baseline training will be available
from the Authority in accordance with a schedule to be determined by the Authority
in consultation with the LPHA.
ii. Other HIV Prevention Services and Structural Activities. At least one staff member
who will be providing HIV prevention services in addition to HIV CTRS and/or
engaging in structural activities supported in whole or in part with funds provided
under this Agreement, from LPHA and each Provider must attend in-service skills
building meetings and/or training as reasonably requested and scheduled by the
Authority from time to time.
b. Minimum Service Requirements.
HIV Counseling. Testing and Referral Services. All HIV Counseling, Testing and
Referral Services supported in whole or in part with funds provided under this
Agreement must be delivered in accordance with LPHA's HIV Prevention Program
Model Plan and must meet the following minimum requirements:
i. HIV Counseling, Testing, and Referral Services must be available on a voluntary
basis and in both confidential and anonymous formats within the LPHA's service
area. Each individual seeking such services must be informed that anonymous HIV
testing is available. Although LPHA must make both confidential and anonymous
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142008 PGM -DESCHUTES COUNTY
HIV testing available, LPHA is not required to make both available at every site at
which LPHA offers HIV testing.
ii. HIV Counseling, Testing and Referral Services must be provided in accordance
with applicable Oregon and Federal statutory and regulatory requirements, must be
easily accessible, available, culturally appropriate, and must include information
about HIV / AIDS reporting laws. The identity of an individual receiving HIV
Counseling, Testing and Referral Services must not be released to anyone without
the written consent of the individual, except when otherwise required, or permitted,
by Oregon or Federal statute or regulation.
iii. HIV Counseling, Testing and Referral Services must be available for priority
populations regardless of an individual's ability to pay. LPHA may impose fees for
HIV Counseling, Testing and Referral Services but fees may not exceed the
reasonable cost of the service. LPHA may not deny HIV Counseling, Testing and
Referral Services because of an individual's inability to pay for the services.
Revenues generated from HIV Counseling, Testing and Referral Services supported
in whole or in part with funds provided under this Agreement, and any donations
received for HIV Counseling, Testing and Referral Services, may only be used for
HIV prevention services. LPHA must report all HIV Counseling, Testing, and
Referral Services fee revenue and donations to the LPHA on the "Oregon Health
Authority Public Health Division Expenditure and Revenue Report" under Section
B of Exhibit C of this Agreement.
iv. All individuals receiving HIV Testing, Counseling and Referral Services who are at
increased risk for HIV infection must have information offered to them regarding
appropriate prevention and testing services for related infections (e.g. hepatitis,
sexually transmitted infections, and tuberculosis, as appropriate)
v. All individuals receiving HIV Testing, Counseling and Referral Services must
receive Client Focused Counseling that includes information regarding HIV
transmission and prevention and the meaning of HIV test results and counseling to
help the individual identifY personal risk behaviors while emphasizing realistic
behavior change goals to reduce those risks.
vi. LPHAs will assure that at least 95% of positive test results are delivered to clients
testing for HIV.
vii. HIV test results must be provided in a professional and supportive manner.
Individuals must be provided adequate opportunity to ask questions regarding HIV
test results.
viii. IfLPHA tests an individual for HIV and the test result is positive (either preliminary
or confirmatory), LPHA must:
a.) Explain to the individual the meaning ofthe test results.
b.) Encourage the individual to participate in Partner Counseling and Referral
Services and facilitate entry to this service.
c.) Provide referral for medical evaluation and ensure linkage to care.
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d.) Provide the individual with information about and/or referral to mental health
follow-up, when available and when appropriate.
e.) Provide the individual with information about and/or referral to support services
and organizations.
f.) Maintain the strict confidentiality of both the receipt of the HIV test and the HIV
test result.
g.) Ifthe result is a Rapid HIV Test preliminary positive, offer the individual a
confirmatory HIV test or referral for confirmatory HIV testing.
h.) An LPHA utilizing Rapid HIV Tests must be enrolled in CLIA and have a
Certificate of Waiver.
i.) LPHA must designate an employee involved in LPHA's HIV Counseling,
Testing and Referral Services to participate with the Authority staff in the
development and implementation of quality assurance activities related to HIV
Counseling, Testing and Referral Services as requested by OHA HIV Prevention
staff.
j.) An Authority-approved HIV Test Request and HIV Counseling, Testing, and
Referral Form (Form 44) must be completed for each HIV counseling and
testing encounter that is supported in whole or in part with funds provided under
this Agreement.
c. Otber HIV Prevention Services and Structural Activities. All HIV prevention
services and structural activities supported in whole or in part with funds provided
under this Agreement must be delivered in accordance with LPHA's approved HIV
Prevention Program Model Plan and must meet the following minimum requirements:
i. Program must be evidence-based and targeted to prioritized risk populations and sub
populations identified in the current Oregon HIV Prevention Comprehensive Plan
availab Ie at healthoregon. org/hivprevention.
ii. Strategies endorsed by the CDC, such as Social Network Strategy recruitment into
Counseling and Testing or other evidence-based intervention, may be implemented,
subject to approval of the LPHA's Planning Program Model Plan by the OHA HIV
Prevention Program and completion of relevant training for staff.
iii. Structural activities, such as network building to meet the needs of a targeted
popUlation group, work with related agencies to promote HIV risk reduction, etc.,
may be implemented, subject to approval of the LPHA's Planning Program Model
Plan by the OHA HIV Prevention Program.
iv. OHA HIV Prevention-approved programs must be implemented with fidelity to the
core elements of the evidence-based intervention. (A core element is a part of the
intervention that is crucial to satisfYing the intervention's goals and objectives.)
d. All HIV Prevention Services. All LPHAs providing HIV prevention services
supported in whole or in part with funds provided under this Agreement must meet the
following requirements:
i. All agencies that provide HIV prevention services supported entirely or in part with
funds provided under this Agreement must comply with the required reporting
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requirements. This includes participating in monitoring related capacity building
activities.
ii. Condoms must be available and distributed to populations engaging in high risk
behaviors, consistent with populations targeted by the LPHA in its HIV Prevention
Program Model Plan.
iii. If any part of the HIV prevention program of the LPHA is supported by federal HIV
prevention funds, all HIV educational materials must be reviewed and approved by
a local or statewide Program Review Panel in accordance with CDC guidelines.
iv. All HIV educational materials developed or purchased with HIV Prevention
Services funds and approved by a local or statewide Program Review Panel must be
accessible to the public or target population in LPHA's service area.
v. Contractors are required to conduct data submissions at least quarterly. If these
reporting timelines are not met, OHA HIV Prevention Program staff will work with
the contractor to establish and implement a corrective action plan.
vi. Additionally, contractors provide Quarterly Fiscal Expenditure reports on the
amount and percentage of funds used for each HIV Prevention activity identified in
the agency's program plan using the appropriate tab of the "OHA HIV Prevention
Program Plan & Reporting Workbook". This report is due within 30 days after the
close of each calendar quarter.
vii. No financial assistance provided to LPHA for HIV Prevention Services may be used
to provide treatment and/or case management services.
e. Conflicts. In the event of a conflict or inconsistency between the provisions of the HIV
Prevention Program Model Plan and the other provisions of this Program Element
Description, the other provisions of this Program Element Description shall take
precedence.
f. Confidentiality. In addition to the requirements set forth in Section 6 of Exhibit
General Terms and Conditions, of this Agreement and above in this Program Element
Description, all providers of HI V Prevention Services supported in whole or in part with
funds provided under this Agreement must comply with the following confidentiality
requirements:
i. All materials related to the delivery of HIV Prevention Services that contain names
of individuals receiving services or other identifying information must be kept in a
locked and secure area/cabinet, which allows access only to authorized personnel
and all computers and data programs that contain such information must have
restricted access. Providers of HIV Prevention Services must comply with all
applicable county, state and federal confidentiality requirements applicable to the
delivery of HIV Prevention Services. Each provider agency will designate an
Overall Responsible Party (ORP) for confidentiality protection procedures.
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ii. Breaches of confidentiality are serious and require immediate action. Therefore,
supervisory or administrative staff of a provider of HIV Prevention Services must
evaluate all known alleged breaches by its staff, including volunteers and
subcontractor staff, of the confidentiality requirements of this Program Element
Description and must document the process of resolution of breaches of
confidentiality. All confirmed breaches of the confidentiality requirements of this
Program Element Description must result in appropriate sanctions in accordance
with Provider policy and procedure and applicable law. Each provider of HIV
Prevention Services must report to the Authority the nature of confirmed breaches
by its staff, including volunteers and subcontractors, of the confidentiality
requirements of this Program Element Description within 14 days from the date of
evaluation by the provider.
iii. Providers of HIV Prevention Services must establish and comply with a written
policy and procedure regarding a breach of the confidentiality requirements of this
Program Element Description. Such policy must describe the consequences to the
employee, volunteer or subcontractor staff for a verified breach of the
confidentiality requirements ofthis Program Element Description.
4. Certain limitations on use of financial assistance awarded for HIV Prevention Services.
Funds awarded for HIV Prevention Services may only be used to support the following
activities during the period for which the funds are awarded:
a. Programs defined and described in the current Oregon HIV Prevention Comprehensive
Plan available at healthoregon.orglhivprevention.
b. Networking, collaborating, and building relationships with other agencies working with
the targeted populations. This may include attending meetings and giving presentations
at said agencies;
c. Other supporting activities such as advertising and promotion of activities;
d. Travel costs incurred conducting services;
e. Purchase and/or production of program materials;
f. Necessary office equipment and/or supplies to conduct activities;
g. Training and/or conferences for staff and/or supervisors that is relevant to the
intervention and/or working with the target popUlations. This includes monitoring and
evaluation trainings;
h. Paperwork, meetings, and preparation related to conducting programs;
i. Supervision, data collection and review, participation in planning and networking
groups, and/or other related activities directly related to the delivery of HIV prevention
services included in the LPHA HIV Prevention Program Plan, which has been approved
by the Authority.
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5. Agency responsibility if subcontracting for delivery of services. An LPHA may use a
portion of HIV Prevention program funding to subcontract with another community
based agency for delivery of services with the following responsibilities:
a. A Local Public Health Authority which contracts for services using program funds will
ensure the completion of the "OHA HIV Prevention Program Plan & Reporting
Workbook" both for its agency and the subcontractor agency submitting both in a
timely manner as requested by the program.
b. LPHAs will ensure that the subcontractor's fiscal and monitoring data is submitted in a
timely manner.
c. In partnership with the state program, LPHA will identify and participate in capacity
building and quality assurance activities applicable to the subcontractor.
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Program Element #08: Ryan White Program, Part B HIV/ AIDS Services
1. General Description. Funds provided under this Agreement for this Program Element must
only be used, in accordance with and subject to the requirements and limitations set forth
below, to deliver to eligible individuals with HIV and their families one or more of the services
described in the Program, Part B of XXVI of the PHS Act as amended by the Ryan White
HIV/AIDS Treatment Extension Act of 2009(Ryan White Program) , referred to hereafter as
"Ryan White Program" and the Oregon Ryan White Program, Part B HIV Care & Treatment
Program Manual (July 2011 and any revisions thereafter throughout the term of the contract),
referred to hereafter as the "Program Manual." Expenditure of these funds must be directly
related to an individual's HIV positive status and is necessary to help him/her remain in HIV
medical care or to the removal of barriers to his/her receipt of appropriate medical care and
treatment. All Ryan White Program, Part B HIV / AIDS Services that are supported in whole or
in part with funds provided under this Agreement must be delivered in accordance with the
Program Manual.
2. Definitions specific to Ryan White Program, Part B HIV/AIDS Services.
a. Case Management or Case Management Services: Case management is a range of
client-centered services that link clients with health care, psychosocial and other
services. These services ensure timely and coordinated access to medically appropriate
levels of health and support services and continuity of care through ongoing assessment
of the client's and other key family members' needs and personal support systems. Key
activities include (1) initial assessment of service needs, (2) development of a
comprehensive, individualized service plan, (3) coordination and referral follow-up of
services required to implement the plan; (4)client monitoring to assess the efficacy of
the plan; and (5) periodic re-evaluation and adaptation of the plan as necessary over the
life of the client. Case management includes client-specific advocacy and review of the
client's utilization of services. Case management includes, but is not limited to face-to
face coordination, phone contact, and other appropriate forms of communication.
Two types of case management are aJ lowable: medical case management and non
medical case management. Medical case management must be provided by a Registered
Nurse licensed in Oregon. The coordination and follow-up of medical treatments is a
component of medical case management. Medical case management includes the
provision of medical treatment adherence counseling to ensure readiness for, and
adherence to, HIV/AIDS medication regimens and treatments. Additionally, medical
case management includes liver health, nutritional and oral health assessment and
education.
b. Oregon Health Authority (OHA), Part B Ryan White Program, Part B HIV Medical
Case Management Standards of Service: A written document incorporated herein by
this reference that outlines or defines the set of standards and provides directions for
HIV / AIDS Case Management in the State of Oregon. These standards are also intended
to provide a framework for evaluating HIV/AlDS Case Management Services and to
define a professional case manager's accountability to the public and to the individuals
receiving Ryan White Program, Part B Program, Part B HIV/AlDS Services. These
standards are available at www.healthoregon.orglhiv.
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c. HRSAlHAB or Health Resources and Services Administration/HIV I AIDS Bureau: The
agency of the U.S. Department of Health and Human Services that is responsible for
administering the Ryan White Program. Information about HRSA is available at
www.hab.hrsa.gov
d. Oregon HIV Care Coalition (OHCC): A state-wide planning and advisory body
convened by the Oregon Health Authority to provide input and recommendations to
assist the State of Oregon in meeting federal requirements and improve programs
applicable to grants received under the Ryan White Part B Program. OHCC and the
Statewide HIV Prevention planning group will be merged in 2012.
e. XXVI of the PHS Act as amended by the Ryan White HIV/AIDS Treatment Extension
Act of 2009 (Ryan White Program): Public Law 111-87, enacted in 1990 and
reauthorized in 1996, 2000, 2006 and extended in 2009, which is the federal legislation
enacted to address the health care and support service needs of individuals living with
the HIV disease and their families in the United States and its territories.
f. Program, Part B HIV Care and Treatment Program: The State program, funded
predominately under Program, Part B of the Ryan White Program, for improving the
quality, availability, and organization of health care and support services to individuals
with HIV and their families, with the goal of improved health outcomes for individuals
with HIV.
g. Oregon Ryan White Program, Part B HIV Care & Treatment Program Manual: The
Program Manual, incorporated herein by this reference, that defines the range of
services that may be supported with funds awarded under this Agreement for Ryan
White Program, Part B HIV/AIDS Services, the standards for these services, eligibility
for these services, the program monetary caps and levels of service, the priorities for the
use of funds made available for Ryan White Program and reporting requirements, Part
B HIV/AIDS Services under this Agreement. Manual documents can be found online at
www.healthoregon.org/hiv.
3. Procedural and Operational Requiremeuts. All Ryan White Program, Part B HIV/AIDS
Services supported in whole or in part with funds provided under this Agreement must be
delivered in accordance with the following procedural and operational requirements:
a. Eligibility. Ryan White Program, Part B HIV/AIDS Services may only be delivered to
HIV-infected individuals in LPHA's service area who are active participants in Case
Management Services that comply with the requirements of the Oregon Program, Part B
HIV Medical Case Management Standards of Service, and to their affected families of
origin or choice. HIV verification must be obtained and a payer for HIV primary care
medical services must be identified within 30 working days from the date of Intake.
Verification of HIV status may be undertaken only after LPHA obtains the required
consent of that individual to the release of HIV -specific information. This
documentation may not be released to a third party without further consent of that
individual.
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b. Certain Limitations on Use of Financial Assistance.
i. Financial assistance provided under this Agreement for Ryan White Program, Part B
HIV/AIDS Services may not be used to cover the costs for any item or service
covered by other state, federal, or private benefits or service programs. The financial
assistance provided under this Agreement for Ryan White Program, Part B
HIV/AIDS Services must be used as dollars of last resort. LPHA must document in
the records of the individual receiving the Ryan White Program, Part B HIV I AIDS
services that the funds are being used in a manner that complies with this paragraph.
ii. Financial assistance provided under this Agreement for Ryan White Program, Part B
HIV I AIDS Services may only be used for services necessary to facilitate a person
living with HIV I AIDS to access and remain engaged in HIV medical care and
treatment. Financial assistance provided under this Agreement for Ryan White
Program, Part B HIV/AIDS Services may only be used for support services that
directly benefits the health of, or is related to the HIV positive status of an
individual.
iii. Only clients at or below 250% of federal poverty level are eligible for financial
assistance.
iv. No charges to clients shall be imposed for services rendered under this PE.
v. Under no circumstances may the financial assistance be used to provide direct
reimbursement to an individual receiving Ryan White Program, Part B HIV/AIDS
Services.
vi. Financial assistance provided under this Agreement for Ryan White Program, Part B
HIVI AIDS Services may only be used in accordance with the Program Policies,
Services Definitions and Guidance for the Ryan White Program, Part B HIV Care
and Treatment Program, as submitted with the Oregon application for Ryan White
Program, Part B funding, which document is incorporated by this reference and is
available for review at www.healthoregon.orglhiv.
vii. LPHA, as the first-tier contractor, may use up to 10% of the aggregate financial
assistance provided under this Agreement for Ryan White Program, Part B
HIV/AIDS Services to cover LPHA's costs of administering its Ryan White
Program, Part B HIV/AIDS Services. LPHA may permit any of its Providers of
Ryan White Program, Part B HIV/AIDS Services, as second-tier contractor, to use
up to 10% of the funds paid to that Provider by LPHA for Ryan White Program,
Part B HIV/AIDS Services for Provider administrative costs. The aggregate of
funds provided under this Agreement for Ryan White Program, Part B HIV/AIDS
Services that are used to cover administrative costs beyond the first line entity may
not exceed 10% of the total Ryan White Program, Part B HIV/AIDS Services funds
expended by LPHA under this Agreement. For purposes of this limitation, the costs
of administration, including expenses such as overhead and indirect charges, are
those related to the administration of this Agreement and the financial assistance
provided for Ryan White Program, Part B HIV/AIDS Services hereunder, the
awarding of agreements to Providers through requests for proposals, agreement
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monitoring procedures, and completion of Ryan White Program data reports and
other required reports, to the extent such costs are allowable under applicable OMB
cost principles.
c. General Requirements Applicable to all Ryan White Program, Part B HIV I AIDS
Services.
i. Financial assistance provided under the Agreement for Ryan White Program, Part B
HIV/AIDS Services must be budgeted by LPHA in a manner that would reasonably
be expected to assure funding availability throughout the contract period; and with a
priority to "Core" services as defined within the program guidance. Financial
assistance to specific clients must be prioritized based on a client's level of need and
in accordance with the Program Manual, (Program Policies, Services Definitions,
and Guidance and the HIV Medical Case Management Standards of Service), which
is available for download and review at www.healthoregon.orglhiv.
ii. All Ryan White Program, Part B HIV I AIDS Services supported in whole or in part
with funds provided under this Agreement must be delivered consistent with the
service priorities set forth in the Program Manual (Program Policies, Services
Definitions and Guidance), LPHA must use the funds awarded to LPHA under this
Agreement for Ryan White Program, Part B HIV/AIDS Services in accordance with
the care services budget which is attached to this Program Element Description as
Attachment 1 and incorporated herein by this reference (the "Care Services
Budget"). Modifications of this budget may only be made with OHA approval, as
reflected in an amendment to this Agreement, duly executed by all parties.
iii. In the event of any conflict or inconsistency between LPHA's Care Services Budget
and the provisions of this Program Element Description (excluding any
attachments), the provisions of this Program Element Description (excluding any
attachments) shall control.
iv. All Ryan White Program, Part B HIV/AIDS Services must be available and
delivered in a culturally and linguistically appropriate manner and must meet the
National Standards on Culturally and Linguistically Appropriate Services (CLAS);
specifically the mandates which are the current Federal requirements for all
recipients of Federal funds (Standards 4, 5, 6, and 7 at
http://www.omhrc.gov/templates/browse.aspx?lvl=2 &lvlID= 15.).
v. LPHA will comply with the Americans with Disabilities Act (ADA) requirements
and ensure that the facility is accessible by public transportation or provide for
transportation assistance to the facility when needed, which may be paid utilizing
funds under this Agreement per guidance in Section 3.c.i. ofthis Program Element.
vi. LPHA providing Ryan White Program, Part B HIV IAIDS Services may not solicit
or receive payments in kind or cash for purchasing, leasing, ordering, or
recommending the purchase, lease or ordering of any goods, facility services or
items. Applicable policies must be available upon request.
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d. Case Management.
i. Case Management services must be provided to all eligible individuals within
LPHA's service area who seek such services and must be delivered consistently
throughout the period for which financial assistance is awarded under this
Agreement for Ryan White Program, Part B HIV I AIDS Services.
ii. All Case Management services must be delivered in accordance with the Oregon
Program, Part B HIV Medical Case Management Standards of Service.
iii. LPHA shall establish a grievance policy for recipients of Ryan White Program, Part
B HIV/AIDS Services supported in whole or in part with funds provided under this
Agreement and shall make this policy known to and available to individuals
receiving the services, as requested.
iv. All Providers of Ryan White Program, Part B HIV/AIDS Services must obtain, and
maintain in the file ofthe individual receiving the services, appropriately signed and
dated releases of information and consents to care for each such individual prior to
commencement of services.
e. Confidentiality. In addition to the requirements set forth in section 6 of Exhibit E of
this Agreement, all Providers of Ryan White Program, Part B HIV IAIDS Services must
comply with the following confidentiality requirements:
i. No information regarding the existence of an individual's HIV-positive status may
be kept or retained on file by a Provider of Ryan White Program, Part B HIV IAIDS
Services without the existence of an established "client with service provider"
relationship between the Provider and the individual. This relationship is
established when a Provider of Ryan White Program, Part B HIV IAIDS Services, at
a minimum, engages in an interview or dialog with the individual that results in a
specific record being developed relative to prospective services available to that
individual.
ii. All materials related to the delivery of Ryan White Program, Part B HIV I AIDS
Services that contain names or other identifying information of individuals receiving
services must be kept in a locked and secure area/cabinet, which allows access only
to authorized personnel, and all computers and data programs that contain such
information must have restricted access. Staff computers must be in a secure area
not accessible by the public, and computer systems must be password protected.
Providers of Ryan White Program, Part B HIV I AIDS Services must comply with all
county, state and federal confidentiality requirements applicable to the delivery of
Ryan White Program, Part B HIV/AIDS Services.
iii. Breaches of confidentiality are serious and require immediate action. Therefore, the
supervisory or administrative staff of a Ryan White Program, Part B HIV/AIDS
Services funded Provider must immediately investigate, evaluate and, if necessary,
correct any alleged breaches by its staff of the confidentiality requirements of this
Program Element; further, Provider must document the steps it takes to resolve any
breaches of confidentiality. All confirmed breaches of the confidentiality
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requirements of this Program Element must result in appropriate sanctions in
accordance with Provider policy and procedure and applicable law. Each Provider
of Ryan White Program, Part B HIV I AIDS Services must report to OHA in
sufficient detail any confirmed breaches by its staff of the confidentiality
requirements of this Program Element within 14 days of Provider's evaluation of
such breaches as described above.
iv. Providers of Ryan White Program, Part B HIV/AIDS Services must establish and
comply with a written policy and procedure regarding breach of the confidentiality
requirements of this Program Element. Such policy must describe the consequences
to the employee or volunteer for a verified breach of the confidentiality
requirements of this Program Element.
v. Providers of Ryan White Program, Part B HIV I AIDS Services must conduct an
annual review, and maintain documentation of that annual review, of county, state,
and federal requirements regarding the confidentiality of information related to
individuals receiving Ryan White Program, Part B HIV/AIDS Services. Providers
of Ryan White Program, Part B HIV/AIDS Services must require employees and
any non-paid staff (i.e. volunteers) who, in the course of performing their job, have
access to such information to have an annual review of the confidentiality
requirements and to acknowledge in writing his/her understanding of such
requirements governing this information.
vi. Providers of Ryan White Program, Part B HIV IAIDS Services must provide an on
site private room for individuals providing Case Management services to counselor
interview individuals receiving Ryan White Program, Part B HIV/AIDS Services.
f. LPHA Staffing Requirements and Staff Qualifications.
i. LPHA must employ a Registered Nurse trained in the use of the Oregon Program,
Part B HIV Medical Case Management Standards of Service for the delivery of
Ryan White Program, Part B HIV/AIDS Services. Any additional staff must also be
trained in the use of the Oregon Program, Part B HIV Medical Case Management
Standards of Service.
ii. LPHA shall provide staffing for Case Management services as identified in the Care
Services Budget and in accordance with the Oregon Program, Part B HIV Medical
Case Management Standards of Service.
iii. All LPHA and Provider staffwho provide Ryan White Program, Part B HIV/AIDS
Services must attend training sessions and be appropriately trained on the delivery
of such services, as reasonably designated by OHA. OHA will inform LPHA of the
schedule and locations for the training sessions.
iv. LPHA shall provide an Information Technology (IT) contact to execute and ensure
compliance with the RW CAREWare Client Tier Installation Instructions, which are
available from OHA upon request.
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g. LPHA Fiscal Controls and General Administration.
i. LPHA must have appropriate fiscal controls in place for the use and disbursement of
financial assistance provided under this Agreement for Ryan White Program, Part B
HIV/AIDS Services. LPHA must document in its files the types of agreement
monitoring activities that LPHA will perform with respect to Provider Agreements
for the delivery of Ryan White Program, Part B HIV/AIDS Services and the
projected schedule of such monitoring activities during the term of this Agreement.
Required monitoring activities include but are not limited to determining whether
the basic elements of the Program, Part B Program Manual (July 2011) are being
met and taking appropriate action ifthey are not. LPHA must submit to OHA copies
of all Provider Agreements (Le. LPHA Financial Assistance Grant Agreements) for
the delivery of Ryan White Program, Part B HIV IAIDS Services during the term of
this Agreement. LPHA may not pay the Provider with funds received under this
Agreement for this Program Element until OHA has received a copy of the Provider
Agreement. OHA's obligation to disburse financial assistance provided under this
Agreement for this Program Element to cover payments on a Provider Agreement is
conditioned on OHA' receipt of a copy of that Provider Agreement. LPHA must
notify OHA in writing of LPHA's process for selecting Providers to provide Ryan
White Program, Part B HIV IAIDS Services supported in whole or in part with the
financial assistance provided under this Agreement for this Program Element (e.g.,
competitive request for proposals or sole source award) prior to commencing the
selection process.
ii. LPHA must notify OHA within 10 business days and in writing, of proposed
changes, during the term of this Agreement, in the budget or in the availability of
Ryan White Program, Part B HIV/AIDS Services funded through this Agreement, to
include service hours, staffing, professional qualifications of staff, and fiscal
management. A revised budget must be re-submitted to OHA for approval of
changes when applicable.
4. Reporting Obligations and Periodic Reporting Requirements. In addition to the reporting
requirements set forth in Section 8 of Exhibit E of the Agreement, LPHA and any sub
contractors shall submit the following reports and information to OHA:
a. Quarterly Progress Reports must be submitted no later than October 31, January 31,
April 30 and July 31 for the quarters ending September 30, December 31, March 31 and
June 30 in each fiscal year. Quarterly Progress Reports include a narrative report and
Administrative Fiscal Form. Reporting forms are found in the Program Manual (July
2011).
b. LPHA must conduct a local chart review utilizing the approved program review tool
found in the Program Manual. The results of this review will be compiled into the
Client Chart Review Summary report, as described in Program Manual (July 2011) and
submitted to the Program not later than October 31 SI of each fiscal year.
c. LPHA shall conduct an annual audit. LPHA's receiving federal funds exceeding
$500,000 must comply with the applicable audit requirements and responsibilities set
forth in the Office of Management and Budget Circular A-133 entitled "Audits of
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States, Local Governments and Non-Profit Organizations." Verification of the
completed audit will be obtained through the Secretary of State Audit Division.
d. Any LPHA awarded funds under this Program Element who is not subject to A-133
audit requirements must receive an annual financial program audit by a qualified
independent accountant. Selection of the auditor must be clearly defined in the LPHA's
policies and procedures and be available upon request. A copy of the completed audit
report from a qualified, independent auditor must be submitted by June 30 th of each
fiscal year.
e. With respect to each individual receiving Ryan White Program, Part B HIV / AIDS
Services with funds provided under this Agreement, demographic, service and clinical
data must be collected and reported to the OHA as described in the Program, Part B
Program Manual (July 2011). This manual may be obtained from
www.healthoregonorglhiv. LPHA must utilize the HRSA developed software package,
RW CAREWare, to enter the data obtained by LPHA and as described in the Oregon
RW CAREWare User Guide found in the Program Manual (July 2011). Users are
required to enter all demographic, service and clinical data fields within 30 days of the
date of service. Use of RW CAREWare software and reporting system requires high
speed internet connectivity) and must be compliant with the minimum requirements
outlined in the "Oregon DHS RW CAREWare Client Tier Installation Instructions"
available upon request. The software configuration that will be used includes a client
tier at the local level that connects to a business and data tier managed by the Oregon
Health Authority, requiring LPHA to connect to the centralized database for data entry
purposes.
5. Performance Goals. OHA will conduct a comprehensive review of LPHA's performance
every three years as a part of the state triennial review process. The results of the review,
including commendations, compliance findings, and recommendations are communicated to
the Local Public Health Authority and the County Health Administrator. The review tool and
review schedule can be found at the following link: http://egov.oregongov/DHS/pMhd/lhd
trt.shtml.
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Attachment 1
Oregon Ryan White Program, Part B
HIV Case Management Quality Improvement Program
Care Services Budget
[Reserved}
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Program Element #10: Sexually Transmitted Disease (STD) Case Management Services
1. Description. Resources provided under this Agreement for this Program Element may only be
used, in accordance with and subject to the requirements and limitations set forth below, to
deliver Sexually Transmitted Disease Case Management Services to protect the health of
Oregonians from infectious disease and to prevent the long-term adverse consequences of
failing to identify and treat STDs. Sexually Transmitted Disease Case Management Services
include but are not limited to case finding and disease surveillance, medical supplies, health
care provider services, examination rooms, clinical and laboratory diagnostic services,
treatment, prevention, intervention, education activities, and medical follow-up.
2. Definitions Specific to STD Case Management Services.
a. Contact Interview: A contact interview is an interview conducted with an STD
infected individual. The objective of the interview is to prevent further spread of disease
through the prompt identification and examination of all elicited partners of the infected
individual. The interview is designed to ensure that the individual understands the
seriousness of the disease, and motivates the individual to cooperate with STDIHIV
control efforts.
b. Disease Intervention Specialist (DIS): A DIS (sometimes also referred to as a
Communicable Disease Investigator or CDI) is an individual employed by the Oregon
Health Authority (OHA) or a Local Public Health Authority (LPHA) that is specially
trained to provide components of STD Case Management Services, i.e. client
interviewing, partner notification and referral, untreated patient referral, education
activities and consultation for individuals diagnosed with an STD. Additional duties
can be performed only with the approval ofOHA.
c. Report Format: The designated form for reporting a STD case or suspected STD case
to OHA, which is form OHA 8352. A copy of the form is available from OHA upon
request.
d. Reportable STDs: A reportable STD is the diagnosis of an individual infected with any
of the following infections or syndromes: Chancroid, Chlamydia, Gonorrhea,
Lymphogranuloma Venereum, acute Pelvic Inflammatory Disease, and Syphilis, as
further described in Division 18 of OAR Chapter 333, and HIV, as further described in
ORS 433.045.
3. Type of Resources. OHA may provide, pursuant to this Agreement, any or all of the types of
resources described below to assist LPHA in delivering Sexually Transmitted Disease Case
Management Services. The specific types of resources and the amount thereof are reflected in
the Financial Assistance A ward or the footnotes thereof. The resources may include:
a. In-Kind Resources: Tangible goods or supplies having a monetary value that is
determined by OHA. Examples of such In-Kind Resources include goods such as
condoms, pamphlets, and antibiotics for treating STDs.
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b. Technical Assistance Resources (Direct Assistance): Services of a OHA DIS, that
OHA makes available to LPHA to support the LPHA's delivery of STD Case
Management Services
c. Financial Assistance Resources specific to DIS Activity: Funds made available to
LPHA solely for use in covering a portion of the salary of a DIS employed by LPHA to
deliver components of STD Case Management Services.
4. Procedural and Operational Requirements. All STD Case Management Services supported
in whole or in part with resources provided to LPHA under this Agreement must be delivered
in accordance with the following procedural and operational requirements:
a. LPHA acknowledges and agrees that the LPHA bears the primary responsibility, as
described in Divisions 17, 18, and 19, of Oregon Administrative Rules (OAR) Chapter
333, for identifying potential outbreaks of STDs within LPHA's service area, for
preventing the incidence of STDs within LPHA's service area, and for reporting in a
timely manner the incidence of Reportable STDs within LPHA's service area to the
appropriate OHA authorities.
b. LPHA may not deny STD clinical services to an individual seeking such services from
LPHA. STD clinical services are a component of STD Case Management Services and
may consist of screening individuals for reportable STDs and treating individuals
infected with Reportable STDs and their sexual partners for the disease. Note: Because
the State does not fund HIV clinical care and most counties cannot afford to provide
HIV clinical care, this section does not apply to HIV.
c. As required by applicable law, LPHA must provide STD Case Management services
including surveillance, case finding, and prevention activities, to the extent that local
resources permit, related to chlamydia, gonorrhea, syphilis, and HIV, in accordance
with:
i. Oregon Administrative Rules (OAR), Chapter 333, Divisions 17, 18, and 19;
ii. "Program Operations: Guidelines for STD Prevention", published by the Centers for
Disease Control and Prevention (CDC) and dated as of (1998 version), which
includes the federal standards for the operation of state and local STD prevention
programs, and "STD Treatment Guidelines", published by CDC and dated as of
August 2006. Both of these documents are available for review at
http://www.cdc.gov/std/program/;
iii. The "Region X Infertility Prevention Project: Program Guidelines and Data
Collection" manual dated as of January 2005. This manual can be downloaded for
reference from: http://www.centerforhealthtraining.org;
iv. "OHA Investigative Guidelines for Notifiable Diseases" which can be found at:
http://www.oregon.govIOHAlphlacdlreportinglguideln/guideln.shtml; and,
v. Oregon Revised Statutes (ORS) 433.045.
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d. LPHA must evaluate STD morbidity and laboratory results reported to the LPHA by
health care providers and laboratories for completeness and appropriate treatment
regimen. For each STD morbidity and laboratory result reported to LPHA, LPHA must
complete and submit to the appropriate OHA authority, within two weeks of receiving
the STD morbidity and laboratory results, the "Confidential STD Case Report" form
(OHA 8352), as further described in Division 18 of OAR Chapter 333.
e. LPHA, as appropriate, must examine, evaluate, and treat for Reportable STDs, each
individual referred to LPHA by a DIS. Generally individuals referred by a DIS are sex
partners of individuals with a Reportable STD or an individual who has tested positive
for a Reportable STD, but has not received treatment. LPHA must provide the
Reportable STD examination, diagnosis and treatment, if necessary, to the DIS referred
individual within four working days of referral.
f. If LPHA receives In-Kind Resources under this Agreement in the form of medications
for treating STDs, LPHA may use those medications only to treat individuals infected
with, or suspected of having Reportable STDs or to treat the sex partners of individuals
infected with Reportable STDs, subject to the following requirements:
i. The medications must be provided at no cost to the individuals receiving treatment.
ii. LPHA must perform a monthly medication inventory and maintain a medication log
of all medications supplied to LPHA under this Agreement. Specifically, LPHA
must log-in and log-out each dose dispensed.
iii. LPHA must return expiring medications supplied to LPHA under this Agreement to
the appropriate OHA authority at least 90 days prior to the medication expiration
date. LPHA shall be liable to OHA for the CDC federal contract price, per dose, of
all unused medications supplied to LPHA under this Agreement that are not
returned to OHA prior to their expiration date.
g. If LPHA receives In-Kind Resources under this Agreement in the form of condoms,
LPHA may distribute those condoms at no cost to individuals infected with an STD and
to other individuals who are at risk for STDs. LPHA may not, under any circumstances,
sell condoms supplied to LPHA under this Agreement.
h. IfLPHA receives Technical Assistance Resources under this Agreement:
i. LPHA must provide a private room in LPHA's clinic area for the DIS to counsel
and interview individuals. This room must have basic office furniture to include a
desk, telephone, and locking file cabinet.
ii. LPHA must provide on-site parking at no cost to the DIS with come and go
privileges to accommodate investigative activity.
iii. LPHA must provide clerical support to the DIS for STD Case Management
Activities including but not limited to, outreach, morbidity reporting, and other
related DIS activities.
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142008 PGM· DESCHUTES COUNTY
iv. LPHA must in conjunction with the OHA's STD Program manager review DIS
activities and accomplishments on a semi-annual basis. This can be done using the
OHA's Sexually Transmitted Disease Management Information System (STDMIS)
or Oregon Public Health Epidemiologists' User System (ORPHEUS) databases for
the measurement of DIS STD Case Management Services productivity or the
LPHA's database if agreeable to the OHA and the LPHA.
i. [Multnomah County only] If LPHA receives Financial Assistance Resources specific
to DIS Activity, under this Agreement:
i. LPHA must provide DIS access to motor vehicle parking with come and go
privileges, to accommodate investigative activity.
ii. LPHA must submit quarterly reports to the OHA's STD Program describing DIS
activities and indices achieved during the quarter in accordance with the DIS
Activity Outcomes. The report must be submitted no later than the end of the month
following the end of each calendar quarter during the period for which Financial
Assistance Resources specific to DIS Activity are awarded under this Agreement.
iii. In the event of a Reportable STD outbreak or shortage of DIS staff outside
MuItnomah County, the LPHA must make additional DIS available upon request by
the OHA's STD Program Manager.
iv. LPHA must provide staff time to examine, diagnose, and treat all individuals
seeking examination, diagnosis or treatment of a Reportable STD. LPHA staff must
also perform, as resources permit, STD intervention (Contact Interview and partner
notification) services to individuals with Reportable STDs diagnosed by or reported
to LPHA.
j. [Jackson County only] If LPHA receives Financial Assistance Resources specific to
DIS Activity, under this Agreement:
i. LPHA must dedicate up to 20% FTE DIS to provide STD Case Management
Services in Josephine and Klamath Counties to the extent requested by the LPHAs
for Josephine and Klamath Counties.
ii. LPHA must provide staff time to examine, diagnose, and treat all individuals
seeking examination, diagnosis or treatment of a Reportable STD. LPHA staff must
also perform, as resources permit, STD intervention (Contact Interview and partner
notification) services to individuals with Reportable STDs diagnosed by or reported
to LPHA.
5. Reporting Obligations and other Requirements. In addition to the reporting requirements
set forth in Section 8 of Exhibit E of this Agreement, LPHA shall submit to OHA the reports
described above.
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Program Element #12: Public Health Emergency Preparedness Program (PHEP)
1. Description. Funds provided under this Agreement to Local Public Health Authorities
(LPHA) for a Public Health Emergency Preparedness Program (PHEP) may only be used in
accordance with, and subject to, the requirements and limitations set forth below. The PHEP
shall address mitigation, preparedness, response and recovery phases for public health
emergencies through plan development and revision, exercise and response activities based on
the 15 CDC identified Public Health Preparedness Capabilities.
2. Definitions Specific to PHEP Programs.
a. Capability Performance Measure Analysis: An assessment of the difference between
prescribed CDC Capabilities organized by function and current local capabilities using
an evaluation tool developed by the Health Security Preparedness and Response
Program (HSPRP).
b. CDC: U.S. Department of Health and Human Services, Centers for Disease Control
and Prevention.
c. Community Hazard Risk Assessment: A community hazard risk assessment is a
process leading to a written document that presents findings used to assess and identify
community-specific public health hazards and vulnerabilities so that plans may be
developed to reduce or eliminate these threats.
d. Electronic Surveillance System for Early Notification of Community based Epidemics
(ESSENCE): An automated, real-time syndromic surveillance system with mapping and
graphing capabilities that monitors emergency department visits across the state to
identify emerging public health events.
e. Health Alert Network (HAN): A web-based, secure, redundant, electronic
communication and collaboration system operated by OHA, available to all Oregon
public health officials, hospitals, labs and service providers. The data it contains is
maintained jointly by OHA and all LPHAs. This system provides continuous, high
speed electronic access for Oregon public health officials and service providers to
public health information including the capacity for broadcasting information to Oregon
public health officials and service providers in an emergency 24 hours per day, 7 days
per week. The secure HAN has a call down engine that can be activated by state or
local Preparedness Health Alert Network administrators. The HAN also has a secure,
access-controlled document library which can be used to share information and post
plans.
f. Health Security Preparedness and Response Program (HSPRP): A state level program
that is a joint effort with the Conference of Local Health Officials (CLHO) and the
tribes to develop plans and procedures to prepare Oregon to respond, mitigate, and
recover from public health emergencies.
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g. Investigative Guidelines: Oregon Disease Investigation Guidelines can be found at:
http://public.health.oregon.govldiseasesconditionslcommunicablediseaselreportingcom
municablediseaselreportingguidelineslpageslindex.aspx
h. Medical Countermeasures: Vaccines, antiviral drugs, antibiotics, antitoxin, etc. in
support of treatment or prophylaxis to the identified population in accordance with
public health guidelines or recommendations.
i. National Incident Management System CNIMS): The Federal Homeland Security
Administration's system for integrating effective practices in emergency preparedness
and response into a comprehensive national framework for incident management. The
NIMS enables emergency responders at all levels and in different disciplines to
effectively manage incidents no matter what the cause, size or complexity. More
information can be viewed at: http://www.fema.gov/emergencY/nims/index.shtm
j. Oregon Public Health Epidemiology User System (ORPHEUS): An application that
integrates information on reportable communicable diseases for state and local use.
Information can be found at: http://public.health.oregon.gov/diseasesconditions/
communicablediseasellocalhealthdepartmentslpagesloutbreak.aspx
k. Oregon Incident Response Information System (OR-IRIS): A mapping tool developed
jointly by the Oregon Department of Environmental Quality and the Oregon Health
Authority to bring relevant information to incident planning and response state-wide.
I. Public Information Officers (PIOs): The communications coordinators (officers)
spokespersons for governmental organizations.
or
m. Public Health Emergency Preparedness (PHEP): local public health systems designed to
better prepare Oregon to respond, mitigate, and recover from public health emergencies.
D. Reviews: The evaluation of an LPHA's Public Health Emergency Preparedness and
Response materials, products, plans, and activities conducted twice each year by state
and local preparedness staff using instruments developed by Oregon Health Authority
with collaboration and consultation with the Conference of Local Health Officials.
o. Receipt, Stage and Storage (RSS): The site where Strategic National Stockpile assets
are received staged and stored (RSS). To be an approved RSS, the warehouse must meet
minimum federal recommendations regarding security, climate control, size, lighting,
dock capacity, and access to warehouse resources.
p. Strategic National Stockpile (SNS): A CDC program developed to provide rapid
delivery of pharmaceuticals, medical supplies and equipment for an ill-defined threat in
the early hours of an event, a large shipment of specific items when a specific threat is
known or technical assistance to distribute SNS materiel. SNS program support includes
the 12-hour Push Pack, vendor managed inventory (VMI), and Federal Medical
Stations.
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142008 PGM -DESCHUTES COUNTY
q. Vaccine Adverse Events Reporting System (VAERS): A passive surveillance program
used to monitor vaccine safety in the United States. V AERS collects reports of adverse
events occurring after vaccination from public and private providers, parents, patients,
and vaccine manufacturers.
3. General Requirements. All of LPHA's PHEP services and activities supported in whole or in
part with funds provided under this Agreement and particularly as described in this Program
Element Description shall be delivered or conducted in accordance with the following
requirements and to the satisfaction ofOHA:
a. Non-Supplantation. Funds provided under this Agreement for this Program Element
shall not be used to supplant state, local, other non-federal, or other federal funds.
b. Audit Requirements. In accordance with federal guidance, each entity receiving funds
shall, not less than once every two years, audit its expenditures of PHEP funding. Such
audits shall be conducted by an entity independent of the agency and in accordance with
the federal Office of Management and Budget Circular A-133. Audit reports shall be
sent to the OHA, who will provide them to the CDC. Failure to conduct an audit or
expenditures made not in accordance with PHEP cooperative agreement guidance and
grants management policy may result in a requirement to repay funds to the federal
treasury or the withholding of funds.
c. Work Plan. LPHA shall implement its PHEP activities in accordance with its OHA
approved Work Plan using the example set forth in Attachment 2 to this Program
Element Description. The Work Plan form includes a table for you to document
unplanned activities that demonstrate your capabilities. Modifications to this plan may
only be made with HSPRP approval.
d. Public Health Preparedness Staffing. LPHA shall identify a Public Health Preparedness
Coordinator position acceptable to the OHA. The Public Health Preparedness
Coordinator will be the OHA's chief point of contact related to program issues. The
Public Health Preparedness Coordinator will ensure that all scheduled preparedness
coordination conference calls and statewide preparedness coordination meetings and the
LPHA PHEP Annual Review are attended by an LPHA representative. LPHA must
staff its PHEP Program at the appropriate level to implement its PHEP activities in
accordance with its approved Work Plan, depending on its level offunding, as specified
in the award of funds for this Program Element.
e. Use of Funds. Funds awarded to the LPHA under this Agreement for this Program
Element may only be used for activities related to the CDC Public Health Preparedness
Capabilities in accordance with an approved Budget using the template set forth as
Attachment 1 to this Program Element Description. Modifications to the budget
totaling $5,000 or more may only be made with HSPRP approval.
f. Meeting Attendance and Participation. LPHA must attend HSPRP meetings and
participate in workgroups, as reasonably required by HSPRP as follows:
i. Attendance at PHEP grantee meetings.
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142008 PGM -DESCIIUTES COUNTV
ii. Training and/or conferences for staff and/or supervisors that is relevant to PHEP,
examples include PIO and ICS training.
iii. Paperwork, meetings, conference calls and preparation related to PHEP services and
activities.
iv. Participation in combined local/state PHEP workgroups for the development of
PHEP program materials and activities.
g. Conflict between Documents. In the event of any conflict or inconsistency between the
provisions of the PHEP work plan or budget (as set forth in Attachments 1 and 2) and
the provisions of this Agreement or this Program Element Description, the provisions of
this Agreement or the provisions of this Program Element Description, as applicable,
shall control.
h. PHEP Program Reviews. LPHA shall submit its materials and tools for the Annual
Review in a manner satisfactory to the OHA. Semi Annual reviews are to be completed
by February 15 of each year. The annual reviews are to be conducted during July and
August. All reviews are to be completed no later than August 31 each year. The
materials, products, plans and documentation of activities to be reviewed, are identified
for LPHA at least four weeks prior to the scheduled review.
i. Budget and Expense Reporting. Using the budget and expense to budget Excel file set
forth in Attachment 1 and available for download from the HAN document library:
https://oregonhan.org/PagesIDefauit.aspx attached hereto and incorporated herein by
this reference, LPHA shall provide to OHA by August 31, of each year, a budget using
actual award amounts, detailing LPHA's expected costs to operate its PHEP programs
during the period of July I, through June 30 of each year. LPHA shall submit to OHA
by February 15 of each year, the actual expense-to-budget report for the period of July
1, through December 31. The LPHA shall provide to the OHA by August 31 of each
year, the actual expense-to-budget report for the period of July 1, through June 30. The
budget and expense to budget set forth in Attachment 1 shall be the only form used to
satisty this requirement. All equipment purchases of $5,000 or more that use PHEP
funds will be identified in this budget report.
4. Procedural and Operational Requirements.
a. Public Health Capability Performance Measure Analysis Introduction & Purpose.
During the next 4 years, local and tribal jurisdictions will work to demonstrate the
ability to perform all applicable CDC Public Health Preparedness Capabilities. To
determine 1) which capabilities the state as a whole should focus on, and 2) what
activities should be prioritized within each jurisdiction, counties and tribes will be asked
to complete a capability assessment in 2012-13 and to annually update this information.
b. Public Health Capability Performance Measure Analysis. LPHA shall complete a Public
Health Capability Performance Measure Analysis using the assessment tool provided
and approved by HSPRP by August 15 each year.
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142008 PGM DESCHUTES COUNTY
c. Work Plan Description. Counties must develop a work plan for the budget period. The
work that LPHAs assign themselves in the work plan will be based on the gaps
identified in the Public Health Capability Performance Measure Analysis, using the
Public Health Consequences Analysis and improvement plans developed from after
action reports from real events or exercises to help prioritize which capabilities and
functions are most important to have fully developed in their jurisdiction. An example is
set forth in Attachment 2 to this Program Element Description.
d. Public Health Preparedness Program Work Plan. LPHA shall develop a Public Health
Preparedness Program work plan using the template set forth as Attachment 2 to this
Program Element Description focusing in the current year on activities to build or
sustain CDC Public Health Capabilities and associated functions. The work plan must
be completed and approved by OHA by September 15 each year.. At a minimum
LPHA must build two capabilities in the work plan. Current capabilities shall be
sustained.
e. Public Health Preparedness Program Work Plan Performance. LPHA shall complete
activities in their HSPRP approved PHEP work plans by June 30 each year. If LPHA
completes fewer than 75% of the planned activities in its Local PHEP work plan for two
consecutive years, it may not be eligible to receive funding under this Program Element
in the next fiscal year.
f. HAN. LPHA shall identifY a local HAN Administrator. The local HAN Administrator
shall:
i. Ensure local HAN user and county role directory is maintained (add, modifY and
delete users; make sure users have the correct license).
ii. Act as a single point of contact for all LPHA HAN issues, user groups, and training.
iii. Serve as the LPHA authority on all HAN related access (excluding hospitals and
tribes).
iv. Conduct internal tests of the HAN Call Down alerting system two times per year to
verify LPHA's ability to alert its staff with emergency response roles, and record
results of such testing, including date and time of test and interval between alert
notification and 90% complete response.
v. Coordinate with the State HAN Coordinator to ensure the roles and available system
licenses are appropriately distributed with each county.
vi. Post, publish and update plans and maintain the local and county HAN document
library folders.
vii. Perform general administration for all local implementation of the HAN system in
their respective organizations.
viii. Review their LPHA HAN users two times annually to ensure users are assigned
their appropriate roles and that appropriate users are deactivated.
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142008 PGM • DESCHUTES COUNTY
ix. HAN-related PerfOrmance Measures:
Performance Measure 0.1: A HAN Administrator will be appointed for each
LPHA and this person's name and contact information will be provided to the
appropriate County Liaison and the State HAN Admin Coordinator.
Performance Measure 0.2: LPHA HAN Administrator will facilitate in the
development of HAN accounts for new LPHA users, and will document that LPHA
HAN user accounts are up to date at least twice annually.
Performance Measure 0.3: LPHA will upload AARs from incidents and exercises
within 60 days of their completion.
Performance Measure 0.4: LPHA will provide documentation of two HAN tests
per program year, each with a 90% complete response in 60 minutes.
Performance Measure 0.5: LPHA will once annually confirm all plans and
appropriate procedures are uploaded to HAN Document Center.
g. Satellite Phones. LPHA shall comply with the terms and conditions of use of "OHA
Issued Satellite Phones," set forth in Attachment 3 to this Program Element Description.
h. OR-IRIS. LPHA shall comply with the terms and conditions of the use of OR-IRIS
agreements if signed by the LPHA. An example of an OR-IRIS agreement is set forth
in Attachment 4 to this Program Element Description.
i. Exercise Requirements. LPHA shall develop and conduct an exercise program that tests
LPHA's all-hazard emergency response plans, utilizing an After Action Report,
Improvement Plan, and Exercise Evaluation Guide. As further described below, the
program shall include exercises that involve LPHA's administration, the local
jurisdiction's emergency management and other emergency response partners. LPHA
shall annually submit to OHA for approval before December 15, an updated Training
and Exercise Plan. The Training and related exercise Plan shall meet the following
conditions:
i. The Training and related exercise Plan shall, at a minimum, outline the exercise
program priorities, CDC capabilities, and training and exercise schedule.
ii. The plan shall demonstrate continuous improvement and progress toward increased
capability of the LPHA to perform critical tasks while exercising to the gaps
identified within their Gap Analysis process.
iii. The plan shall include priorities which address lessons learned from previous
exercises, as described in LPHA's existing After Action Reports (AARs) and
Improvement Plans (IPs).
iv. At a minimum, the plan shall identifY at least 1:\\10 exercises per year and shall
identifY a cycle of exercises that increase in complexity from year one to year three,
2013-2015 INTERGOVERNMENTAL AGREEMENT .·OR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 42 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
progressing from discussion based exercises (e.g. seminars, workshops, tabletop
exercises, games) to operations based exercises (e.g. drills, functional exercises and
full-scale exercises); exercises of similar complexity are permissible within any
given year of the plan.
v. LPHA shall work with emergency management to integrate exercises with the
county exercise schedule.
vi. Performance Measure 0.6: At a minimum, LPHA shall, before June 30 each year,
develop and satisfactorily execute two public health preparedness exercises as
outlined in the LPHA's approved Training and Exercise Plan. LPHA shall submit to
OHA for approval an exercise scope, including goals, objectives, activities, list of
invited participants, and list of exercise design team members, for each of the
exercises at least 45 days before each exercise is scheduled to take place. LPHA
shall provide to the OHA an AAR documenting each exercise within 60 days of
conducting the exercise. Disease outbreaks or other public health emergencies
requiring a LPHA response may, upon OHA's approval, be used to satisfY exercise
requirements. NIMS compliant procedures for LPHA command and control shall be
used to manage the response to the communicable disease or public health
emergencies.
j. Training. LPHA shall be responsible for ensuring the following:
i. Staff responsible for public health emergency planning and response roles shall be
trained for their respective roles consistent with Conference of Local Health
Officials Minimum Standards dated June 2008, including training on how to
discharge the LPHA statutory responsibility to take measures to control
communicable disease in accordance with applicable law. The Conference of Local
Health Officials Minimum Standards may be viewed at:
http://public.health.oregon.gov/ProviderPartnerResources/LocalHealthDepartment
ResourceslP ageslrekrence. aspx
ii. Identifying and training appropriate LPHA staff for response to bioterrorism,
chemical, radiation, communicable diseases, and general emergency response.
iii. All local HAN users complete HAN training necessary for their user license.
iv. LPHA shall maintain training records for all local public health staff with
emergency response roles.
v. Performance Measure 0.7: The LPHA training shall include an evaluation
component. LPHA is to be NIMS compliant. To determine NIMS compliance and
view the standards go to: http://www.kma.govlemergencY/nimsl
k. Planning. The LPHA shall maintain and execute emergency preparedness procedures/
plans as a component of its jurisdictional Emergency Operations Plan (see attachment 5
for a recommended list). All LPHA emergency procedures shall comply with the NIMS.
The emergency preparedness procedures shall address the 15 CDC capabilities and/or
hazards described in their Community Hazard Risk Assessment and revisions shall be
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142008 PGM -DESCHUTES COUNTY
done according to the schedule included in each LPHA plan, or according to the local
emergency management agency schedule, but not less than once every five years after
completion as required in OAR 104-0 I 0-005.
I. Contingent Emergency Response Funding. Such funding is subject to restrictions
imposed by CDC at the time of the emergency and would provide funding under
circumstances when a delay in award would result in serious injury or other adverse
impact to the public.
Since the funding is contingent upon Congressional appropriations, whether contingent
emergency response funding awards can be made will depend upon the facts and
circumstances that exist at the time of the emergency; the particular appropriation from
which the awards would be made, including whether it contains limitations on its use;
authorities for implementation; or other relevant factors. No activities are specified for
this authorization at this time.
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ATTACHMENT 1
TO PROGRAM ELEMENT #12
BUDGET TEMPLATE
Brief descnption of activities, for example, This poSitIon has primary responsibility
for L)County public health preparedness activities.
Bnef description of actiVities and responsibllties
Slief description of activities and responsiblities
Contract with L..J Company, for (L......__"';) services.
Contract with L..J Company, for ( ) services.
Contract with L..J Company for, ( , services.
TOTAL INDIRECT CHARGES@_%ofDirectExpenses:
Date, Name and Phone Number of person who prepared budget.
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 45 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
$0
$0
$0
$0
$0
$0
$0
$0
$0
Preparedness Program Expense to Budget (Example)
( ) County
Period of the Report (July 1, 20_-Oecember
PERSONNEL
Salary
Fringe Benefits
TRAVEL
In-State Travel:
Out-of-State Travel:
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER
TOTAL DIRECT
TOTAllNDtRECT @XX% of Direct Expenses (or describe method):
TOTAL:
Date, name and phone number of person who prepared expense to budget report
Notes:
The budget total should reflect the total amount in the most recent Notice of Grant Award.
The budget in each category should reflect the total amount in that
category for that fine item in your submitted budget
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142008 PGM -DESCHUTES COUNTY
Expense
Budget to date Variance
$0
$0
$0
SO $0
$0
$0
$0
$0
$0
$0
$0
$0
$0 $0
$0
$0
$0
$0
$0
$0
$0
$0
Preparedness Program Expense to Budget (Example)
( ) County
Period of the Report (July 1, 20_ -June 30, 20r-"-->~__-.--...--_--r___--r
PERSONNEL
Salary
Fringe Benefits
TRAVel
In-State Travel:
Out-of-State Travel:
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER
TOTAL DIRECT
TOTAL INDIRECT @XX%ofDirectExpenses(ordescribe method): ~_........;;.$_0-t==-...;.;.......",""
TOTAL:
Date, name and phone number of person who prepared expense to budget report
Notes:
The budget total should reflect the total amount in the most recent Nonce of Grant Award.
The budget in each category should reflect the total amount in that
category for that line item in your submitted budget
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142008 PGM -DESCI1UTES COUNTY
Public Health Emerge.ncy Preparedness
Equipment Inventory List
To be completed for all major equipment or property acquired or furnisUd with Public Health ErruqencyPteparedness ful
year with II unit. ac:quisiUon cost of $5,000 or more.
Equipment Location:
Completed by:
Phone Number:
Item Description
Serial It or hlentifitation
Number kqutsitlon Date Purthase Price
"Purchased by
Federal Fundi
• in accordance with 45 CFR 74.37 or 45 CFR 92.5
Pleas. return the compfeted form to your Regional Ualson by August 11 of each vear.
Questions on this form can be directed to Jill Snyder at 971-673.0714 or your Rl!(don Uaison.
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142008 PGM DESCHUTES COUNTY
A ITACHMENT 2
TO PROGRAM ELEMENT #12
WORK PLAN
Suggested process for work plan development:
1. Begin by listing all ofthe activities you regularly do in the preparedness program annually:
• Meetings regularly attended and/or lead by local public health preparedness
• Exercises, to include drills such as HAN tests, staff notification, Sat phone tests
• Plan/procedure update and revision (whatever your cycle is for doing this)
• Trainings, workshops, and community events.
2. List the activities that you have previously completed that you believe are important to repeat
and/or activities you believe are important to do but haven't done because they haven't been
supported by PE 12 requirements.
3. Gather the jurisdictional Hazard Vulnerability Assessment, the Health Consequences Analysis,
the results of your capability assessment and improvement plans from past exercises and
events.
4. Use these documents to develop a list of the activities necessary to maintain your current
capabilities and to determine the areas where you need to build capability. Make sure you use
the information from the HVA, HCA and the Capability Assessment to prioritize those
capabilities necessary for you to have and maintain.
5. Fill in the following table (next page) with the activities you plan to do within the year (July 1
June 30) to sustain the capability you currently have.
6. Add activities to the table to build the capabilities that you have determined are a priority.
You will develop your projected work plan for the upcoming program year. This will be reviewed
with your liaison at mid-year and end of year. A work plan that includes updates through mid-year and
year end will need to be provided to your liaison at the review.
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Example Work Plan
Planned Activity
(Sustain or Build)
Start
Date
End
Date
Expected
Outcomes
Actual
Outcomes
----
Capability Gaps Local hazards
----
Notes:
(see note a. be/ow)
Example: Bio-hazard
Detection System
Table top exercise
(Sustain)
(b.)
4/1511 3
(c.)
6/15/13
(d.)
Review ofBDS
response plans,
recommendation for
plan/procedure edits,
agreement among
response partners on
roles and
resp_onsibilities
(e.) (j.)
Cap. 4 FI,
Cap 6 FI-3,
Cap 8 F 2-4
(g.)
Cap 6 FI QI;
F2Q6;
------
(h.)
Postal sorting
facility
(io)
I
•
i
---
Explanatory notes for Example Work Plan (above):
a. Describe in detail the activity and whether it is an activity to sustain or build capability
b. The proposed start date, this date to be updated to reflect when activity actually started
c. The proposed end date, this date to be updated to reflect when activity actually ended
d. Describe what you expect to achieve and/or the products you expect to develop from this activity
e. Describe what is actually achieved and/or the products created from this activity
J. Indicate the capabilities and functions within the capabilities that are addressed by this activity
g. Indicate the gaps identified in the capability assessment addressed by this activity
h. Indicate the local hazard with which this activity relates or mitigates
i. For use at mid-term and year-end reviews.
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 50 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
ATTACHMENT 3
TO PROGRAM ELEMENT #12
OBA ISSUED SATELLITE TELEPHONES
AGENCY TERMS and SHIPPING INFORMATION
PLEASE READ CAREFULLY
ELIGIBLE ORGANIZATIONS:
• All Oregon Hospitals ~(1) Iridium 9505A Kit + Phone
• All PHEP funded Oregon Tribes ~(1) Iridium 9505A Kit +Phone
• All County Local Public Health Departments ~(2) Iridium 9505A Kits +Phone**
* * Some exceptions apply.
INSTRUCTIONS:
1. Review the terms.
2. Complete the information below and sign.
3. Fax the signed form to 971-673-1307 Attention: Katie McLellan.
4. Your phone will be delivered as requested.
!! Complete and return only one (1) form per agency and fax to: 971-673-1307!!
Name of Tribe, hospital, or LPHA:
Name of Preparedness Coordinator in HAN:
(Must be a HAN member)
Correspondent Contact Phone Number:
Correspondent Contact Email:
Delivery Preference (Circle only 1): {Ground Ship} ~Note state may opt to deliver in person.
{Pick up at State Public Health HQ in Portland -PSOB}
{Our PHEP Liaison or Regional Coordinator will deliver}
Ship to Address: (Organization)
(ATTN -name):
Address -line 1:
Address: -line 2:
City, State, Zip:
By signing below, my agency agrees to the terms listed on page 2 below. The individual(s) in the preparedness
coordinator role in Oregon HAN will keep updated profiles and act as the single point of contact for the state
and partners regardless of how my organization chooses to assign and deploy its phone(s).
Signature Authority:
Name and Title (printed):
2013·2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 51 OF 167 PAGES
142008 PGM • DESCHUTES COUNTY
PHEP SATELLITE TELEPHONE TERMS
All state satellite phones are provided under the following terms.
Failure to abide by these terms will result in service termination or return of the phone.
I. All phones are for official use only (FOUO) for health and medical emergency response (ESF 8) training, testing,
exercise, and actual events in Oregon and neighboring states. All other use is strictly prohibited. Phone use is
restricted to state public health officials, local health departments, hospitals, and tribes.
II. Phones must be used for voice communication only and must not be used for data or faxing.
III. Phone(s) remain property of the Oregon Health Authority (OHA) and are subject to the conditions of use related
to state equipment and OHA Information Security Office Policy (ISO).
IV. Access fees and minutes are paid in full by the state on a monthly basis through FY 2010. The master account will
be audited every month to monitor use. Each phone has a minimum (10) minutes of charged talk time per month
for testing, exercise and training. (Training may include use at off-site clinics where no cellular service is
available in rural counties.) Use beyond (10) minutes must be related to health and medical response. Lack of
testing may be cause for service termination or return of the phone.
V. If an individual possesses a phone and resigns, retires, is terminated, or is deceased; the phone must be re
assigned within the organization within 24 hours and the associated HAN account must be updated.
VI. All phones must successfully participate in 3 (of 4) annual notification drills (unless an actual event conflicts with
the date of an exercise) run by the state public health preparedness program. Assigned users are expected, without
exception, to call the State Public Health Agency Operations Center (AOC) using their satellite phone after an
exercise HAN alert is sent. Specific details will be posted to HAN in folder "000 HAN System Operations" in
the satellite phone folders.
VII. Individuals with an assigned phone must enter and maintain their satellite phone number in their Secure HAN
user account under 'Alternate Satellite Phone Number.'
VIII. Any individual assigned a satellite phone must be an active HAN user and trained at the HAN 101 level and keep
an updated profile. The user must keep their satellite phone number updated in their HAN profile.
IX. Phones assigned to LPHAs, tribe, or hospital phones are the responsibility of the individual listed in HAN as the
"Preparedness Coordinator" (or Deputy Preparedness Coordinator, if applicable) role in each health department,
tribe, or hospital. The individual in this role must act as the single point of contact for the phone(s) regardless of
whether the phone is permanently issued to this person.
X. The state will not replace or repair stolen, lost, or broken phones.
XI. All phones, at all times, must be deployed, assigned, and maintained by a single individual; however, sharing the
phone within your agency or organization is encouraged. The individual holding responsibility for each phone
must be an employee of its respective organization. The phone voicemail should be configured and accessible to a
shared group of users if the phone is intended to serve more than a single user.
XII. All phone users must be trained in Iridium 9505A care and operation.
XIII. Phones must be stored in secure location(s).
XIV. Participating agencies will determine optimal deployment and storage locations.
XV. Phones must remain in Oregon unless the responsible party is traveling or is deployed outside of Oregon.
XVI. Phones must never be checked baggage on a commercial flight. They must be part of your carry-on baggage.
XVII. Phones must never be stored in a vehicle where they are visible.
XVIII. If a phone is stolen, lost, misplaced, or destroyed; the responsible individual must contact
HAN OREGON@.state.or.us or 971-673-1319 within 24 hours to ensure the service is suspended.
By signing below, my agency agrees to these terms.
Signature:___________________Date:___________
Name & Title:_______
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 52 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
ATTACHMENT 4
TO PROGRAM ELEMENT #12
OR-IRIS AGREEMENT
NOTE TO LPHA: THE FOLLOWING "ACCESSAGREEMENT"
IS AN EXAMPLE ONLY -DO NOT COMPLETE OR SIGN/
Agreement Number 000000
State of Oregon
Network and In/ormation Systems
Access Agreement
In compliance with the Americans with Disabilities Act, this document is available in
alternate formats such as Braille, large print, audio recordings, Web-based
communications and other electronic formats. To request an alternate format, please
send an e-mail to dhsalt@state.or.us or call 503-378-3486 (voice) or 503-378-3523
(1TY) to arrange for the alternative format.
This Agreement is between the State ofOregon, acting by and through Oregon Health Authority,
hereinafter referred to as "OHA" or "Grantor" interchangeably and...
LPHAName
Address
City, ST Zip
Phone number:
Fax number:
Email address:
... hereinafter referred to as "Agency" or "Receiver" interchangeably.
Access to be granted under this Agreement relates principally to OHA's
Name o/O/fice, Program, etc.
Address
City, state, zip
Agreement Administrator:
Phone number:
Fax number:
Email address:
2013·2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 53 OF 167 PAGES
142008 PGM· DESCHUTES COUNTY
1. PURPOSE
The purpose of this Agreement is to define the roles and responsibilities of the parties when
accessing information, networks, and systems of either party, to identify which party is
recelvmg the access/information (Receiver) and which party is providing the
access/information (Grantor), and to identify the information/system access required.
2. EFFECTIVE DATE AND DURA TION
This Agreement shall become effective June 1,2012 regardless ofthe date on which all parties
have signed and shall remain perpetually effective until terminated. The parties agree to
review and the Agreement as necessary every 2 years. Parties agree to amend the Agreement
as necessary, and terminate the Agreement and all resulting access privileges when access is
no longer necessary.
3. RESERVATION OF RIGHTS / TERMINATION
This Agreement may be terminated at any time by mutual consent ofthe parties.
This Agreement may be terminated by either party upon delivery of 30 days written notice of
the other party.
Grantor ofthe access/information reserves the right to immediately revoke the Access granted
through this Agreement for failure to comply with the requirements ofthis Agreement.
Grantor of the access/information reserves the right to terminate this Agreement or modify
access to the information if there are changes or revised interpretations in federal or state
laws, rules, regulations, or if Grantor has changes in policies that require such change.
The Receiver of the access/information agrees to provide the Grantor of the
information/access, as requested, access to Receiver's officers, agents, LPHAs, subcontractors,
employees, facilities and records necessary to determine:
• Receiver's compliance with the terms and conditions ofthis Agreement;
• Whether or not to continue to grant Access, in whole or in part, under this Agreement;
• Any additional information the Grantor ofthe information/access may require to meet any
state or foderallaws, rules and regulations regarding use and disclosure;
• Receiver's documentation ofa written security risk management plan.
In the event the Receiver fails to abide with the above requirement, the Grantor of the
information/access reserves the right to immediately revoke the access granted through this
Agreement.
4. INDEMNITY / INSURANCE
OHA and Agency shall be responsible exclusively with respect to their own employees, for
providing for employment-related benefits and deductions that are required by law, including
but not limited to federal and state income tax deductions, workers compensation coverage,
and PERS contributions. Each party shall be responsible, to the other, to the extent permitted
by the Oregon Constitution, subject to the limitations of the Tort Claims Act (ORS
30.260-30.300), only for the acts, omissions or negligence of its own officers, employees or
agents.
5. DOCUMENTS
This Agreement consists of this document and includes the following listed exhibits which are
incorporated into this Agreement:
201J..2015INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 54 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
A. Exhibit A: Roles and Responsibilities
B. Attachment 1: Scope ofAccess
There are no other Agreement documents unless specifically referenced and incorporated in
this Agreement.
6. CONFIDENTIALITY, PRIVA CY, AND SECURITY
A. Confidentiality ofClient Information
1) All information as to personal facts and circumstances obtained by the LPHA on the
client shall be treated as privileged communications, shall be held confidential, and
shall not be divulged without the written consent of the client, his or her attorney,
the responsible parent ofa minor child, or his or her guardian except as required by
other terms of this contract. Nothing prohibits the disclosure of information in
summaries, statistical, or other form, which does not identify particular individuals.
2) The use or disclosure of information concerning clients shall be limited to persons
directly connected with the administration of this contract. Confidentiality policies
shall be applied to all requests from outside sources.
3) OHA, LPHA and any subcontractor will share information as necessary to
effectively serve OHA clients.
B. Information Privacy/Security/Access
If the Work performed under this Agreement requires LPHA or its subcontractor(s) to
have access to or use of any OHA computer system or other OHA Iriformation Asset for
which OHA imposes security requirements, and OHA grants LPHA or its
subcontractor(s) access to such OHA Information Assets or Network and Information
Systems, LPHA shall comply and require all subcontractor(s) to which such access has
been granted to comply with OAR 407-014-0300 through OAR 407-014-0320, as such
rules may be revisedfrom time to time. For purposes ofthis section, "Information Asset"
and "Network and Information System" have the meaning set forth in OAR 407-014
0305, as such rule may be revised from time to time.
7. AGREEMENT CONTACTS
OHA: Agreement Administrator:
Public Health Division
Address
City, Slate Zip
Phone number:
Fax Number:
Email:
LPHA: LPHAName
Address
City, OR Zip
Phone number:
Facsimile number:
Email:
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PuBLIC HEALTH SERVICES PAGE 55 OF 167 PAGES
t 42008 PGM -DESCHUTES COUNTY
8. SIGNATURES
LPHA, by the signature ofits authorized representative, hereby acknowledges that he/she has
read this Agreement, understands it, and agrees to be bound by its terms and conditions.
LPHA signature
OHA signature
OCP signature
EXHIBIT A
ROLES AND RESPONSIBILITIES
1. DEFINITIONS
• "Access" means access to any combination of Client Records, Information Assets, and
Network and Information Systems.
• "Client Record(s) " means any client, applicant, or participant information regardless of the
media or source, provided by OHA to the LPHA.
• "User" means any individual authorized to access Network and Information Systems and
who has an assigned unique log-on identifier.
• "Individual User Profile (IUP) " refers to an OHA form used to authorize a User, identify
their job assignment and the required access to OHA Network and Information System(s}. It
generates a unique alpha/numeric code used to access the OHA Network and Information
Systems. (NOTE: The LPHA may have a similar process to be used when granting OHA
access to their information.)
• "Network and In/ormation System(s)" is the computer infrastructure which provides
personal communications; Client Records; regional, wide area, and local networks; and the
internetworking ofvarious types ofnetworks.
• "In/ormation Asset(s}" refers to all information provided through OHA, regardless of the
source, which requires measures for security and privacy.
• "Incident" is a threat or event that compromises, damages, or causes a loss of confidential
or protected information (e.g., unauthorized disclosure ofinformation, failure to protect user
IDs, theft ofcomputer equipment or Client Records, etc.)
2. ACCESS CONTROL
Receiver agrees to keep the GIS Data Tool Secure.
If required for access, the Grantor agrees to promptly review requests, including forms such as
the IUP, andwill:
• Notify the Receiver of the approval or denial of its request for each User for whom Access
has been requested;
• Provide any unique log-on identifier required for approved Access;
• Ensure that updates to approved inquiry processes and instructions are provided to LPHA.
Receiver agrees to complete any forms (such as the IUP) for each person for whom Access is
requested. The original shall be kept in a secure location. The form shall be provided to the
Grantor upon request.
No User shall access data or use the GIS tool for any purpose other than those specifically
authorized under this Agreement.
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 560F 167 PAGES
142008 PGM -DESCHUTES COUNTY
Except as otherwise specified or approved by the Grantor neither the Receiver nor its Users shall
modify, alter, delete, or destroy any Information Assets.
The Receiver shall immediately notify the Grantor when the Receiver, or its Users, no longer
require Access whether due to changes in their individual duties or due to changes in the
Receiver's programs covered under this Agreement.
3. SECURITY
The Receiver shall have established privacy and security measures in place that meet or exceed
the standards set in laws, rules, and regulations, and that are applicable to Users regarding the
safeguarding, security and privacy of Client Records, all Information Assets, regardless of the
media, and all Network and Information Systems.
The Receiver shall prevent any unauthorized access to the Grantor's Network and Information
Systems by its Users. The Receiver shall ensure the level of security and privacy protection
required in accordance with this Agreement is documented in a security risk management plan.
The Receiver shall make its security risk management plan available to the Grantor for review
upon request.
The Receiver shall maintain security of equipment and ensure the proper handling, storage and
disposal ofall Information Assets accessed, obtained, or reproduced through this Agreement to
prevent inadvertent destruction or loss, ensure proper disposal when the authorized use of that
information ends, consistent with the record retention requirements otherwise applicable to this
Agreement.
4. USER DISCLOSURE OF INFORMATION
Wrongfol use or disclosure of Information Assets by the Receiver or its Users may cause the
immediate revocation of the access granted though this Agreement, in the sole discretion of the
Grantor, or the Grantor may specify a reasonable opportunity for the Receiver to cure the
unauthorized use or disclosure and end the violation, and terminate access if the Receiver does
not do so within the time specified by the Grantor. Legal actions also may be taken for violations
ofapplicable regulations and laws.
The Receiver shall immediately report any Incidents involving Access addressed in this
Agreement to the Grantor. The Receiver shall comply, and shall cause its subcontractors to
comply, with any requirements for identifying and addreSSing a privacy or security Incident. This
requirement applies regardless ofwhether the Incident was accidental or otherwise.
The Receiver and its Users shall comply with all federal and state laws, rules, and regulations
applicable to the privacy, confidentiality, or security ofAccess, including HIP AA. The Receiver
shall have established privacy and security measures in place that meet or exceed the standards
set in OAR 407-014-0300 through OAR 407-014-0320.
The use and disclosure ofany Access is strictly limited to the minimum information necessary to
perform the required services.
5. SUBCONTRACTING The Receiver shall ensure all subcontractors are held to the same
requirements as the Receiver regarding Access.
6. COSTS Each party to this Agreement will bear their own cost, ifany, related to obtaining
Access.
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE lilNANCING OF PUBLIC HEALTH SERVICES PAGE 57 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
ATTACHMENT #1
SCOPE OFACCESS
Contracting Business Entity (CBE) refers to any person, business, non-profit organization, tribe or
governmental entity, which are contracted to provide and/or exchange services and/or products with
DHS/OHA where an information exchange is required. OHA desires to share a copy ofthe GIS Data
Tool developed by the Public Health Preparedness Program (PHEP) with the CBE for the purpose of
CBE and its subcontractor(s) adding additional layers to the platform and to the layers PHEP has
created.
It is the understanding of both parties that the GIS Data Tool will be used for our emergency
preparedness planning, response and recovery activities. The parties agree to share data layers over
time or upon request as a mutual resource.
CBE will grant OHA access to some or all ofthe data layers added to the GIS Data Tool, as agreed by
both parties. The information in the GIS Data Tool is considered sensitive but unclassified, and shall
be used for official use only.
Access and informationflow will occur from:
DHS/OHA to CBE (i.e. CBE has access to DHS/OHA 's Information Assets and systems)
CBE to DHS/OHA (i.e. DHS/OHA has access to CBE's Information Assets and systems)
:J Both ofthe above (i.e. information is exchanged both ways)
Information to be accessed includes:
PHI Personal Health Information (OHI), Personal Health Information (PHI) means
information that relates to:
• The individuals past, present orfuture physical or mental health or condition,
• The provision ofhealth care to the individual, or
• The past, present, or future payment for the provision ofhealth care to the individual, and that
identifies the individual, or for which there is a reasonable basis to believe it can be used to
identifY the individual.
o Personally Identifiable Information (PII), Personal Identity Information (PII) means personally
identifiable information, which iflost, compromised, or disclosed without authorization, could result in
substantial harm, embarrassment, inconvenience, or unfairness to an individual.
:J Financial Iriformation
o Information contains only de-identified Health Information (Do NOT check ifPHI or PII is checked)
de-identified health information means health information that does not identifY an individual and with
respect to which no reasonable basis exists to believe that the information can be used to identifY an
individual is not individually identifiable [as defined in 45 CFR § 164.514(a)).
J Other information (describe): None ofthe above. Access to copy ofGIS Tool, and to data and layers
within the GIS Data Tool only (prOVided by OHA).
Systems to be accessed include:
J E-Mail DHS/OHA email account authorized. This authorizes the CBE to acquire DHS/OHA email
accounts upon completed IUP for each individual, and requires signature by a DHS/OPHA manager.
~j Network -Network login authorized. This authorizes the CBE to acquire DHS/OHA Network Login
IDs upon completed IUP for each individual, and requires signature by a DHS/OHA manager.
J Other (Describe): Neither ofthe above.
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 58 OF 167 PAGES
142008 PGM -DESCHliTES COUNTY
ATTACHMENT 5
TO PROGRAM ELEMENT #12
RECOMMENDED PLANS
ESF-8, Health and Medical, is not an exclusively public
health responsibility. Public health should be deeply .CountyEOP involved in most ifnot all ofthe issues included therein, ESF 8 however, and will likely act as the coordinating entity for
• Public Health ESF-8. This is something that must be worked out
• Medical/ EMS locally in coordination with local emergency
• Mental Health management and with EMS, mental health services,
• Mass Fatality Management health care providers and chiefelected officials.
Public Health Specific Plans / Procedures
PHEP Base Plan ([fnot part of ESF-8)
• Direction and Control (how response is organized)
• Public Information, Emergency Risk Communication
• Communications (Tactical communications, information sharing)
• Resource Management Plan / Procedures
Public Health Operations
• Emergency Mass Dispensing / Vaccination and/or Distribution
• Isolation and quarantine (may be in EPI procedures)
• Surveillance and outbreak investigation (how to ramp up; may be in EPI procedures)
• Environmental Health
• Water and Food Safety, Sanitation and Air quality (depends on county)
Volunteer Management Plan / Procedures
Behavioral Health (addressed separately or integrated into plans/procedures)
Vulnerable Populations (addressed separately or integrated into plans/procedures)
Biodetection System Response (only for Medford, Portland areas)
Continuity of Operations Plan
Supporting Documents
Public Health HV A / HRA
Mutual Aid Agreements Required elements may be included
as part ofPublic Health Vulnerable populations data
Preparedness Plans or EOP, as
stand-alone plans and procedures
Adoption ordinance / documentation
or-in some cases-in other policy Maintaining Preparedness
or procedure documents. When Training and Exercise Plan
organizing these elements, priority Two exercises / year
should be given to making them Tribal Coordination (if applicable)
practical and usable.2417 Contact Testing
HAN testing, staff assembly drills
Sat Phone Testing
Plan update schedule and documentation
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PuBLIC HEALTH SERVICES PAGE 59 OF 167 PAGES
142008 PGM -DESCHuns COUNTY
Program Element #13: Tobacco Prevention and Education Program (TPEP)
1. Description. Funds provided under the Financial Assistance Agreement for this Program
Element may only be used, in accordance with and subject to the requirements and limitations
set forth below, to implement Tobacco Prevention and Education Program (TPEP) activities in
the following areas:
a. Facilitation of Community Partnerships: Accomplish movement toward tobacco-free
communities through a coalition or other group dedicated to the pursuit of agreed upon
tobacco control objectives. Community partners should include non-governmental
entities as well as community leaders.
b. Creating Tobacco-Free Environments: Promote the adoption of tobacco policies,
including voluntary policies in schools, workplaces and public places. Enforce local
tobacco-free ordinances and the Oregon Indoor Clean Air Act (OICAA.)
c. Countering Pro-Tobacco Influences: Reduce the promotion of tobacco on storefronts,
in gas stations, at community events and playgrounds in the community. Counter
tobacco industry advertising and promotion. Reduce youth access to tobacco products,
including working with retailers toward voluntary policies.
d. Promoting Quitting Among Adults and Youth: Integrate the promotion of the
Oregon Tobacco Quit Line into other tobacco control activities.
e. Enforcement: Assist with the enforcement of statewide tobacco control laws, including
minors' access to tobacco and restrictions on smoking through formal agreements with
OHA, Public Health Division.
f. Reducing the Burden of Tobacco-Related Chronic Disease: Address tobacco use
reduction strategies in the broader context of chronic diseases and other risk factors for
tobacco-related chronic diseases including cancer, asthma, cardiovascular disease,
diabetes, arthritis, and stroke.
2. Procedural and Operational Requirements. By accepting and using the financial assistance
funds provided by OHA under this Financial Assistance Agreement and this Program Element,
LPHA agrees to conduct TPEP activities in accordance with the following requirements:
a. LPHA must have on file with OHA an approved Local Program Plan by no later than
June 30 th of each year. OHA will supply the required format and current service data for
use in completing the plan. LPHA shall implement its TPEP activities in accordance with
its approved Local Program Plan. Modifications to this plan may only be made with
OHA approval.
b. LPHA must assure that its local tobacco program is staffed at the appropriate level,
depending on its level of funding, as specified in the award of funds for this Program
Element.
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 60 Of' 167 PAGES
142008 PGM DESCHUTES COUNTY
c. LPHA must use the funds awarded to LPHA under this Agreement for this Program
Element in accordance with its budget as approved by OHA and attached to this
Program Element as Attachment I and incorporated herein by this reference.
Modifications to the budget may only be made with OHA approval. Funds awarded for
this Program Element may not be used for treatment, other disease control programs, or
other health-related efforts not devoted to tobacco prevention and education.
d. LPHA must attend all TPEP meetings reasonably required by OHA.
e. LPHA must comply with OHA's TPEP Program Guidelines and Policies.
f. LPHA must coordinate its TPEP activities and collaborate with other entities receiving
TPEP funds or providing TPEP services.
g. In the event of any omission from, or conflict or inconsistency between, the provisions
of the Local Program Plan on file at OHA, the Budget set forth in Attachment I and the
provisions of the Agreement and this Program Element, the provisions of the
Agreement and this Program Element shall control.
3. Reporting Requirements. LPHA must submit Local Program Plan reports on a quarterly
schedule to be determined by OHA. The reports must include, at a minimum, LPHA's progress
during the quarter towards completing activities described in its Local Program Plan. Upon
request by OHA, LPHA must also submit reports that detail quantifiable outcomes of activities
and data accumulated from community-based assessments oftobacco use.
4. Performance Measures. LPHAs that complete fewer than 75% of the planned activities in its
Local Program Plan for two consecutive calendar quarters in one state fiscal year shall not be
eligible to receive funding under this Program Element during the next state fiscal year.
2013-20)5 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 61 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
Attachment 1
Budget
line Item Budget and Narrative Worksheet
Please complete the following Line Item Budget for. !~TP9~PE'I3 ~~!ilt"t.f1~14)
identify only fUnds requested under the OHA TPEP PE13 RFA.
Please call your Community Programs Liaison with questiom; related to this form
Agency: Deshules County Heatth Services
Fiscal
Contact: Sheni Pinner
E-mail
address: sherrip@deschutee.ory
Phone
Number: 541-322-7509 Fax
Number: 541-3227565
Budget
Cateaories
Description Total
(1) SaJary PosiIianfl T"'of~ SaIaIy(OII'II'IUBI) ,.oftime
·1HEl
.of-.llls
~1I!d TaQlbWy
$11865
1 TPEP Coordinator $$IIi_ 100.00% 12 52,005.00
:2 Program~ ....~2(lOO% 12 18,963.40
3 Administrator 1.64% 12 896.95
4 12 0.00
TOTAL SAlARY $71,865.35
~':t TPEP Coon:IinaIDr. PIimary-'......-.:INlOI'JlII'Id imp/ernefoter of PI:13 ~in ..... wail plan.
2 Program Manager: f"rI:IoIides SlraIEgic pIarv!ing. IHClIIa!S and <Xlmmunicat:ic1n \1i1a11O !he lWCO!!!iS of !he -'<
plan.
3~Adminis.1raIDr: Advocates fer TPEP inltiallYes _ County Oep;irlment~,AdrnInistr3lDr and
(2) Fringe
Benefits
PosiIianfl Tatal SaIaIy Baelf~ ,. TaQlf'vinge
$21,132
1 52,005.001 37.20% : 19,345.86
2 18,963.40 39.50% . 7,490.54
3 896.95 33.00% = 295.99
4 0.00 : 0.00
TOTAL FRINGE $27132.40
(3) Equipment lie1 equipmenL """-aI!e<PPne<ol ~ferpragr.lm ll.... ~.prir>!eI1. $1,500
$1500
NarTaIMt' : IapIcp -.~sbIion
(4) Supplies 00 not lie1. These items include supplies for meetings, general office supplies
paper, pens, computer disks, highlightefS, binders, foldem, etc.Irain.
i
$2.050
e.
$2,050
{5} Travel This""""",, in-5!a1a. ~_.JlII'Id"""""1O all ~"'
$1,800
VUlur_ I Sublcl'aI
~.. :
PwThem: 500 $500
!-lotti: 000 $600
AJrfare: $0
Reg.. i'ee5: 200 $200
Other: 100 $100
Mileage; MiIH: 708 I x !i65 I ...... mile $400
(6)OIher Please Iist.
$8,584
Program Supplies $2,043
Signage $4,000
Advertieing $2,541
~
(7) Contracts:
ConIiracts must be
~edby
liaison
Ue1 all sub-contradS and all conI:ractual costs, if applicable.
$20000
Contractor TBD-Focus Gf{wps; survey distributions; data collection; I $20,000
I $0
(8) Total Direc:t
Costs
(Sum of 1 II:lrough 7.
"$132,932
(9)Cost
AIIocaliioo and
Indirect Rate
Indirect@ 0.00% $0
$0
(10} TOTALS (Sum of 8 & 9) Should equal OHA TPEP PE 13 Request.
$132,932
20I3-2015INTERGOVERNMENTAl AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 62 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
Program Element #15: Healthy Communities (HC) Phase II -Implementation
1. Description. Funds provided under the Financial Assistance Agreement for this Program
Element may only be used, in accordance with and subject to the requirements and limitations
set forth below, to implement Healthy Communities (HC) activities in the following areas:
a. Application of HC Assessment and Capacity-Building Efforts: In coordination with
the Tobacco Prevention and Education Program (TPEP), implement prioritized
objectives based on the local plan developed through the HC Training Institutes.
Implementation of prioritized objectives should incorporate prevention, risk reduction
and management activities related to arthritis, asthma, cancers, diabetes, heart disease
and stroke.
b. Facilitation of Community Partnerships: Accomplish movement toward
establishment of policies, environments and systems that support healthy communities
through a coalition or other group dedicated to the pursuit of agreed upon best and
promising practice objectives based on HC community assessments. Community
partners should include non-governmental entities as well as community leaders.
c. Development of Local Champions: Foster ongoing communication and education
with community leaders, including elected leaders, on effective, comprehensive
strategies for reducing the burden of tobacco-related and other chronic diseases in
communities, schools, worksites, and health systems through establishment of policies
and sustainable system change. Coordinate with statewide partners for strategic
planning for the purpose of developing and sustaining a county and statewide
infrastructure for tobacco-related and other chronic disease prevention and health
promotion.
d. Promotion of Healthy Food and Physical Activity: Promote healthy food choices and
physical activity opportunities for chronic disease prevention and risk reduction through
the establishment of policies and sustainable systems change that supports healthy
communities, schools, worksites, and health systems.
e. Countering Unhealthy Food and Tobacco Influences: Promote protection from
exposure or access to secondhand smoke, tobacco products, unhealthy foods, and the
advertising and promotions of tobacco and unhealthy food through establishment of
policies and sustainable systems change that supports healthy communities, schools,
worksites, and health systems. Promote and connect to arthritis, asthma, cancer,
diabetes, heart disease, and stroke chronic disease self-management and the Quit Line in
all activities.
f. Facilitate Development of Chronic Disease Self-Management Networks and
Systems: Promote optimal availability of and access to chronic disease self
management programs in communities, schools, worksites, and health systems through
the establishment of policies, environments and local delivery systems for chronic
disease self-management. Promote the Quit Line in all activities. Establish sustainable
evidence-based self-management programs, including comprehensive, chronic disease
management programs tailored to specific chronic conditions including arthritis,
2013-20151NTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PuBLIC HEALTH SERVICES PAGE 63 OF 167 PAGES
142008 PGM -DESCHUUS COUNTY
asthma, cancer, diabetes, heart disease, and stroke. Incorporate the promotion of
tobacco cessation, healthy eating and physical activity into chronic disease management
systems.
g. Integrate tobacco use reduction in all Healthy Communities interventions: Conduct
tobacco use reduction strategies in all HC Program activities in partnership with
Tobacco Prevention & Education Programs. Utilize the experience and
accomplishments gained from TPEP to build HC policy and systems change in the
broader contexts of other risk factors and chronic conditions including arthritis, asthma,
cancer, diabetes, heart disease, and stroke.
h. Enforcement: Assist, through formal agreements with OPHD, with the enforcement of
statewide chronic disease prevention and control laws.
2. Procedural and Operational Requirements. By accepting and using the financial assistance
funding provided by OHA under the Financial Assistance Agreement and this Program Element,
LPHA agrees to conduct HC Program activities in accordance with the following requirements:
a. LPHA must have on file with OHA, an approved Local Program Plan developed in
response to a Request for Applications or Proposals that specifies minimum
requirements for which funding is available no later than July 30 in year one and by
July 30 in year 2 and thereafter. OHA will supply the required format and current
service data for use in completing the plan. LPHA shall implement its HC activities in
accordance with its approved Local Program Plan. Modifications to this plan may only
be made with OHA approval.
b. LPHA must assure that its HC program is staffed at an appropriate level, depending on
its level of funding, as specified in the award of funds for this Program Element as
indicated in the Request for Applications or Proposals.
c. LPHA must use the funds awarded to LPHA under this Agreement for this Program
Element in accordance with its budget as approved by OHA and as set forth in
Attachment 1 to this Program Element Description. Modifications to the budget may
only be made with OHA approval. Funds awarded for this Program Element may not be
used for medical treatment, delivery of cessation services, or other health-related efforts
not devoted to HC as determined by OHA.
d. LPHA must attend all HC Program meetings, as reasonably required by OHA. LPHA
must participate in HC Program evaluation activities, as reasonably required by OHA.
e. LPHA must comply with OHA's HC Program Guidelines and Policies, including as
amended from time to time.
f. LPHA must coordinate its HC Program activities and collaborate with other entities
receiving HC Program funds or providing HC services.
g. In the event of any omission from, or conflict or inconsistency between, the provisions
of the Local Program Plan and OHA-approved Budget, the provisions of the Agreement
2013-20151NTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 64 OF 167 PAGES
142008 PGM DESCHUTES COUNTY
and this Program Element, the provisions of the Agreement and this Program Element
shall control.
3. Reporting Requirements. LPHA must submit quarterly Local Program Plan reports on a
schedule to be determined by OHA. The reports must include, at a minimum, LPHA's progress
during the reporting period in completing activities described in its Local Program Plan. LPHA
must submit the following upon request by OHA: outcomes reports that detail quantifiable
outcomes of activities and data accumulated from community-based assessments included in
the Local Program Plan. LPHA must participate in coordinated He Program evaluation
activities, as reasonably required by OHA.
4. Performance Measures. If LPHA completes fewer than 75% of the planned activities in its
Local Program Plan for two consecutive reporting periods in one state fiscal year, it will not be
eligible to receive funding under this Program Element in the next state fiscal year.
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 65 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
Attachment 1
Budget
Line Item Budget and Nan-ative Worksheet
Please complete the folloWing Une Item Budget for: OHA PE15 or PE14 for FY2014 (07/01113-06130/14)
Identify only funds requested under the OHA PEE 15 or PEE 14 RFA.
Please caD your Community prograrm; Liaison with quesoons related to this form
Agency:
Fiscal
Contact:
E-mail
adt:tre1lls:
Deschutes County Health Services Public HeaIlh
sherrLpinner@deschutes.org
PhOne
Number: 541-322-7509 Fax
Number: 541-322-7565
Budget
(1) Salary
(2) Fringe
Benefits
DeseciptiOO
2 wing Well Coon:Iinalor
(Bnonda Johruson)
3
4
TOTAL SALARY
TOTAL FRINGE
(3) Equipment List equipment.
N ............ • .
•
"/' ..
50·~i;·.•·· 12
(4) Supplies Do not list. These items include supplies for meetings, general office supplies ie.
paper, pens, computer dl!!.ks, hlghlighters, binders, folders, elc.
(5) Travel In_
uutut_
(6}Other Please list.
living Well instructor stipends
(7) Conlracts: List all sub~ontracts a.nd all contractual costs, if applicable.
27,354.00
24,294.60
0.00
0.00
$51,648.80
·10,604.83
9,596.4~
0.00
0.00
$20,401.26
$0
so
I
$40(J
$600
$0
$200
5100
S56S
$3,000
$3,33
$(]
$(]
$(]
$(]I
$(]
ConITacts musl
be ~"f>PI""tEd ~~ .---------------------------------------------------------.-----------~
(8) Total (SUm of 1 through 7}
Direct Cosls
(9) Cost
Allocation and Indirect @ D.DO%
Indirect Rate
(10) TOTALS (Sum of 8, & 9). Should equal OHA PE 150( PE14 Request.
$0
Total
$20,4.111
$0
$1,000
$1,865
$6,335
$()
581,250
$()
$81,250
2013.2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 66 OF 167 PAGES
142008 PGM • DESCHUTES COUNTY
Program Element #40: Family Health Services ("FHS") -Special Supplemental Nutrition_
Program for Women, Infants and Children ("WIC") Services
The funds provided under this Agreement for Program Element #40 must only be used in
accordance with and subject to the restrictions and limitations set forth below to provide the following
services:
• Special Supplemental Nutrition Program for Women, Infants and Children services ("WIC
Services"),
• Farm Direct Nutrition Program services ("FDNP Services"), and
• Breastfeeding Peer Counsel ing Program services ("BFPC Services").
The services described in Sections 2,3, and 4 below, are ancillary to basic WIC Services described
in Section 1. In order to participate in the services described in Sections 2, 3, or 4, LPHA must be
delivering basic WIC Services as described in Section 1. The requirements for WIC Services also
apply to services described in Sections 2, 3, and 4.
1. WIC Services.
a. Description of WIC Services. WIC Services are nutrition and health screening,
Nutrition Education related to individual health risk and Participant category,
Breastfeeding promotion and support, health referral, and issuance of Food Instruments
for specifically prescribed Supplemental Foods to Participants during critical times of
growth and development in order to prevent the occurrence of health problems and to
improve the health status of mothers and their children.
b. Definitions Specific to WIC Services.
i. Applicants: Pregnant women, Breastfeeding women, Postpartum Women, infants
and children up to 5 years old who are applying to receive WIC Services, and the
breastfed infants of applicant Breastfeeding women. Applicants include individuals
who are currently receiving WIC Services but are reapplying because their
Certification Period is about to expire.
ii. Assigned Caseload: Assigned Caseload for LPHA, which is set out in the Oregon
Health Authority (OHA), Public Health Division, Financial Assistance Award
document, is determined by OHA using the WIC funding formula approved by
CHLO MCH and CHLO Executive Committee in February of 2003. This Assigned
Caseload is used as a standard to measure LPHA's caseload management
performance and is used in determining NSA funding for LPHA.
iii. Breastfeeding: The practice of a mother feeding her breast milk to her infant(s) on
the average of at least once a day.
20!3-20ISINTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 67 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
iv. Breastfeeding Women: Women up to one year postpartum who breastfeed their
infants.
v. Caseload: For any month, the sum of the actual number of pregnant women,
Breastfeeding Women, Postpartum Women, infants and children who have received
Supplemental Foods or Food Instruments during the reporting period and the actual
number of infants breastfed by Participant Breastfeeding Women (and receiving no
Supplemental Foods or Food Instruments) during the reporting period.
vi. Certification: The implementation of criteria and procedures
document each Applicant's eligibility for WIC Services.
to assess and
vii. Certification Period: The time period during which a Participant is eligible for
WIC Services based on hislher application for those WIC Services.
viii. Documentation: The presentation of written or electronic documents or documents
in other media that substantiate statements made by an Applicant or Participant or a
person applying for WIC Services on behalf of an Applicant or Participant.
ix. Food Instrument: A voucher, check, coupon or other document that is used by a
Participant to obtain Supplemental Foods.
x. Health Services: Ongoing, routine pediatric, women's health and obstetric care
(such as infant and child care and prenatal and postpartum examinations) or referral
for treatment.
xi. Nutrition Education: The provIsion of information and educational materials
designed to improve health status, achieve positive change in dietary habits, and
emphasize the relationship between nutrition, physical activity, and health, all in
keeping with the individual's personal and cultural preferences and socio-economic
condition and related medical conditions, including, but not limited to,
homelessness and migrancy.
xii. Nutrition Education Contact:
provision of Nutrition Education.
Individual or group education session for the
xiii. Nutrition Education Plan: An annual plan developed by LPHA and submitted to
and approved by OHA that identifies areas of Nutrition Education and breastfeeding
promotion and support that are to be addressed by LPHA during the period of time
covered by the plan.
xiv. Nutrition Services and Administration (NSA) Funds: Funding disbursed under or
through this Agreement to LPHA to provide direct and indirect costs necessary to
support the delivery ofWIC Services by LPHA.
xv. Nutrition Risk: Detrimental or abnormal nutritional condition(s) detectable by
biochemical or anthropometric measurements; other documented nutritionally
related medical conditions; dietary deficiencies that impair or endanger health; or
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 68 OF 167 PAGES
142008 PGM -DESCHUTES COU:"ITY
conditions that predispose persons to inadequate nutritional patterns or nutritionally
related medical conditions.
xvi. Participants or WIC Participants: Pregnant women, Breastfeeding women,
Postpartum Women, infants and children who are receiving Supplemental Foods or
Food Instruments under the program, and the breastfed infants of participating
Breastfeeding Women.
xvii. Postpartum Women: Women up to six months after termination of a pregnancy_
xviii. Supplemental Foods: Those foods containing nutrients determined to be beneficial
for pregnant, Breastfeeding and Postpartum Women, infants and children, as
determined by the United States Department of Agriculture, Food and Nutrition
Services for use in conjunction with the WIC Services. These foods are defined in
the WIC ManuaL
xix. TWIST: The WIC Information System Tracker which is OHA's statewide
automated management information system used by state and local agencies for:
(A.) provision of direct client services including Nutrition Education, risk
assessments, appointment scheduling, class registration, and Food
Instrument issuance;
(8.) redemption and reconciliation of Food Instruments including electronic
communication with the banking contractor;
(C.) compilation and analysis of WIC Services data including Participant and
vendor information; and
(D.) oversight and assurance ofWIC Services integrity.
xx. TWIST User Training Manual: The TWIST User Training Manual, and other
relevant manuals, now or later adopted, all as amended from time to time by updates
as accepted by the LPHA.
xxi. WIC: The Special Supplemental Nutrition Program for Women, Infants and
Children authorized by section 17 of the Child Nutrition Act of 1966, 42 U.S.C.
1786, as amended through PL 1 05-394, and the regulations promulgated pursuant
thereto, 7 CFR Ch. II, Part 246.
xxii. WIC Manual: The Oregon WIC Program Policies and Procedures Manual, and
other relevant manuals, now or later adopted, all as amended from time to time by
updates accepted by the LPHA.
c. Procedural and Operational Requirements of WIC Services. All WIC Services
supported in whole or in part, directly or indirectly, with funds provided under this
Agreement must be delivered in accordance with the following procedural and
operational requirements and in accordance with the WIC Manual:
20Il-2015INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 690F 167 PAGES
142008 PGM -DESCHUTES COUNTY
i. Staffing Requirements and Staff Qualifications.
(A.) LPHA must utilize a competent professional authority at each of its WIC
Services sites for Certifications, in accordance with 7 CFR 246.6(b)(2), and
the agreement approved by the CLHO Maternal and Child Health (MCH)
Committee on January 2001, and the CLHO Executive Committee on
February 2001; and re-approved as written by the CLHO Maternal and Child
Health (MCH) Committee on March 2006, and the CLHO Executive
Committee on April 2006. A competent professional authority is an
individual on the staff of LPHA who demonstrates proficiency in certifier
competencies, as defined by the Policy #660 in the WIC Manual (a copy of
which OHA will provide to LPHA) and is authorized to determine Nutrition
Risk and WIC Services eligibility, provide nutritional counseling and
Nutrition Education and prescribe appropriate Supplemental Foods.
(B.) LPHA must provide access to the services of a qualified nutritionist for
Participants and LPHA staff to ensure the quality of the Nutrition Education
component of the WIC Services, in accordance with 7 CFR 246.6(b )(2); the
1997 State Technical Assistance Review (STAR) by the U.S. Department of
Agriculture, Food and Consumer Services, Western Region (which is
available from Department upon request); as defined by Policy #661; and the
agreement approved by the CLHO MCH Committee on January 200 I and
March, 2006 and the CLHO Executive Committee on February 2001 and
April 2006. A qualified nutritionist is an individual who has a master's
degree in nutrition or its equivalent; is a Registered Dietitian (RO) registered
with the American Dietetic Association (ADA) or an individual eligible for
registration with the ADA; or is an Oregon Licensed Dietitian (LD).
ii. General WIe Services Requirements. By utilizing OHA financial assistance to
deliver WIC Program services, LPHA agrees to deliver these WIC services in
accordance with the requirements set forth as follows:
(A.) LPHA shall provide WIC Services only to Applicants certified by LPHA as
eligible to receive WIC Services. All WIC Services must be provided by
LPHA in accordance with, and LPHA must comply with, all the applicable
requirements detailed in the Child Nutrition Act of 1966, as amended
through Pub.L.I05-394, November 13, 1998, and the regulations
promulgated pursuant thereto,7 CFR, Part 246,3106,3017,3018, Executive
Order 12549, the WIC Manual, OAR 333-054-0000 through 0090, such U.S.
Department of Agriculture directives as may be issued from time to time
during the term of the Agreement, the TWIST User Training Manual (copies
available from OHA upon request), and the agreement approved by the
CLHO MCH Committee on January 2001, and the CLHO Executive
Committee on February 2001; and re-approved as written by the CLHO
MCH Committee on March 2006, and the CLHO Executive Committee on
April 2006.
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 70 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
(8.)
(C.)
(D.)
(E.)
(F.)
(G.)
LPHA must make available to each Participant and Applicant referral to
appropriate Health Services and shall inform them of the Health Services
available. In the alternative, LPHA shall have a plan for continued efforts to
make Health Services available to Participants at the WIC clinic through
written agreements with other health care providers when health services are
provided through referral, in accordance with 7 CFR 246.6(b)(3) and (5);
and the agreement approved by the CLHO MCH Committee 1-01 on
January 2001, and by the CLHO Executive Committee 2-01 on February
2001; and re-approved as written by the CLHO MCH Committee on March
2006, and the CLHO Executive Committee on April 2006.
Each WIC LPHA must make available to each Participant a minimum of two
Nutrition Education contacts appropriate to the Participant's Nutrition Risks
and needs during the Participant's Certification Period, in accordance with 7
CFR 246.11 and the agreement approved by the CLHO MCH Committee on
January 2001, and by the CLHO Executive Committee on February 2001;
and re-approved as written by the CLHO MCH Committee on March 2006,
and the CLHO Executive Committee on April 2006.
LPHA must document Participant and Applicant information in TWIST for
review, audit and evaluation, including all criteria used for Certification,
income information and specific criteria to determine eligibility, Nutrition
Risk(s), and food package assignment for each Participant, in accordance
with 7 CFR 246.7 and the agreement approved by the CLHO MCH
Committee on January 2001, April 2004, and March 2006, respectively, and
the CLHO Executive Committee on February 2001and April 2006 and the
TWIST User Training Manual.
LPHA must maintain complete, accurate, documented and current
accounting records of all WIC Services funds received and expended by
LPHA in accordance with 7 CFR 246.6(b)(8) and the agreement approved
by the CLHO MCH Committee on January 2001, and by the CLHO
Executive Comm ittee on February 2001; and re-approved as written by the
CLHO MCH Committee on March 2006, and the CLHO Executive
Committee on April 2006.
LPHA, in collaboration with OHA, shall manage its Caseload in order to
meet the performance measures for its Assigned Caseload, as specified
below, in accordance with 7 CFR 246.6 (b)(l) and the agreement approved
by the CLHO MCH Committee on January 2001, and by the CLHO
Executive Committee on February 2001; and re-approved as written by the
CLHO MCH Committee on March 2006, and the CLHO Executive
Committee on April 2006.
As a condition to receiving funds under the Agreement, LPHA must have on
file with OHA, a current annual Nutrition Education Plan that meets all
requirements related to plan, evaluation, and assessment.. Each Plan must be
marked as to the year it covers and must be updated prior to its expiration.
OHA reserves the right to approve or require modification to the Plan prior
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 71 OF 167 PAGES
142008 PGM -OESCHUTESCOUNTY
to any disbursement of funds under this Agreement. The Nutrition
Education Plan, as updated from time to time, is an attachment to this
Agreement, in accordance with 7 CFR 246.11 (d)(2); and the agreement
approved by the CLHO MCH Committee on January 2001, April 2004, and
by the CLHO Executive Committee on February 2001; and re-approved as
written by the CLHO MCH Committee on March 2006, and the CLHO
Executive Committee on April 2006.
(H.) LPHA shall utilize at least twenty percent (20%) of its NSA Funds for
Nutrition Education activities, and the percentage specified in its financial
assistance award for Breastfeeding education and support, in accordance
with 7 CFR 246.14(c)(1) and the agreement approved by the CLHO MCH
Committee on January 2001, and by the CLHO Executive Committee on
February 2001; and re-approved as written by the CLHO MCH Committee
on March 2006, and the CLHO Executive Committee on April 2006 ..
(I.) Monitoring: OHA will conduct on-site monitoring of the LPHA biennially
for compliance with all applicable OHA and federal requirements as
described in the WIC Manual. Monitoring will be conducted in accordance
with 7CFR 246.l9(b)(1 )-( 6); and the agreement approved by CLHO MCH
Committee on January 2001, and by CLHO Executive Committee on
February 2001; and re-approved as written by the CLHO MCH Committee
on March 2006, and the CLHO Executive Committee on April 2006. The
scope of this review is described in Policy 215 in the WIC Manual.
d. Reporting Obligations and Periodic Reporting Requirements. In addition to the
reporting obligations set forth in Section 8 of Exhibit E of this Agreement, LPHA shall
submit the following written reports to OHA:
i. Quarterly reports on (1) the percentage of its NSA Funds used for Nutrition
Education activities and (2) the percentage used for Breastfeeding education and
support.
ii. Quarterly time studies conducted in the months of October, January, April and July
by all LPHA WIC staff.
e. Performance Measures.
i. LPHA shall serve an average of greater than or equal to 97% and less than or equal
to 103% of its Assigned Case load over any twelve (12) month period.
ii. OHA reserves the right to adjust its award of NSA Funds, based on LPHA
performance in meeting or exceeding Assigned Case load.
2. Special Supplemental Nutrition Program for Women, Infants and Children -Farm Direct
Nutrition Program (FDNP) Services.
a. General Description of FDNP Services. FDNP Services provide resources in the form
of fresh, nutritious, unprepared foods (fruits and vegetables) from local farmers to
2013-20151NTERGOVERNMENTAL AGREEI\U:NT FOR THE FINANCING OF PuBLIC HEALTH SERVICES PAGE 72 OF 167 PAGES
]42008 PGM -DESCHUTES COUNTY
women, infants, and children who are nutritionally at risk and who are WIC
Participants. FDNP Services are also intended to expand the awareness, use of and sales
at local farmers' markets and farm stands. FDNP Participants receive checks that can be
redeemed at local farmers' markets and farm stands for Eligible Foods.
b. Definitions Specific to FDNP Services. In addition to the definitions in Section I.b.
above, the following terms used in this Section 2 shall have the meanings assigned below,
unless the context requires otherwise:
i. Eligible Foods: Fresh, nutritious, unprepared, Locally Grown fruits, vegetables and
herbs for human consumption. Foods that have been processed or prepared beyond
their natural state, except for usual harvesting and cleaning processes, are not
Eligible Foods. Honey, maple syrup, cider, nuts, seeds, eggs, meat, cheese and
seafood are examples of foods that are not Eligible Foods.
ii. Farmers' Market: Association of local farmers who assemble at a defined location
for the purpose of selling their produce directly to consumers.
iii. Farmers' Market Season or Season: June I -October 31.
iv. Farm Stand: A location at which a single, individual farmer sells hislher produce
directly to consumers or a farmer who owns/operates such a farm stand. This is in
contrast to a group or association of fanners selling their produce at a farmers'
market.
v. FDNP: The WIC Farm Direct Nutrition Program authorized by section 17(m) of the
Child Nutrition Act of 1966,42 U.S.c. 1786(m), as amended by the WIC Farmers'
Market Nutrition Act of 1992, Pub. L. 102-214, enacted on July 2,1992.
vi. Locally Grown Produce: Produce grown within Oregon's borders, but may also
include produce grown in areas in neighboring states adjacent to Oregon's borders.
vii. Recipients: WIC Participants who (1) are one of the following: pregnant women,
Breastfeeding women, non-Breastfeeding Postpartum Women, infants 6 -12
months old at any time during the Fanners' Market Season and children 1 4 years
of age at any time during the Season and (2) have been chosen by the LPHA to
receive FDNP Services.
c. Procedural and Operational Requirements for FDNP Services. All FDNP Services
supported in whole or in part, directly or indirectly, with funds provided under this
Agreement must be delivered in accordance with the following procedural and
operational requirements:
i. Staffing Requirements and Staff Qualifications. LPHA shall have sufficient staff
to ensure the effective delivery of required FDNP Services.
ii. General FDNP Services Requirements. All FDNP Services must comply with all
requirements as specified in OHA's Farm Direct Nutrition Program Policy and
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 7JOF 167 PAGES
142008 PGM· DESCHUTES COUNTY
Procedures in the WIC Manual, including but not limited to the following
requirements:
(A.) Coupon Distribution: OHA will deliver FDNP checks to the LPHAs who
will be responsible for distribution of these checks to Recipient. Each
Recipient must be issued one packet of checks after confirmation of
eligibility status. The number of check packets allowed per family will be
announced before each season begins.
(B.) Recipient Education: Checks must be issued in a face-to-face contact after
the Recipient/guardian has received a FDNP orientation that includes
Nutrition Education and information on how to shop with checks.
Documentation of this education must be put in TWIST or a master file if
TWIST is not available. Details of the education component can be found in
the Farmers' Market Client Education Requirements Policy in the WIC
Manual.
(C.) Security: Checks must be kept locked up at all times except when in use and
at those times a LPHA staff person must attend the unlocked checks.
(D.) Check Issuance and LPHA Responsibilities: LPHA must document the
required certification information and activities on a Participant's record in
the TWIST system in accordance with the requirements set out in Policy 640
of the WIC Manual. LPHA shall follow the procedures set out in Policy
1100 of the WIC Manual to ensure compliance with the FDNP services
requirements.
(E.) Complaints/Abuse: LPHA must address all Civil Rights complaints
according to Policy 230, Civil Rights, in the WIC Manual. Other types of
complaints must be handled by LPHA's WIC Coordinator in consultation
with the State FDNP coordinator if necessary. LPHAs must record all
complaints on an Oregon FDNP comment form (see Appendix B of Policy
1100 of the WIC Manual), and all originals of the completed form must be
forwarded to the State FDNP Coordinator.
(F.) Monitoring: OHA will monitor the FDNP practices of LPHA. OHA will
review the FDNP practices of LPHA at least once every two years. The
general scope of this review is found in Policy 1100 in the WIC Manual.
OHA monitoring will be conducted in accordance with 7 C.F.R. Ch. II, Part
246 and agreement approved by the CLHO MCH Committee on January
200 I, and by the CLHO Executive Committee on February 2001; and re
approved as written by the CLHO MCH Committee on March 2006, and the
CLHO Executive Committee on April 2006.
iii. Reporting Obligations and Periodic Reporting Requirements. The reporting
obligations of LPHA are set forth in the Section 8 of Exhibit E of this Agreement.
2013-20151NTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PuBLIC HEALTH SERVICES PAGE 74 OF 167 PAGES
142008 PGM DESCHt:TES COUNTY
3. Breastfeeding Peer Counseling (BFPC) Services
a. General Description of BFPC Services. The purpose ofBFPC Services is to increase
breastfeeding duration and exclusivity rates by providing basic Breastfeeding
infonnation, encouragement, and appropriate referral primarily during non-traditional
work hours at specific intervals to pregnant and Breastfeeding women who are
Participants through a Peer Counselor from the local community.
b. Definitions Specific to BFPC Services.
i. Peer Counselor: A paraprofessional support person with LPHA who meets the
qualifications as stated in the WIC Manual and provides basic Breastfeeding
infonnation and encouragement to pregnant women and Breastfeeding mothers who
are Participants.
ii. LPHA Breastfeeding Peer Counselor Coordinator or BFPC Coordinator: An
LPHA staff person who supervises (or if the governing collective bargaining
agreement or local organizational structure prohibits this person from supervising
staff, mentors and coaches and directs the work of) BFPC Peer Counselors and
manages the delivery of the BFPC Services at the local level according to the WIC
Manual.
iii. State Breastfeeding Peer Counseling Project Coordinator or State BFPC
Coordinator: An OHA staff person who coordinates and implements the BFPC
Services for Oregon.
iv. Assigned Peer Counseling Caseload: Assigned Peer Counseling for LPHA, which
is set out in the OHA, Public Health Division, Financial Assistance Award
document, is detennined by OHA using the WIC Peer Counseling funding fonnula.
This Assigned Peer Counseling Caseload is used as a standard to measure LPHA's
peer counseling case load management perfonnance and is used in detennining peer
counseling funding for LPHA.
v. Peer Counseling Caseload: For any month, the sum of the actual number of
women assigned to an LPHA peer counselor.
c. Procedural and Operational Requirements of the BFPC Services. All BFPC
Services supported in whole or in part with funds provided under this Agreement must
be delivered in accordance with the following procedural and operational requirements:
i. Staffing Requirements and Staff Qualifications.
(A.) LPHA shall provide a BFPC Coordinator who meets the qualifications set
forth in the WIC Manual and who will spend an adequate number of hours
per week managing the delivery of BFPC Services and
supervisinglmentoringlcoaching the Peer Counselor(s). The average number
of hours spent managing the delivery of BFPC Services will depend upon
the LPHA's Assigned Peer Counseling Caseload and must be sufficient to
maintain caseload requirements specified in the WIC Manual.
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(B.) LPHA shall recruit and select women from its community who meet the
selection criteria in the WIC Manual to serve as Peer Counselors.
ii. General Requirements for the BFPC Services.
(A.) WIC Manual Compliance: All BFPC Services funded under this
Agreement must comply with all state and federal requirements specified in
the WIC Manual and the All States Memorandum (ASM) 04-2
Breastfeeding Peer Counseling Grants/Training.
(B.) Confidentiality: Each Peer Counselor shall abide by federal, state and local
statutes and regulations related to confidentiality of Participant infonnation.
(C.) Job Parameters and Scope of Practice: The LPHA position description,
selection requirements and scope of practice for Peer Counselor(s) shall be
in accordance with the WIC Manual.
(D.) Required Documentation: LPHA shall document Participant assignment
to a peer counselor in TWIST. LPHA shall assure that all Peer Counselors
document all contact with Participants according to the WIC Manual.
(E.) Referring: LPHA shall develop and maintain a referral protocol for the
Peer Counselor(s) and a list of lactation referral resources, specific to their
agency and community.
(F.) LPHA-provided Training: LPHA shall assure that Peer Counselors receive
new employee orientation and training in their scope of practice, including
elements described in the WIC Manual
(G.) Conference Calls: LPHA shall assure that the BFPC
participate in periodic conference calls sponsored by OHA.
Coordinator(s)
(H.) Frequency of Contact with Participant: LPHA shall follow the minimum
requirements as stated in the WIC Manual specifying the type, the number
and the timing of Participant notifications, and the number and type of
interventions included in a Peer Counselor's assigned caseload.
(I.) Availability. Peer Counselors shall be available to Participants who are part
of their caseload by phone during non-clinic hours, such as evenings and
weekends.
(J.) Plan Development: LPHA shall develop a plan as described in the WIC
Manual to assure that the delivery of BFPC Services to Participants is not
disrupted in the event of Peer Counselor attrition or long-tenn absence.
(K.) Calculation of BCP Services Time: LPHA staff time dedicated to
providing BCP Services shall not be included in the regular WIC quarterly
time studies described in Section I(e)(ii) above.
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(L.) Counting of BFPC Services Expenditures: LPHA shall not count
expenditures from the BFPC Services funds towards meeting either its
LPHA breastfeeding promotion and support targets or its Nutrition
Education requirement.
(M.) Monitoring. OHA will do a review of BFPC Services as part of its regular
WIC Services review of LPHA once every two years. OHA will conduct
quarterly reviews of Peer Counseling Caseload. LPHA will cooperate with
such OHA monitoring.
(N.) Performance Measures:
(i.) LPHA shall serve at least 97% of its Assigned Peer Counseling Caseload
over any twelve-month period.
(ii.) OHA reserves the right to adjust its award of BFPC Funds, based on
LPHA performance in meeting Assigned Peer Counseling Caseload.
iii. Reporting Obligations and Periodic Reporting Requirements. In addition to the
reporting obligations set forth in Section 8 ofExhibit E of the Agreement, LPHA shall
submit the following reports to OHA:
(A.) A quarterly expenditure report detailing BFPC Services expenditures
approved for personal services, services and support, and capital outlay in
accordance with the WIC Manual.
(B.) A quarterly activity report summarizing the BFPC Services provided by
LPHA, as required by the WIC Manual
iv. Terms Specific to BFPC Services. OHA reserves the right to discontinue funding
BFPC Services if the LPHA does not follow the requirements related to BFPC
Services as stipulated in the WIC Manual.
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Program Element #41: Reproductive Healtb Program
1. General Description. Family Planning Services are the educational, clinical and social
services necessary to aid individuals to determine freely the number and spacing of their
children. The purpose of the Reproductive Health Program is to provide these services through
a broad range of effective contraceptive methods and reproductive health services on a
voluntary and confidential basis.
2. Definitions Specific to tbe Reproductive Healtb Program.
a. Ablers & Associates: Vendor for data processing contracted by the Oregon Health
Authority, Reproductive Health Program.
b. Client Visit Record (CVR): Data collection tool for family planning encounters
developed by HHS, Office of Population Affairs, Region X, Office of Family Planning,
available from the OHA, Reproductive Health Program.
c. Federal Poverty Level (FPL) Guidelines: The annually adjusted poverty income
guidelines prescribed by HHS which OHA provides to LPHA by April of each year to
determine income eligibility for clients.
d. Federal Title X Program: The federal program authorized under Title X of the Public
Health Service Act to provide family planning services, supplies and education to
anyone seeking them. By law, priority is given to low-income clients.
e. Oregon Infertility Prevention Project (IPP): A project funded by the Centers for
Disease Control & Prevention (CDC) to control the spread of Chlamydia through the
collaborative efforts of sexually transmitted disease clinics, reproductive health care
providers, and public health laboratories.
f. Program Income: Additional revenue generated by the provision of reproductive
health services, such as client fees, donations, third party insurance and Medicaid
reimbursement.
g. Title X Program Guidelines: Title X Program Guidelines for Project Grants for
Family Planning Services published by the Office of Population Affairs, Office of
Public Health and Science, Office of Family Planning 2001.
3. Procedural and Operational Requirements. All reproductive health services supported in
whole or in part with funds provided under this agreement must be delivered in compliance
with the requirements of the Federal Title X Program as detailed in statutes and regulations,
including but not limited to 42 USC 300 et.seq., 42 CFR Part 50 subsection 301 et seq., and 42
CFR Part 59 et seq., the Title X Program Guidelines for Family Planning, the Program
Instructions, and the Oregon Health Authority, Office of Family Health, Reproductive Health
Program Manual.
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a. Title X Program Guidelines: LPHA must: 1.) comply with the Federal Title X
Guidelines for Family Planning, 2.) ensure confidentiality for all clients receiving
reproductive health services, including specific requirements for adolescents, and 3.)
comply with any subsequent program instructions issued by the Office of Population
Affairs, including the following:
i. Operation of clinical sites that are open to the public on an established schedule
and have specified clinical personnel as well as ancillary staff who can provide
Family Planning Services to the pUblic.
Citation 42 CFR 59.5 (b)(3)
ii. Provide a broad range of contraceptive methods as defined in the Federal Title X
GuideHnes for Family Planning Services and as specified by the OHA
Reproductive Health Program.
Citation 42 CFR 59.5 (a)(I)
iii. Provide an education program which includes outreach to inform communities of
available services and benefits of family planning.
Citation 42 CFR 59.5 (b)(3)
b. Data Collection: LPHA must collect and submit client data for each individual
receiving any service supported in whole or in part with OHA funds provided under this
agreement.
Citation 42 USC 701-709
c. Chlamydia Testing: Unless this requirement is waived by OHA, LPHA shall
participate in the Oregon Infertility Prevention Project for Chlamydia testing and adhere
to that project's standards for identifying, screening and testing.
Citation 42 CFR 59.5 (a)(I)
4. Reporting Requirements. In addition to the reporting obligations set forth in Exhibit E
Section 8 of this agreement, LPHA shall submit to OFH the following written reports:
a. Annual Plan for Family Planning Services covering the period of July 1 through June
30 of the succeeding year. OHA will supply the due date, required format and current
service data for use in completing the plan.
Title X Regulation 6.2
b. Projected Budget for Family Planning Services covering the period of July] through
June 30 of the succeeding year. OHA will provide due date and required format.
Citation 45 CFR 92.20
c. Family Planning Program-Specific Revenue and Expenditure Report must be
submitted quarterly to the Office of Financial Services and to the Reproductive Health
Program Office on the dates specified in Exhibit E Section 8 of this Agreement.
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5. Program Income
a. Sliding Fee Scale: If any charges are imposed upon a client for the provision of family
planning services assisted by the State under this Program Element, such charges: (1)
will be pursuant to an OFH-approved sliding fee schedule of charges, (2) will not be
imposed with respect to services provided to low-income clients, and (3) will be
adjusted to reflect the income, resources, and family size of the client provided the
services, in accordance with 42 USC 701-709.
Citation 42 CFR 59.5 (a) (7) and (a) (8)
b. Fees: Any fees collected for family planning services shall be used only to support the
Family Planning Program.
Citation 45 CFR 74.21, 74.24, 92.20, 92.25
c. Disposition of Program Income Earned: OHA requires that LPHA maintain separate
fiscal accounts for program income collected from providing family planning services.
Program income collected under this Agreement subsection must be fully expended by
the tennination date of this Agreement and only for the provision of the services set
forth in this Program Element description, and may not be carried over into subsequent
years. See definition 2.e of this PE for definition of program income.
Citation 45 CFR 74.21, 74.24, 92.20, 92.25
d. Indirect Costs: LPHA may not use more than 10% of the funds awarded for family
planning services on indirect costs. For purposes of this Contract, indirect costs are
defined as costs incurred by an organization that are not readily identifiable but are
nevertheless necessary to the operation of the organization and the perfonnance of its
programs." These costs include, but are not limited to, "costs of operating and
maintaining facilities, administrative salaries, equipment, depreciation, etc." in
accordance with 42 USC 701-709.
Citation 42 USC 701-709
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Program Element #42: Maternal, Child and Adolescent Health (MCAH) Services
1. Purpose of MCAH Services. Funding provided under the current Public Health Financial
Assistance Agreement (the "Agreement") for this Program Element shall only be used in
accordance with and subject to the restrictions and limitations set forth below to provide the
following services:
• Maternal, Child and Adolescent Health (MCAH) Preventive Health Services (or "MCAH
Service(s)");
• Oregon Mothers Care (OMC) Services;
• Maternity Case Management (MCM) Services; and
• Babies First! (Blst!) and/or Nurse Family Partnership (NFP)
If funds awarded to LPHA for MCAH Services, in the Financial Assistance A ward located at
Exhibit B to the Agreement, are restricted to a particular MCAH Service, those funds shall only
be used by LPHA to support delivery of that specific service. All performance by LPHA under
this Program Element, including but not limited to reporting obligations, shall be to the
satisfaction of OHA.
2. General Requirements
a. Data Collection: LPHA must provide MCAH client data, in accordance with Title V
Section 506 [42 USC 706], to the OHA with respect to each individual receiving any
MCAH Service supported in whole or in part with MCAH Service funds provided
under this Agreement.
b. Administration: LPHA shall not use more than 10% of the Federal Title V funds
awarded for a particular MCAH Service on indirect costs. For purposes of this
Agreement, indirect costs are defined as "costs incurred by an organization that are not
readily identifiable but are nevertheless necessary to the operation of the organization
and the performance of its programs." These costs include, but are not limited to, "costs
of operating and maintaining facilities, for administrative salaries, equipment,
depreciation, etc." in accordance with Title V, Section 504 [42 USC 704(d)].
c. Sliding Fee Scale: If any charges are imposed upon a client for the provision of health
services assisted by the State under this Program Element, such charges: (I) will be
pursuant to a public sliding fee schedule of charges, (2) will not be imposed with
respect to services provided to low-income mothers and children, and (3) will be
adjusted to reflect the income, resources, and family size of the client provided the
services, in accordance with Title V, Section 505 [42 USC 705 (5) (D)].
d. Fees: Use of any fees collected for these services shall be dedicated to such services.
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e. Medicaid Application: Title V of the Social Security Act mandates that all maternal
and child health-related programs identify and provide application assistance for
pregnant women and children potentially eligible for Medicaid services. LPHA must
collaborate with OHA to develop the specific procedures that LPHA will implement to
provide Medicaid application assistance to pregnant women and children who receive
MCAH Services supported in whole or in part with funds provided under this
Agreement and who are potentially eligible for Medicaid services, according to Title V
Section 505 [42 USC 705(a)(5)(F)(iv)] .
f. MCAH Funds
i. MCAH funds shall be used for any service or activity described in this Program
Element according to the following limitations:
(A.) MCAHlTitle V Child and Adolescent Health Funds: A minimum of thirty
percent (30%) of the total LPHA Federal Title V Funds are designated for
services for infants, children, and adolescents (Title V, Section 505 [42 USC
705 (a)(3)(A)]).
(B.) MCAHffitie V Flexible Funds: The remainder of the total LPHA Federal
Title V Funds are designated for program or services for women, infants,
children and adolescents.
(C.) MCAHlPerinatal Health State General Funds: Perinatal Health State
General Funds shall be used by LPHA for public health services for women
during the perinatal period (one year prior to conception through one year
postpartum ).
(D.) MCAHlChild and Adolescent Health State General Funds: Child and
Adolescent Health State General Funds shall be used by LPHA for public
health services for infants, children and adolescents.
(E.) Federal Title V Funds: Federal Title V Funds shall not be used as match
for any federal funding source.
ii. Babies First! (BIst!) and NFP Services. State General Funds for B I st! shall be
limited to expenditures for those services. MCAHlTitle V Funds (2.g.i.(A). and
(B).) may also be used for activities connected with the Blst! and/or NFP Services
within the limitations described in subsection 2.g.i., above,
iii. School-Based Health Centers. MCAH/Title V Funds (2.g.i.(A). and (B).) may
also be used for School-Based Health Centers within limitations of subsection 2.g.i.
above.
3. MCAH Services Supported by MCAH Funds
a. Definitions Specific to this Section.
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i. MCAH Services: Activities, functions, or services that support the optimal health
outcomes for women before and between pregnancies, during the perinatal time
period, infants, children and adolescents.
ii. MCAH Flexible Funds: Federal Title V and State General Funds that can be used
for any MCAH Service within the scope of the limitations in 2.g.i. above.
b. Procedural and Operational Requirements. All MCAH Services supported in whole
or in part with MCAH Funds provided under this Agreement must be delivered in
accordance with the following procedural and operational requirements:
i. LPHA shall submit a Comprehensive MCAH Plan of the public health goals and
services appropriate for the MCAH population within the jurisdiction of the county.
A Comprehensive MCAH Plan shall include:
(A.) Assessment of the health needs of the MCAH population
(B.) Goals, objectives, activities, and timelines
(C.) Evaluation plan to measure progress and outcomes of the Plan.
(D.) Projected use of MCAH Flexible Funds and other funds supporting Plan
activities and goals
ii. LPHA shall provide MCAH Services administered or approved by OHA that
support optimal health outcomes for women, infants, children, and adolescents.
(A.) Services administered by OHA include (but are not limited to):
(I.) Preconception health services such as preventive health and health risk
reduction services such as screening, counseling and referral for safe
relationships, domestic violence, alcohol, substance and tobacco use and
cessation, and maternal depression and mental health. Preconception
health is defined as interventions that aim to identify and modify
biomedical, behavioral, and social risks to a woman's health or
pregnancy outcome through prevention and management, emphasizing
those factors which must be acted on before conception or early in
pregnancy to have maximal impact.
(II.) Perinatal health services such as OMC Services, MCM Services; or other
preventive health services that improve pregnancy outcomes and health.
(III.) Infant and child health services such asB I st! and NFP Services, Child
Care Consultation, Sudden Infant Death Syndrome/Sudden Unexplained
Infant Death Follow-up, Oral Health including dental sealant services; or
other health services that improve health outcomes for infants and young
children; and
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(IV.) Adolescent health services such as School-Based Health Centers; ; teen
pregnancy prevention; or other adolescent preventive health services that
improve health outcomes for adolescents.
(8.) LPHA may provide other MCAH services identified through the LPHA
Comprehensive MCAH Plan and local public health assessment, and
approved by OHA.
(C.) Subject to OHA approval and notwithstanding the provisions of sections 1.,
and 2.f. of this Agreement, LPHA may provide MICAH-related clinical or
outpatient services with funds under this Program Element, when all other
payment options for such services are unavailable.
c. Reporting Obligations and Periodic Reporting Requirements. In addition to the
reporting requirements set forth in section 8 of Exhibit E of this Agreement, LPHA
shall submit Annual Reports for the Comprehensive MCAH Plan and collect and submit
data for clients receiving MCAH Services supported with funds from OHA under this
Agreement, satisfactory to OHA.
i. A progress report on the goals and activities of the Comprehensive MCAH Plan
must be submitted in conjunction with the Local Public Health Authority Annual
Progress Report.
ii. By September 30 of each year, all client visit data for the previous state fiscal year
(July I-June 30) must be entered into the Oregon Child Health Information Data
System (ORCHIDS).
(A.) The LPHA may transmit data in an electronic file structure defined by OHA.
Electronic transmission of visit data files may be submitted quarterly;
however, all client visit data from the previous state fiscal year must be
complete and transmitted to OHA by September 30 of each year.
(B.) If LPHA pays Providers for Services with MCAH funds, LPHA shall
include client data from those Providers.
iii. At a minimum, client data shall include: the number of clients served, the
demographic profile of clients, number of visits or encounters, the types of services
provided, and source of payment for services.
4. Oregon MothersCare ("OMC") Services
a. General Description. OMC Services are referral services to prenatal care and related
services provided to pregnant women as early as possible in their pregnancies, with the
goal of improving access to early prenatal care services in Oregon. OMC Services shall
provide an ongoing outreach campaign, utilize the statewide toll-free SafeNet (211 Info)
telephone hotline system, and provide local access sites to assist women to obtain
prenatal care services.
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b. Procedural and Operational Requirements for OMC Services. All OMC Services
supported in whole or in part with funds provided under this Agreement must be
delivered in accordance with the following procedural and operational requirements:
i. LPHA must designate a staff member as its Oregon MothersCare Coordinator to
work with OHA on developing a local delivery system for OMC Services. LPHA's
Oregon MothersCare Coordinator must work closely with OHA to promote
consistency around the state in the delivery ofOMC Services.
it LPHA must follow the Oregon MothersCare Protocols, as described in OHA's
Oregon MothersCare Manual April, 2005, provided to LPHA and its locations at
which OMC Services are available, when providing OMC Services such as outreach
and public education about the need for and availability of first trimester prenatal
care, maternity case management, prenatal care, including dental care, and other
services as needed by pregnant women.
iii. As part of its OMC Services, LPHA must develop and maintain an outreach and
referral system and partnerships for local prenatal care and related services.
iv. LPHA or its OMC site designee must assist all women seeking OMC Services in
accessing prenatal services as follows:
(A.) LPHA must provide follow up services to clients and women referred to
LPHA by the SafeNet (211 Info) and other referral sources; inform these
individuals of the link to the local prenatal care provider system; and provide
advocacy and support to individuals in accessing prenatal and related
services.
(B.) LPHA must provide facilitated and coordinated intake services and referral
to the following services: CPC Services (such as pregnancy testing,
counseling, Oregon Health Plan ("OHP") application assistance, first
prenatal care appointment); MCM Services (such as initial care needs
assessment and home visiting services); WIC Services; health risk screening;
other pregnancy support programs; and other prenatal services as needed.
v. LPHA shall make available OMC Services to all pregnant women within the
county. Special outreach shall be directed to Low-Income women and women who
are members of racial and ethnic minorities or who receive assistance in finding and
initiating CPC. Outreach includes activities such as talks at meetings of local
minority groups, exhibits at community functions to inform the target popUlations,
and public health education with a focus on the target minorities. "Low-Income"
means having an annual household income which is 185% or less of the federal
poverty level ("FPL") for an individual or family.
vi. LPHA shall make available to all Low-Income pregnant women within the county
assistance in applying for OHP coverage.
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vii. LPHA shall make available to all Low-Income pregnant women within the county
and all pregnant women within the county who are members of racial and ethnic
minorities referrals to additional perinatal health services.
viii. LPHA shall designate a representative who shall attend OMC site meetings
conducted by OHA.
ix. Except as specified below, LPHA shall deliver directly all OMC Services supported
in whole or in part with financial assistance provided to LPHA under this
Agreement. With the prior written approval of OHA, LPHA may contract with one
or more Providers for the delivery of OMC Services.
c. Reporting Obligations and Periodic Reporting Requirements. In addition to the
reporting requirements set forth in section 8 of Exhibit E of this Agreement, LPHA
must collect and submit client encounter data quarterly on individuals who receive
OMC Services supported in whole or in part with fund provided under this Agreement.
LPHA shall submit the quarterly data to OHA using OMC client tracking forms
approved by OHA for this purpose.
5. Maternity Case Management ("MCM") Services
a. General Description. Maternity Case Management ("MCM"), a component of
perinatal services, includes assistance with health, economic, social and nutritional
factors of clients which can negatively impact birth outcomes.
b. Definitions Specific to MCM Services. Case Management, Case Management Visit,
Client Service Plan, High Risk Case Management, High Risk Client,
Home/Environmental Assessment, Initial Assessment, Nutritional Counseling,
PrenatalfPerinatal Care Provider, and Telephone Case Management Visit have the
meanings set forth in OAR 410-130-0595.
c. Procedural and Operational Requirements for MCM Services. All MCM Services
provided with funds under this Program Element as well as those provided through the
Oregon Health Plan must be delivered in accordance with the Maternity Case
Management Program requirements set forth in OAR 410-130-0595.
d. Reporting Obligations and Periodic Reporting Requirements. In addition to the
reporting obligations set forth in Section 8 of Exhibit E, of this Agreement, LPHA shall
collect and submit client data for all clients and visits occurring during the calendar year
on to OHA, regardless of whether an individual receiving services has delivered her
baby.
i. By September 30 each year, all client visit data for the previous state fiscal year
(July I-June 30) must be entered into the Oregon Child Health Information Data
System (ORCHIDS).
(A.) The LPHA may transmit data in an electronic file structure defined by OHA.
Electronic transmission of visit data files may be submitted quarterly;
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however, all client visit data from the previous state fiscal year must be
complete and transmitted to OHA by September 30 of each year.
(B.) If LPHA pays Providers for Services with MCAH funds, LPHA shall
include client data from those Providers.
ii. Client data reports shall include: the number of clients served, the demographic
profile of clients, number of visits or encounters, the types of services provided,
source of payment for services, trimester at first prenatal visit, infant gestational age
at delivery, infant birth weight, and infant feeding method.
iii. All data must be collected when MCM funds made available under this Agreement
are used to provide or pay for (in whole or in part) an MCM service.
6. Babies First! and Nurse Family Partnership (Blst!INFP) Services
a. General Description. The primary goal of B I st!INFP Services is to prevent poor
health and early childhood development delay in infants and children who are at risk.
Blst!INFP Services are delivered or directed by Public Health Nurses (PHNs) and are
provided during home visits. PHNs conduct assessment, screening, case management,
and health education to improve outcomes for high-risk children. The definition of
"Public Health Nurses" and client eligibility criteria are provided in OAR 410-138-000
b. Procedural and Operational Requirements. All Blst!INFP Services supported in
whole or in part with funds provided under this Agreement must be delivered in
accordance with the following procedural and operational requirements
i. Staffing Requirements and Staff Qualifications. LPHA must designate a staff
member as its B 1 st!INFP Coordinator
ii. Home Visits.
(A.) B I st!INFP Services must be delivered by or under the direction of a PHN. A
PHN must complete assessments and screenings at 0-6 weeks and 4, 8, 12,
18, 24, 36, 48, and 60 months or by LPHA agreement with NFP National
Service Office. These activities should occur during home visits. Home
visits may also occur to carry out a nursing care plan. Screening and
assessment include, but are not limited to, the following activities:
(I.)An assessment of the child's growth.
(II.)A developmental screening.
(III.)A hearing, vision and dental screening.
(IV.)An assessment of parent/child interactions.
(V.)An assessment of environmental learning opportunities and safety.
(VI.)An assessment of the child's immunization status.
(VII.)Referral for medical and other care when assessments indicate that care is
needed.
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(B.) Blst!INFP Services must be delivered in accordance with OAR 410-138-000
through OAR 410-138-0390. Nurse Family Partnership (NFP) protocols
must also be delivered pursuant to guidelines in agreement with the LPHA
and the Nurse Family Partnership National Service Office.
(http://www.nurse(amilypartnership.orgiassetsIPDFIPolicY/HV-Funding
GuidancelNFP Implement Agreement.)
(C.) Blst!INFP Services must include follow up on referrals made by OHA for
Early Hearing Detection and Intervention, described in ORS 433.321 and
433.323.
iii. Targeted Case Management. LPHA, as a provider of Medicaid services, shall
comply with the Targeted Case Management billing policy and codes in OAR 410
138-0000 through 410-138-0390. NFP Services comply with the Blst! requirements
and may be combined with Babies First! Targeted Case Management.
c. Reporting Obligations and Periodic Reporting Requirements. In addition to the
reporting requirements set forth in section 8 of Exhibit E of this Agreement, LPHA
shall collect and report to OHA, in a format acceptable to OHA, the following data on
LPHA's delivery ofHRI Services:
i. By September 30 each year, all client visit data for the previous state fiscal year
(July I-June 30) must be entered into the Oregon Child Health Information Data
System (ORCHIDS).
(A.) The LPHA may transmit data in an electronic file structure defined by OHA.
Electronic transmission of visit data files may be submitted quarterly;
however, all client visit data from the previous state fiscal year must be
complete and transmitted to OHA by September 30 of each year.
(B.) If LPHA pays Providers for Services, LPHA shall include client data from
those Providers.
ii. Client data reports shall include: the number of clients served, the demographic
profile of clients, number of visits or encounters, the types of services provided, and
source of payment for services. The Blst!INFP Client Data Form provided by OHA
lists details ofthe required data elements.
iii. All data elements must be collected when funds provided under this Agreement for
B 1 st!INFP Services are used to pay for (in whole or in part) a B] st!INFP Service.
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Program Element #43: Public Health Practice ("PHP") -Immunization Services
The funds awarded under this Agreement for Public Health Practice services may only be used
in accordance with and subject to the restrictions and limitations set forth to provide immunization
services ("Immunization Services") as described in more detail below. All changes to Program
Element 43 are effective upon receipt of grant award.
1. General Procedural and Operational Requirements. Use of any fees collected for purpose
of Immunization Services shall be dedicated to and only used for payment of such Services.
2. General Description. Immunization Services are provided in the community to prevent and
mitigate vaccine-preventable diseases for all people by reaching and maintaining high lifetime
immunization rates. The services include direct services such as education about and
administration of vaccines to vulnerable populations, as well as population-based services
including public education, enforcement of school immunization requirements, and technical
assistance for healthcare providers who are providing vaccines to their client populations.
3. Definitions Specific to Immunization Services.
a. 317 Program: A program that provides free vaccine to children and adults who meet
eligibility requirements based on insurance status, age, school immunization
requirements, risk factors, and disease exposure.
b. ALERT lIS: Oregon Health Authority's state-wide immunization information system.
c. Assessment, Feedback, Incentives, & eXchange or AFIX: A continuous quality
improvement process developed by CDC to improve clinic immunization rates and
practices. Information about AFIX can be found at www.healthoregon.orglvfc
d. Billable Doses: Vaccine doses given to individuals who are insured for vaccines and
can afford their insurer's co-payor deductible.
e. Centers for Disease Control and Prevention or CDC: Federal Centers for Disease
Control and Prevention.
f. Delegate Agency: Immunization Provider providing Immunization Services pursuant
to a subcontract of the LPHA for the purposes of providing immunization services to
targeted populations.
g. Enhanced Ordering Cycle (EOC): A CDC process for ordering vaccines, where
ordering frequency is linked to provider size, vaccine usage, and storage capacity.
h. Exclusion Orders: Orders notifying a parent or guardian of non-compliance with the
SchoollFacility Immunization Law, available for review at
http://1.usa.gov/OregonSchool
i. [Reserved]
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j. Forecasting: Detennining vaccine doses that are due for an individual, based on the
individual's immunization history and age.
k. Monthly Vaccine Report or MVR: Monthly vaccine inventory report for vaccine
accountability filled out by LPHA and submitted to Oregon Health Authority.
I. Public Provider AgreementlPublic Provider Profile: Signed agreement, required by
CDC, between Oregon Health Authority and any LPHA that receives State-Supplied
VaccinelIG. LPHA shall comply with the tenns and conditions ofthe Public Provider
Agreement, including submitting an annual Public Provider Profile that enumerates the
population seen by the LPHA. The Oregon Health Authority will maintain and have
available for review the signed Public Provider Agreement and Public Provider Profile
for Immunization Services at the Oregon Health Authority's office located at 800 NE
Oregon St, Ste 370, Portland, OR 97232.
m. Service Areas: Geographic areas in Oregon served by Oregon immunization providers.
n. State-Supplied VaccinelIG: Vaccine or Immune Globulin provided by the Oregon
Health Authority including, but not limited to, vaccine procured with federal and state
funds. Federal funds support vaccines for the Vaccine for Children Program, an
entitlement program that provides free vaccine to children 0 through 18 years who are
American Indian/Alaskan Native, uninsured, underinsured and served in a public clinic
or on Medicaid; and the 317 Program, a program that provides free vaccine to children
and adults who meet eligibility requirements based on insurance status, age, school
immunization requirements, risk factors, and disease exposure.
o. Surveillance: The investigation, confirmation and reporting of communicable diseases
and conditions.
p. Vaccine Administration Record or VAR: An Oregon Health Authority-approved
record documenting immunization screening questions asked of an individual receiving
a vaccine and the data of the vaccines administered to the individual.
q. Vaccine Adverse Events Reporting System or V AERS: Federal system for reporting
adverse events to administered immunizations, available at http://vaers.hhs.gov/index
r. Vaccine Eligibility: An individual's eligibility for state-supplied vaccine. Infonnation
about vaccine eligibility is available at the Oregon Health Authority website:
www.healthoregon.orglvfc
s. Vaccines for Children Program: A Federal entitlement program that provides no-cost
vaccines to children 0 through 18 years who satisfY one ofthe following criteria:
i. They are American Indian/Alaskan Native;
it They are uninsured;
iii. They are on Medicaid;
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iv. They are underinsured and are served in Federally Qualified Health Centers
(FQHC) or Rural Health Centers (RHC); or
v. They are served by LPHAs that have sub-designation agreements with
FQHCsIRHCs.
t. Vaccine Information Statement or VIS: Information statement about each vaccine
that is produced by CDC.
u. Vaccine Stewardship: State law requiring all entities that administer vaccines to: 1)
report all vaccine administration data to ALERT liS; and 2) biannually confirm that at
least two employees are trained and certified in vaccine storage, handling and
administration (unless exempt under statute).
4. Procedural and Operational Requirements. All Immunization Services supported in whole
or in part with funds provided under this Agreement or delivered with State-Supplied
Vaccine/IG must be delivered in accordance with the following procedural and operational
requirements:
a. State-Supplied Vaccine/IG.
i. LPHA shall appropriately document in the Oregon Health Authority developed or
approved VAR and report to the Oregon Health Authority the appropriate eligibility
ofthe client for State-Supplied Vaccine/IG, using the list of codes and the Vaccine
Eligibility charts provided by the Oregon Health Authority, Immunization Program,
to the LPHA and posted on the website:
http://J. usa.govllmmunizationProvider Resources
ii. LPHA will be billed quarterly by the Oregon Health Authority for Billable Doses
provided to those clients who are insured for vaccines and can afford their insurer's
co-payor deductible.
b. Vaccine Management & Accountability.
i. LPHA will comply with Vaccine Stewardship statute and rules, including:
biennially certifYing that at least 2 immunization staff are presently trained in
vaccine storage, handling and administration training(s).
ii. LPHA shall track, store, and manage the supply and distribution of vaccine,
according to OHA and CDC guidelines set forth in the Public Provider Agreement
and the OHA's Standard Operating Procedures (SOP) posted on the website:
http://J.usa.gov/lmmunizationProviderResources Procedures include but are not
limited to the following:
iii. LPHA will designate one staff member as primary vaccine coordinator and at least
one back-up vaccine coordinator to be responsible for all key vaccine management
and accountability requirements per the Public Provider Agreement and SOP.
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iv. OHA-approved SOPs for routine and emergency vaccine routines shall be reviewed
and updated annually by LPHA, or when there is a change in staff who have
responsibilities specified in the plans.
v. Routine and Emergency SOPs must include storage and handling plans that include
guidance regarding: ordering vaccines; controlling inventory; storing vaccines &
monitoring conditions (i.e., twice-daily temperature logging); minimization of
vaccine wastage; proper vaccine stock rotation; vaccine receiving, packing and
transporting; emergency contact information & event plans; and documentation of
all routine and emergency events.
vi. LPHA will have appropriate refrigeration units and temperature tracking equipment
to store vaccine and maintain proper conditions. Certified 24-hour temperature
tracking devices that meet NIST or ASTM standards are required to track
temperatures in any refrigerator or freezers used to store vaccine. Whenever a
refrigerator or freezer is found to be outside the acceptable temperature range,
LPHA must call their State Immunization Health Educator at: (971) 673-0300, for
resolution.
vii. LPHA will follow all CDC and OHA cold chain requirements. This includes (but is
not limited to): following all vaccine off-site transporting protocols and procedures;
reporting and responding to vaccine expiration, wastage and compromised cold
chain events; returning all spoiled or expired state-supplied vaccines; prohibition of
pre-drawing vaccines into syringes; and safeguarding of vaccines by providing
facility security.
c. Delegate Agencies.
i. All Delegate Agencies to which the LPHA supplies State-Supplied Vaccine/IG must
agree to the requirements as spelled out in the County Delegate Agency Vaccine
Certification "0", a copy of which is available from the OHA's Immunization
Program at (971) 673-0300.
ii. LPHA shall complete a County Delegate Agency Vaccine Certification "0" for
every Delegate Agency biennially. This Certification "0", when executed by the
LPHA and acknowledged and agreed to by a Delegate Agency, serves as the
agreement between the LPHA and that Delegate Agency.
iii. LPHA shall review each Delegate Agency on-site biennially using the Delegate
Agency Review Tool, which OHA will provide to LPHA.
d. Vaccine Administration.
i. Annually in accordance with a schedule determined by OHA in consultation with
LPHA or as requested by OHA, LPHA shall submit a duly executed Immunization
Program Public Provider Agreement and Public Provider Profile, both of which are
requirements of CDC for any LPHA that receives State-Supplied Vaccine/IG.
LPHA shall comply with the terms and conditions of the Public Provider
Agreement.
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ii. OHA will maintain and have available for review the signed Immunization Program
Public Provider Agreement and Public Provider Profile at the OHA's office located
at 800 NE Oregon St, Ste 370, Portland, OR 97232.
iii. All State-Supplied Vaccine/IO must be offered to appropriate clients and may only
be administered in accordance with the current recommendations of the Department
of Health and Human Services' Advisory Committee on Immunization Practices
(ACIP) and OHA's Communicable Disease Summaries, as summarized in OHA's
Model Standing Orders for Vaccines, and in accordance with the Standards for
Child and Adolescent Immunization Practices and the Standards for Adult
Immunization Practices. These documents and standards are available for review at:
http://J. usa.gov/lmmunizationProviderResources
iv. In connection with the administration of a vaccine, LPHA must:
(A.) Provide to the recipient, parent or legal representative, documentation of
vaccines received at visit. LPHA may provide a new immunization record
or update the recipient's existing handheld record.
(B.) Document administration of the immunization in a permanent file, including:
vaccine name, date of administration, vaccine eligibility code, manufacturer
and lot number, signature and title of the person administering the dose,
address of clinic, date printed on the VIS, date the VIS was given,
contraindication questions, and HIPAAI ALERT signature requirement. At a
minimum, must retain OHA's "Vaccine Administration Record" or an OHA
approved equivalent as documentation.
(C.) LPHA shall comply with state and federal statutory and regulatory retention
schedules, available for review at OHA's office located at 800 NE Oregon
St, Ste 370, Portland, OR 97232. In cases of claim or lawsuit arising out of
the administration of vaccine to any individual, vaccine administration
records must be retained until final disposition of the claim, including
completion of any appeals.
(D.) LPHA shall not impose a charge for the cost of State-Supplied Vaccine/IO,
except for Billable Doses. Vaccine charges for Billable doses must not
exceed the Oregon Health Authority published price list.
(E.) LPHA shall not impose a charge for the administration of State-Supplied
Vaccine/IO, except for Billable doses, in any amount higher than $15.19 (per
shot), the maximum fee established by Medicaid for the State of Oregon.
(F.) LPHA shall not deny administration of a VFC or 317 vaccines to a child
seeking such vaccine due to the inability of the child's
parent/guardian/individual of record to pay an administration fee. VFC and
317 administration fees must be waived ifthe client is unable to pay.
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e. Immunization Rates and Assessments. OHA shall provide annually to LPHA their
AFIX rates and their population-based rates for the entire county. LPHA shall
participate in annual AFIX quality improvement activities, and use these rate data to
direct immunization activities.
f. Perinatal Hepatitis B Prevention.
i. LPHA must provide case-management services to all confirmed or suspect HBsAg
positive mother-infant pairs identified by LPHA or OHA in LPHA's Service Area.
Case management, in accordance with the Perinatal Hepatitis B Prevention Program
Guidelines posted on the OHA website at: http://i.usa.gov/PerinatalHepB shall
include, at a minimum:
(A.) Notification of the appropriate hospital infection control unit of any pending
delivery by an HBsAg-positive pregnant woman who has been reported to
the LPHA.
(B.) Enrollment of newborn into case management program and initial education
and referral of HBsAg-positive mother and her susceptible household and
sexual contacts for follow-up care including offering vaccination to all
susceptibles.
(C.) If LPHA's service area is anywhere in Oregon excluding Washington and
Clackamas counties, the LPHA is responsible for documentation of the
infant's completion or status of the 3-dose hepatitis B vaccine series by ] 5
months of age and post-serological testing by 18 months of age. LPHA shall
submit such documentation, as applicable, to the OHA at the time that each
dose is administered to the infant and/or susceptible household or sexual
contact and at the time that the testing is conducted.
(D.) If LPHA's service area is Multnomah County, the award of funds under this
Agreement to LPHA for this Program Element will include funds to
implement centralized case management work for the tri-county area, to
included Clackamas, Multnomah and Washington counties. The funds
awarded for centralized case management work will be identified by
footnote in the award. LPHA shall use this portion of the award to fund a
position responsible for tracking clients and reporting doses administered
and testing completed.
ii. LPHA shall work with hospitals to promote the administration of Hepatitis B birth
doses to all infants and Hepatitis B immune globulin (HBIG) and hepatitis B
vaccines to infants born to HBsAg-positive women, and women whose HBsAg
status is unknown.
g. Tracking and Recall.
i. LPHA shall forecast shots due for a child eligible for Immunization Services using
the ALERT lIS electronic forecasting system.
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ii. LPHA must cooperate with OHA to recall a client if a dose administered by LPHA
to such client is found by LPHA or OHA to have been mishandled and/or
administered incorrectly, thus rendering such dose invalid.
h. WIClImmunization Integration. LPHA must assist and support the efforts ofOHA to
provide WIC Services in compliance with the intent of the USDA Policy Memorandum
#2001-7: Immunization Screening and Referral in WIC, available for review at OHA 's
office located at 800 NE Oregon St, Ste 370, Portland, OR 97232.
i. Vaccine Information. In connection with LPHA's administration of each vaccine,
LPHA must:
i. Provide to the vaccine recipient (or the recipient's parent or legal representative if
the recipient is a minor) a copy of CDC's current VIS.
ii. Confirm that a recipient, parent, or legal representative has read, or has had read to
them, the VIS and has had their questions answered prior to the administration of
the vaccine.
iii. Make the VIS available in another language (for example, Spanish), if there are
significant numbers of individuals seeking vaccines for whom English is not their
first language.
j. Outreach and Education. LPHA must, during the state fiscal year, design and
implement two educational or outreach activities in LPHA's Service Area (either singly
or in collaboration with other community and service provider organizations) for
parents and/or private vaccine providers designed to raise childhood and/or adult
immunization rates. These educational and outreach activities may include activities
intended to reduce barriers to immunization, but may not include special immunization
clinics that provide vaccine for school children or flu prevention.
k. Surveillance of Vaccine-Preventable Diseases. LPHA must conduct disease
surveillance within its Service Area in accordance with the Communicable Disease
Administrative Rules, the Investigation Guidelines for Notifiable Diseases, the Public
Health Laboratory Users Manual, and the Model Standing Orders for Vaccine, available
for review at:
• http://public.health.oregon.gov/DiseasesConditions/CommunicableDisease
• http://public.health.oregon.gov/LaboratoryServices
• http://1. usa.govlimmunizationproviderresources
I. Adverse Events Following Immunizations. LPHA must complete and return a
V AERS form to OHA if:
i. An adverse event immunization administration occurs, as listed in "Reportable
Events Following Immunization", available for review at
http://vaers.hhs.govlprojessionalslindex#Guidance1
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ii. OHA requests a 60-day and/or one year follow-up report to an earlier reported
adverse event; or
iii. Any other event LPHA believes to be related directly or indirectly to the receipt of
any vaccine administered by LPHA or others occurs within 30 days of vaccine
administration, and results in either the death of the person or the need for the
person to visit a licensed health care provider or hospital.
m. Hepatitis B Screening and Documentation
i. LPHA shall screen for HBsAg status, or refer to a health care provider for screening
of HBsAg status, all pregnant women receiving prenatal care from public prenatal
programs.
ii. LPHA shall work with hospitals within LPHA's Service Area selected by OHA to
strengthen hospital-based screening and documentation of every delivering
woman's hepatitis B serostatus.
iii. LPHA shall, in accordance with a schedule determined by OHA in consultation with
LPHA, develop and implement an action plan to work with hospitals identified by
OHA or LPHA to improve HBsAg screening for pregnant women.
iv. LPHA shall cause laboratories and health care providers to promptly report HBsAg
positive pregnant women to LPHA.
n. SchoollFacility Immunization Law
i. LPHA must comply with the Oregon School Immunization Law, Oregon Revised
Statutes 433.235 433.284, available for review at http://l.usa.gov/OregonSchoo/
ii. LPHA shall complete an annual Immunization Status Report that contains the
immunization levels for attendees of: certified childcare facilities; preschools; Head
Start facilities; and all schools (K through 7th grade) within LPHA's Service Area.
LPHA shall submit this report to OHA no later than 23 days after the third
Wednesday of February of each year in which LPHA receives funding for
Immunization Services under this Agreement.
o. Affordable Care Act Adult Immunization Grant
i. One time only funding.
ii. All Oregon LPHAs will opt in by SUbmitting an application outlining activities
which needs to be approved by the Oregon Immunization Program.
iii. All work for subsections (A) through (G) below is to be completed by June 30,
2014.
iv. Funds cannot be expended on vaccine.
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(A.) LPHA shall establish partnerships with at least (number based on county
population) pharmacies to initiate or increase influenza and/or Tdap adult
immunization by 10% or more.
(B.) LPHA shall develop or improve relationships with at least (number based on
county population) non-healthcare employers with at least 50 employees
with the goal of each employer offering at least one employee influenza
and/or Tdap adult vaccination program.
(C.) LPHA shall work with community health centers in their county (e.g.
Federally Qualified Health Center or Rural Health Clinic) to expand adult
influenza and/or Tdap immunization services. The work with each center
will include a baseline assessment of patient population (by racial/ethnic
group) and immunization coverage, followed by a measurement of change in
vaccine uptake.
(D.) LPHA shall work with at least (number based on county population)
healthcare institutions to improve healthcare worker influenza vaccination
rates The work with each institution will include a baseline assessment of
healthcare worker immunization coverage, followed by an annual
measurement of change in vaccine uptake with a goal of increasing coverage
by 10%.
(E.) LPHA shall work with long term care facilities (number based on county
population) to increase employee influenza vaccinations by ] 0%, based on
OHPR baseline data.
(F.) LPHA shall submit project activities summary and grant-related
expenditures to the Oregon Immunization Program Grant Coordinator on a
monthly basis, dates to be determined by OHA.
(G.) LPHA shall submit a final project report by June 30, 20]4.
5. Performance Measures. LPHA shall meet the following performance measures:
a. LPHA shall improve the 4th DTaP immunization coverage rate by one (]) percentage
point each year and/or maintain a rate greater than or equal to 90%. [Compliance
suspended for 201212013.]
b. LPHA shall reduce their Missed Shot rate by one (]) percentage point each year and/or
maintain the rate of:$; 10%. [Compliance suspended for 2012/2013.]
c. 95% of all state-supplied vaccines shall be coded correctly per age-eligibility
guidelines.
d. 80% of infants living in LPHA's Service Area exposed to perinatal hepatitis B shall be
immunized with the 3-dose hepatitis B series by 15 months of age.
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e. 80% of all vaccine administration data shall be data entered within 14 days of
administration.
6. Terms and Conditions Particular to LPHA's Performance of the Immunization Services.
a. LPHA shall reimburse OHA for the cost of wasted State-Supplied Vaccine/IG and/or
Billables due to inadequate handling, including, but not limited to:
i. expiration
ii. theft/vandalism
iii. lack of thermometers
iv. power failure
v. faulty equipment used in the storage and shipment of State-Supplied Vaccine/IG
from LPHA to OHA
vi. Delegate Agency which does not maintain the vaccine according to manufacturer
standards.
b. OHA will issue one initial bill and up to two (2) follow-up bills for the cost of wasted
State-Supplied Vaccine/IG and/or Billables for anyone quarterly billing period. OHA
will not fill future vaccine orders following the third bill until payment is received for
the delinquent billing period.
c. LPHA must return to OHA, at LPHA's expense, all Styrofoam vaccine shipping
containers received by LPHA from OHA.
d. LPHA shall cover the cost of mailing/shipping to parents all Exclusion Orders and to
schools, school-facility packets which are materials for completing the annual
school/facility exclusion process as required by the Oregon School Immunization Law,
Oregon Revised Statutes 433.235 433.284 and the administrative rules promulgated
pursuant thereto, which can be found at: http://I.usa.gov/OregonlmmunizationLaw
e. LPHA shall participate in State-sponsored immunization conference(s) and other
training(s). LPHA shall receive dedicated funds for one person from LPHA to attend
required conference(s) and training(s). If one staff person's travel expenses exceed the
dedicated award (based on State of Oregon per diem rates), the State shall amend the
LPHA's annual award to cover the additional costs. LPHA may use any balance on the
dedicated award (after all State-required trainings are attended) to attend immunization
related conference(s) and training(s) of their choice.
7. Reporting Obligations and Periodic Reporting Requirements. In addition to the reporting
requirements set forth in section 8 of Exhibit E of this Agreement, LPHA shall submit the
following reports to OHA's Immunization Program:
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142008 PGM· DESCHUTES COUSTY
a. Monthly Vaccine Report: This report must be submitted with every order.
b. Vaccine Orders: These orders must be submitted according to the Enhanced Ordering
Cycle (EOC) assigned by OHA.
c. A copy of the completed Delegate Review Tool and Certificate "D" for each Delegate
Agency must be sent to OHA by the date determined by OHA in consultation with
LPHA, but in any event within two calendar months of the date that LPHA receives the
request from OHA for the completed Delegate Agency Review Tool and Certification
"D".
d. LPHA shall submit vaccine administration data within 14 days of vaccine
I
I
administration to ALERT liS via electronic data transfer or user interface. If LPHA is
submitting vaccine administration data electronically to ALERT, LPHA shall
electronically flag clients who are deceased or have moved out of the Oregon Service I Area or the LPHA jurisdiction.
e. LPHA shall use the inventory module in ALERT liS when available. I
I f. LPHA shall complete and return a V AERS form to OHA if any of the conditions I precedent set forth at Section 4.1. ofthis Program Element occur.
~ g. LPHA shall complete and submit an Immunization Status Report as required in Section
4.n. of this Program Element.
h. LPHA shall complete and submit an annual immunization plan checklist. The annual
checklist-and any required explanation-shall be due on May 1 st, except in years for
which an alternative due date is required by the Office of Community Liaison. Report
format and county schedule is available for review at OHA's office located at 800 NE
Oregon St, Ste 370, Portland, OR 97232.
i. LPHA shall submit a written corrective action plan for any unsatisfactory responses to
high-priority questions stemming from the triennial review site visit.
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Program Element #44: School Based Health Centers (SBHC)
1. School-Based Health Center ("SBHC") Services
a. Definitions:
School-Based Health Center ("SBHC"): A facility located on school grounds that
delivers acute, chronic, preventive and mental health services to school-aged children
and is certified in accordance with the OHA Standards for Certification for School
Based Health Centers.
b. Procedural and Operational Requirements.
i. The funds provided under this Agreement for SBHC Services shall only be used to
support activities related to planning, oversight, maintenance, administration,
operation, and delivery of services within one or more SBHC as required by OHA's
SBHC funding formula.
ii. All SBHC Services must be delivered in accordance with the guidelines set forth in
the 2010 Standards for Certification for SBHC, a copy of which is available from
OHA or accessible on the Internet at:
http://public. health. oregon. govlHealthyp eopleFami!ieslYouthiHealthSchoollSchool
BasedHealthCentersiDocumentsiCertiticationStandards2010. pdf
The 2010 Standards for Certification for SBHC includes administrative, operations
and reporting guidance, and minimum standards and/or requirements in the areas of:
Certification Process, Sponsoring Agency/Facility, Operations/Staffing, Laboratory,
Clinical Services, Data Collection! Reporting, and Quality Assurance.
iii. LPHA must provide the oversight and technical assistance so that each SBHC in its
jurisdiction meets the 2010 Standards for Certification for SBHC.
iv. LPHA shall assure to OHA that all certification documentation and subsequent
follow-up items are completed by the requested date(s) in accordance with the
OHA's certification review cycle.
c. Reporting Obligations and Periodic Reporting Requirements. In addition to the
reporting requirements set forth in Section 8 of Exhibit E of this Agreement, LPHA
shall assure that all SBHC's in its county jurisdiction:
i. Submit annual client encounter data in a form acceptable to OHA and in accordance
with the 2010 Standards for Certification for SBHC no later than July 15th for the
preceding service year (July 1 -June 30), and
ii. Submit annual SBHC Key Performance Measure (KPM) data in a form acceptable
to OHA and in accordance with the 2010 Standards for Certification for SBHC no
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later than October 1st for the preceding service year (July I -June 30). The current
list of KPMs can be found at:
http://public.health.oregon.gov/HealthyPeopleFamilies/YouthlHealthSchoollSchool
BasedHealthCenterslDocumentslKPMpdf
iii. Submit annual SBHC Billing, Revenue and Funding data in the form acceptable to
aHA no later than October I st for the preceding service year (July I-June 30). The
current data collection form can be found at www.healthoregon.orglsbhcin the
folder titled SBHC Data Requirements
iv. Submit annual SBHC hours of operation and staffing in the form acceptable to aHA
no later than October 1 st for the current service year. The current data collection
form can be found at www.healthoregon.orglsbhc in the folder titled SBHC Data
Requirements.
v. Submit completed annual patient satisfaction survey data no later than June 1 st.
vi. Implement a billing process for SBHC services
vii. Complete the triennial National Assembly on School-Based Health Care SBHC
Census Survey. Current SBHC Census Survey timeline and details can be found at
www.nasbhc.org.
2. SBHC Planning Grants (for specific LPHAs in 2013-2015)
a. This section is applicable only to those LPHAs who have received a Planning Grant
from the Oregon Health Authority (aHA). Current and potential LPHAs will be
notified if the 2013 Legislature approves and appropriates funds for SBHC Planning
Grants or the SBHC State Program Office has other available funds for SBHC
development.
b. An SBHC planning grant is one-time funds to assist the LPHA in developing a strategic
plan for implementing SBHC Services in the LPHA county jurisdiction. The following
terms and conditions apply ifthe Authority selects LPHA to receive a planning grant:
1 i. Phase I (October 1,2013 -June 30,2014) Strategic Planning
(A.) LPHA shall create and implement a collaborative strategic plan in
I
I partnership with community agencies in order to develop, implement, and
maintain SBHC Services to serve school-age children. This plan's target
must have the SBHC sites operational and ready for certification by Spring
J 2015. SBHC certification standards are available from aHA or by using the
weblink provided in Section I.a.ii above.
(B.) LPHA shall participate in monthly technical assistance calls at times
mutually agreed to between aHA SBHC Program and LPHA Phase I
Planning LPHAs. In addition each SBHC site may have at least one
technical assistance visit by an aHA SBHC Program staff member.
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(C.) By July 15, 2014, LPHA shall submit a final report and line item
expenditure report briefly describing its activities and progress to date on the
development of SBHC Services together with a copy of its strategic plan and
proposed implementation budget for Phase II.
ii. Phase II (August 15, 2014-June 30, 2015) Strategic Planning
(A.) LPHA shall implement the approved Phase I SBHC strategic plan and have
the planned SBHC Services operational and ready for certification by Spring
2015. Sites must become certified by Spring 2015 to maintain current
funding and to receive SBHC awards in accordance with the approved
funding formula in effect and contingent on available funding. SBHC
certification standards are available at: www.healthoregon.govlsbhc.
(B.) LPHA shall participate in monthly technical assistance calls at times
mutuaHy agreed to between OHA SBHC Program and LPHA Phase II
Planning LPHAs. In addition, each SBHC site may have at least one
technical assistance visit by an OHA SBHC Program staff member.
iii. Advance Phase (October 1, 2013-June 30, 2014 or July 1, 2014 -June 30,
2015) Strategic Planning
(A.) LPHA shall create and implement a coHaborative strategic plan in partnership
with community agencies in order to develop, implement, and maintain
SBHC Services to serve school-age children. This plan's target must have
the SBHC sites operational and ready for certification by Spring 20] 4 or
Spring 2015. SBHC certification standards are avaiJable at
www.healthoregon.govlsbhc. .
(B.) LPHA shall participate in monthly technical assistance calls at times mutually
agreed to between the Authority SBHC Program and Advance Phase
Planning LPHAs. In addition, each SBHC site may have at least one
technical assistance visit by a Authority SBHC Program staff member.
(C.) LPHA must become certified in by Spring 2014 or Spring 2015 to maintain
current funding and to receive SBHC awards in accordance with the
approved funding formula in effect and contingent on available funding.
SBHC certification standards are available at: www.healthoregon.orglsbhc
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Program Element #47: Family Health Services ("FHS") -Project LAUNCH
(Deschutes Co. only)
1. General Description and Purpose.
a. The Substance Abuse and Mental Health Services Administration, SAMHSA has
awarded funds to the State of Oregon to initialize and support specific ongoing
activities related to "Linking Actions for Unmet Needs in Children's Health" (Project
LAUNCH). The purpose of Project LAUNCH is to promote the well ness of young
children, birth to eight years of age. Project LAUNCH defines wellness as optimal
functioning across all developmental domains, including physical, social, emotional,
cognitive and behavioral health. Project LAUNCH is a five year grant, from 2009-2014,
with a demonstration project component in Deschutes County.
b. The purpose of Oregon LAUNCH is to develop a state and local coordinated child
serving system that integrates behavioral and physical health services. Oregon
LAUNCH will provide an integrated and holistic system of wellness, prevention and
treatment services to assist 1,500 children, birth to eight-years of age, and their families
in Deschutes County, Oregon over a five-year period.
c. The funds provided under this Financial Assistance Agreement for this Program
Element shall only be used, in accordance with and subject to the requirements and
limitations set forth below, as supplemental funds to support Oregon LAUNCH.
2. Definitions Specific to Oregon LAUNCH.
a. Early Childhood Matters -Oregon's framework for a statewide birth-through-five
Early Childhood system.
b. The Early Childhood Council (ECC) -This council consist of three subcommittees:
• Health Matters
• Early Learning Matters
• Family Matters
3. Local Project LAUNCH Resources, Organizations, and Related Programs:
I
a. Child Care Resource and Referral is the resource and referral that provides services
and mental health consultation to childcare providers.
b. Deschutes County Commission on Children and Families (DCCF) is a governmental
agency that promotes child abuse prevention and early intervention through early
childhood care, education and community partnerships.
c. Deschutes County Health System -School-Based Health Centers (DCHS-SBHC)
are primary care health clinics located in the elementary schools in Deschutes County.
1
t
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d. Family Access Network (FAN) is a local non-profit organization that provides family
advocacy services in every public school to assist children and families in accessing
services to meet basic needs.
e. Family Access Network Coalition (18 organizations) is a school based organization
that advocates for children and families.
f. Family Resource Center (FRC) is the primary local provider for parenting education.
FRC currently uses:
• Incredible Years (IY)
• Parenting Wisely (PW)
g. Healthy Beginnings is a prevention-focused program to ensure that children meet age
appropriate developmental standards upon entering kindergarten and increase parents'
skills by bringing accessible, educational, preventive screenings to children ages birth to
5 and their parents.
h. Healthy Families ofthe High Desert is a child abuse prevention program that provides
parent groups and home visitation services to first time parents.
i. KIDS Center is a local organization that offers advocacy, child abuse prevention
programs, medical assessments, victim counseling, family therapy, and parent training
services.
j. Latino Community Association is a local organization that serve as the resource for
the local Hispanic community.
k. Local Interagency Coordinating Council is a group of providers and families who
coordinate services for children with disabilities.
I. Mountain Star Family Relief Nursery is an emergency childcare and support system
for families that are facing domestic violence, child abuse, and neglect.
m. Neighbor Impact is the local organization that provides Head Start programs.
n. Parent Child Interaction Therapy is an intervention developed to reduce child
behavioral problems and risks for child abuse.
o. Promoting First Relationships is an intervention model that to promote trusting and
secure caregiver-child relationships and the child's healthy social emotional
development.
4. Procedural and Operational Requirements. The funds provided under this Cooperative
Agreement between SAMHSA, the State of Oregon Department of Human Services, and
Deschutes County shall only be used to support activities related to planning, administration,
operation, and delivery of services as outlined by the SAMHSA Project LAUNCH grant
guidelines.
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a. SAMHSA Project LAUNCH -Specific Local Requirements and Timelines
i. Create and fiIJ the local-level position of Child Wellness Coordinator by January 4,
2010.
ii. Convene Deschutes County Council on Young Child Well ness on a recurring basis.
iii. Develop a local level strategic plan for the LAUNCH initiative by May 1 t\2010.
iv. Implement local level changes in child wellness policy, service systems, evaluation,
as indicated by the LAUNCH strategic plan throughout the 5 year grant cycle, 2009
2014.
v. Participate in the Evaluation Task Force and contribute data to the Evaluation Plan
on a recurring basis.
vi. Train providers on Evidence Based Program Interventions identified in the Grant:
Promoting First Relationships, Parents as Teachers, Parent Child Interaction
Therapy and Incredible Years throughout the 5 year grant cycle, 2009-2014.
I vii. Increase early identification of development and mental health issues through
comprehensive developmental assessments and referral. The School Based Health
Centers will begin using these developmental assessments by March, 2010. I
ij viii. Integrate Parent Child Interaction Therapy into primary care in school-based health
clinics and FQHC settings throughout the 5 year grant cycle, 2009-2014.
ix. Create Healthy Child Family Support Teams (HCFST) at the School Based Health
Centers (SBHC). These HCFSTs will consist of a nurse practitioner, a mental health
consultant and a family access network advocate, who will provide coordinated
services and healthcare in a "Medical Home" model. The HCFST will provide care
throughout the 5 year grant cycle, 2009-2014.
x. Implement "Promoting First Relationships" in the Deschutes County public health
nurse home visiting program by December, 2010.
xi. Expand "Parents as Teachers" into the community home visitation programs offered
by Healthy Families of the High Desert throughout the 5 year grant cycle, 2009
2014.
xii. Provide parent skills training using: Incredible Years" and "Parenting Wisely"
curricula by June, 2010.
xiii. Work with DCHS Public Information Coordinator to create and implement a Young
Child Well ness campaign by December, 2011.
b. Reporting Obligations and Periodic Reporting Requirements. In addition to the reporting
obligations set forth in section 8 of Exhibit E, of this Agreement, LPHA, will submit a
quarterly invoice to the DHS Contract Administrator describing work performed, timelines
and budget updates on a quarterly basis during the current Agreement period.
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Program Element #48:Teen Pregnancy Prevention Personal Responsibility Education Program
PREP
1. Purpose and General Description of Services Funding provided under this Program Element
is to implement jCuidatef, a six session, interactive, small group program; designed to educate
adolescents on both abstinence and contraception to prevent pregnancy and sexually
transmitted infections (STIs), including HIV /AIDS, and at least three adulthood preparation
subjects defined by federal guidance.
2. Procedural and Operational Requirements
a. Funds provided under this Financial Assistance Agreement for this Program Element
may only be used by Local Public Health Authority (LPHA), in accordance with and
subject to the requirements and limitations set forth below, to deliver to eligible youth
the teen pregnancy prevention program, ("iCuidate! ")
b. LPHA delivery shall reflect core program elements of the intervention listed at:
http://www.selectmedia.orglprogramslcuidate.html.
c. LPHA will recruit qualified youth ages 13 -18 to participate in the program.
d. LPHA will implement jCufdate! with a minimum of250 youth each contract year of the
grant (July I through June 30).
e. LPHA will inform community members about program offerings.
f. At each implementation site, facilitators are required to share with youth participants,
information about reproductive health and sexually transmitted infection services
available in their community.
g. LPHA will:
i. Participate in all project trainings. Including, but not limited to, having facilitators
participate in a jCuidate! Training of Facilitators to become certified in
implementing the Program with youth.
it Participate in all conference calls and regularly scheduled meetings with state staff
iii. Collect evaluation data according to Oregon Health Authority and Federal
Requirements
iv. Provide space for project implementation.
v. Partner with others in the community including youth serving organizations and/or
Latino serving organizations.
vi. Report any concerns to state staff as they arise.
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3. Reporting Obligations and Periodic Reporting Requirements
a. LPHA will supply all data with respect to this program in a matter satisfactory to OHA
and in accordance with post-award state plan. LPHA staff will submit, in a matter
satisfactory to OHA, reports on activities completed, participants at each jCuidate!
session, participant knowledge, attitudes and behaviors. Reports in the third year of the
grant are to be submitted to the State by September 30, 2013; March 30,2014; and June
30, 2014. OHA will provide report due dates for subsequent years and supply guidance
ofthe reporting requirements and required format for submitting reports.
b. If selected, LPHA agrees to participate in federal evaluation.
4. Funds.
a. Funds may be used by LPHA to cover reasonable costs of personnel, consultants,
equipment, supplies, grant-related travel, and other grant-related costs.
b. Funds must be used by LPHA in a manner consistent with program requirements as
outlined in the Program Element and as otherwise directed by OHA. Allowable
administrative functions/costs include:
i. Usual and recognized overhead, including indirect rates for all consortium
organizations that have a federally approved indirect cost rate; and
ii. Management and oversight of specific project components by LPHA funded under
this Program Element.
c. Funds may not be used by LPHA for building alterations or renovations, construction,
fundraising activities, political education or lobbying.
d. Funds may not be used by LPHA to support inherently religious activities, including,
but not limited to, religious instruction, worship, prayer, or proselytizing.
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Program Element #50: Safe Drinking Water (SDW) Program
1. Description and Pnrpose. The purpose of the Safe Drinking Water (SDW) program is to
reduce the incidence and risk of waterborne disease and exposure of the public to hazardous
substances potentially present in drinking water supplies. Services provided under this program
element include: assuring that water suppliers are informed of necessary actions to comply with
drinking water monitoring and maximum contaminant level requirements; inspecting public
water systems and assuring that identified deficiencies are corrected; and providing technical
regulatory assistance to public water suppliers. All performance by LPHA under this Program
Element, including but not limited to reporting obligations, shall be to the satisfaction of OHA.
a. Funds provided under this Agreement are intended to enable LPHA to assume primary
responsibility for the quality of drinking water provided by most of the public water
systems located within LPHA's jurisdiction and may only be used, in accordance with
and subject to the requirements and limitations set forth below, to deliver the SDW
services described in this Program Element Description.
b. Public drinking water systems addressed in this Program Element Description include
community water systems, non-transient non-community water systems, and transient
non-community water systems, serving 3,300 or fewer people and using ground water
or purchased surface water sources only, and those activities specifically listed for non
EPA water systems using ground water sources only.
c. The work described herein is designed to meet the following EPA National Drinking
Water Objective as follows:
"91 % of the population served by community water systems will receive water that
meets all applicable health-based drinking water standards during the year"; and
"90% of the community water systems will provide water that meets all applicable
health-based drinking water standards during the year."
2. Definitions Specific to the SDW Program.
a. Community Water System: A public water system that has 15 or more service
connections used by year-round residents, or that regularly serves 25 or more year
round residents.
b. Drinking Water Services (DWS): OHA, Public Health Division, DWS is the state
program that administers and enforces state and federal safe drinking water quality
standards for all public water systems in the state of Oregon.
c. Groundwater: Any water, except capillary moisture, beneath the land surface or
beneath the bed of any stream, lake, reservoir or other body of surface water within the
boundaries of this state, whatever may be the geologic formation or structure in which
such water stands, flows, percolates, or otherwise moves.
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d. Maximum Contaminant Level (MCL) Violation: MCL violations occur when a
public water system's water quality test results demonstrate a level of a contaminant
that is greater than the established Maximum Contaminant Level.
e. Non-EPA Water System: A public water system serving 4-14 connections or 10-24
people during at least 60 days per year.
f. Non-Transient Non-Community Water System (NTNWS): A public water system
that is not a Community Water System and that regularly serves at least 25 of the same
persons over 6 months per year.
g. OHA: Oregon Health Authority
h. Priority Non-Complier (PNC): Water systems with system scores of II points or
more, including those whose system scores have dropped below 11 points but have
unresolved MCL violations.
i. Professional Engineer (PE): A person currently registered as a Professional Engineer
by the Oregon State Board of Examiners for Engineering and Land Surveying.
j. Public Water System(EPA definition): A system for the provision to the public of
water for human consumption through pipes or other constructed conveyances, if such
system has at least 15 connections or regularly serves at least 25 individuals.
k. Public Water System (Oregon definition): A system for the provision of water for
human consumption through pipes or other constructed conveyances with at least 4
service connections, or serves water to public or commercial premises that are used by
an average of at least 10 individuals daily at least 60 days each year.
I. Registered Environmental Health Specialist (REHS): A person currently registered
as an Environmental Health Specialist by the Oregon Environmental Health
Registration Board.
m. Regulated Contaminants: Drinking water contaminants for which Maximum
Contaminant Levels or Water Treatment Performance Levels have been established
under Oregon Administrative Rule (OAR) 333-061-0030.
n. Safe Drinking Water Information System (SDWIS):
information national database system.
USEPA's safe drinking water
o. System Score: A point-based system developed by USEPA to assess overall
compliance of water systems, based on unaddressed violations for monitoring periods
ending within the last five (5) years.
p. Transient Non-Community Water Systems (TNCWS): A public water system that
serves a transient population of25 or more persons.
q. USEPA or EPA: United States Environmental Protection Agency.
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r. Water Quality Alert: A water quality sample report from the SDWIS data system that
demonstrates contamination detection at a public water system and prompts further
investigation and action to assure the system's drinking water meets all applicable
standards.
s. Water System Information Form: A report form to update information on a public
water system for the purpose of maintaining a database inventory record that is current,
accurate, and complete.
t. Water System Survey (Sanitary Survey): An on-site review to evaluate the adequacy
of the water system to provide safe drinking water. A water system survey must include
the source of a public water system, the water intake, treatment system, storage and
distribution facilities, operation and maintenance, water system records, and compliance
with applicable drinking water regulations.
3. Procedural and Operational Requirements.
a. General Requirements. All services supported in whole or in part with funds provided
to LPHA under this Agreement for this Program Element must be delivered in
accordance with the following procedural and operational requirements:
b. Required Services:
i. Respond to Emergencies: LPHA shall develop, maintain, and carry out a response
plan for public water system emergencies, including disease outbreaks, spills,
operational failures, and water system contamination. LPHA shall notify DWS in a
timely manner of emergencies that may affect drinking water supplies.
ii. Conduct Independent Enforcement Actions: LPHA shall take independent
enforcement actions against licensed facilities that are also public water systems as
covered under the following OARs: 333-029 (traveler's accommodations), 333-030
organizational camps), 333-031 (recreational parks), 333-039 (mass gatherings),
333-060 (public swimming pools), 333-062 (pools and spas), 333-150 (food
sanitation-food establishments), 333-162 (commissaries and warehouses), and 333
170 (bed and breakfast facilities). LPHA shall report independent enforcement
actions taken and water system status to DWS using the documentation and
reporting requirements specified in this Agreement.
iii. Maintain and Use Drinking Water System Data Base: LPHA shall maintain access
via computer to DWS's safe drinking water information system database (SDWIS).
Access to DWS's drinking water system database is considered essential to carry
out the program effectively. LPHA shall make timely changes to DWS's SDWIS
database inventory records of public water systems to keep records current.
iv. Provide Technical Regulatory Assistance: LPHA shall provide technical regulatory
assistance in response to requests from water system operators for information on
and interpretation of regulatory requirements. LPHA shall respond to water system
complaints received as appropriate or as referred by DWS.
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v. Investigate Water Quality Alerts: LPHA shall investigate all water quality alerts for
detections of regulated contaminants at community, non-transient non-community,
transient non-community, and non-EPA water systems. LPHA shall consult with
and provide advice to the subject water system operator on appropriate actions to
ensure that follow-up sampling is completed and to ensure that any confirmed water
quality violations are corrected or resolved. LPHA shall provide advice to the
subject water system operator on the correct methods for issuing public notification
as required and any needed advisory to users on protective action.
vi. Conduct Water System Surveys: LPHA shall conduct a Water System Survey of
each EPA public water system within LPHA's jurisdiction as scheduled by DWS:
each community water system every three (3) years; and each non-transient non
community and each transient non-community water system every five (5) years.
LPHA shall use the following procedure for conducting a Water System Survey:
(a.) Contact the subject public water system owner/operator to schedule an
appointment and explain the information required to complete the water
system survey.
(b.) Review the subject public water system file information, water quality
history, and data base inventory information.
(c.) Conduct an on-site review of the water system source, treatment, storage,
and distribution facilities; review its operation, management, and compliance
with regulations; and determine deficiencies, if any that could result in
unsafe drinking water.
(d.) Complete water system survey forms.
(e.) Collect coliform sample(s) at LPHA's reasonable discretion and as
otherwise directed by DWS.
(f.) Verbally inform the owner and operator of the subject public water system
of any significant deficiencies identified, timelines that all deficiencies must
be corrected by, and if a written corrective action plan must be submitted.
(g.) Verify that water system survey is complete.
(h.) Prepare cover letter using a template provided by DWS that identifies all
significant deficiencies found, the timelines for correcting deficiencies, and
when a corrective action plan is due.
(i.) Mail cover letter, water system survey report, and any coliform sample
result(s) to the subject public water system.
G.) Submit the cover letter, water system survey report, and any coliform sample
result(s) to DWS.
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vii. Resolve Priority Non-compliers (PNC): LPHA shall review the system score list
provided by DWS at least monthly, and shall contact and provide assistance to all
EPA community, non-transient non-community, and transient non-community water
systems that are priority non-compliers (PNCs) as follows:
(a.) When a water system is designated as a PNC by DWS, LPHA shall take the
following actions:
(I.) Contact the water supplier and discuss any unaddressed violations
with emphasis on the MCL violations, determine the reasons for all
aspects of noncompliance, and inform the water supplier on ways to
correct the noncompliance. Confinn that database infonnation is
current and accurate on ownership and water system classification.
(2.) Advise the owner/operator to carry out public notification as required
by OAR 333-061-0042.
(3.) Submit public notices received and contact reports on LPHA follow
up actions to DWS.
(4.) Periodically monitor PNC systems to ensure they are making
adequate progress on returning to compliance. A PNC is considered
resolved when its system score drops below II points and all MCL
violations have been addressed.
(b.) LPHA shall review all persistent PNCs at five (5) months after being
designated as a PNC to determine if the water system can be returned to
compliance within three (3) months.
(c.) If the water system can be returned to compliance within three (3) months,
LPHA shall send written notice to the owner/operator (copy to DWS) with a
compliance schedule listing corrective actions required and a deadline for
each action. LPHA shall follow up to ensure corrective actions are
implemented.
(d.) If it is determined the water system cannot be returned to compliance within
three (3) months, LPHA shall prepare and submit to DWS a written request
for a formal enforcement action, including LPHA's evaluation of the reasons
for noncompliance by the water supplier. The request shall include the
current owner's name and address, a compliance schedule listing corrective
actions required, and a deadline for each action. LPHA shall notifY the
person(s) responsible for the subject water system's operation that formal
enforcement has been requested.
viii. Conduct Water System Survey Significant Deficiency Follow-ups: LPHA shall
follow-up on identified significant deficiencies between surveys on EPA
community, non-transient non-community, and transient non-community water
systems to verify that all deficiencies have been corrected. After deficiencies are
corrected, LPHA shall prepare a list of the deficiencies and the dates of correction
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and submit to DWS. If all deficiencies are not corrected, LPHA shall ensure the
water system has an approved corrective action plan submitted to DWS to correct
all deficiencies, per OAR 333-061-0076 (6)(b), (7), (8). Deficiencies include those
currently defined in the DWS-Drinking Water Program publication titled Water
System Survey Reference Manual (October 2009).
ix. Track and Follow-up on Enforcement Actions: after DWS issues an enforcement
action, LPHA shall monitor the corrective action schedule contained in the action,
and verify completion of each corrective action by the water supplier. LPHA shall
document all contacts and verifications and submit documentation to the DWS.
LPHA shall document any failure by the water supplier to meet any correction date
and notifY the DWS within 30 days. LPHA shall notify DWS when all corrections
are complete and submit the notice within 30 days.
x. Inventory and Document New Water Systems: LPHA shall inventory existing water
systems that are not in the DWS inventory as they are discovered, including non
EPA systems, using the forms designated by DWS. LPHA shall provide the
documentation to DWS within 60 days of identification of an un inventoried water
system. Alternatively, LPHA may perform a water system survey to collect the
required inventory information, rather than submitting the forms designated by
DWS.
c. Supplemental Services: If LPHA has completed all Required Services above, LPHA
may complete supplemental services listed below as resources allow:
i. Resolve Violations for non-PNC Systems: LPHA may conduct work on EPA public
water systems that are not PNC systems in the manner described in b. vii (a.) above
for addressing PNCs. LPHA shall prioritize work on these systems according to the
relative health risk involved with MCL violations the highest priority, and according
to system classification with community water systems receiving the highest
priority.
it Conduct Engineering Plan Review Inspections: LPHA may, on request of DWS,
inspect construction or major modifications of public water systems to determine
conformance to engineering plans reviewed and approved by the DWS. Inspections
must consist of an on-site visit to verify construction is completed in accordance
with the approved 'plans. LPHA shall document the facilities checked and any
differences between the constructed facilities and the approved plans.
Documentation shall be forwarded to DWS within 30 days ofthe inspection.
iii. Assist with Emergency Response Plan Development: LPHA may assist water
suppliers to complete their Emergency Response Plans and ensure that completed
plans meet DWS standards.
iv. Conduct Other Customized and Negotiated Work: LPHA may conduct such
customized and negotiated work as required or requested by DWS to maintain safe
and efficient public water system operations. LPHA shall prepare and submit for
DWS review and approval a proposal for the customized and negotiated work
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including a detailed task list and a listing of expected outcomes. DWS must approve
the proposal for customized and negotiated work.
d. Requesting On-Site Assistance from DWS. When on-site assistance from DWS is
requested, LPHA is responsible for: scheduling DWS assistance, making arrangements
to involve the water system operator, being present when DWS assistance is conducted
in the field, and conducting follow-up work as necessary after the on-site assistance.
e. Staffing Requirements and Qualifications.
i. LPHA shall develop and maintain staff expertise necessary to carry out the services
described herein.
H. LPHA staff shall maintain and assimilate program and technical information
provided by DWS, attend drinking water training events provided by DWS, and
maintain access to information sources as necessary to maintain and improve staff
expertise.
iii. LPHA shall hire or contract with personnel registered as Environmental Health
Specialists or Professional Engineers with experience in environmental health to
carry out the services described herein.
4. Documentation and Reporting Requirements.
a. Documentation of Field Activities and Water System Contacts. LPHA shall prepare
and maintain adequate documentation of field activities and water system contacts as
required to:
i. Maintain accurate and current public water system inventory information.
ii. Support formal enforcement actions.
iii. Describe current regulatory status of water systems.
iv. Evaluate the performance and effectiveness of the drinking water program.
v. Guide and plan program activities.
b. Minimum Standard for Documentation. LPHA shall, at a minimum, prepare and
maintain the following required documentation on forms supplied by DWS:
i. Water system surveys and significant deficiencies.
ii. Water System Information (Inventory), Entry Structure Diagram, and Source
Information updates.
iii. Field and office contacts in response to complaints, water quality alerts, PNCs,
enforcement actions, requests for regulatory assistance, follow-up on water system
survey deficiencies, and plan review follow-up.
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iv. Waterborne illness reports and investigations.
v. All correspondence with public water systems under LPHA'sjurisdiction and DWS.
vi. Documentation regarding reports and investigations of spills and other emergencies
affecting or potentially affecting water systems.
vii. Copies of public notices received from water systems.
c. Monthly Reporting. LPHA shall submit to DWS on a monthly basis, on forms
supplied by DWS, the information in Section 4.b. above in order for DWS to maintain
state primacy for the federal safe drinking water program.
d. DWS Audits. LPHA shall give DWS free access to all LPHA records and
documentation pertinent to this Agreement for the purpose ofDWS audits.
e. Additional Documentation and Reporting Requirements.
i. LPHA must submit a work plan for the delivery of services under this Agreement
and by a date determined by DWS. The plan must be approved by DWS prior to
implementation. The plan must list all services intended to be provided to water
systems over the two-year term of this Agreement and be categorized by the types
of services and the number of each of the types of services proposed. Any changes
to a work plan must be approved by DWS and shall be implemented through an
amendment to the current Agreement.
ii. By the 20th of each month LPHA must submit a report, as set forth in Attachment I
to this Program Element Description, "Required Drinking Water Services
Provided", detailing the work accomplished during the prior month. The report
must list all services provided to water systems covered under this Agreement and
include water systems' names and ID numbers, the services provided, and service
dates. Services must be categorize by type and provide the number of each type of
service.
5. Performance Measures. DWS will use three (3) performance measures to evaluate LPHA's
performance as follows:
a. Complete 100% of water system surveys. Calculation: number of surveys completed
divided by the number of surveys required.
b. Respond to 100% of alerts. Calculation: number of alerts responded to divided by the
number of alerts generated.
c. Resolve or address 100% of PNCs. Calculation: number of PNCs resolved and
addressed divided by the total number of PNCs. A PNC is addressed when it is referred
to DWS for formal enforcement.
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 115 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
6. Responsibilities of DWS. The intent of this Program Element Description and associated
funding award is to enable LPHA to independently conduct an effective local drinking water
program. DWS recognizes its role to provide assistance and program support to LPHA to foster
uniformity of statewide services. DWS agrees to provide the following services to LPHA. In
support of local program services, DWS will:
a. Distribute drinking water program and technical information in a timely manner to
LPHA.
b. Sponsor at least one annual 8-hour workshop for LPHA drinking water program staff at
a central location and date to be determined by DWS. DWS will provide workshop
registration, on-site lodging, meals, and arrange for continuing education unit (CEU)
credits. LPHA is responsible for travel expenses for LPHA staff to attend.
Alternatively, at the discretion ofthe DWS, the workshop may be web-based.
c. Sponsor at least one regional 4-hour workshop at three (3) locations at locations and
dates to be determined by DWS to supplement the annual workshop. DWS will provide
training materials and meeting rooms. LPHA is responsible for travel expenses for its
staffto attend. Alternatively, at the discretion of the DWS, the workshop may be web
based.
d. Provide LPHA with the following information from the public water system database:
i. Immediately: Alert data.
ii. Continuously: Listings of PNCs, updated monthly.
iii. Quarterly: Performance measure calculations.
iv. Continuously: Individual water system inventory and water quality data.
e. Support electronic communications and data transfer between DWS and LPHA to
reduce time delays, mailing costs, and generation of hard copy reports.
f. Maintain sufficient technical staff capacity to assist LPHA staff with unusual drinking
water problems that require either more staff than is available to LPHA for a short time
period, such as a major emergency, or problems whose technical nature or complexity
exceed the capability of LPHA staff.
g. Refer to LPHA all routine inquiries or requests for assistance received from public
water system operators for which LPHA is responsible.
h. Prepare formal enforcement actions against public water systems in the subject County,
except for licensed facilities, according to the priorities contained in the current
State/EPA agreement.
i. Prepare other actions against water systems as may be authorized or required by DWS.
2013·20151:-<n:RGOVERNMENTAL AGREEME:-<T FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 116 OF 167 PAGES
142008 PGM· DESCHUTES COUNTY
Attachment 1 to Program Element #50: Safe Drinking Water (SDW) Program
REQUIRED DRINKING WATER SERVICES PROVIDED 2013-15
LPHA: I MONTH: I YEAR:
EMERGENCY RESPONSES
I
Date of Service PWS# PWSName 10#
INDEPENDENT ENF. ACTIONS
Date of Service PWS# PWSName
TECHIREG ASSISTANCE
Date of Service pws# PWSName
ALERTS # Alerts =
Date of Service PWS# PWSName
SURVEYS # Surveys =
Date of Service PWS# PWSName
PNCsRESOLVED # PNCs resolved =
I
Date of Service PWS# PWSName 10#
SURVEY FOLLOW-UP #1 # All deficiencies corrected
Date of Service PWS# PWSName
SURVEY FOLLOW-UP #2 # On corrective action plan =
Date of Service PWS# PWSName
ENFORCEMENT TRACK & FlU # All complete
pws# PWSName
Date of Service
NEW WATER SYSTEMS # New Systems
PWS# PWS Name
Date of Service
NOTES ON MONTHLY ACTIVITIES:
2013·2015 INTERGOVERNMENTAL AGREEMf:NT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 117 OF 167 PAGES
142008 PGM· DESCHUTES COUNTY
OREGON HEALTH AUTHORITY
2013-2015 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF PUBLIC HEALTH SERVICES
EXHmITC
FINANCIAL ASSISTANCE A WARD AND
REVENUE AND EXPENDITURE REPORTING FORMS
This Exhibit C of the Agreement consists of and contains the following Exhibit sections:
1. Financial Assistance Award.
2. Oregon Health Authority Public Health Division Expenditure and Revenue Report (for
an Programs Except Family Planning.)
3. Oregon Health Authority Public Health Services Expenditure and Revenue Report (for
FAMILY PLANNING ONLY).
4. Explanation of the Financial Assistance Award.
2013·2015 INTERGOVERNMENTAl, AGREEMENT FOR THE FINANCING OF PuBUC HEALTH SERVICES PAGE 118 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
FINANCIAL ASSISTANCE A WARD
State of Oregon Page 1013
Oregon Health Authority
Public Health Division
1) Grantee 2) Issue Date This Action
Name: Deschutes County Health Dept. April 18,2013 ORIGINALS
FY2014
Street: 2577 N. E Courtney 3) Award Period
City: Bend From July 1,2013 Through June 30, 2014
State: OR Zip Code: 97701
4) DHS Public Health Funds Approved
Previous IncreaseJ Grant
Program Award (Decrease) Award
PE01 State Support for Public Health 177,353
(a)
PE 03 TB Case Management 1,216
PE 07 HIV Prevention Services 29,874
H IV Prevention Block Grant Services
Ryan White Title II HIV I AIDS Services
PE 08 Ryan White-Case Management 76,282
PE 08 Ryan White-Support Services 26,786
PE 12 Pub. Health Emergency Preparedness/(July-Aug_ 9)
PE 12 Pub. Health Emergency PreparednesS/(Aug 10-June30}
PE 13 Tobacco Prevention & Education 132,932
PE 15 Healthy Communities Phase Ii 81,250
PE 40 Women, Infants and Children 640,528
FAMILY HEALTH SERVICES (c d)
PE 40 WIC --PEER Counseling 44,100
FAMILY HEALTH SERVICES (g.,h)
5) FOOTNOTES:
a) Based on the certified population estimate of July 1,2012. Prepared by the Portland State
University Population Research center.
b) Funds will not be shifted between categories or fund types. The same program may be funded
by more than one fund type, however, federal funds may not be used as match for other
federal funds ( such as Medicaid ).
c) July -September grant is $160,132 ; and includes $6,254 of minimum Nutrition Education: and
$7,817 for Breastfeeding Promotion.
d) October-June grant is $480,396 , and includes $96,079 of minimum Nutrition Education amount
and $23,451 for Breastfeeding Promotion.
e) Please note that Chlamydia and High Cost Contraceptives funds have been folded into
the Title X funds and are no longer a separate line item.
f} Immunization Special Payments are funded by State General Fund and matched dollar for
dollar \'\lith Medicaid.
6) Capital Outlay Requested in This Action:
Prior approval is required for Capital Outlay. capital Outlay is defined as an expenditure for equip
ment with a purchase price in excess of $5,000 and a life expectancy greater than one year.
PROGRAM ITEM DESCRIPTION
I
I
PROG.
COST APPROV
PAm: 1190F 167 PAGES2013·2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PuBLIC HEALTH SERVICES
142008 PGM DESCHUTES COUNTY
1) Grantee
State of Oregon
Oregon Hea.lth Authority
Public Health Division
Name: Deschutes County Health Dept.
2) Is.sue Date
April 18, 2013
Street 2577 N. E. Courtney 3) Award Period
Page2of3
This Action
ORIGINALS
FY2014
City: Bend From July 1,2013 Through June 30,2014
State: OR Zi Code: 97701
4) OHS Public Health Funds Approved
Program
PE 41 Family Planning Agency Grant
FAMilY HEALTH SERVICES
PE 42 MCH/Child & Adolescent Health --General Fund
FAMilY HEALTH SERVICES
-TitieV Child & Adolescent Health
HEALTH SERVICES
H-TitJeV --Flexible Funds
Y HEALTH SERVICES
H/Perinatat Health General Fund
Y HEAlTH SERVICES
First
FAMILY HEAlTH SERVICES
PE 42 Oregon MothersCare
FAMilY HEALTH SERVICES
PE 43 Immunization Special Payments
FAMilY HEALTH SERVICES
PE 43 Immunization -Conference Travel
FAMilY HEALTH SERVICES
PE 44 Schoof Based Health Centers
FAMILY HEALTH SERVICES
PE 47 linking Actions for Unmet Needs in Child Health Project
FAMilY HEALTH SERVICES
Teen Pregnency Prevention P. R. E. P.
IlY HEALTH SERVICES
5) FOOTNOTES:
Previous
Award
g) $11,025 is the July through September funding to local agencies.
Increasel Grant
(Decrease) Award
189,387
e
11,323
b
17,860
b
41,675
(b)
6,035
b
19,106
20,153
39,871
ef)
600
205,000
h) $33,075 shows October, 2013 through June 30th, 2014 funding portion to tocal agencies
i) $162,764 is for July 1,2013 to September 30, 2013 period,
6) Capital Outlay Requested in This Action:
Prior approval is required for Capital Outlay. Capital Outlay is defined as an expenditure for equip
ment with a purchase price in excess of $5,000 and a life expectancy greater than one year.
PROGRAM ITEM DESCRIPTION
PROG.
COST APPROV
2013·2015 INTERGOVERNMENTAL AGREEME:NT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 120 OF 167 PAGES
142008 PGM· DESCHUTES COUNTY
State of Oregon Page 3 013
Oregon Health Authority
Public Health Division
1} Grantee 2} Issue Date This Action
Name: Deschutes County Health Dept April 18, 2013 ORIGINALS
FY2014
Street: 2577 N. E Courtney 3) Award Period
City: Bend From July 1, 2013 Through June 30, 2014
State: OR Zip Code: 97701
4) DHS Public Health Funds Approved
Previous Increase! Grant
Program Award (Decrease) Award
PE 50 Safe Drinking Water Program 93,863
TOTAL ° 0 2604741
5) FOOTNOTES:
6) Capital Outlay Requested in This Action:
Prior approval is required for Capital Outlay. Capital Outlay is defined as an expenditure fur equip
ment with a purchase price in excess of $5,000 and a lire expectancy greater than one year.
PROGRAM ITEM DESCRIPTION
I
I
PROG.
COST APPROV
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 121 OF )67 PAGES
142008 PGM • DESCHUTES COUNTY
OREGON HEALTH AUTHORITY
PUBUC HEALTH DIVISION EXPENDITURE ANO REVENUE REPORT
For All Programs ~Family Planning
Agency: ______________________
Program: ________________________
Period: July 11~;fuij;-;:-__
breakdown in the following categories:
Nutrition I
Client Servicesl-I ______..... Education ..._____--I
Breastfeedtng promotionl-I ______.....
revenues reported were authorized for use by the agency in support of this program and that
lIexpe'ldil:urE~s and encumbrances reported are true and correct to the best of my knowledge and belief.
PREPARED BY PHONE
Note 1: If Section II., Une 4. Expenditures are reimbursed by State Medicaid, State General Funds, State Other
funds, do not report Program Income on Section A. Une S.
Note 2: 4:' erR 9;U:'(b). Income directly generated by grant supported activit., (Section B. line 5.),
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 122 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
TITlE OF FORM: OHA Public Health Division Expenditure and Revenue Report FORM NUMBER: ~
WHO MUST COMPl.fTf THE 13-152: All agencies receiving fundS awarded through Oregon Health Authority
IntergcNemmental Asreement for Financing Pliblic Health Services must complete this report for each Irant
funded program exrept Family Planning. Asendes are responsible for assuring that each report is completed
accurately, sl$ned and submitted in a timely manner.
WHERE TO SUBMIT: Submit ~to controcts Payable, Department 0/Human Servkes,
500 Summer Sf. N.E. E-9J, Solem, OR 9730J, FAX (S03) 947·1313 O!l. EnlDil to: Of5..Contracf.lnvons@)dhsDhD.stote.or.us
WHEN TO SUBMIT: Reports for grants are due ~fol!owlng the end of the 3·, 6-, and 9-month periods
(to/2S, 1/25, 4/25) and ~after the 12-montb period (8/25) in each fiscal year. ~expenditure reports due
and not received by the 25th will delay payments for .t!Igrant programs until reports for dprograms have been
received from the payee for the reporting period.
INSTRUCTIONS FOR COMPLETION: Report expenditures of Non-OHA/PHO (Oreson Health Authority/Public
Health Division) funds in addition to those for which reimbursement is being claimed. This reportins feature Is
necessary for protrams due to the requitement of matchlng federal dollars with state and/or local dollars.
A. YEAR TO DATE expenditures are reported when payment is made or a legal obllaatlon is incurred.
8. YEAR TO DATE revenue is reported when recognized.
A. EXPENPITURES
Enter cumulative expenditures in appropriilte column.
• Hon-OHOIPHD Expenditures are all program expenditures not reimbursed by Public Health DIvision.
• PHD Expenditures are reimbursable expendltutes!ess program income.
WI(; grantees mU$t break down PHD cumulative expenditures into the 4 categor~s listed on the form. Refer to
Policy 3lS: Fiscal Requirements of the Oregon WIC Program Policy and Procedure Manual for definitions of the
cate:gories.
Une 1. Personal Services: Report total salaries that apply to the program. Since payroU expenses may vary from
month to month, an approximate amount may be listed for each reporting period J:l!£tIll the final period.
Exact yearly cost must be reponed.
Federailluidelines, 2 CFR 225..Appendix 8.8. (OM8 Circular A-8?). require the maintenance of illdequate
time-activity reports for individuals paid from grant funds.
!i.!:lf:.l. Services and Supplies: Report all services and suppl~5 e)(penditures for the program.
JJnti. capital Outlay, Capital Outlay is defined 11$ expenditure ofa sinale item costing more than $5,000 with a Ufe
expectancy of more than one year. Itemize all capital outlay expenditures by cost and description. Federal
regulations require that capital equipment tdesk. chairs, laboratory equipment, etc., continue to be used within the
program area. Property records for non-expendable personal property shall be maintained atcurately per Subtitie
A-Department of Health and Human Services, 45 Code of Federal Regulation (aR) Pan 92.32 and Part 74.34.
Prior apprmml must be obtoinedlor anr purchase of a single Item or speciolpUtpDSt? equipment having an
acquisition cost 0/$5,(J(J() Of mon (PHS Grants Porky Statement; WIC, see Federal Regu/at/tms Section
246.14).
8. REVENUES
Enter revenues that support program on appropriate lines. Identify sources of Other Local Funds on lines 1)
through 6b.
WHEN A BUOGn REVISION IS REQUIRED: It is unO!!tstood that the pattern of expenses will follow the
estimates set forth in the approved budget application. To facilitate program development, however, transfers
between expense categories may be made by the local agency except in the followlng instances. when a budget
revision will be required:
• If a transfer would result in or reflect a significant change In the character or scope of the program.
• If there is a sl$nili(:ant expenditure in a budget catellery for which funds were not initially budgeted in approved
application.
REIMBURSEMENT FROM TH£ STATE: Transler document will be forwarded to the county treasurer (where
appropriate) with a copy to the local agency when Public Health Division makes reimbursement.
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 123 OF 167 PAGES
142008 PGM -DESCHUTES COUNTV
---------------
OREGON HEALTH AUTHORITY
PUBLIC HEALTH SERVICES
REVE~UE A.~D EXPE~'DITURE REPORT
FOR F A:\ULY PLANNING O~LY
Agency: _____________ Period:
Plt>ast> rt>ad th(' instrlldions on th(' I'(,Y(,l'S(, sid(' of this form ruefully
PE 41 Family Planning Grant Expenditw'es Fiscal
Year-to-Date
Personal Services (Salaries & Benefits)
Services and Supplies
Capital Outlay
Total PE 41 Expens('s SO.OO
PE 41 Family Planning Grant R('\'enu('
Title X State Fal~ly PlatUling Grant Payments
Title X Program Income: SO.OO
a. Client Fees -Self-Pay
b. Donations
c. Third Party Insurance Reimbm'sement
Total PE 41 Rev('nu(' SO.OO
Oth('l' Revt>nu(' (R('quirt>d by Grantor) Fi<;eal
Year-to-Date
Medicaid / OHP
CCare
County General Funds
In-kind
Other (please identify)
Total Oth('r R('venll(, SO.OO
CERTIFICATE I certify that reyellUeS reported were authorized for use by the agency in
support oft11i5 program and that expenditures atid encumbrances rep01ted are tme and conect
to the best of my knowledge and belief
PREPARED BY PHONE
AUTHORIZED AGENT DATE
Form #23-152-FP (Rev. 05/12)
2013--2015 JNTERGOVERNMENTALAGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 124 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
Instructions fol' Completing the Family Planning
Revenue and ExpenditnrE' Report
You lllllst use this foml to report on your Oregon Health Authority Title X Family Planning Grant. Ifreporting
OJ} a Family Planning special project or directed supplement funds. you must submit an additional separate
Revenue and Expenditure Report for Fanlily Planning.
When to Suhmit
Expenditure reports are due 25 daYS foUo\\,ing the end of each 3. 6 and 9-month quarter (10 125, ll25, 4/25) and
SO days after the fiscal year (8/25). Ifexpenditure reports are not received by the 2S lh payments will be delayed
until correctly completed l-eportS have been received.
Where to Submit
Submit Original to: Contracts. Payable. Department of Hluuan Services. 500 SlIDllller Street NE E-91, Salem, OR
FAX (503) 947-2313, OFS-Contract.Invoices@db.soha.&tate.or.u&
Submit Copy to:
Instl'Ul'tion'>
OHA Reproductive Health ProlmUlL SOO NE Oregon Sf. #370, Portland. OR 97232
FAX (971) 673-0278. judith.andreasen@state.or.us
PE 41 FMilLY PLM1I;Ll~"G EXPENDITURES: Plea~e subnlit the expendittu'es for your Title X progl'anl
services. Use a second separate fol'lll to report expenditures against special project fLulds.
Pl!1'Sonal St'YVlCl'S : Salaries are to be reported ill total. Since payroll expen<..e... may vary from month to month.
an approximate atUOlUlt may be listed for each reporting period except the final period. wruch mu'.>t show exact
yearly expense. Federal guidelines (OMB Circular A-S7) require the maiutenanee of adequate time!aethity
reports if an individual is paid from grant funds.
Services and Supplies : Total all "iervices and supplie ... expenditures purchased \vith the grant funds.
Capital Dutta}, : Capital outlay is de:tilled as an expenditure for an item with a purchase price in excess of
$5.000 and a life expectancy greatet· than one year. It is necessary to itemize all capital outlay by cost and
description. Ifadditional space is needed for capital outlay. record the total outlay on Line 4 and attach an
addendmD to the report.
Fedetal regulations require thai capibl equipment (i.e .• desks, chairs, bbot::rtory equipmm.t, etc.) continue to be used within the
program area. Propeny records for nOD~xpendablC' personal property acquired with grnnt funds !Shall be maintained accurately
per Subtitle A-Department ofHealth and Human St'1"\1ceS, 45 Code of Federal Regulations (CFR) Part 9232 and Part 74.34.
PE 41 FAI.'VIILY PLAA"'NIXG RE\'"E~'UE: Repol1 revenues that support this program on tbe appropriate lines.
Title X Stall' Familr Planning Grant Payments: Title X payment" received by the state Reproductive Health
Program,
Titll' X Program Income (45CFR Po!:.t-Awaro Requirement): Program income means gross income received
by the grantee directly generated by it grant supported activity. Add lines A B to calculate program income.
Be sure tllst you are reporting on the cUlDulative year-to-d.-lte.
OTHER REYE~lJE: TIle Office ofPopulation Affiars requires grantees to repoI1 all Family Plamling progratn
revenue. Ifyollr program receives monies from MedicaidOHP. CCare. Comlty General FlUlds. andior In Kind
you must complete those ...ections.
ICERTIFlCATE: The signature of the authorized agent is required to indicate rusher approyal of the report.
Form #23-152-FP (Rev. 05112)
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 125 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
EXPLANATION OF FINANCIAL ASSISTANCE A WARD
The Financial Assistance Award set forth above and any Financial Assistance Award amendment must
be read in conjunction with this explanation for purposes of understanding the rights and obligations of
OHA and LPHA reflected in the Financial Assistance Award.
1. Format and Abbreviations in Financial Assistance Award
a. Heading. The heading of the Financial Assistance Award consists of the following
information (1) the name and address of the LPHA; (2) the date upon which the Financial
Assistance Award is issued, and, if the Financial Assistance Award is a revision of a
previously issued Financial Assistance Award, the number of the revision; and (3) the
period of time for which the financial assistance is awarded and during which it must be
expended by LPHA, subject to any restrictions set forth in the Footnotes section (see I.c.
below) of the Financial Assistance Award. Subject to the restrictions and limitations of this
Agreement and except as otherwise specified in the Footnotes, the financial assistance may
be expended at any time during the period for which it is awarded regardless ofthe date of
this Agreement or the date the Financial Assistance Award is issued.
b. Funds Approved. This section contains information regarding the Program Elements for
which OHA is providing financial assistance to LPHA under this Agreement and other
information provided for purpose of facilitating LPHA administration of the fiscal and
accounting elements of this Agreement. Each Program Element for which financial
assistance is awarded to LPHA under the Agreement is listed by its Program Element code
and its Program Element name (full or abbreviated). In certain cases, funds may be
awarded solely for a sub-element of a Program Element. In such cases, the sub-element for
which financial assistance is awarded is listed by its Program Element code, its Program
Element name (full or abbreviated) and its sub-element name (full or abbreviated) as
specified in the Program Element. The awarded funds, administrative information and
restrictions on a particular line are displayed in a columnar format as follows:
i. Column 1, Program Element: This column will contain the Program Element
name and code for each Program Element (and sub-element name, if applicable) for
which OHA has awarded financial assistance to LPHA under this Agreement. Each
Program Element name and code set forth in this section of the Financial Assistance
A ward corresponds to a specific Program Element Description set forth in Exhibit
B. Each sub-element name (if specified) corresponds to a specific sub-element of
the specified Program Element.
ii. Column 2, Previous Award: In instances in which a revision to the Financial
Assistance Award is made pursuant to an amendment duly issued by OHA and
executed by the parties, the presence of an amount in this column will indicate the
amount of financial assistance that was awarded by OHA to the LPHA, for the
Program Element (or sub-element) identified on that line, prior to the issuance of the
amendment. The information contained in this column is for information only, for
purpose offaciJitating LPHA's administration of the fiscal and accounting elements
of this Agreement, does not create enforceable rights under this Agreement and
shall not be considered in the interpretation ofthis Agreement.
201J..2015INTERGOVERNMENTAL AGREEME;IIT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 1260F 167 PAGES
142008 PGM -DESCHUTES COUNTY
iii. Column 3, Increase/(Decrease): In instances in which a revision to the Financial
Assistance Award is made pursuant to an amendment duly issued by OHA and
executed by the parties, the presence of an amount in this column will indicate the
amount by which the financial assistance awarded by OHA to the LPHA, for the
Program Element (or sub-element) identified on that line, is increased or decreased
by the amendment. The information contained in this column is for information
only, for purpose of facilitating LPHA' s administration of the fiscal and accounting
elements ofthis Agreement, does not create enforceable rights under this Agreement
and shall not be considered in the interpretation of this Agreement.
iv. Column 4, New Financial Assistance Award: The amount set forth in this column
is the amount of financial assistance awarded by OHA to LPHA for the Program
Element (or sub-element) identified on that line and is OHA's maximum financial
obligation under this Agreement in support of services comprising that Program
Element (or sub-element). In instances in which OHA desires to limit or condition
the expenditure of the financial assistance awarded by OHA to LPHA for the
Program Element (or sub-element) in a manner other than that set forth in the
Program Element Description or elsewhere in this Agreement, these limitations or
conditions shall be indicated by a letter reference(s) to the "Footnotes" section, in
which an explanation of the limitation or condition will be set forth.
c. Footnotes: This section sets forth any special limitations or conditions, if any, applicable
to the financial assistance awarded by OHA to LPHA for a particular Program Element (or
sub-element). The limitations or conditions applicable to a particular award are indicated by
corresponding letter references appearing in the "Footnotes" section and on the appropriate
line of the "New Grant Award" column of the "Funds Approved" section. LPHA must
comply with the limitations or conditions set forth in the "Footnotes" section when
expending or utilizing financial assistance subject thereto.
d. Capital Outlay Requested in This Award Action: In instances in which LPHA requests,
and OHA approves an LPHA request for, expenditure of the financial assistance provided
hereunder for a capital outlay, OHA's approval ofLPHA's capital outlay request will be set
forth in this section of the Financial Assistance A ward. This section contains a section
heading that explains the OHA requirement for obtaining OHA approval for an LPHA
capital outlay prior to LPHA's expenditure of financial assistance provided hereunder for
that purpose, and provides a brief OHA definition of a capital outlay. The information
associated with OHA's approval of LPHA's capital outlay request are displayed in a
columnar format as follows:
i. Program Element Service: The information presented in this column indicates the
particular Program Element (or sub-element), the financial assistance for which
LPHA may expend on the approved capital acquisition.
ii. Item Description: The information presented in this column indicates the specific
item that LPHA is authorized to acquire.
iii. Cost: The information presented in this column indicates the amount of financial
assistance LPHA may expend to acquire the authorized item.
2013-2015 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES PAGE 127 OF 167 PAGES
142008 PGM -DESCHUTES COUNTY
iv. Program Approval: The presence of the initials of an OHA official approves the
LPHA request for capital outlay.
2. Financial Assistance Award Amendments. Amendments to the Financial Assistance Award
are implemented as a full restatement of the Financial Assistance Award modified to reflect the
amendment. Therefore, if an amendment to this Agreement contains a new Financial
Assistance Award, the Financial Assistance Award in the amendment supersedes and replaces,
in its entirety, any prior Financial Assistance Award.
2013-2015 INTERGOVERNMENTAL AGREEMENT fOR THE FINANCING Of PUBLIC HEALTH SERVICES PAGE 128 Of 167 PAGES
142008 PGM -DESCHUTES COUNTY
OREGON HEALTH AUTHORITY
2013-2015 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF PUBLIC HEALTH SERVICES
EXHIBITD
SPECIAL TERMS AND CONDITIONS
Enforcement of the Oregon Indoor Clean Air Act. This section is for the purpose of providing for
the enforcement of laws by LPHA relating to smoking and enforcement of the Oregon Indoor Clean
Air Act (for the purposes of this section, the term "LPHA" will also refer to local government entities
e.g. certain Oregon counties that agree to engage in this activity.)
1. Authority. Pursuant to ORS 190.110, LPHA may agree to perform certain duties and
responsibilities related to enforcement of the Oregon Indoor Clean Air Act, 433.835 through
433.875 and 433.990(D) (hereafter "Act") as set forth below.
2. LPHA Responsibilities. LPHA shall assume the following enforcement functions:
a. Maintain records of all complaints received using the complaint tracking system provided
by OHA's Tobacco Prevention and Education Program (TPEP).
b. Comply with the requirements set forth in OAR 333-015-0070 to 333-015-0085 using OHA
enforcement procedures.
c. Respond to and investigate all complaints received concerning noncompliance with the Act
or rules adopted under the Act.
d. Work with noncompliant sites to participate in the development of a remediation plan for
each site found to be out of compliance after an inspection by the LPHA.
e. Conduct a second inspection of all previously inspected sites to determine if remediation
has been completed within the deadline specified in the remediation plan.
f. Notify TPEP within five business days of a site's failure to complete remediation, or a site's
refusal to allow an inspection or refusal to participate in development of a remediation plan.
See Section 3.c. "OHA Responsibilities."
g. For each non-compliant site, within five business days of the second inspection, send the
following to TPEP: intake form, copy of initial response letter, remediation form, and all
other documentation pertaining to the case.
h. LPHA shall assume the costs of the enforcement activities described in this section. In
accordance with an approved Community-based work plan as prescribed in OAR 333-0 I 0
0330(3)(b), LPHAs may use Ballot Measure 44 funds for these enforcement activities.
i. If a local government has local laws or ordinances that prohibit smoking in any areas listed
in ORS 433.845, the local government is responsible to enforce those laws or ordinances
using local enforcement procedures. In this event, all costs of enforcement will be the
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responsibility of the local government. Ballot Measure 44 funds may apply; see Section
2.h. above.
3. OHA Responsibilities. OHA shall:
a. Provide an electronic records maintenance system to be used in enforcement, including
forms used for intake tracking, complaints, and site visit/remediation plan, and templates to
be used tor letters to workplaces and/or public places.
b. Provide technical assistance to LPHAs.
c. Upon notification of a failed remediation plan, a site's refusal to allow a site visit, or a site's
refusal to develop a remediation plan, review the documentation submitted by the LPHA
and issue citations to non-compliant sites as appropriate.
d. If requested by a site, conduct contested case hearings in accordance with the
Administrative Procedures Act, ORS 183.411 to ] 83.4 70.
e. Issue final orders for all such case hearings.
f. Pursue, within the guidelines provided in the Act and OAR 333-015-0070 -OAR 333-0] 5
0085, cases of repeat offenders to assure compliance with the Act.
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OREGON HEALTH AUTHORITY
2013-2015 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF PUBLIC HEALTH SERVICES
EXHIBITE
GENERAL TERMS AND CONDITIONS
1. Disbursement and Recovery of Financial Assistance.
a. Disbursement Generally. Subject to the conditions precedent set forth below and
except as otherwise specified in an applicable footnote in the Financial Assistance
Award, OHA shall disburse financial assistance awarded for a particular Program
Element, as described in the Financial Assistance Award, to LPHA in substantially
equal monthly allotments during the period specified in the Financial Assistance Award
for that Program Element, subject to the following:
i. At the request of LPHA, OHA may adjust monthly disbursements of financial
assistance to meet LPHA program needs.
ii. OHA may reduce monthly disbursements of financial assistance as a result of, and
consistent with, LPHA' s underexpenditure of prior disbursements.
iii. After providing LPHA 30 days advance notice, OHA may withhold monthly
disbursements of financial assistance if any of LPHA's reports required to be
submitted to OHA under Section 8 of this Exhibit E or that otherwise are not
submitted in a timely manner or are incomplete or inaccurate subject to Exhibit C,
Sections 2, 3, or 4. OHA may withhold the disbursements under this subsection until
the reports have been submitted or corrected to OHA's satisfaction.
OHA may disburse to LPHA financial assistance for a Program Element in advance of
LPHA's expenditure of funds on delivery of the services within that Program Element,
subject to OHA recovery at Agreement Settlement of any excess disbursement. The
mere disbursement of financial assistance to LPHA in accordance with the
disbursement procedures described above does not vest in LPHA any right to retain
those funds. Disbursements are considered an advance of funds to LPHA which LPHA
may retain only to the extent the funds are expended in accordance with the terms and
conditions of this Agreement.
b. Conditions Precedent to Disbursement. OHA's obligation to disburse financial
assistance to LPHA under this Agreement is subject to satisfaction, with respect to each
disbursement, of each of the following conditions precedent:
i. No LPHA default as described in Section 12 of this Exhibit has occurred.
ii. LPHA's representations and warranties set forth in Section 2 of this Exhibit are true
and correct on the date of disbursement with the same effect as though made on the
date of disbursement.
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c. Recovery of Financial Assistance.
i. Notice of Underexpenditure or Misexpenditure. If OHA believes there has been
an Underexpenditure (as defined in Exhibit A) of moneys disbursed under this
Agreement, OHA shall provide LPHA with written notice thereof and OHA and
LPHA shall engage in the process described in Section l.c.ii. below. If OHA
believes there has been a Misexpenditure (as defined in Exhibit A) of moneys
disbursed to LPHA under this Agreement, OHA shall provide LPHA with written
notice thereof and OHA and LPHA shall engage in the process described in Section
I.c.iii.
ii. Recovery of Underexpenditure.
(A) LPHA's Response. LPHA shall have 90 calendar days from the effective
date of the notice of Underexpenditure to pay OHA in full or notifY the OHA
that it wishes to engage in the appeals process set forth in Section 1.c.ii.(B)
below. If LPHA fails to respond within that 90-day time period, LPHA shall
promptly pay the noticed Underexpenditure amount.
(B) Appeals Process. If LPHA notifies OHA that it wishes to engage in an
appeal process, LPHA and OHA shall engage in non-binding discussions to
give the LPHA an opportunity to present reasons why it believes that there is
no Underexpenditure, or that the amount of the Underexpenditure is different
than the amount identified by OHA, and to give OHA the opportunity to
reconsider its notice. LPHA and OHA may negotiate an appropriate
apportionment of responsibility for the repayment of an Underexpenditure. At
LPHA request, OHA will meet and negotiate with LPHA in good faith
concerning appropriate apportionment of responsibility for repayment of an
Underexpenditure. In determining an appropriate apportionment of
responsibility, LPHA and OHA may consider any relevant factors. An
example of a relevant factor is the extent to which either party contributed to
an interpretation of a statute, regulation or rule prior to the expenditure that
was officially reinterpreted after the expenditure. If OHA and LPHA reach
agreement on the amount owed to OHA, LPHA shall promptly repay that
amount to OHA by issuing payment to OHA or by directing OHA to withhold
future payments pursuant to Section 1.c.ii.(C) below. If OHA and LPHA
continue to disagree about whether there has been an Underexpenditure or the
amount owed, the parties may agree to consider further appropriate dispute
resolution processes, including, subject to Oregon Department of Justice
(DOJ) and LPHA counsel approval, arbitration.
(C) Recovery From Future Payments. To the extent that OHA is entitled to
recover an Underexpenditure pursuant to Section 1.c.ii.(B), OHA may recover
the Underexpenditure by offsetting the amount thereof against future amounts
owed to LPHA by OHA, including, but not limited to, any amount owed to
LPHA by OHA under any other contract or agreement between LPHA and
OHA, present or future. OHA shall provide LPHA written notice of its intent
to recover the amounts of the Underexpenditure from amounts owed LPHA by
OHA as set forth in this Section l.c.ii.(C), and shall identifY the amounts owed
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142008 PGM· DESCHUTES COUNTY
by OHA which OHA intends to offset, (including contracts or agreements, if
any, under which the amounts owed arose) LPHA shall then have 14 calendar
days from the date of OHA's notice in which to request the deduction be made
from other amounts owed to LPHA by OHA and identified by LPHA. OHA
shall comply with LPHA's request for alternate offset, unless the LPHA's
proposed alternative offset would cause OHA to violate federal or state
statutes, administrative rules or other applicable authority, or would result in a
delay in recovery that exceeds three months. In the event that OHA and
LPHA are unable to agree on which specific amounts, owed to LPHA by
OHA, the OHA may offset in order to recover the amount of the
Underexpenditure, then OHA may select the particular contracts or
agreements between OHA and LPHA and amounts from which it will recover
the amount of the Underexpenditure, within the following limitations: OHA
shall first look to amounts owed to LPHA (but unpaid) under this Agreement.
If that amount is insufficient, then OHA may look to any other amounts
currently owing or owed in the future to LPHA by OHA. In no case, without
the prior consent of LPHA, shall OHA deduct from anyone payment due
LPHA under the contract or agreement from which OHA is offsetting funds an
amount in excess of twenty-five percent (25%) of that payment. OHA may
look to as many future payments as necessary in order to fully recover the
amount of the Underexpenditure .
iii. Recovery of Misexpenditure.
(A) LPHA's Response. From the effective date of the notice of Misexpenditure,
LPHA shall have the lesser of (i) 60 calendar days, or (ii) if a Misexpenditure
relates to a Federal Government request for reimbursement, 30 calendar days
fewer than the number of days (if any) OHA has to appeal a final written
decision from the Federal Government, to either:
(i.) Make a payment to OHA in the full amount of the noticed
Misexpenditure identified by OHA;
(ii.) Notify OHA that LPHA wishes to repay the amount of the noticed
Misexpenditure from future payments pursuant to Section 1.c.iii.(C)
below; or
(iii.) Notify OHA that it wishes to engage in the applicable appeal process set
forth in Section 1.c.iii.(B) below.
If LPHA fails to respond within the time required by this Section l.c.iii.(A),
OHA may recover the amount of the noticed Misexpenditure from future
payments as set forth in Section J .c.iii.(C) below.
(B) Appeal Process. If LPHA notifies OHA that it wishes to engage in an appeal
process with respect to a noticed Misexpenditure, the parties shall comply with
the following procedures, as applicable:
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(i.) Appeal from OHA-Identified Misexpenditure. If OHA's notice of
Misexpenditure is based on a Misexpenditure solely of the type
described in Sections l3.b. or c. of Exhibit A, LPHA and OHA shall
engage in the process described in this Section l.c.iii.(8)(L) to resolve a
dispute regarding the noticed Misexpenditure. First, LPHA and OHA
shall engage in non-binding discussions to give LPHA an opportunity to
present reasons why it believes that there is, in fact, no Misexpenditure
or that the amount of the Misexpenditure is different than the amount
identified by OHA, and to give OHA the opportunity to reconsider its
notice. LPHA and OHA may negotiate an appropriate apportionment of
responsibility for the repayment of a Misexpenditure. At LPHA request,
OHA will meet and negotiate with LPHA in good faith concerning
appropriate apportionment of responsibility for repayment of a
Misexpenditure. In determining an appropriate apportionment of
responsibility, LPHA and OHA may consider any relevant factors. An
example of a relevant factor is the extent to which either party
contributed to an interpretation of a statute, regulation or rule prior to the
expenditure that was officially reinterpreted after the expenditure. If
OHA and LPHA reach agreement on the amount owed to OHA, LPHA
shall promptly repay that amount to OHA by issuing payment to OHA or
by directing OHA to withhold future payments pursuant to Section
1.c.iii.(C) below. If OHA and LPHA continue to disagree as to whether
or not there has been a Misexpenditure or as to the amount owed, the
parties may agree to consider further appropriate dispute resolution
processes including, subject to Oregon Department of Justice (DOJ) and
LPHA counsel approval, arbitration.
(iL) Appeal from Federal-Identified Misexpenditure.
(a) If OHA's notice of Misexpenditure is based on a Misexpenditure of
the type described in Exhibit A, Section 13.a. and the relevant
Federal Agency provides a process either by statute or administrative
rule to appeal the determination of improper use of federal funds, the
notice of disallowance or other federal identification of improper use
of funds and if the disallowance is not based on a federal or state
court judgment founded in allegations of Medicaid fraud or abuse,
then LPHA may, prior to 30 days prior to the applicable federal
appeals deadline, request that OHA appeal the determination of
improper use, notice of disallowance or other federal identification of
improper use of funds in accordance with the process established or
adopted by the Federal Agency. If LPHA so requests that OHA
appeal the determination of improper use of federal funds, federal
notice of disallowance or other federal identification of improper use
of funds, the amount in controversy shall, at the option of LPHA, be
retained by the LPHA or returned to OHA pending the final federal
decision resulting from the initial appeal If the LPHA does request,
prior to the deadline set forth above, that OHA appeal, OHA shall
appeal the determination of improper use, notice of disallowance or
other federal identification of improper use of funds in accordance
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142008 PGM -DESCHUTES COUNTY
with the established process and shall pursue the appeal until a
decision is issued by the Departmental Grant Appeals Board of the
Department of Health and Human Services (HHS) (the "Grant
Appeals Board") pursuant to the process for appeal set forth in 45
C.F.R. Subtitle A, Part 16, or an equivalent decision is issued under
the appeal process established or adopted by the Federal Agency.
LPHA and OHA shall cooperate with each other in pursuing the
appeal. If the Grant Appeals Board or its equivalent denies the appeal
then either LPHA, OHA, or both may, in their discretion, pursue
further appeals. Regardless of any further appeals, within 90 days of
the date the federal decision resulting from the initial appeal is final,
LPHA shall repay to OHA the amount of the noticed Misexpenditure
(reduced, if at all, as a result of the appeal) by issuing payment to
OHA or by directing OHA to withhold future payments pursuant to
Section l.c.iii.(C) below. To the extent that LPHA retained any of
the amount in controversy while the appeal was pending, the LPHA
shall pay to OHA the interest, if any, charged by the Federal
Government on such amount.
(b) If the relevant Federal Agency does not provide a process either by
statute or administrative rule to appeal the determination of improper
use of federal funds, the notice of disallowance or other federal
identification of improper use of funds or LPHA does not request
that OHA pursue an appeal prior to 30 days prior to the applicable
federal appeals deadline, and if OHA does not appeal, then within 90
days of the date the federal determination of improper use of federal
funds, the federal notice of disallowance or other federal
identification of improper use of funds is final LPHA shall repay to
OHA the amount of the noticed Misexpenditure by issuing a payment
to OHA or by directing OHA to withhold future payments pursuant
to Section 1.c.iii.(C) below.
(c) If LPHA does not request that OHA pursue an appeal of the
determination of improper use of federal funds, the notice of
disallowance, or other federal identification of improper use of funds,
prior to 30 days prior to the applicable federal appeals deadline but
OHA nevertheless appeals, LPHA shall repay to OHA the amount of
the noticed Misexpenditure (reduced, if at all, as a result of the
appeal) within 90 days of the date the federal decision resulting from
the appeal is final, by issuing payment to OHA or by directing OHA
to withhold future payments pursuant to Section 1.c.iii.(C) below.
(d) Notwithstanding Section l.c.iii,(A)(i.) through l.c.iii.(A)(iii.), if the
Misexpenditure was expressly authorized by an OHA rule or an
OHA writing that applied when the expenditure was made, but was
prohibited by federal statutes or regulations that applied when the
expenditure was made, LPHA will not be responsible for repaying
the amount of the Misexpenditure to OHA, provided that:
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142008 PGM -DESCHUTES COUNTY
(1)
(2)
(3)
(4)
(5)
(6)
Where post -expenditure official reinterpretation of federal
statutes or regu lations results in a Misexpenditure, LPHA and
OHA will meet and negotiate in good faith an appropriate
apportionment of responsibility between them for repayment of
the Misexpenditure.
For purposes of this Section l.c.iii.(B)(iL)(d), an OHA writing
must interpret this Agreement or an OHA rule and be signed by
the Director of the OHA or by one of the following OHA
officers concerning services in the category where the officers
are listed:
Public Health Services:
• Public Health Director
• Deputy Public Health Director
• Office Administrators for the Director or Deputy Director
OHA shall designate alternate officers in the event the offices
designated in the previous sentence are abolished. Upon LPHA
request, OHAshall notify LPHA of the names of individual
officers with the above titles. OHA shall send OHA writings
described in this paragraph to LPHA by mail and email.
The writing must be in response to a request from LPHA for
expenditure authorization, or a statement intended to provide
official guidance to LPHA or counties generally for making
expenditures under this Agreement. The writing must not be
contrary to this Agreement or contrary to law or other
applicable authority that is clearly established at the time of the
writing.
If OHA writing is in response to a request from LPHA for
expenditure authorization, the request must be in writing and
signed by the director of an LPHA department with authority to
make such a request or by the LPHA Counsel. It must identify
the supporting data, provisions of this Agreement and
provisions of applicable law relevant to determining if the
expenditure should be authorized.
An OHA writing expires on the date stated in the writing, or if
no expiration date is stated, six years from the date of the
writing. An expired OHA writing continues to apply to LPHA
expenditures that were made in compliance with the writing
and during the term of the writing.
OHA may revoke or revise an OHA writing at any time if it
determines in its sole discretion that the writing allowed
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expenditure in violation of this Agreement or law or any other
applicable authority.
(7) OHA rule does not authorize an expenditure that this
Agreement prohibits.
(e) Recovery From Future Payments. To the extent that OHA is entitled to
recover a Misexpenditure pursuant to Section l.c.iii.(B)(i.) or (ii.), OHA may
recover the Misexpenditure by offsetting the amount thereof against future
amounts owed to LPHA by OHA, including but not limited to, any amount
owed to LPHA by OHA under this Agreement or any amount owed to LPHA
by OHA under any other contract or agreement between LPHA and OHA,
present or future. OHA shall provide LPHA written notice of its intent to
recover the amount of the Misexpenditure from amounts owed LPHA by OHA
as set forth in this Section l.c.iii.(C) and shall identifY the amounts owed by
OHA that OHA intends to offset (including the contracts or agreements, if
any, under which the amounts owed arose and from those OHA wishes to
deduct payments from). LPHA shall then have 14 calendar days from the date
of OHA's notice in which to request the deduction be made from other
amounts owed to LPHA by OHA and identified by LPHA. OHA shall comply
with LPHA's request for alternate offset, unless the LPHA's proposed
alternative offset would cause OHA to violate federal or state statutes,
administrative rules or other applicable authority. In the event that OHA and
LPHA are unable to agree on which specific amounts are owed to LPHA by
OHA, that OHA may offset in order to recover the amount of the
Misexpenditure, then OHA may select the particular contracts or agreements
between OHA and County and amounts from which it will recover the amount
of the Misexpenditure, after providing notice to LPHA, and within the
following limitations: OHA shall first look to amounts owed to LPHA (but
unpaid) under this Agreement. If that amount is insufficient, then OHA may
look to any other amounts currently owing or owed in the future to LPHA by
OHA. In no case, without the prior consent of LPHA, shall OHA deduct from
anyone payment due LPHA under the contract or agreement from which
OHA is offsetting funds an amount in excess of twenty-five percent (25%) of
that payment. OHA may look to as many future payments as necessary in
order to fully recover the amount ofthe Misexpenditure.
d. Additional Provisions Related to Parties Rights/Obligations With Respect to
Underexpenditures and Misexpenditures.
i. LPHA shall cooperate with OHA in the Agreement Settlement process.
ii. OHA's right to recover Underexpenditures and Misexpenditures from LPHA under
this Agreement is not subject to or conditioned on LPHA's recovery of any money
from any other entity.
iii. If the exercise of the OHA's right to offset under this provision requires the LPHA
to complete a re-budgeting process, nothing in this provision shall be construed to
prevent the LPHA from fully complying with its budgeting procedures and
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142008 PGM· DESCHUTES COUNTY
obligations, or from implementing decisions resulting from those procedures and
obligations.
(A) Nothing in this provision shall be construed as a requirement or agreement by
the LPHA or the OHA to negotiate and execute any future contract with the
other.
(B) Nothing in this Section I.d. shall be construed as a waiver by either party of
any process or remedy that might otherwise be available.
2. Representations and Warranties.
a. LPHA represents and warrants (subject to the limitations of Article XI, §I 0 of the
Oregon Constitution and the Oregon Tort Claims Act as amended (currently ORS
30.260 through 30.300),) as follows:
i. Organization and Authority. LPHA is a political subdivision of the State of Oregon
duly organized and validly existing under the laws of the State of Oregon. LPHA
has full power, authority and legal right to make this Agreement and to incur and
perform its obligations hereunder.
ii. Due Authorization. The making and performance by LPHA of this Agreement (1)
have been duly authorized by all necessary action by LPHA and (2) do not and will
not violate any provision of any applicable law, rule, regulation, or order of any
court, regulatory commission, board, or other administrative agency or any
provision of LPHA's charter or other organizational document and (3) do not and
will not result in the breach of, or constitute a default or require any consent under
any other agreement or instrument to which LPHA is a party or by which LPHA
may be bound or affected. No authorization, consent, license, approval of, filing or
registration with or notification to any governmental body or regulatory or
supervisory authority is required for the execution, delivery or performance by
LPHA of this Agreement.
iii. Binding Obligation. This Agreement has been duly executed and delivered by
LPHA and constitutes a legal, valid and binding obligation of LPHA, enforceable in
accordance with its terms subject to the laws of bankruptcy, insolvency, or other
similar laws affecting the enforcement of creditors' rights generally.
iv. Services. To the extent services are performed by LPHA, the delivery of each
Program Element service will comply with the terms and conditions of this
Agreement and meet the standards for such Program Element service as set forth
herein, including but not limited to, any terms, conditions, standards and
requirements set forth in the Financial Assistance A ward and applicable Program
Element Description.
b. Warranties Cumulative. The warranties set forth in this section are in addition to, and
not in lieu of, any other warranties provided.
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142008 PGM -DESCHUTES COUNT\'
c. OHA represents and warrants (subject to the limitations of Article XI, §7 ofthe Oregon
Constitution and the Oregon Tort Claims Act as amended (currently ORS 30.260
through 30.300),) as follows:
i. Organization and Authority. OHA has full power, authority and legal right to make
this Agreement and to incur and perform its obligations hereunder.
ii. Due Authorization. The making and performance by OHA of this Agreement (I)
have been duly authorized by all necessary action by OHA and (2) do not and will
not violate any provision of any applicable law, rule, regulation, or order of any
court, regulatory commission, board, or other administrative agency and (3) do not
and will not result in the breach of, or constitute a default or require any consent
under any other agreement or instrument to which OHA is a party or by which OHA
may be bound or affected. No authorization, consent, license, approval of, filing or
registration with or notification to any governmental body or regulatory or
supervisory authority is required for the execution, delivery or performance by OHA
of this Agreement, other than approval by the Department of Justice if required by
law.
iii. Binding Obligation. This Agreement has been duly executed and delivered by OHA
and constitutes a legal, valid and binding obligation of OHA, enforceable in
accordance with its terms subject to the laws of bankruptcy, insolvency, or other
similar laws affecting the enforcement of creditors' rights generally.
3. Use of Financial Assistance. LPHA may use the financial assistance disbursed to LPHA
under this Agreement solely to cover actual Allowable Costs reasonably and necessarily
incurred to implement Program Elements during the term of this Agreement. LPHA may not
expend financial assistance provided to LPHA under this Agreement for a particular Program
Element (as reflected in the Financial Assistance Award) on the implementation of any other
Program Element.
4. Provider Contracts. Except when the Program Element Description expressly requires a
Program Element Service or a portion thereof to be delivered by LPHA directly, LPHA may
use the financial assistance provided under this Agreement for a particular Program Element
service to purchase that service, or portion thereof, from a third person or entity (a "Provider")
through a contract (a "Provider Contract"). Subject to Section 5 of this Exhibit E, LPHA may
permit a Provider to purchase the service, or a portion thereof, from another person or entity
under a subcontract and such subcontractors shall also be considered Providers for purposes of
this Agreement and the subcontracts shall be considered Provider Contracts for purposes of this
Agreement. LPHA shall not permit any person or entity to be a Provider unless the person or
entity holds all licenses, certificates, authorizations and other approvals required by applicable
law to deliver the Program Element service. The Provider Contract must be in writing and
contain each of the provisions set forth in Exhibit H, in substantially the form set forth therein,
in addition to any other provisions that must be included to comply with applicable law, that
must be included in a Provider Contract under the terms ofthis Agreement or that are necessary
to implement Program Element service delivery in accordance with the applicable Program
Element Descriptions and the other terms and conditions of this Agreement. LPHA shall
maintain an originally executed copy of each Provider Contract at its office and shall furnish a
copy of any Provider Contract to OHA upon request.
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5. Provider Monitoring. LPHA shall monitor each Provider's delivery of Program Element
services and promptly report to OHA when LPHA identifies a major deficiency in a Provider's
delivery of a Program Element service or in a Provider's compliance with the Provider Contract
between the Provider and LPHA. LPHA shall promptly take all necessary action to remedy
any identified deficiency. LPHA shall also monitor the fiscal performance of each Provider
and shall take all lawful management and legal action necessary to pursue this responsibility.
In the event of a major deficiency in a Provider's delivery of a Program Element service or in a
Provider's compliance with the Provider Contract between the Provider and LPHA, nothing in
this Agreement shall limit or qualifY any right or authority OHA has under state or federal law
to take action directly against the Provider.
6. Records Maintenance, Access, and Confidentiality.
a. Access to Records and Facilities. OHA, the Oregon Secretary of State's office, the
Federal Government, and their duly authorized representatives shall have access to the
books, documents, papers and records of LPHA that are directly related to this
Agreement, the financial assistance provided hereunder, or any Program Element
service for the purpose of making audits, examinations, excerpts, copies and
transcriptions. In addition, LPHA shall permit authorized representatives of OHA to
perform site reviews of all Program Element services delivered by LPHA.
b. Retention of Records. LPHA shall retain and keep accessible all books, documents,
papers, and records, that are directly related to this Agreement, the financial assistance
provided hereunder, or any Program Element service, for a minimum of three (3) years,
or such longer period as may be required by other provisions of this Agreement or
applicable law, following the termination of this Agreement. If there are unresolved
audit or Agreement Settlement questions at the end of the applicable retention period,
LPHA shall retain the records until the questions are resolved.
c. Expenditure Records. LPHA shall establish such fiscal control and fund accounting
procedures as are necessary to ensure proper expenditure of and accounting for the
financial assistance disbursed to LPHA by OHA under this Agreement. In particular,
but without limiting the generality of the foregoing, LPHA shall (i) establish separate
accounts for each Program Element for which LPHA receives financial assistance from
OHA under this Agreement and (ii) document expenditures of financial assistance
provided hereunder for employee compensation in accordance with Office of
Management and Budget (OMB) Circular A-87 and, when required by OHA, utilize
time/activity studies in accounting for expenditures of financial assistance provided
hereunder for employee compensation. LPHA shall maintain accurate property records
of non-expendable property, acquired with Federal Funds, in accordance with OMB
Circular A-122.
d. Safeguarding of LPHA Client Information. LPHA shall maintain the confidentiality
of LPHA Client records as required by applicable state and federal law. Without
limiting the generality of the preceding sentence, LPHA shall comply with the
following confidentiality laws, as applicable: ORS 433.045, 433.075, 433.008,
433.017, 433.092, 433.096, 433.098 and 42 CFR Part 2. LPHA shall create and
maintain written policies and procedures related to the disclosure of LPHA Client
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142008 PGM -DESCHUTES COUNTY
information, and shall make such policies and procedures available to aHA for review
and inspection as reasonably requested by aHA.
7. Alternative Formats and Translation of Written Materials, Interpreter Services. In
connection with the delivery of Program Element services, LPHA shall:
a. Make available to an LPHA Client, without charge to the LPHA Client, upon the LPHA
Client's or aHA's request, any and all written materials in alternate, if appropriate,
formats as required by aHA's administrative rules or by aHA's written policies made
available to LPHA.
b. Make available to an LPHA Client, without charge to the LPHA Client, upon the LPHA
Client's or aHA's request, any and all written materials in the prevalent non-English
languages in LPHA's service area.
c. Make available to an LPHA Client, without charge to the LPHA Client, upon the LPHA
Client's or aHA's request, oral interpretation services in all non-English languages in
LPHA's service area.
d. Make available to an LPHA Client with hearing impairment, without charge to the
LPHA Client, upon the LPHA Client's or aHA's request, sign language interpretation
services and telephone communications access services.
For purposes of the foregoing, "written materials" includes, without limitation, all written
materials created or delivered in connection with the Program Element services and all
Provider Contracts related to this Agreement.
8. Reporting Requirements. For each calendar quarter or portion thereof, during the term of this
Agreement, in which LPHA expends and receives financial assistance awarded to LPHA by
aHA under this Agreement, LPHA shall prepare and deliver to aHA, no later than the 25 days
following the end of the first, second, and third quarters (or end of three, six, and nine month
periods) and 50 days following the end of the fourth quarter (or 12 month period) the following
reports:
a. A separate expenditure report for each Program in which LPHA expenditures and
receipts of financial assistance occurred during the quarter as funded by indication on
the original or formally amended Financial Assistance Award located in the same titled
section of Exhibit C of the Agreement. Each report, (other than reports for PE 41
"Family Planning") must be substantially in the form set forth in Exhibit C titled
"Oregon Health Authority, Public Health Division Expenditure and Revenue Report for
All Programs Except Family Planning."
b. Expenditure reports for PE 41, must be substantially in the form set forth in Exhibit C
titled "Oregon Health Authority Public Health Division Expenditure and Revenue
Report for Family Planning Only", if LPHA expended financial assistance disbursed
hereunder for PE 41 during the quarter.
All reports must be completed in accordance with the associated instructions and must provide
complete, specific and accurate information on LPHA's use of the financial assistance
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142008 PGM -DESCHUTES COUNTY
disbursed to LPHA hereunder. In addition, LPHA shall comply with all other reporting
requirements set forth in this Agreement, including but not limited to, all reporting
requirements set forth in applicable Program Element descriptions. If LPHA fails to comply
with these reporting requirements, OHA may withhold future disbursements of all financial
assistance under this Agreement, as further described in Section 1 of this Exhibit E.
9. Operation of Public Health Program. LPHA shall operate (or contract for the operation of) a
public health program during the term of this Agreement. If LPHA uses financial assistance
provided under this Agreement for a particular Program Element, LPHA shall include that
Program Element in its public health program from the date it begins using the funds provided
under this Agreement for that Program Element until the earlier of (a) termination or expiration
of this Agreement, (b) termination by OHA ofOHA's obligation to provide financial assistance
for that Program Element, in accordance with Section 14 of this Exhibit E or (c) termination by
LPHA, in accordance with Section 14 of this Exhibit E, of LPHA's obligation to include that
Program Element in its public health program.
10. Technical Assistance. During the term of this Agreement, OHA shall provide technical
assistance to LPHA in the delivery of Program Element services to the extent resources are
available to OHA for this purpose. If the provision of technical assistance to the LPHA
concerns a Provider, OHA may require, as a condition to providing the assistance, that LPHA
take all action with respect to the Provider reasonably necessary to facilitate the technical
assistance.
11. Payment of Certain Expenses. If OHA requests that an employee of LPHA, or a Provider or
a citizen providing services or residing within LPHA's service area, attend OHA training or an
OHA conference or business meeting and LPHA has obligated itself to reimburse the
individual for travel expenses incurred by the individual in attending the training or conference,
OHA may pay those travel expenses on behalf of LPHA but only at the rates and in accordance
with the reimbursement procedures set forth in the Oregon Accounting Manual
www.oregon.govIDASISCDISARSlpo/iciesloamIIO.35.00.PR.pd(!ga=t as of the date the
expense was incurred and only to the extent that OHA determines funds are available for such
reimbursement.
12. LPHA Default. LPHA shall be in default under this Agreement upon the occurrence of any of
the following events:
a. LPHA fails to perform, observe or discharge any of its covenants, agreements or
obligations set forth herein.
b. Any representation, warranty or statement made by LPHA herein or in any documents
or reports made by LPHA in connection herewith that are reasonably relied upon by
OHA to measure the delivery of Program Element services, the expenditure of financial
assistance or the performance by LPHA is untrue in any material respect when made;
c. LPHA (i) applies for or consents to the appointment of, or taking of possession by, a
receiver, custodian, trustee, or liquidator of itself or all of its property, (ii) admits in
writing its inability, or is generally unable, to pay its debts as they become due, (iii)
makes a general assignment for the benefit of its creditors, (iv) is adjudicated as
bankrupt or insolvent, (v) commences a voluntary case under the federal Bankruptcy
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1420081'GM • DESCHUTES COliNTY
Code (as now or hereafter in effect), (vi) files a petition seeking to take advantage of
any other law relating to bankruptcy, insolvency, reorganization, winding-up, or
composition or adjustment of debts, (vii) fails to controvert in a timely and appropriate
manner, or acquiesces in writing to, any petition filed against it in an involuntary case
under the Bankruptcy Code, or (viii) takes any action for the purpose of effecting any of
the foregoing; or
d. A proceeding or case is commenced, without the application or consent of LPHA, in
any court of competent jurisdiction, seeking (i) the liquidation, dissolution or winding
up, or the composition or readjustment of debts, of LPHA, (ii) the appointment of a
trustee, receiver, custodian, liquidator, or the like of LPHA or of all or any substantial
part of its assets, or (iii) similar relief in respect to LPHA under any law relating to
bankruptcy, insolvency, reorganization, winding-up, or composition or adjustment of
debts, and such proceeding or case continues undismissed, or an order, judgment, or
decree approving or ordering any of the foregoing is entered and continues unstayed
and in effect for a period of sixty consecutive days, or an order for relief against LPHA
is entered in an involuntary case under the federal Bankruptcy Code (as now or
hereafter in effect).
13. OHA Default. OHA shall be in default under this Agreement upon the occurrence of any of
the following events:
a. OHA fails to perform, observe or discharge any of its covenants, agreements, or
obligations set forth herein; or
b. Any representation, warranty or statement made by OHA herein or in any documents or
reports made by OHA in connection herewith that are reasonably relied upon by LPHA
to measure performance by OHA is untrue in any material respect when made.
14. Termination.
a. LPHA Termination. LPHA may terminate this Agreement in its entirety or may
terminate its obligation to include one or more particular Program Elements in its public
health program:
i. For its convenience, upon at least three calendar months advance written notice to
OHA, with the termination effective as of the first day of the month following the
notice period;
ii. Upon 45 days advance written notice to OHA, if LPHA does not obtain funding,
appropriations and other expenditure authorizations from LPHA's governing body,
federal, state or other sources sufficient to permit LPHA to satisfy its performance
obligations under this Agreement, as determined by LPHA in the reasonable
exercise of its administrative discretion;
iii. Upon 30 days advance written notice to OHA, if OHA is in default under the
Agreement and such default remains uncured at the end of said 30 day period or
such longer period, if any, as LPHA may specify in the notice; or
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iv. Immediately upon written notice to OHA, if Oregon statutes or federal laws,
regulations or guidelines are modified, changed or interpreted by the Oregon
Legislative Assembly, the federal government or a court in such a way that LPHA
no longer has the authority to meet its obligations under this Agreement.
b. OHA Termination. OHA may terminate this Agreement in its entirety or may
terminate its obligation to provide financial assistance under this Agreement for one or
more particular Program Elements described in the Financial Assistance A ward:
i. For its convenience, upon at least three calendar months advance written notice to
LPHA, with the termination effective as of the first day of the month following the
notice period;
ii. Upon 45 days advance written notice to LPHA, if OHA does not obtain funding,
appropriations and other expenditure authorizations from federal, state or other
sources sufficient to meet the payment obligations ofOHA under this Agreement, as
determined by OHA in the reasonable exercise of its administrative discretion.
Notwithstanding the preceding sentence, OHA may terminate this Agreement in its
entirety or may terminate its obligation to provide financial assistance under this
Agreement for one or more particular Program Elements, immediately upon written
notice to LPHA or at such other time as it may determine if action by the Oregon
Legislative Assembly or Emergency Board reduces the OHA's legislative
authorization for expenditure of funds to such a degree that OHA will no longer
have sufficient expenditure authority to meet its payment obligations under this
Agreement, as determined by OHA in the reasonable exercise of its administrative
discretion, and the effective date for such reduction in expenditure authorization is
less than 45 days from the date the action is taken;
iii. Immediately upon written notice to LPHA if Oregon statutes or federal laws,
regulations or guidelines are modified, changed or interpreted by the Oregon
Legislative Assembly, the federal government or a court in such a way that OHA no
longer has the authority to meet its obligations under this Agreement or no longer
has the authority to provide the financial assistance from the funding source it had
planned to use;
iv. Upon 30 days advance written notice to LPHA, if LPHA is in default under this
Agreement and such default remains uncured at the end of said 30 day period or
such longer period, if any, as OHA may specify in the notice;
v. Immediately upon written notice to LPHA, if any license or certificate required by
law or regulation to be held by LPHA or a Provider to deliver a Program Element
service described in the Financial Assistance Award is for any reason denied,
revoked, suspended, not renewed or changed in such a way that LPHA or a Provider
no longer meets requirements to deliver the service. This termination right may
only be exercised with respect to the particular Program Element impacted by the
loss of necessary licensure or certification; or
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vi. Immediately upon written notice to LPHA, if OHA determines that LPHA or any of
its Providers have endangered or are endangering the health or safety of an LPHA
Client or others.
15. Effect of Termination
a. Upon termination of this Agreement in its entirety, OHA shall have no further
obligation to payor disburse financial assistance to LPHA under this Agreement,
whether or not OHA has paid or disbursed to LPHA all financial assistance described in
the Financial Assistance Award, except (a) with respect to funds described in the
Financial Assistance Award, to the extent OHA's disbursement of financial assistance
for a particular Program Element service, the financial assistance for which is calculated
on a rate per unit of service or service capacity basis, is less than the applicable rate
multiplied by the number of applicable units of the Program Element service or
Program Element service capacity of that type performed or made available from the
effective date of this Agreement through the termination date, and (b) with respect to
funds described in the Financial Assistance Award, to the extent OHA's disbursement
of financial assistance for a particular Program Element service, the financial assistance
for which is calculated on a cost reimbursement basis, is less than the cumulative actual
Allowable Costs reasonably and necessarily incurred with respect to delivery of that
Program Element service, from the effective date of this Agreement through the
termination date.
b. Upon termination of LPHA's obligation to perform under a particular Program Element
service, OHA shall have (a) no further obligation to payor disburse financial assistance
to LPHA under this Agreement for administration of that Program Element service
whether or not OHA has paid or disbursed to LPHA all financial assistance described in
the Financial Assistance Award for administration of that Program Element and (b) no
further obligation to payor disburse any financial assistance to LPHA under this
Agreement for such Program Element service, whether or not OHA has paid or
disbursed to LPHA all financial assistance described in the Financial Assistance Award
for such Program Element service except (I) with respect to funds described in the
Financial Assistance Award, to the extent OHA's disbursement of financial assistance
for the particular Program Element service, the financial assistance for which is
calculated on a rate per unit of service or service capacity basis, is less than the
applicable rate multiplied by the number of applicable units of the Program Element
service or Program Element service capacity of that type performed or made available
during the period from the effective date of this Agreement through the termination
date, and (2) with respect to funds described in the Financial Assistance Award, to the
extent OHA's disbursement of financial assistance for a particular Program Element
service, the financial assistance for which is calculated on a cost reimbursement basis, is
less than the cumulative actual Allowable Costs reasonably and necessarily incurred by
LPHA with respect to delivery of that Program Element service during the period from
the effective date ofthis Agreement through the termination date.
c. Upon termination of OHA's obligation to provide financial assistance under this
Agreement for a particular Program Element service, LPHS shall have no further
obligation under this Agreement to provide that Program Element service.
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142008I'GM. DESCHUTES COUNTV
d. Disbursement Limitations. Notwithstanding subsections a. and b. above, under no
circumstances will OHA be obligated to provide financial assistance to LPHA for a
particular Program Element service in excess of the amount awarded under this
Agreement for that Program Element service as set forth in the Financial Assistance
Award.
e. Survival. Exercise of a termination right set forth in Section 14 of this Exhibit E or
termination of this Agreement in accordance with its terms, shall not affect LPHA's
right to receive financial assistance to which it is entitled hereunder as described in
subsections a. and b. above or the right of OHA or LPHA to invoke the dispute
resolution processes under Sections 17 and 18 below. Notwithstanding subsections a.
and b. above, exercise of the termination rights in Section 14 of this Exhibit E or
termination of this Agreement in accordance with its terms, shall not affect LPHA's
obligations under this Agreement or OHA's right to enforce this Agreement against
LPHA in accordance with its terms, with respect to financial assistance actually
disbursed by OHA under this Agreement, or with respect to Program Element services
actually delivered. Specifically, but without limiting the generality of the preceding
sentence, exercise of a termination right set forth in Section 14 of this Exhibit E or
termination of this Agreement in accordance with its terms shall not affect LPHA's
representations and warranties; reporting obligations; record-keeping and access
obligations; confidentiality obligations; obligation to comply with applicable federal
requirements; the restrictions and limitations on LPHA's expenditure of financial
assistance actually disbursed by OHA hereunder, LPHA's obligation to cooperate with
OHA in the Agreement Settlement process; or OHA's right to recover from LPHA; in
accordance with the terms of this Agreement; any financial assistance disbursed by
OHA under this Agreement that is identified as an Underexpenditure or
Misexpenditure. If a termination right set forth in Section 14 of this Exhibit E is
exercised, both parties shall make reasonable good faith efforts to minimize
unnecessary disruption or other problems associated with the termination.
16. Effect of Amendments Reducing Financial Assistance. If LPHA and OHA amend this
Agreement to reduce the amount of financial assistance awarded for a particular Program
Element, LPHA is not required by this Agreement to utilize other LPHA funds to replace the
funds no longer received under this Agreement as a result of the amendment, and LPHA may,
from and after the date of the amendment, reduce the quantity of that Program Element service
included in its public health program commensurate with the amount of the reduction in
financial assistance awarded for that Program Element. Nothing in the preceding sentence shall
affect LPHA's obligations under this Agreement with respect to financial assistance actually
disbursed by OHA under this Agreement or with respect to Program Element services actually
delivered.
17. Resolution of Disputes over Additional Financial Assistance Owed LPHA After
Termination. If, after termination of this Agreement, LPHA believes that OHA disbursements
of financial assistance under this Agreement for a particular Program Element are less than the
amount of financial assistance that OHA is obligated to provide to LPHA under this Agreement
for that Program Element, as determined in accordance with the applicable financial assistance
calculation methodology, LPHA shall provide OHA with written notice thereof. OHA shall
have 90 calendar days from the effective date of LPHA's notice to pay LPHA in full or notifY
LPHA that it wishes to engage in a dispute resolution process. If OHA notifies LPHA that it
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142008 PGM DI1SCHUTES COlJ:'<TY
wishes to engage in a dispute resolution process, LPHA and OHA's Assistant Administrator
shall engage in non-binding discussion to give OHA an opportunity to present reasons why it
believes that it does not owe LPHA any additional financial assistance or that the amount owed
is different than the amount identified by LPHA in its notices, and to give LPHA the
opportunity to reconsider its notice. If OHA and LPHA reach agreement on the additional
amount owed to LPHA, OHA shall promptly pay that amount to LPHA. If OHA and LPHA
continue to disagree as to the amount owed, the parties may agree to consider further
appropriate dispute resolution processes, including, subject to Oregon Department of Justice
and LPHA counsel approval, binding arbitration. Nothing in this Section shall preclude the
LPHA from raising underpayment concerns at any time prior to termination of this Agreement
under Section 18 below.
18. Resolution of Disputes, Generally. In addition to other processes to resolve disputes provided
in this Exhibit, either party may notify the other party that it wishes to engage in a dispute
resolution process. Upon such notification, the parties shall engage in non-binding discussion
to resolve the dispute. If the parties do not reach agreement as a result of non-binding
discussion, the parties may agree to consider further appropriate dispute resolution processes,
including, subject to Oregon Department of Justice and LPHA counsel approval, binding
arbitration. The rights and remedies set forth in this Agreement are not intended to be
exhaustive and the exercise by either party of any right or remedy does not preclude the
exercise of any other rights or remedies at law or in equity.
19. Nothing in this Agreement shall cause or require LPHA or OHA to act in violation of state or
federal constitutions, statutes, regulations or rules. The parties intend this limitation to apply in
addition to any other limitation in this Agreement, including limitations in Section 1 of this
Exhibit E.
20. Purchase and Disposition of Equipment.
a. For purposes of this section, "Equipment" means tangible, non-expendable personal
property having a useful life of more than one year and a net acquisition cost of more
than $5,000 per unit. However, for purposes of information technology equipment, the
monetary threshold does not apply. Information technology equipment shall be tracked
for the mandatory line categories listed below:
i. Network
ii. Personal Computer
iii. PrinterlPlotter
iv. Server
v. Storage
vi. Software
b. For any Equipment authorized by OHA for purchase with funds from this Agreement,
ownership shall be in the name of the LPHA and LPHA is required to accurately
maintain the following Equipment inventory records:
i. description of the Equipment;
ii. serial number;
iii. where Equipment was purchased;
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142008 PGM-DESCHUTES COUNTY
iv.
v.
acquisition cost and date; and
location, use and condition ofthe Equipment
c. LPHA shall provide the Equipment inventory list to the Agreement Administrator
annually by June 30th of each year. LPHA shall be responsible to safeguard any
Equipment and maintain the Equipment in good repair and condition while in the
possession of LPHA or any subcontractors. LPHA shall depreciate all Equipment, with
a value of more than $5,000, using the straight line method.
d. Upon termination of this Agreement, or any service thereof, for any reason whatsoever,
LPHA shall, upon request by OHA, immediately, or at such later date specified by
OHA, tender to OHA any and all Equipment purchased with funds under this
Agreement as OHA may require to be returned to the State. At OHA's direction, LPHA
may be required to deliver said Equipment to a subsequent Provider for that Provider's
use in the delivery of services formerly provided by LPHA. Upon mutual agreement, in
lieu of requiring LPHA to tender the Equipment to OHA or to a subsequent Provider,
OHA may require LPHA to pay to OHA the current value of the Equipment.
Equipment value will be determined as of the date of Agreement or service termination.
e. If funds from this Agreement are authorized by OHA to be used as a portion of the
purchase price of Equipment, requirements relating to title, maintenance, Equipment
inventory reporting and residual value shall be negotiated and the agreement reflected in
a special condition or Footnote authorizing the purchase.
f. Notwithstanding anything herein to the contrary, LPHA shall comply with 45 CFR
92.32 as amended, which generally describes the required maintenance, documentation,
and allowed disposition of equipment purchased with federal grant funds.
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142008 PGM -DESCHl:TES COUNTY
OREGON HEALTH AUTHORITY
2013-2015 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF PUBLIC HEALTH SERVICES
EXHIBITF
STANDARD TERMS AND CONDITIONS
1. Counterparts. This Agreement may be executed in several counterparts, all of which when
taken together shall constitute one agreement binding on all parties, notwithstanding that all
parties are not signatories to the same counterpart. Each copy of this Agreement so executed
shall constitute an original.
2. Governing Law, Consent to Jurisdiction. This Agreement shall be governed by and
construed in accordance with the laws of the State of Oregon without regard to principles of
conflicts of law. Any claim, action, suit or proceeding (collectively, "Claims") between the
parties that arises from or relates to this Agreement shall be brought and conducted solely and
exclusively within a circuit court in the State of Oregon of proper jurisdiction. Except as
provided in this Section neither party waives any form of defense or immunity, whether
sovereign immunity, governmental immunity, immunity based on the eleventh amendment to
the Constitution of the United States or otherwise, from any Claim or from the jurisdiction of
any court. THE PARTIES, BY EXECUTION OF THIS AGREEMENT, HEREBY CONSENT TO THE
IN PERSONAM JURISDICTION OF SAID COURTS. THE PARTIES ACKNOWLEDGE THAT THIS IS A
BINDING AND ENFORCEABLE AGREEMENT AND, TO THE EXTENT PERMITTED BY LAW,
EXPRESSLY WAIVE ANY DEFENSE ALLEGING THAT EITHER PARTY DOES NOT HAVE THE RIGHT
TO SEEK JUDICIAL ENFORCEMENT OF THIS AGREEMENT.
3. Compliance with Law. Both parties shall comply with laws, regulations and executive orders
to which they are subject and which are applicable to the Agreement or to the delivery of
Program Element services. Without limiting the generality of the foregoing, both parties
expressly agree to comply with the following laws, regulations and executive orders to the
extent they are applicable to the Agreement: (a) all applicable requirements of state civil rights
and rehabilitation statutes, rules and regulations; (b) all state laws governing operation of
locally administered public health programs, including without limitation, all administrative
rules adopted by OHA related to public health programs; and (c) ORS 659A.400 to 659A.409,
ORS 659A.145 and all regulations and administrative rules established pursuant to those laws
in the construction, remodeling, maintenance and operation of any structures and facilities, and
in the conduct of all programs, services and training associated with the delivery of Program
Element services. These laws, regulations and executive orders are incorporated by reference
herein to the extent that they are applicable to the Agreement and required by law to be so
incorporated. All employers, including LPHA and OHA, that employ subject workers who
provide Program Element services in the State of Oregon shall comply with ORS 656.017 and
provide the required Workers' Compensation coverage, unless such employers are exempt
under ORS 656.126.
4. Assignment of Agreement, Successors in Interest.
a. LPHA shall not assign or transfer its interest in this Agreement without prior written
approval of OHA. Any such assignment or transfer, if approved, is subject to such
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142008 PGM -DESCHUTES COUNTY
conditions and provisions as OHA may deem necessary. No approval by OHA of any
assignment or transfer of interest shall be deemed to create any obligation of OHA in
addition to those set forth in the Agreement.
b. The provisions of this Agreement shall be binding upon and shall inure to the benefit of
the parties hereto, and their respective successors and permitted assigns.
5. No Third Party Beneficiaries. OHA and LPHA are the only parties to this Agreement and are
the only parties entitled to enforce its terms. The parties agree that LPHA's performance under
this Agreement is solely for the benefit of OHA to assist and enable OHA to accomplish its
statutory mission. Nothing in this Agreement gives, is intended to give, or shall be construed to
give or provide any benefit or right, whether directly, indirectly or otherwise, to third persons
any greater than the rights and benefits enjoyed by the general public unless such third persons
are individually identified by name herein and expressly described as intended beneficiaries of
the terms ofthis Agreement.
6. Integration and Waiver. This Agreement, including all Exhibits, constitutes the entire
agreement between the parties on the subject matter hereof There are no understandings,
agreements, or representations, oral or written, not specified herein regarding this Agreement.
The failure of either party to enforce any provision of this Agreement shall not constitute a
waiver by that party of that or any other provision. No waiver or consent shall be effective
unless in writing and signed by the party against whom it is asserted.
7. Amendment. No amendment, modification or change of terms of this Agreement shall bind
either party unless in writing and signed by both parties and when required the Department of
Administrative Services and Department of Justice. Such amendment, modification or change,
if made, shall be effective only in the specific instance and for the specific purpose given. The
parties, by signature oftheir authorized representative, hereby acknowledge that they have read
this Agreement, understand it, and agree to be bound by its terms and conditions.
8. Headings. The headings and captions to sections of this Agreement have been inserted for
identification and reference purposes only and shall not be used to construe the meaning or to
interpret this Agreement.
9. Construction. This Agreement is the product of extensive negotiations between OHA and
representatives of county governments. The provisions of this Agreement are to be interpreted
and their legal effects determined as a whole. An arbitrator or court interpreting this
Agreement shall give a reasonable, lawful and effective meaning to the Agreement to the extent
possible, consistent with the public interest.
10. Independent Contractors. The parties agree and acknowledge that their relationship is that of
independent contracting parties and that neither party is an officer, employee, or agent of the
other party as those terms are used in ORS 30.265 or otherwise.
11. Limitation of Liabilities. NEITHER PARTY SHALL BE LIABLE TO THE OTHER FOR
ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES ARISING OUT OF OR RELATED
TO THIS AGREEMENT. NEITHER PARTY SHALL BE LIABLE FOR ANY DAMAGES OF
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142008 PGM -DESCIlUTES COUNTY
ANY SORT ARISING SOLELY FROM THE TERMINATION OF THIS AGREEMENT OF
ANY PART HEREOF IN ACCORDANCE WITH ITS TERMS.
12. Ownership ofInteliectual Property.
a. Definitions. As used in this section and elsewhere in this Agreement, the following
terms have the meanings set forth below:
i. "County Intellectual Property" means any intellectual property owned by County
and developed independently from the Work.
ii. "Third Party Intellectual Property" means any intellectual property owned by parties
other than OHA or County.
b. Except as otherwise expressly provided herein, or as otherwise required by state or
federal law, OHA will not own the right, title and interest in any intellectual property
created or delivered by LPHA or a Provider in connection with the Program Element
services With respect to that portion of the intellectual property that LPHA owns,
LPHA grants to OHA a perpetual, worldwide, non-exclusive, royalty-free and
irrevocable license, subject to any provisions in the Agreement that restrict or prohibit
dissemination or disclosure of information, to (]) use, reproduce, prepare derivative
works based upon, distribute copies of, perform and display the intellectual property,
(2) authorize third parties to exercise the rights set forth in Section 12.b.(l) on OHA's
behalf, and (3) sublicense to third parties the rights set forth in Section 12.b.(1).
c. If state or federal law requires that OHA or LPHA grant to the United States a license to
any intellectual property, or if state or federal law requires that OHA or the United
States own the intellectual property, then LPHA shall execute such further documents
and instruments as OHA may reasonably request in order to make any such grant or to
assign ownership in the intellectual property to the United States or OHA. To the extent
that OHA becomes the owner of any intellectual property created or delivered by LPHA
in connection with the Program Element services, OHA will grant a perpetual,
worldwide, non-exclusive, royalty-free and irrevocable license, subject to any
provisions in the Agreement that restrict or prohibit dissemination or disclosure of
information, to LPHA to use, copy, distribute, display, build upon and improve the
intellectual property.
d. LPHA shall include in its Provider Contracts terms and conditions necessary to require
that Providers execute such further documents and instruments as OHA may reasonably
request in order to make any grant of license or assignment of ownership that may be
required by federal or state law.
13. Force Majeure. Neither OHA nor LPHA shall be held responsible for delay or default caused
by fire, civil unrest, labor unrest, natural causes, or war which is beyond the reasonable control
of OHA or LPHA, respectively. Each party shall, however, make all reasonable efforts to
remove or eliminate such cause of delay or default and shall, upon the cessation of the cause,
diligently pursue performance of its obligations under this Agreement. Each party may
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tenninate this Agreement upon written notice to the other party after reasonably detennining
that the delay or breach will likely prevent successful perfonnance ofthis Agreement.
14. Contribution. If any third party makes any claim or brings any action, suit or proceeding
alleging a tort as now or hereafter defined in ORS 30.260 ("Third Party Claim") against a party
(the "Notified Party") with respect to which the other party ("Other Party") may have liability,
the Notified Party must promptly notify the Other Party in writing of the Third Party Claim and
deliver to the Other Party a copy of the claim, process, and all legal pleadings with respect to
the Third Party Claim. Either party is entitled to participate in the defense of a Third Party
Claim, and to defend a Third Party Claim with counsel of its own choosing. Receipt by the
Other Party of the notice and copies required in this paragraph and meaningful opportunity for
the Other Party to participate in the investigation, defense and settlement of the Third Party
Claim with counsel of its own choosing are conditions precedent to the Other Party's liability
with respect to the Third Party Claim.
With respect to a Third Party Claim for which the State is jointly liable with the LPHA (or
would be if joined in the Third Party Claim ), the State shall contribute to the amount of
expenses (including attorneys' fees), judgments, fines and amounts paid in settlement actually
and reasonably incurred and paid or payable by the Agency in such proportion as is appropriate
to reflect the relative fault of the State on the one hand and of the Agency on the other hand in
connection with the events which resulted in such expenses, judgments, fines or settlement
amounts, as well as any other relevant equitable considerations. The relative fault of the State
on the one hand and of the LPHA on the other hand shall be detennined by reference to, among
other things, the parties' relative intent, knowledge, access to infonnation and opportunity to
correct or prevent the circumstances resulting in such expenses, judgments, fines or settlement
amounts. The State's contribution amount in any instance is capped to the same extent it would
have been capped under Oregon law if the State had sole liability in the proceeding.
With respect to a Third Party Claim for which the LPHA is jointly liable with the State (or
would be if joined in the Third Party Claim), the LPHA shall contribute to the amount of
expenses (including attorneys' fees), judgments, fines and amounts paid in settlement actually
and reasonably incurred and paid or payable by the State in such proportion as is appropriate to
reflect the relative fault of the LPHA on the one hand and of the State on the other hand in
connection with the events which resulted in such expenses, judgments, fines or settlement
amounts, as well as any other relevant equitable considerations. The relative fault of the LPHA
on the one hand and of the State on the other hand shall be detennined by reference to, among
other things, the parties' relative intent, knowledge, access to infonnation and opportunity to
correct or prevent the circumstances resulting in such expenses, judgments, fines or settlement
amounts. The LPHA's contribution amount in any instance is capped to the same extent it
would have been capped under Oregon law if it had sole liability in the proceeding.
15. Indemnification by LPHA Contractors. LPHA shall take all reasonable steps to cause its
contractor(s), that are not units of local government as defined in ORS ] 90.003, if any, to
indemnify, defend, save and hold hannless the State of Oregon and its officers, employees and
agents ("Indemnitee") from and against any and all claims, actions, liabilities, damages, losses,
or expenses (including attorney's fees) arising from a tort (as now or hereafter defined in ORS
30.260) caused, or alleged to be caused, in whole or in part, by the negligent or willful acts or
omissions of LPHA's contractor or any of the officers, agents, employees or subcontractors of
the contractor ("Claims"). It is the specific intention of the parties that the Indemnitee shall, in
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all instances, except for Claims arising solely from the negligent or willful acts or omissions of
the Indemnitee, be indemnified by the contractor from and against any and all Claims.
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OREGON HEALTH AUTHORITY
2013-2015 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF PUBLIC HEALTH SERVICES
EXHIBITG
REQUIRED FEDERAL TERMS AND CONDITIONS
General Applicability and Compliance. Unless exempt under 45 CFR Part 87 for Faith-Based
Organizations (Federal Register, July 16,2004, Volume 69, #136), or other federal provisions as may
be amended from time to time, LPHA shall comply and, as indicated, require all Providers and
subcontractors to comply with the following federal requirements to the extent that they are applicable
to this Agreement, to LPHA, or to the Work, or to any combination of the foregoing. For purposes of
this Agreement, all references to federal and state laws are references to federal and state laws as they
may be amended from time to time.
1. Miscellaneous Federal Provisions. LPHA shall comply and require all Providers to comply
with all federal laws, regulations, and executive orders applicable to the Agreement or to the
delivery of Services. Without limiting the generality of the foregoing, LPHA expressly agrees
to comply and require all Providers to comply with the following laws, regulations and
executive orders to the extent they are applicable to the Agreement: (a) Title VI and VII of the
Civil Rights Act of 1964, as amended, (b) Sections 503 and 504 of the Rehabilitation Act of
1973, as amended, (c) the Americans with Disabilities Act of 1990, as amended, (d) Executive
Order 11246, as amended, (e) the Health Insurance Portability and Accountability Act of 1996,
as amended, (f) the Age Discrimination in Employment Act of 1967, as amended, and the Age
Discrimination Act of 1975, as amended, (g) the Vietnam Era Veterans' Readjustment
Assistance Act of 1974, as amended, (h) all regulations and administrative rules established
pursuant to the foregoing laws, (i) all other applicable requirements of federal civil rights and
rehabilitation statutes, rules and regulations, and (j) all federal law governing operation of
Community Mental Health Programs, including without limitation, all federal laws requiring
reporting of Client abuse. These laws, regulations and executive orders are incorporated by
reference herein to the extent that they are applicable to the Agreement and required by law to
be so incorporated. No federal funds may be used to provide Services in violation of 42 USC
14402.
2. Equal Employment Opportunity. If this Agreement, including amendments, is for more than
$10,000, then LPHA shall comply and require all Providers to comply with Executive Order
11246, entitled "Equal Employment Opportunity," as amended by Executive Order 11375, and
as supplemented in U.S. Department of Labor regulations (41 CFR Part 60).
3. Clean Air, Clean Water, EPA Regulations. If this Agreement, including amendments,
exceeds $100,000 then LPHA shall comply and require all Providers to comply with all
applicable standards, orders, or requirements issued under Section 306 of the Clean Air Act (42
U.S.C. 7606), the Federal Water Pollution Control Act as amended (commonly known as the
Clean Water Act) (33 U.S.C. 1251 to 1387), specifically including, but not limited to Section
508 (33 U.S.c. 1368), Executive Order 11738, and Environmental Protection Agency
regulations (2 CFR Part 1532), which prohibit the use under non-exempt federal contracts,
grants or loans of facilities included on the EPA List of Violating Facilities. Violations shall be
reported to OHA, United States Department of Health and Human Services, and the appropriate
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regional office of the Environmental Protection Agency. LPHA shall include and require all
Providers to include in all subcontracts with Providers receiving more than $100,000, language
requiring the Provider to comply with the federal laws identified in this section.
4. Energy Efficiency. LPHA shall comply and require all Providers to comply with applicable
mandatory standards and policies relating to energy efficiency that are contained in the Oregon
energy conservation plan issued in compliance with the Energy Policy and Conservation Act
U.S.c. 6201 et!,seq. (Pub. L. 94-163).
5. Truth in Lobbying. By signing this Agreement, the LPHA certifies, to the best of the LPHA's
knowledge and belief that: no federal appropriated funds have been paid or will be paid, by or
on behalf of LPHA, to any person for influencing or attempting to influence an officer or
employee of an agency, a Member of Congress, an officer or employee of the United States
Congress, or an employee of a Member of Congress in connection with the awarding of any
federal contract, the making of any federal grant, the making of any federal loan, the entering
into of any cooperative agreement, and the extension, continuation, renewal, amendment or
modification of any federal contract, grant, loan, or cooperative agreement.
a. If any funds other than federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency,
a Member of Congress, an officer or employee of United States Congress, or an
employee of a Member of Congress in connection with this federal contract, grant, loan
or cooperative agreement, the LPHA shall complete and submit Standard Form LLL,
"Disclosure Form to Report Lobbying" in accordance with its instructions.
b. The LPHA shall require that the language of this certification be included in the award
documents for all sub-awards at all tiers (including subcontracts, sub-grants, and
contracts under grants, loans, .and cooperative agreements) and that all sub-recipients
and Providers shall certify and disclose accordingly.
c. This certification is a material representation of fact upon which reliance was placed
when this Agreement was made or entered into. Submission of this certification is a
prerequisite for making or entering into this Agreement imposed by section 1352, Title
31 of the U.S. Code as amended. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than $10,000 and not more than $100,000
for each such failure.
d. No part of any federal funds paid to LPHA under this Agreement shall be used, other
than for normal and recognized executive legislative relationships, for publicity or
propaganda purposes, for the preparation, distribution, or use of any kit, pamphlet,
booklet, publication, electronic communication, radio, television, or video presentation
designed to support or defeat the enactment of legislation before the United States
Congress or any state or local legislature or legislative body, except in presentation to
the United States Congress or any state or local legislature itself, or designed to support
or defeat any proposed or pending regulation, administrative action, or order issued by
the executive branch of any state or local government, except in presentation to the
executive branch of any state or local government itself.
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e. No part of any federal funds paid to LPHA under this Agreement shall be used to pay
the salary or expenses of any grant or contract recipient, or agent acting for such
recipient, related to any activity designed to influence the enactment of legislation,
appropriations, regulation, administrative action, or executive order proposed or
pending before the United States Congress or any state government, state legislature or
local legislature or legislative body, other than for normal and recognized executive
legislative relationships or participation by an agency or officer of a state, local or tribal
government in policymaking and administrative processes within the executive branch
of that government.
f. Prohibitions in subsections (e) and (f) of this section shall include any activity to
advocate or promote any proposed, pending or future federal, state or local tax increase,
or any proposed, pending, or future requirement or restriction on any legal consumer
product, including its sale or marketing, including but not limited to the advocacy or
promotion of gun control.
g. No part of any federal funds paid to LPHA under this Agreement may be used for any
activity that promotes the legalization of any drug or other substance included in
schedule I of the schedules of controlled substances established under section 202 ofthe
Controlled Substances Act except for normal and recognized executive congressional
communications. This limitation shall not apply when there is significant medical
evidence of a therapeutic advantage to the use of such drug or other substance or that
federally sponsored clinical trials are being conducted to determine therapeutic
advantage.
6. HIPAA Compliance. OHA is a Covered Entity with respect to its healthcare components as
described in OAR 943-014-0015 for purposes ofthe Health Insurance Portability and
Accountability Act and the federal regulations implementing the Act (collectively referred to as
HIPAA), and OAR 125-055-0100 through OAR 125-055-0130. OHA must comply with
HIPAA to the extent that any Work or obligations of OHA arising under this Agreement are
covered by HIPAA. LPHA shall determine if LPHA will have access to, or create any
Protected Health Information (PHI) in the performance of any Work or other obligations under
this Agreement. To the extent that LPHA will have access to, or create any PHI to perform
functions, activities, or services for, or on behalf of, a healthcare component of OHA in the
performance of any Work required by this Agreement, LPHA shall comply and cause all
Providers and sub-contractors to comply with OAR 125-055-0 I 00 through OAR 125-055-0130
and the following:
a. Privacy and Security of Individually Identifiable Health Information. Individually
Identifiable Health Information about specific individuals is confidential. Individually
Identifiable Health Information relating to specific individuals may be exchanged
between OHA and LPHA for purposes directly related to the provision of services to
Clients which are funded in whole or in part under this Agreement. To the extent that
Contractor is performing functions, activities, or services for, or on behalf of, a
health care component ofOHA in the performance of any Work required by this
Agreement, LPHA shall not use or disclose any Individually Identifiable Health
Information about specific individuals in a manner that would violate OHA Privacy
Rules, OAR 943-014-0000 et. seq., or OHA Notice of Privacy Practices. A copy of the
most recent OHA Notice of Privacy Practices may be obtained by contacting OHA or
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142008 PGM -DESCHUTES COUNTY
by looking up form number 2090 on the OHA web site at
https:llapps.state.or.uslcflIFORMSI.
b. Data Transactions Systems. If LPHA intends to exchange electronic data transactions
with a health care component of OHA in connection with claims or encounter data,
eligibility or enrollment information, authorizations or other electronic transaction,
LPHA shall execute an EDI Trading Partner Agreement with OHA and shall comply
with OHA EDI Rules.
c. Consultation and Testing. If LPHA reasonably believes that LPHA or OHA's data
transactions system or other application of HIPAA privacy or security compliance
policy may result in a violation of HIP AA requirements, LPHA shall promptly consult
the OHA Information Security Office. LPHA or OHA may initiate a request for testing
of HIPAA transaction requirements, subject to available resources and the OHA testing
schedule.
7. Resource Conservation and Recovery. LPHA shall comply and cause all Providers to
comply with all mandatory standards and policies that relate to resource conservation and
recovery pursuant to the Resource Conservation and Recovery Act (codified at 42 U.S.C. 6901
et.seq.). Section 6002 of that Act (codified at 42 U.S.C. 6962) requires that preference be given
in procurement programs to the purchase of specific products containing recycled materials
identified in guidelines developed by the Environmental Protection Agency. Current guidelines
are set forth in 40 CFR Part 247.
8. Audits.
a. LPHA shall comply, and require all Providers to comply, with applicable audit
requirements and responsibilities set forth in this Agreement and applicable state or
federal law.
b. Sub-recipients shall also comply with applicable Code of Federal Regulations (CFR)
and OMB Circulars governing expenditure of federal funds Including, but not limited
to, OMB A-133 Audits of States, Local Governments and Non-Profit Organizations.
9. Debarment and Suspension. LPHA shall not permit any person or entity to be a Provider if
the person or entity is listed on the non-procurement portion of the General Service
Administration's "List of Parties Excluded from Federal Procurement or Non-procurement
Programs" in accordance with Executive Orders No. 12549 and No. 12689, "Debarment and
Suspension" (see 2 CFR Part 180). This list contains the names of parties debarred, suspended,
or otherwise excluded by agencies, and LPHAs declared ineligible under statutory authority
other than Executive Order No. 12549. Subcontractors with awards that exceed the simplified
acquisition threshold shall provide the required certification regarding their exclusion status
and that of their principals prior to award.
10. Drug-Free Workplace. LPHA shall comply and require all Providers to comply with the
following provisions to maintain a drug-free workplace: (i) LPHA certifies that it will provide a
drug-free workplace by publishing a statement notifYing its employees that the unlawful
manufacture, distribution, dispensation, possession or use of a controlled substance, except as
may be present in lawfully prescribed or over-the-counter medications, is prohibited in LPHA's
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J42008 PGM -DESCHUTES COUNTY
workplace or while providing services to OHA clients. LPHA's notice shall specify the actions
that will be taken by LPHA against its employees for violation of such prohibitions; (ii)
Establish a drug-free awareness program to inform its employees about: the dangers of drug
abuse in the workplace, LPHA's policy of maintaining a drug-free workplace, any available
drug counseling, rehabilitation, and employee assistance programs, and the penalties that may
be imposed upon employees for drug abuse violations; (iii) Provide each employee to be
engaged in the performance of services under this Agreement a copy of the statement
mentioned in paragraph (i) above; (iv) Notify each employee in the statement required by
paragraph (i) above that, as a condition of employment to provide services under this
Agreement, the employee will: abide by the terms of the statement, and notify the employer of
any criminal drug statute conviction for a violation occurring in the workplace no later than
five (5) days after such conviction; (v) Notify OHA within ten (10) days after receiving notice
under subparagraph (iv) above from an employee or otherwise receiving actual notice of such
conviction; (vi) Impose a sanction on, or require the satisfactory participation in a drug abuse
assistance or rehabilitation program by any employee who is so convicted as required by
Section 5154 of the Drug-Free Workplace Act of 1988; (vii) Make a good-faith effort to
continue a drug-free workplace through implementation of subparagraphs (i) through (vi)
above; (viii) Require any Provider to comply with subparagraphs (i) through (vii) above; (ix)
Neither LPHA, or any of LPHA's employees, officers, agents or Providers may provide any
service required under this Agreement while under the influence of drugs. For purposes of this
provision, "under the influence" means: observed abnormal behavior or impairments in mental
or physical performance leading a reasonable person to believe the LPHA or LPHA's
employee, officer, agent or Provider has used a controlled substance, prescription or non
prescription medication that impairs the LPHA or LPHA's employee, officer, agent or
Provider's performance of essential job function or creates a direct threat to OHA clients or
others. Examples of abnormal behavior include, but are not limited to: hallucinations, paranoia
or violent outbursts. Examples of impairments in physical or mental performance include, but
are not limited to: slurred speech, difficulty walking or performing job activities; and (x)
Violation of any provision of this subsection may resu It in termination of this Agreement.
11. Pro-Children Act. LPHA shall comply and require all sub-contractors to comply with the
Pro-Children Act of 1994 (codified at 20 U.S.c. section 6081 et. seq.).
12. Medicaid Services. To the extent LPHA provides any Service whose costs are paid in whole
or in part by Medicaid, LPHA shall comply with all applicable federal and state laws and
regulation pertaining to the provision of Medicaid Services under the Medicaid Act, Title XIX,
42 U.S.c. Section J 396 et. seq., including without limitation:
a. Keep such records as are necessary to fully disclose the extent of the services provided
to individuals receiving Medicaid assistance and shall furnish such information to any
state or Federal Agency responsible for administering the Medicaid program regarding
any payments claimed by such person or institution for providing Medicaid Services as
the state or federal agency may from time to time request. 42 U.S.C. Section
1396a(a)(27); 42 CFR 431.107(b)(J) & (2).
b. Comply with all disclosure requirements of 42 CFR 1002.3(a) and 42 CFR 455 Subpart
(8).
c. Maintain written notices and procedures respecting advance directives in compliance
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with 42 U.S.C. Section I 396(a)(57) and (w), 42 CFR 431.1 07(b)(4), and 42 CFR 489
subpart I.
d. Certify when submitting any claim for the provision of Medicaid Services that the
information submitted is true, accurate and complete. LPHA shall acknowledge
LPHA's understanding that payment of the claim will be from federal and state funds
and that any falsification or concealment of a material fact may be prosecuted under
federal and state laws.
e. Entities receiving $5 million or more annually (under this Agreement and any other
Medicaid Agreement) for furnishing Medicaid health care items or services shall, as a
condition of receiving such payments, adopt written fraud, waste and abuse policies and
procedures and inform employees, contractors and agents about the policies and
procedures in compliance with Section 6032 of the Deficit Reduction Act of 2005, 42
U.S.c. § 1396a(a)(68).
13. ADA. LPHA shall comply with Title II of the Americans with Disabilities Act (ADA) of 1990
(codified at 42 U.S.c. 12131 et. seq.) in the construction, remodeling, maintenance and
operation of any structures and facilities, and in the conduct of all programs, services and
training associated with the delivery of Services.
14. Agency-Based Voter Registration. If applicable, LPHA shall comply with the Agency-based
Voter Registration sections of the National Voter Registration Act of 1993 that require voter
registration opportunities be offered where an individual may apply for or receive an
application for public assistance.
15. Disclosure.
a. LPHA shall comply with the provisions of 42 CFR 455.104 which requires the State
Medicaid Agency to obtain the following information from any Provider of Medicaid or
CHIP services, including fiscal agents of Providers and managed care entities: (I) the
name and address (including the primary business address, every business location and
P.O. Box address) of any person (individual or corporation) with an ownership or
control interest in the Provider, fiscal agent or managed care entity; (2) in the case of an
individual, the date of birth and Social Security Number, or, in the case of a
corporation, the tax identification number of the entity, with an ownership interest in the
Provider, fiscal agent or managed care entity or of any subcontractor in which the
Provider, fiscal agent or managed care entity has a 5% or more interest; (3) whether the
person (individual or corporation) with an ownership or control interest in the Provider,
fiscal agent or managed care entity is related to another person with ownership or
control interest in the Provider, fiscal agent or managed care entity as a spouse, parent,
child or sibling, or whether the person (individual or corporation) with an ownership or
control interest in any subcontractor in which the Provider, fiscal agent or managed care
entity has a 5% or more interest is related to another person with ownership or control
interest in the Provider, fiscal agent or managed care entity as a spouse, parent, child or
sibling; (4) the name of any other Provider, fiscal agent or managed care entity in which
an owner of the Provider, fiscal agent or managed care entity has an ownership or
control interest; and, (5) the name, address, date of birth and Social Security Number of
any managing employee of the Provider, fiscal agent or managed care entity.
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b. LPHA shall comply with the provIsions of 42 CFR 455.434 which requires as a
condition of enrollment as a Medicaid or CHIP Provider, to consent to criminal
background checks, including fingerprinting when required to do so under state law, or
by the category of the Provider based on risk of fraud, waste and abuse under federal
law. As such, a Provider must disclose any person with a 5% or greater direct or indirect
ownership interest in the Provider whom has been convicted of a criminal offense
related to that person's involvement with the Medicare, Medicaid, or title XXI program
in the last I 0 years.
c. OHA reserves the right to take such action required by law, or where OHA has
discretion, it deems appropriate, based on the information received (or the failure to
receive) from the Provider, fiscal agent or managed care entity.
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OREGON HEALTH AUTHORITY
2013-2015 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF PUBLIC HEALTH SERVICES
EXHIBITH
REQUIRED PROVIDER CONTRACT PROVISIONS
1. Expenditure of Funds. Provider may expend the funds paid to Provider under this Contract
solely on the delivery of , subject to the following limitations (in addition to
any other restrictions or limitations imposed by this Contract):
a. Provider may not expend on the delivery of any funds paid to Provider
under this Agreement in excess of the amount reasonable and necessary to provide quality
delivery of_ . ____
b. If this Agreement requires Provider to deliver more than one service, Provider may not
expend funds paid to Provider under this Contract for a particular service on the delivery of
any other service.
c. Provider may expend funds paid to Provider under this Contact only in accordance with
federal OMB Circular A-87 as that circular is applicable on allowable costs.
2. Records Maintenance, Access and Confidentiality.
a. Access to Records and Facilities. LPHA, the Oregon Health Authority, the Secretary of
State's Office of the State of Oregon, the Federal Government, and their duly authorized
representatives shall have access to the books, documents, papers and records of Provider
that are directly related to this Contract, the funds paid to Provider hereunder, or any
services delivered hereunder for the purpose of making audits, examinations, excerpts,
copies and transcriptions. In addition, Provider shall permit authorized representatives of
LPHA and the Oregon Health Authority to perform site reviews of all services delivered by
Provider hereunder.
b. Retention of Records. Provider shall retain and keep accessible all books, documents,
papers, and records, that are directly related to this Contract, the funds paid to Provider
hereunder or to any services delivered hereunder, for a minimum of three (3) years, or such
longer period as may be required by other provisions of this Contract or applicable law,
following the termination of this Contract. If there are unresolved audit or other questions
at the end of the above period, Provider shall retain the records until the questions are
resolved.
c. Expenditure Records. Provider shall establish such fiscal control and fund accounting
procedures as are necessary to ensure proper expenditure of and accounting for the funds
paid to Provider under this Contract. In particular, but without limiting the generality of the
foregoing, Provider shall (i) establish separate accounts for each type of service for which
Provider is paid under this Contract and (ii) document expenditures of funds paid to
Provider under this Contract for employee compensation in accordance with Office of
Management and Budget (OMB) Circular A-87 and, when required by LPHA, utilize
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142008 PGM -DESCHUTES COUNTY
time/activity studies in accounting for expenditures of funds paid to Provider under this
Contract for employee compensation. Provider shall maintain accurate property records of
non-expendable property, acquired with Federal Funds, in accordance with OMB Circular
A-I22.
d. Safeguarding of Client Information. Provider shall maintain the confidentiality of client
records as required by applicable state and federal law. Without limiting the generality of
the preceding sentence, Provider shall comply with the following confidentiality laws, as
applicable: ORS 433.045, 433.075, 433.008, 433.017, 433.092, 433.096, 433.098 and 42
CFR Part 2. Provider shall create and maintain written policies and procedures related to
the disclosure of client information, and shall make such policies and procedures available
to LPHA and the Oregon Health Authority for review and inspection as reasonably
requested.
3. Alternative Formats of Written Materials. In connection with the delivery of services,
Provider shall:
a. Make available to a Client, without charge to the Client, upon the Client's, the County's or
the Oregon Health Authority's request, any and all written materials in alternate, if
appropriate, formats as required by Oregon Health Authority administrative rules or by
Oregon Health Authority's written policies made available to Provider.
b. Make available to a Client, without charge to the Client, upon the Client's, County's or the
Oregon Health Authority's request, any and all written materials in the prevalent non
English languages in the area served by Provider.
c. Make available to a Client, without charge to the Client, upon the Client's, County's or the
Oregon Health Authority's request, oral interpretation services in all non-English languages
in the area served by Provider.
d. Make available to a Client with hearing impairments, without charge to the Client, upon the
Client's, LPHA's or the Oregon Health Authority's request, sign language interpretation
services and telephone communications access services.
For purposes of the foregoing, "written materials" includes, without limitation, all work product
and contracts related to this Contract.
4. Compliance with Law. Provider shall comply with all state and local laws, regulations,
executive orders and ordinances applicable to the Contract or to the delivery of services
hereunder. Without limiting the generality of the foregoing, Provider expressly agrees to
comply with the following laws, regulations and executive orders to the extent they are
applicable to the Contract: (a) all applicable requirements of state civil rights and rehabilitation
statutes, rules and regulations; (b) all state laws governing operation of public health programs,
including without limitation, all administrative rules adopted by the Oregon Health Authority
related to public health programs; and (d) ORS 659A.400 to 659A.409, ORS 659A.l45 and all
regulations and administrative rules established pursuant to those laws in the construction,
remodeling, maintenance and operation of any structures and facilities, and in the conduct of all
programs, services and training associated with the delivery of services under this Contract.
These laws, regulations and executive orders are incorporated by reference herein to the extent
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142008 PGM -DESCHUTES COUNTY
that they are applicable to the Contract and required by law to be so incorporated. All
employers, including Provider, that employ subject workers who provide services in the State
of Oregon shall comply with ORS 656.017 and provide the required Workers' Compensation
coverage, unless such employers are exempt under ORS 656.126. In addition, Provider shall
comply, as if it were LPHA thereunder, with the federal requirements set forth in Exhibit G to
that certain 2009-2010 Intergovernmental Agreement for the Financing of Public Health
Services between LPHA and the Oregon Health Authority dated as of July 1, 2010, which
Exhibit is incorporated herein by this reference. For purposes of this Contract, all references in
this Contract to federal and state laws are references to federal and state laws as they may be
amended from time to time.
5. Grievance Procedures. If Provider employs fifteen (15) or more employees to deliver the
services under this Contract, Provider shall establish and comply with employee grievance
procedures. In accordance with 45 CFR 84.7, the employee grievance procedures must provide
for resolution of allegations of discrimination in accordance with applicable state and federal
laws. The employee grievance procedures must also include "due process" standards, which, at
a minimum, shall include:
a. An established process and time frame for filing an employee grievance.
b. An established hearing and appeal process.
c. A requirement for maintaining adequate records and employee confidentiality.
d. A description of the options available to employees for resolving disputes.
Provider shall ensure that its employees and governing board members are familiar with the
civil rights compliance responsibilities that apply to Provider and are aware of the means by
which employees may make use of the employee grievance procedures. Provider may satisfy
these requirements for ensuring that employees are aware of the means for making use of the
employee grievance procedures by including a section in the Provider employee manual that
describes the Provider employee grievance procedures, by publishing other materials designed
for this purpose, or by presenting information on the employee grievance procedures at periodic
intervals in staff and board meetings.
6. Independent Contractor. Unless Provider is a State of Oregon governmental agency,
Provider agrees that it is an independent contractor and not an agent ofthe State of Oregon, the
Oregon Health Authority or LPHA.
7. Indemnification. To the extent permitted by applicable law, Provider shall defend (in the case
of the State of Oregon and the Oregon Health Authority, subject to ORS chapter 180), save and
hold harmless the State of Oregon, the Oregon Health Authority, LPHA, and their officers,
employees, and agents from and against all claims, suits, actions, losses, damages, liabilities,
costs and expenses of any nature whatsoever resulting from, arising out of or relating to the
operations ofthe Provider, including but not limited to the activities of Provider or its officers,
employees, Providers or agents under this Contract.
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8. Required Provider Insurance Language.
a. First tier Provider(s) that are not units of local government as defined in ORS 190.003
shall obtain, at Provider's expense, and maintain in effect with respect to all
occurrences taking place during the term of the contract, insurance requirements as
specified in Exhibit I of the 2013-2015 Intergovernmental Agreement for the Financing
of Public Health Services between LPHA and the Oregon Health Authority and
incorporated herein by this reference.
b.. Provider(s) that are not units of local government as defined in ORS 190.003, shall
indemnify, defend, save and hold harmless the State of Oregon and its officers,
employees and agents ("Indemnitee") from and against any and all claims, actions,
liabilities, damages, losses, or expenses (including attorneys' fees) arising from a tort
(as now or hereafter defined in ORS 30.260) caused, or alleged to be caused, in whole
or in part, by the negligent or willful acts or omissions of Provider or any of the
officers, agents, employees or subcontractors of the contractor( "Claims"). It is the
specific intention of the parties that the Indemnitee shall, in all instances, except for
Claims arising solely from the negligent or willful acts or omissions of the Indemnitee,
be indemnified by the Provider from and against any and all Claims.
9. Subcontracts. Provider shall include sections I through 8, in substantially the form set forth
above, in all permitted subcontracts under this Agreement.
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OREGON HEALTH AUTHORITY
2013-2015 INTERGOVERNMENTAL AGREEMENT
FOR THE FINANCING OF PUBLIC HEALTH SERVICES
EXHIBIT I
PROVIDER INSURANCE REQUIREMENTS
General Requirements. LPHA shall require its first tier Providers(s) that are not units of local
government as defined in ORS 190.003, if any, to: i) obtain insurance specified under TYPES AND
AMOUNTS and meeting the requirements under ADDITIONAL INSURED, "TAIL" COVERAGE,
NOTICE OF CANCELLATION OR CHANGE, and CERTIFICATES OF INSURANCE before the
Providers perform under contracts between LPHA and the Providers (the "Provider Contracts"), and ii)
maintain the insurance in full force throughout the duration of the Provider Contracts. The insurance
must be provided by insurance companies or entities that are authorized to transact the business of
insurance and issue coverage in the State of Oregon and that are acceptable to OHA. LPHA shall not
authorize Providers to begin work under the Provider Contracts until the insurance is in full force.
Thereafter, LPHA shall monitor continued compliance with the insurance requirements on an annual or
more frequent basis. LPHA shall incorporate appropriate provisions in the Provider Contracts
permitting it to enforce Provider compliance with the insurance requirements and shall take all
reasonable steps to enforce such compliance. Examples of "reasonable steps" include issuing stop work
orders (or the equivalent) until the insurance is in full force or terminating the Provider Contracts as
permitted by the Provider Contracts, or pursuing legal action to enforce the insurance requirements. In
no event shall LPHA permit a Provider to work under a Provider Contract when the LPHA is aware
that the Provider is not in compliance with the insurance requirements. As used in this section, a "first
tier" Provider is a Provider with whom the LPHA directly enters into a Provider Contract. It does not
include a subcontractor with whom the Provider enters into a contract.
TYPES AND AMOUNTS.
1. WORKERS COMPENSATION. Insurance in compliance with ORS 656.017, which requires
all employers that employ subject workers, as defined in ORS 656.027, to provide workers'
compensation coverage for those workers, unless they meet the requirement for an exemption
under ORS 656.126(2). Employers Liability insurance with coverage limits of not less than
$500,000 must be included.
2. PROFESSIONAL LIABILITY
Il:1 Required by OHA 0 Not required by OHA.
Professional Liability Insurance covering any damages caused by an error, omission or
negligent act related to the services to be provided under the Provider Contract, with limits
not less than the following, as determined by OHA, or such lesser amount as OHA approves
in writing:
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C8J Per occurrence for all claimants for claims arising out of a single accident or occurrence:
Provider Contract not-to-exceed under this
Agreement:
Required Insurance Amount:
i $0 -$1,000,000. $1,000,000.
$1,000,001. -$2,000,000. $2,000,000.
$2,000,00 I. -$3,000,000. $3,000,000.
In excess of$3,000,001. $4,000,000.
I
J
3. COMMERCIAL GENERAL LIABILITY
[8J Required by OHA D Not required by OHA.
Commercial General Liability Insurance covering bodily injury, death, and property damage in a
form and with coverages that are satisfactory to OHA. This insurance shall include personal injury
liability, products and completed operations. Coverage shall be written on an occurrence form
basis, with not less than the following amounts as determined by OHA, or such lesser amount as
OHA approves in writing:
Bodily Injury, Death and Property Damage:
[8J Per occurrence for all claimants for claims arising out of a single accident or occurrence:
I
Provider Contract not-to-exceed under this
Agreement:
Required Insurance Amount:
$0 -$1,000,000. $1,000,000.
I
$1,000,001. -$2,000,000. $2,000,000.
$2,000,00 I. -$3,000,000. $3,000,000.
I In excess of $3,000,00 1. $4,000,000.
4. AUTOMOBILE LIABILITY INSURANCE
[8J Required by OHA D Not required by OHA.
Automobile Liability Insurance covering all owned, non-owned and hired vehicles. This
coverage may be written in combination with the Commercial General Liability Insurance
(with separate limits for "Commercial General Liability" and "Automobile Liability").
Automobile Liability Insurance must be in not less than the following amounts as
determined by OHA, or such lesser amount as OHA approves in writing:
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Bodily Injury, Death and Property Damage:
~ Per occurrence for all claimants for claims arising out of a single accident or occurrence:
I Provider Contract not-to-exceed under this
i Agreement:
Required Insurance Amount:
$0 -$1,000,000. $1,000,000.
$1,000,001. -$2,000,000. $2,000,000.
$2,000,001. -$3,000,000. $3,000,000.
In excess of $3,000,00 1. $4,000,000.
5. ADDITIONAL INSURED. The Commercial General Liability insurance and Automobile
Liability insurance must include the State of Oregon, its officers, employees and agents as
Additional Insureds but only with respect to the Provider's activities to be performed under the
Provider Contract. Coverage must be primary and non-contributory with any other insurance
and self-insurance.
6. "TAIL" COVERAGE. If any of the required insurance policies is on a "claims made" basis,
such as professional liability insurance, the Provider shall maintain either "tail" coverage or
continuous "claims made" liability coverage, provided the effective date of the continuous
"claims made" coverage is on or before the effective date of the Provider Contract, for a
minimum of 24 months following the later of : (i) the Provider's completion and LPHA 's
acceptance of all Services required under the Provider Contract or, (ii) the expiration of all
warranty periods provided under the Provider Contract. Notwithstanding the foregoing 24-month
requirement, if the Provider elects to maintain "tail" coverage and if the maximum time period
"tail" coverage reasonably available in the marketplace is less than the 24-month period described
above, then the Provider may request and OHA may grant approval of the maximum "tail "
coverage period reasonably available in the marketplace. If OHA approval is granted, the Provider
shall maintain "tail" coverage for the maximum time period that "tail" coverage is reasonably
available in the marketplace.
7. NOTICE OF CANCELLATION OR CHANGE. The Provider or its insurer must provide 30
days' written notice to LPHA before cancellation of, material change to, potential exhaustion of
aggregate limits of, or non-renewal of the required insurance coverage(s).
8. CERTIFICATE(S) OF INSURANCE. LPHA shall obtain from the Provider a certificate(s)
of insurance for all required insurance before the Provider performs under the Provider
Contract. The certificate(s) or an attached endorsement must specify: i) all entities and
individuals who are endorsed on the policy as Additional Insured and ii) for insurance on a
"claims made" basis, the extended reporting period applicable to "tail" or continuous "claims
made" coverage.
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