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Home My WebLink AboutDoc 457 - IGA - DHS - Health Services2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 1 of 148 pages 132011 pgm.DOC - Deschutes County In compliance with the Americans with Disabilities Act, this document is available in alternate formats such as Braille, large print, audio tape, oral presentation, and electronic format. To request an alternate format call the State of Oregon, Department of Human Services, Office of Forms and Document Management at (503) 378-3523 or TTY (503) 947-5330. AGREEMENT #132011 DEPARTMENT OF HUMAN SERVICES 2010-2011 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES This Department of Human Services 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services (the “ Agreement ”) is between the State of Oregon acting by and through its Department of Human Services (“ Department ”) 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 Department and the 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 the Department 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 of Department; WHEREAS, LPHA has requested financial assistance from Department to operate or contract for the operation of LPHA’s public health programs; WHEREAS, Department is willing, upon the terms of 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: 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 2 of 148 pages 132011 pgm.DOC - Deschutes County AGREEMENT 1. Effective Date and Duration. This Agreement shall become effective on July 1, 2010 . Unless terminated earlier in accordance with its terms, this Agreement shall terminate on June 30, 2011. 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 In the event of a conflict 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: (a) this Agreement without Exhibits, (b) Exhibit A (c) Exhibit F, (d) Exhibit E (e) Exhibit C, (f) Exhibit D, (g) Exhibit B, (h) Exhibit G, and (i) Exhibit H. 3. Vendor or Sub-Recipient Determination. In accordance with the State Controller’s Oregon Accounting Manual, policy 30.40.00.102, and DHS procedure “Contractual Governance”, DHS’ determination is that LPHA is a sub-recipient . Catalog of Federal Domestic Assistance (CFDA) #(s) of federal funds to be paid through this Agreement are listed at Exhibit A, Section 16 “Program Element”.) 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 3 of 148 pages 132011 pgm.DOC - Deschutes County IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the dates set forth below their respective signatures. APPROVED: STATE OF OREGON ACTING BY AND THROUGH ITS DEPARTMENT OF HUMAN SERVICES (D EPARTMENT ) By: Name: William J. Coulombe Title: Deputy Public Health Director Date: DESCHUTES COUNTY ACTING BY AND THROUGH ITS DESCHUTES COUNTY HEALTH SERVICES (LPHA) By: Name: Title: Date: DEPARTMENT OF JUSTICE – APPROVED FOR LEGAL SUFFICIENCY Approved by D. Kevin Carlson, Senior Assistant Attorney General on June 7, 2010. Copy of approval on file at DHS, Office of Contracts and Procurement (OC&P.) REVIEWED : DEPARTMENT OF HUMAN SERVICES , OFFICE OF CONTRACTS & PROCUREMENT By: Name: Phillip G. McCoy, OPBC Title: Contract Specialist Date: 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 4 of 148 pages 132011 pgm.DOC - Deschutes County DEPARTMENT OF HUMAN SERVICES 2010-2011 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 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services. 2. “Agreement Settlement” means Department’s reconciliation, after termination of this Agreement, of amounts Department actually disbursed to LPHA under this Agreement with amounts that Department is obligated to pay to LPHA under this Agreement based on allowable expenditures as properly reported to Department in accordance with this Agreement. Department 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. “Claim” has the meaning set forth in Section 4 of Exhibit F. 5. “Conference of Local Health Officials” or “CLHO” means the Conference of Local Health Officials created by ORS 431.330. 6. “Department” means the Department of Human Services of the State of Oregon. 7. “Federal Funds” means all funds paid to LPHA under this Agreement that Department receives from an agency, instrumentality or program of the 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 Award 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 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 5 of 148 pages 132011 pgm.DOC - Deschutes County 12. “Medicaid” means Federal Funds received by Department under Title XIX of the Social Security Act. 13. “Misexpenditure” means money disbursed to LPHA by Department 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 Department 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 Department 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 any one 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 Department pays to LPHA pursuant to this Agreement: Program Element Name Funding Source(s) Program Element Code State Support for Public Health (SSPH) General Fund PE 01 Cities Readiness Initiative (CRI) Program 93.069 PE 02 Tuberculosis (TB) Services General Fund PE 03 Public Health Response to H1N1 Influenza Vaccination Program 93.069 PE 04 Health Impact Assessment Program (HIA) Other Funds PE 05 HIV Prevention Services General Fund and CFDA# 93.940 PE 07 Ryan White Title II HIV/ AIDS Services General Fund, Other Funds and CFDA# 93.917 PE 08 Ryan White Part B MAI HIV/AIDS Services Other Funds PE 09 Sexually Transmitted Disease (STD) General Fund and CFDA# 93.940 PE 10 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 6 of 148 pages 132011 pgm.DOC - Deschutes County Public Health Emergency Preparedness and Communicable Disease Response Program CFDA# 93.069 PE 12 Tobacco Prevention and Education Program (TPEP) Other Funds PE 13 Healthy Communities (HC) Phase I Other Funds PE 14 Healthy Communities (HC) Phase II Other Funds PE 15 Tribal, Tobacco Prevention and Education Program (TPEP) Other Funds PE 16 Program Design and Evaluation Services (PDES) General Fund, Other Funds and CFDA#’s 93.110, 93.116, 93.944, 93.253, 93.283, 93.240, 66.609, 20.613, and 93.994 PE 19 Statewide Lead-Line Program CFDA# 66.707 PE 20 Services to Victims of Sexual Offenses (SO) (OCADSV only) CFDA# 93.991 PE 21 Emerging Infections Program (EIP) (OHSU only) CFDA# 93.283 PE 23 Hepatitis C Registry Study Program CFDA# 93.283 PE 24 Metropolitan Area Pertussis Surveillance (MAPS) CFDA# 93.283 PE 25 Active Bacterial Core Surveillance (ABCs) CFDA# 93.283 PE 26 Assoc. for Professionals in Infection Control & Epidemiology (APIC) CFDA# 93.283 PE 29 Youth Suicide Prevention Services CFDA# 93.243 PE 35 Multnomah Co. Hepatitis C Surveillance (OHSU Only) CFDA# 93.283 PE 38 Maternity Case Management (MCM) Program (Deschutes and Hood River Counties only) CFDA# 66.609 PE 39 Family Health Services (FHS) WIC and WIC Farmers Market CFDA# 10.557 and 10.578 PE 40 FHS Women’s Health & Family Planning Services CFDA# 93.217 PE 41 FHS Maternal and Child Health (MCH) Services General Fund and CFDA# 93.994 PE 42 FHS Immunization Services General Fund and CFDA#s 93.268 and 93.712 PE 43 FHS School-Based Health Centers General Fund PE 44 Tribal Maternal and Child Health (MCH) Services CFDA# 93.994 PE 45 Tribal Immunization Services (ARRA Stimulus Funds) CFDA# 93.712 PE 46 Project LAUNCH CFDA# 93.243 PE 47 17. “Program Element Description” means the description of the services falling within a Program Element, as set forth in Exhibit B. 18. “Underexpenditure” means money disbursed to LPHA by Department under this Agreement that remains unexpended by LPHA at Agreement termination. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 7 of 148 pages 132011 pgm.DOC - Deschutes County DEPARTMENT OF HUMAN SERVICES 2010-2011 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES EXHIBIT B 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 or CD: 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 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://www.oregon.gov/DHS/ph/lhd/reference.shtml , and the Department of Human Services in accordance with ORS 431.345 and OAR 333 Division 14. 3. Standards for Program Operation a. LPHA must operate its Communicable Disease control 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. b. As part of its Communicable Disease control program, LPHA must, within its service area, investigate the outbreak of Communicable Diseases, institute appropriate Communicable 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 8 of 148 pages 132011 pgm.DOC - Deschutes County Disease control measures, and submit reports to Department as prescribed in DHS CD Investigative Guidelines available at http://Oregon.gov/DHS/ph/acd/reporting/disrpt.shtml. c. In anticipation of next year's annual plan (ORS 431.385), LPHA must develop a plan to reduce barriers to accreditation. The LPHA will use the results of the self assessment survey conducted last year and within the limits of available funds, identify accreditation barriers and implement a plan to reduce those barriers. Implementation report to be completed by October 15, 2010. 4. Reporting Requirements LPHA must complete and submit to Department, no later than August 25, 2011, an Oregon Department of Human Services Public Health Division Expenditure and Revenue Report with respect to LPHA’s expenditure of the funds provided under this Agreement for SSPH. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 9 of 148 pages 132011 pgm.DOC - Deschutes County 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. a. 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 the Department’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. i. Evaluated (in context of contact investigation): A contact received a complete TB symptom review and tests as described in the Department’s Investigative Guidelines. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 10 of 148 pages 132011 pgm.DOC - Deschutes County 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 October 2009, which are incorporated herein by this reference are available for review at (new link to be inserted) . l. Latent TB Infection (LTBI): 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, physical examination, TB skin test or QuantiFERON –TB Gold 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 the Department’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 the Department’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. (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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 11 of 148 pages 132011 pgm.DOC - Deschutes County (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 of TB. 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, the Department must be contacted and a plan to ensure compliance discussed. (A) Clinical indications which may require DOT include: (I) HIV and TB co-infection (II) Reactivation of TB 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 (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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 12 of 148 pages 132011 pgm.DOC - Deschutes County (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 of the 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 nonadherence (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 of TB within LPHA’s jurisdiction 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). c. 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. d. 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 the Department. e. The LPHA will accept Class B waivers and interjurisdictional 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 the Department: 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 13 of 148 pages 132011 pgm.DOC - Deschutes County a. LPHA shall notify the Department’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 the Department, notify the Department 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 the Department’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 the Department’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 the Department’s TB Program in accordance with the timelines described in the instructions for the reporting forms designated by the Department 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, 93.0% 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 (LTBI), 88.0% will start treatment. e. For contacts of sputum AFB smear-positive TB cases that have started treatment for newly diagnosed LTBI, 79.0% will complete treatment . f. For TB cases in patients ages 12 years or older with a pleural or respiratory site of disease, 95% will have a sputum culture result reported. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 14 of 148 pages 132011 pgm.DOC - Deschutes County Program Element #07: HIV 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 high-risk populations in LPHA’s service area; and c. structural activities that facilitate the delivery of HIV prevention services to high-risk populations in the LPHA’s service area. All services must be provided in accordance with the LPHA’s Planning Worksheet #3 Program Model Target Numbers that has been approved by the DHS HIV Prevention Program. High-risk populations identified in Oregon are persons living with HIV, men who have sex with men, injection drug users, men who have sex with men who also inject drugs, and sex partners of any of the above. Funds awarded under this Agreement may only be expended on Services included in the LPHA’s HIV Prevention Planning Worksheet #3 Program Model Target Numbers that has been approved by the DHS HIV Prevention Program. 2. Definitions Specific to HIV Prevention Services. a. CLHO/HIV: Conference of Local Health Officials/HIV subcommittee of CLHO Executive. b. CDC: Federal Centers for Disease Control and Prevention. 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. 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 to other appropriate services. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 15 of 148 pages 132011 pgm.DOC - Deschutes County e. HIV Prevention Planning Worksheet #3 Program Model Target Numbers: The plan set forth in Attachment 1 attached hereto and incorporated herein by this reference 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. f. Comprehensive Risk Counseling Services or “CRCS” (formerly known as Prevention Case Management or “PCM”): Individual-centered HIV prevention intervention activity with the fundamental goal of promoting the adoption of HIV risk-reduction behaviors by individuals with multiple, complex problems and risk-reduction needs. CRCS provides intensive, ongoing, and individualized prevention counseling, support and service brokerage. g. 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 so they can avoid infection, or, if already infected, can prevent transmitting to others. PCRS helps partners gain earlier access to individualized counseling, HIV testing, medical evaluation, treatment, and other prevention services. h. Program Evaluation and Monitoring System or PEMS: The individual-level and aggregate-level data system developed by CDC to monitor services provided by CDC- funded state and local health departments and community-based organizations. i. Community Review Panel (a/k/a 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/forms/hiv.htm , that reviews and 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 Department or the LPHA. j. 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. k. Rapid HIV Test: An FDA-approved HIV test that yields negative and preliminary positive test results within a short time period (less than 30 minutes) after processing specimen. l. 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.) m. Clinical Laboratory Improvement Amendments or CLIA: Federal legislation that governs the licensing of laboratories n. CLIA Certificate of Waiver: Allows laboratory to perform simple laboratory tests. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 16 of 148 pages 132011 pgm.DOC - Deschutes County 3. Procedural and Operational Requirements a. Staffing Requirements and Staff Qualifications 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 client focused counseling methods and in rapid HIV counseling and testing (if providing Rapid HIV Tests) according to CDC HIV CTRS guidelines. Baseline training will be available from Department in accordance with a schedule to be determined by Department in consultation with LPHA. ii. Other HIV Prevention Services and Structural Activities. (a.) All individuals 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 must have a demonstrated ability to work with the targeted populations identified in the LPHA’s HIV Prevention Planning Worksheet #3 Program Model Target Numbers. (b.) At least one staff member or supervisor, 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 Department from time to time. b. Minimum Service Requirements i. 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 Planning Worksheet #3 Program Model Target Numbers and must meet the following minimum requirements: (a.) 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 HIV testing available, LPHA is not required to make both available at every site at which LPHA offers HIV testing. (b.) HIV Counseling, Testing and Referral Services must be provided in accordance with applicable Oregon and Federal statutory and regulatory requirements, must be easily accessible and available and culturally appropriate, and must include information about HIV/AIDS reporting laws. (c.) HIV Counseling, Testing and Referral Services must be available regardless of an individual’s ability to pay. LPHA may impose fees for HIV Counseling, Testing and 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 17 of 148 pages 132011 pgm.DOC - Deschutes County 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 Counseling, Testing and Referral Services. LPHA must report all HIV Counseling, Testing, and Referral Services fee revenue and donations to Department on the revenue and expenditure reports required by Section 8 of Exhibit E of this Agreement. (d.) All individuals receiving HIV Testing, Counseling and Referral Services who are at increased risk for HIV infection must receive information about appropriate prevention and testing services for related infections (e.g., hepatitis, sexually transmitted infections, and tuberculosis). (e.) 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 and commit to steps to reduce risk, while emphasizing realistic behavior change goals. (f.) LPHAs will attempt to assure that at least 75% of negative and 95% of positive test results are delivered to clients testing for HIV. (g.) 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. (h.) If LPHA tests an individual for HIV and the test result is positive (either preliminary or confirmatory), LPHA must: (1.) Explain to the individual the meaning of the test results. (2.) Encourage the individual to participate in Partner Counseling and Referral Services and facilitate entry to this service when the individual expresses interest in the referral. (3.) Provide the individual with information about and/or referral to Comprehensive Risk Counseling Services. (4.) Provide the individual with information about and/or referral to mental health follow-up, when available and when appropriate. (5.) Provide the individual with information about and/or referral to support services and organizations. (6.) Maintain the strict confidentiality of both the receipt of the HIV test and the HIV test result. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 18 of 148 pages 132011 pgm.DOC - Deschutes County (7.) If the result is a Rapid HIV Test preliminary positive, offer the individual a confirmatory HIV test or referral for confirmatory HIV testing. (8.) If the result is a confirmatory positive, provide the individual with: (i.) Referral for medical evaluation. (ii.) Counseling regarding the notification of partners at risk. (iii.) Information about and/or referral to Partner Counseling and Referral Services, if available and appropriate. (iv.) Information about accessing and/or referral to HIV case management services, insurance (such as the Oregon Health Plan) and emergency resources (Ryan White, CareAssist) if available and appropriate. (i.) 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 by Oregon or Federal statute or regulation. A written copy of the confidential HIV test results may be released to the individual tested only upon request of that individual and after that individual or an authorized representative has signed an appropriate release. Individuals who receive anonymous HIV testing may only receive a verbal notification of the HIV test result. (j.) An LPHA utilizing Rapid HIV Tests must be enrolled in CLIA and have a Certificate of Waiver. (k.) LPHA must designate an employee involved in LPHA’s HIV Counseling, Testing and Referral Services to participate with Department staff in the development and implementation of quality assurance activities related to HIV Counseling, Testing and Referral Services. (l.) A Department-approved HIV Test Request and HIV Counseling, Testing, and Referral Forms must be completed for each HIV counseling and testing encounter that is supported in whole or in part with funds provided under this Agreement. The Department-approved HIV Test Request and HIV Counseling, Testing, and Referral Forms, including "post-test disposition," must be returned to the address specified on the HIV Counseling, Testing, and Referral Request form within one week of the day following the reporting of HIV test results to the individual tested. If the individual tested does not return for results within 30 days of testing, the Department-approved HIV Counseling, Testing, and Referral Form, including "post-test disposition," must indicate why the results were not provided to the individual and must be returned, to the address specified on the HIV Test Request form, within one week of the 30-day period after testing. ii. Other 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 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 19 of 148 pages 132011 pgm.DOC - Deschutes County Prevention Planning Worksheet #3 Program Model Target Numbers and must meet the following minimum requirements: (a.) Program must be evidence-based and targeted to a prioritized risk population identified by the Oregon Statewide HIV Prevention Planning Group, as indicated in its Oregon HIV Prevention Comprehensive Plan, dated September 2009, available at http://oregon.gov/DHS/ph/hiv. (b.) Strategies endorsed by the CDC, such as Comprehensive Risk Counseling Services, Social Network strategies, outreach or recruitment into Counseling and Testing or other evidence-based intervention, may be implemented, subject to approval of the LPHA’s Planning Worksheet #3 Program Model Target Numbers by the DHS HIV Prevention Program. (c.) 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 Worksheet #3 Program Model Target Numbers by the DHS HIV Prevention Program. (d.) DHS HIV Prevention-approved programs must be implemented with fidelity to the core elements of the evidence-based intervention. (A core element is an aspect of the intervention that must not be modified because it is crucial to satisfying the intervention’s risk reduction objectives.) iii. 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: (a.) All individuals who provide HIV prevention services supported in whole or in part with funds provided under this Agreement must participate in related process monitoring and evaluation activities, including the submission of data for entry into PEMS, as reasonably requested by Department and consistent with CDC Guidelines. (b.) Condoms must be available and distributed to populations engaging in high risk behaviors, consistent with populations targeted by the LPHA in its HIV Prevention Planning Worksheet #3 Program Model Target Numbers. (c.) 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 Community Review Panel in accordance with CDC guidelines. (d.) All HIV educational materials developed or purchased with HIV Prevention Services funds and approved by the Community Review Panel must be accessible to the public or target population in LPHA’s service area. (e.) LPHA must collect and submit all individual-level and aggregate-level data, as described in and using the designated PEMS forms to the Department within one week of the date on which the individual received the service. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 20 of 148 pages 132011 pgm.DOC - Deschutes County (f.) No financial assistance provided to LPHA for HIV Prevention Services may used to provide treatment and/or case management services. iv. Conflicts. In the event of a conflict or inconsistency between the provisions of the HIV Prevention Planning Worksheet #3 Program Model Target Numbers and the other provisions of this Program Element Description, the other provisions of this Program Element Description shall prevail. v. Confidentiality. In addition to the requirements set forth in Section 6 of Exhibit E of this Agreement and Section 3.b.(i) of this Program Element Description, all providers of HIV Prevention Services supported in whole or in part with funds provided under this Agreement must comply with the following confidentiality requirements: (a.) 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. (b.) 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, 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 Department the nature of confirmed breaches by its staff, including volunteers, of the confidentiality requirements of this Program Element Description within 14 days form the date of evaluation by the provider. (c.) 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 or volunteer for a verified breach of the confidentiality requirements of this Program Element Description. (d.) Providers of HIV Prevention Services must conduct an annual review, and maintain documentation of that review, of county, state, and federal requirements regarding the confidentiality of information related to individuals receiving HIV Prevention Services. Providers of HIV Prevention Services must require employees and volunteers who, in the course of performing their job, have access to such information to have an annual confidentiality review and by his/her signature acknowledge understanding of the information. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 21 of 148 pages 132011 pgm.DOC - Deschutes County vi. 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 Oregon HIV Prevention Comprehensive Plan dated September 2009, available at http://oregon.gov/DHS/ph/hiv/. (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 are relevant to the intervention and/or working with the target populations; (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 Planning Worksheet #3 Program Model Target Numbers, which has been approved by the Department. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 22 of 148 pages 132011 pgm.DOC - Deschutes County Attachment 1 Program Element #7 – HIV Prevention Services Local HIV Prevention Program Planning Worksheet #3 Program Model Target Numbers 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 23 of 148 pages 132011 pgm.DOC - Deschutes County 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 24 of 148 pages 132011 pgm.DOC - Deschutes County 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 25 of 148 pages 132011 pgm.DOC - Deschutes County 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 26 of 148 pages 132011 pgm.DOC - Deschutes County 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 27 of 148 pages 132011 pgm.DOC - Deschutes County 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 28 of 148 pages 132011 pgm.DOC - Deschutes County Attachment 2 Program Element #7 – HIV Prevention Services Local HIV Prevention Program Spending Plan 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 29 of 148 pages 132011 pgm.DOC - Deschutes County 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 30 of 148 pages 132011 pgm.DOC - Deschutes County 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 31 of 148 pages 132011 pgm.DOC - Deschutes County 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 2010), 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 allowable: 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 Program, Part B Ryan White Program, Part B HIV 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/AIDS 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/AIDS Services. These standards are available at www.healthoregon.org/hiv . 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 32 of 148 pages 132011 pgm.DOC - Deschutes County c. HRSA/HAB or Health Resources and Services Administration/HIV/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 Department 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 Program. e. Portland TGA: The Portland Transitional Grant Area consisting of Clackamas , Columbia , Multnomah , Washington , and Yamhill counties in Oregon, and Clark county in Washington state. f. 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. g. 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. h. Oregon Ryan White Program, Part B HIV Care & Treatment Program Manual (July 2010): 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 Requirements. 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 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 33 of 148 pages 132011 pgm.DOC - Deschutes County 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/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/AIDS Services may only be used for services necessary to facilitate a person living with HIV/AIDS to access 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. 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. v. Financial assistance provided under this Agreement for Ryan White Program, Part B HIV/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.org/hiv . vi. 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 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 34 of 148 pages 132011 pgm.DOC - Deschutes County c. General Requirements Applicable to all Ryan White Program, Part B HIV/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) which is available for download and review at www.healthoregon.org/hiv . ii. All Ryan White Program, Part B HIV/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 only 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 Department 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 .) 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/AIDS Services. ii. All Case Management services must be delivered in accordance with the Oregon Program, Part B HIV 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 of the individual receiving the services, appropriately signed and dated 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 35 of 148 pages 132011 pgm.DOC - Deschutes County 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/AIDS 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/AIDS 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/AIDS 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/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/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 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/AIDS Services must report to Department 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/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 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 36 of 148 pages 132011 pgm.DOC - Deschutes County 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/AIDS Services must provide an on-site private room for individuals providing Case Management services to counsel or 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 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 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 Case Management Standards of Service. iii. All LPHA and Provider staff who 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 Department. Department 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 Department upon request. 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 2010) are being met and taking appropriate action if they are not. LPHA must submit to Department copies of all Provider Agreements (i.e. LPHA Financial Assistance Grant Agreements) for the delivery of Ryan White Program, Part B HIV/AIDS Services during the term of this Agreement. LPHA may not pay the Provider with funds received under this Agreement for this Program Element until Department has received a copy of the Provider Agreement. Department’s obligation to disburse financial assistance provided under this Agreement for this Program Element to cover payments on a Provider Agreement is conditioned on Department’ receipt of a copy of that Provider Agreement. LPHA must notify Department in writing of LPHA’s process for selecting Providers to provide Ryan White Program, Part B HIV/AIDS 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 37 of 148 pages 132011 pgm.DOC - Deschutes County ii. LPHA must notify Department within 10 business days and in writing, of proposed changes, during the term of this Agreement, in the availability of Ryan White Program, Part B HIV/AIDS Services funded through this Agreement, i.e. service hours, staffing, professional qualifications of staff, and fiscal management. 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 shall submit the following reports and information to Department: 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. Quarterly Progress Reports include a narrative report and Administrative Fiscal Form. Reporting forms are found in the Program Manual (July 2010). 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 2010) and submitted to the Program not later than October 31. c. 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 Department as described in the Program, Part B Program Manual (July 2010). This manual may be obtained from www.healthoregon.org/hiv . 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 4.1 User Guide found in the Program Manual (July 2010). 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 from Department 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 at Department, requiring LPHA to connect to the centralized database for data entry purposes. 5. Performance Goals. Department 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.oregon.gov/DHS/ph/lhd/lhd-trt.shtml . 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 38 of 148 pages 132011 pgm.DOC - Deschutes County Attachment 1 Oregon Ryan White Program, Part B HIV Case Management Quality Improvement Program Care Services Budget HIV CASE MANAGEMENT AND SUPPORT SERVICES PROGRAM BUDGET FY 2011 (J ULY 1, 2010 – JUNE 30, 2011) COUNTY/SERVICE PROVIDER: Deschutes County Public Health Department Administrator/ED: HIV Case Management and Support Services Program Supervisor: Phone: Fax: e-mail: SECTION 1: Award Allocation 1. Amount of funds awarded for Case Management services $76,534 Amount of funds awarded for Support Services $21,262 2. Does your agency accept this award? Yes, the county/service concurs with the Department of Human Services (DHS/PH), HIV Care and Treatment Program plan for services in FY 2011. No, the county/service declines to accept the funds assigned. The agency understands that in choosing this option the Department of Human Services will identify a service provider to provide Ryan White service in the community for FY 2011. 3. The county/service provider has the option to move up to 25% of the Support Services allocation to the Case Management line item. Would you like to exercise this option? No, the county/service provider will use the original award allocation presented above. Yes, the county/service provider would like to move 25% of the support services award to the case management earmark. IMPORTANT: You must call Jill Snyder at 971-673- 0156 before continuing with this form. Approved 03/30/10 jfs 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 39 of 148 pages 132011 pgm.DOC - Deschutes County SECTION II: Budget Projections IMPORTANT 1. This form must be completed by staff responsible for program budgets and fiscal monitoring. 2. If you are sub-contracting for services, the county must submit a Care Service Budget form for the sub-contracting agency and the county/service provider Case Management Earmark Only Line Item 1. Annual Salary & Fringe (Direct Services) 2. FTE 3. # of Hours/ Month 4. Admin/ Indirect (no more than 10%) 5. Total 6. Other Funds (Agency Contribution) Not Required Personnel Example: John Doe $38,750 .50 86 $19,375 $1500 Case Management (non-nurse staff) Name of Staff $ $ $ $ $ $ $ $ $ $ $ $ Nurse Case Management (RN) Name of Staff $ $ $ Non-Case Management or Supervisory Services Name of Staff $ $ $ Total Salaries & Total # of Hours Per Month $ $ (Total Indirect) $ $ 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 40 of 148 pages 132011 pgm.DOC - Deschutes County Line Item 1. Annual Salary & Fringe (Direct Services) 2. FTE 3. # of Hours/ Month 4. Admin/ Indirect (no more than 10%) 5. Total 6. Other Funds (Agency Contribution) Not Required Direct Program Costs (materials, equipment, and supplies) $ $ $ $ Other Indirect (please describe): $ $ $ Grand Total (Equal to total Case Management Earmark) $ $ $ $ Support Services Earmark Only Line Item 1. Direct Services 2. Admin/Indirect (no more than 10%) 3. Grand Total (Equal to total Support Services Earmark) 4. Other Funds (Agency Contribution) Not Required Support Services $ $ $ $ A. PLEASE NOTE: IF ANY LINE ITEM CHANGES WITHIN EACH EARMARK BY MORE THAN 25% WITHIN THE FISCAL YEAR , THE COUNTY MUST SUBMIT AN UPDATED BUDGET. PLEASE CONTACT JILL SNYDER , 971-673-0156 FOR FURTHER DETAILS . 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 41 of 148 pages 132011 pgm.DOC - Deschutes County B. Detailed Description of Admin/Indirect Activities If Admin/Indirect is reported on the line item budget for either the Case Management or Support Services Earmark please answer the following questions. 1. Attach the county/service provider’s Indirect Schedule/Cost Allocation Plan. If this is not available please list what your agencies Indirect covers (i.e. rent, phone, supplies) 2. Describe in detail how these funds will be used to support and monitor the HIV Case Management and Support Services Program and the counties/agencies sub-contractors (i.e. frequency of site visits, chart reviews, etc.). The program reserves the right to request time activity logs related to this work within the FY. C. Signature lines: Budget completed by: Fiscal Manager (or responsible party): Date: D. E-mail to: Jill Snyder, HST Fiscal Coordinator - jill.f.snyder@state.or.us Or mail to: DHS/PH 800 NE Oregon St. #1105 attn: Jill Snyder, HST Fiscal Coordinator Portland, OR 97232 E. Due by: April 1, 2010 F. Questions? Call Jill Snyder at 971-673-0156 or jill.f.snyder@state.or.us 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 42 of 148 pages 132011 pgm.DOC - Deschutes County 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 STD/HIV control efforts. b. Disease Intervention Specialist or DIS: A DIS (sometimes also referred to as a Communicable Disease Investigator or CDI) is an individual employed by Department or a local public health authority 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 of DHS. c. Report Format: The designated form for reporting a STD case or suspected STD case to Department, which is form DHS 8352. A copy of the form is available from Department 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. Department 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 Award or the footnotes thereof. The resources may include: a. In-Kind Resources: Tangible goods or supplies having a monetary value that is determined by Department. Examples of such In-Kind Resources include goods such as condoms, pamphlets, and antibiotics for treating STDs. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 43 of 148 pages 132011 pgm.DOC - Deschutes County b. Technical Assistance Resources (Direct Assistance): Services of a Department DIS, that Department 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 Department 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. “DHS Investigative Guidelines for Notifiable Diseases” which can be found at: http://www.oregon.gov/DHS/ph/acd/reporting/guideln/guideln.shtml ; and, v. Oregon Revised Statutes (ORS) 433.045. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 44 of 148 pages 132011 pgm.DOC - Deschutes County 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 Department authority, within two weeks of receiving the STD morbidity and laboratory results, the “Confidential STD Case Report” form (DHS 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 Department authority at least 90 days prior to the medication expiration date. LPHA shall be liable to Department for the CDC federal contract price, per dose, of all unused medications supplied to LPHA under this Agreement that are not returned to Department 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. If LPHA 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 45 of 148 pages 132011 pgm.DOC - Deschutes County iv. LPHA must in conjunction with the Department’s STD Program manager review DIS activities and accomplishments on a semi annual basis. This can be done using the Department’s Sexually Transmitted Disease Management Information System (STDMIS) or Oregon Public Health Epi User System (ORPHEUS) databases for the measurement of DIS STD Case Management Services productivity or the LPHA’s database if agreeable to the Department 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 Department’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 Multnomah County, the LPHA must make additional DIS available upon request by the Department’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 Department the reports described above. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 46 of 148 pages 132011 pgm.DOC - Deschutes County Program Element #12: Public Health Emergency Preparedness Program (PHEP) 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, to operate a Public Health Emergency Preparedness Program (“PHEP”) to respond to public health emergencies. The functions and responsibilities of the PHEP shall be detailed in the local emergency response plans of the local emergency management agency within the governmental jurisdiction. The PHEP shall address mitigation, preparedness, response and recovery phases of public health emergency response through plan development, exercise, response activities and plan revision. 2. Definitions Specific to PHEP Programs. a. Annual Review: Evaluation of an LPHA’s PHEP materials, products, plans, and activities conducted by a team of state and local preparedness staff using instruments developed by Department in collaboration and consultation with the Conference of Local Health Officials (CLHO.) Items to be examined in the annual review will be identified for the subject LPHA at least four weeks prior to the scheduled review. b. Bioterrorism: The unlawful use, or threatened use, of microorganisms or toxins derived from living organisms to produce death or disease in humans, animals or plants. c. CDC: U. S. Department of Health and Human Services, Centers for Disease Control and Prevention. d. Communicable Disease: Any disease that is transmissible by infection or contagion. e. Disease of Public Health Significance or Reportable Disease: A Disease required to be reported to local and state public health officials, including a case or cluster of unusual disease. The list of reportable Diseases can be viewed at: http://oregon.gov/DHS/ ph/acd/reporting/reportable.shtml. The following statutes and administrative rules govern Reportable Diseases: ORS 433.004, and OAR 333-018-0000 to 333-018-0015. f. Division of the Strategic National Stockpile (DSNS): CDC program which manages the SNS program. g. DSNS Local Technical Assistance Review (TAR) tool : a form developed by DSNS to evaluate and score local mass dispensing plans h. ESF 8/Health and Medical Annex or Public Health Base Plan: For the purposes of this Program Element, ESF 8/Medical Annex refers to LPHA’s public health or medical plans to respond to a major disaster or public health emergency. i. Federal Medical Stations (FMS): The FMS is a Health and Human Services deployable healthcare system that can deliver large-scale primary healthcare services anywhere in the U.S. A team of approximately 100 personnel is needed to staff the FMS, with personnel provided primarily by the USPHS. Each FMS contains a three-day supply of medical and pharmaceutical resources to sustain 250 stable primary care-based patients who require hospital services. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 47 of 148 pages 132011 pgm.DOC - Deschutes County j. H1N1: Pandemic H1N1 is a novel strain of Influenza type “A” virus first identified in April 2009. It causes illness symptoms and severity that are similar to those resulting from seasonal flu infection. However, because it is a new virus, very few people have immunity, and, as a result many may become ill with this infection. k. Hazard and Vulnerability Analysis (HVA): A hazard vulnerability analysis is a written document used to assess and identify community specific public health hazards and vulnerabilities so that plans may be developed to reduce or eliminate these threats. l. Health Alert Network (HAN): A web based, secure, redundant, electronic communication and collaboration system operated by Department, available to all Oregon public health officials, hospitals, labs and service providers. The data it contains is maintained jointly by Department 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 HAN administrators. The HAN also has a secure, access controlled document library which can be used to share information and post plans. The Hospital Capacity Web site (HOSCAP) is built within the HAN net work. A limited number of HAN users can access HOSCAP with their HAN user ID and password. m. Hospital Preparedness Program (HPP): The Hospital Preparedness Program (HPP) enhances the ability of hospitals and health care systems to prepare for and respond to bioterrorism and other public health emergencies. n. Homeland Security Exercise and Evaluation Program (HSEEP) : The Homeland Security Exercise and Evaluation Program is a capabilities and performance-based exercise and real event after action and improvement plan program that provides a standardized policy, methodology, and language for designing, developing, conducting, and evaluating all exercise . o. Incident Command System Standard: The National Incident Management System’s standard for facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, to perform domestic incident management activities in response to incidents, such as explosions, bioterrorism attacks, chemical releases, earthquakes, and tsunamis, which have significant public health impact. p. The Learning Center (TLC): A web-based system operated by Department that allows for on-line training and tracking of course registration, competency-based training, individual tracking of knowledge, skill, and ability competencies, e-learning, and evaluation and assessment of courses and training experiences. q. Mass: A large, but non-specific amount or number. r. National Incident Management System (NIMS): 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 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 48 of 148 pages 132011 pgm.DOC - Deschutes County 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 s. Outbreak: The occurrence of more cases of disease than typically expected in a given area or among a specific group over a particular period of time. t. Outbreak Investigation: A process to determine the cause of an Outbreak including, source of infection, and mode of transmission, and to identify risk factors and to reduce morbidity and mortality. u. Prophylaxis: The prevention of, or protective treatment for disease. v. Public Health Emergency Response (PHER) Grant: Funding provided by U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC) for Public Health Emergency Response (PHER). The purpose of the grant is to support and enhance the state and local public health infrastructure that is critical to public health preparedness and response . w. Strategic National Stockpile or SNS: A CDC program developed to provide rapid delivery of a broad spectrum 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 and/or technical assistance to distribute SNS materiel. SNS program support includes the 12-hour Push Pack, vendor managed inventory (VMI), for pharmaceuticals and medical supplies, and Federal Medical Stations. 3. General Requirements. All of LPHA’s PHEP services and activities supported in whole or in part with funds provided under this Agreement shall be delivered or conducted in accordance with the following requirements: 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 Department, 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. Public Health Preparedness Coordinator. LPHA shall identify a Public Health Preparedness Coordinator acceptable to the Department. The Public Health Preparedness Coordinator will be the Department’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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 49 of 148 pages 132011 pgm.DOC - Deschutes County d. Annual Review Staffing. LPHA shall provide adequate staff satisfactory to the Department to participate in the Annual Review process. LPHA shall submit its materials and tools for the Annual Review in a manner satisfactory to the Department. The annual reviews are to be conducted during July and August 2010. All reviews are to be completed no later than August 31, 2010 4. Public Health Emergency Preparedness Procedures and Plans. a. Consistent with the CDC, State and Local Public Health Emergency Preparedness Cooperative Agreement No. U90/CCU017007-09 between the State of Oregon and the CDC, the PHEP of the public health and social service emergency fund CFDA # 93.069 funding opportunity number CDC – RFA-TP09-902- H1N1 09 and this Program Element, the LPHA shall maintain and execute emergency preparedness procedures as a component of its jurisdictional Emergency Operations Plan. All LPHA emergency procedures shall comply with the NIMS. The emergency preparedness procedures shall address the capabilities and hazards described below. Review and revisions shall be 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 104-010-005. The governing body of the LPHA shall maintain and update the components described in subsection below, including procedures to address bioterrorism and smallpox events. Other components shall be adopted as local jurisdiction rules apply. b. The jurisdictional Emergency Operations Plan shall describe the procedures necessary to successfully implement the following functions and capabilities: i. LPHA ESF 8/Health and Medical all hazard plan ii. United States Postal Service Bio Detection Systems Alert (for jurisdictions having the USPS BDS systems) iii. LPHA All Hazard Public Health Vulnerability Assessment (HVA) iv. LPHA Emergency Communication v. LPHA Strategic National Stockpile receipt, storage and dispensation c. The jurisdictional Emergency Operations Plan shall describe the procedures necessary to mitigate, respond and recover from the following hazards: i. Pandemic Influenza ii. Chemical Event iii. Natural Disaster iv. Radiation Event v. Bioterrorism 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 50 of 148 pages 132011 pgm.DOC - Deschutes County vi. Smallpox d. LPHA will either directly develop and coordinate or support the development and coordination of the jurisdiction’s Behavioral Health plans and procedures. e. At a minimum, all public health emergency preparedness and response plans whose development is supported in whole or in part with funds provided for this Program Element shall meet the county format. f. Federal Medical Stations (FMS): Selected LPHA will actively participate and assist in the ESF 8 Health and Medical plan development for the use, support and deployment of FMS. g. Monitoring: LPHA shall provide to Department, at the Annual Review of LPHA’s PHEP Program, the plans described in subsection 4.b. above. Additionally, LPHA shall provide copies of the adoption ordinance or minutes of the meeting in which LPHA’s ESF 8/Health and Medical Annex was adopted by LPHA’s governing body. This adoption requirement needs only to be met once. 5. Community Engagement. a. LPHA shall build upon community engagement activities to educate community partners and the public about the LPHA’s Pandemic Influenza Plan and community based response. Activities could include, but are not limited to: compiling lists of key stakeholders. Developing and delivery of presentations on pandemic influenza; coordination with Department and other partners to develop consistent, statewide pandemic influenza related health messages and education materials for the general public. b. LPHA shall actively support the development of state and local community disease control measures, vaccine and antiviral distribution plans. Such support may include attendance at planning meetings, review and comment on planning documents and other material support as needed for plan completion. c. LPHA shall actively support the development of medical surge plans in conjunction with hospital and health care preparedness planning underway in the Hospital Preparedness (HPP) regions in which the LPHA service area is located. These plans are the responsibility of the HPP Regional Lead Agencies, but LPHAs have a substantive role in their development and execution. Such support may include attendance at regional planning meetings, review and comment on planning documents and other material support as needed for plan completion. 6. Mutual Aid Procedures. a. LPHA shall draft a standard operating procedure for accessing its existing Mutual Aid agreements and determining when LPHA has expended, or will imminently expend, its local resources in responding to a public health emergency. This procedure shall identify who will make this determination and how it will be made. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 51 of 148 pages 132011 pgm.DOC - Deschutes County b. LPHA shall include a description of its progress on mutual aid planning in the twice annually reports required by Section 13 of this Program Element Description. Documentation of the draft standard operating procedure and participation in statewide mutual aid planning shall be provided to Department in connection with the Annual Review of LPHA’s PHEP Program. Documentation may consist of meeting minutes, copies of emails, draft mutual-aid agreements or telephone/conference call notes related to mutual- aid planning. 7. Emergency Response Procedure Minimums. LPHA shall develop, incorporate, review and maintain within its public health emergency procedures for the following: a. receiving reports from laboratories and providers; b. requesting additional resources, receiving, storing and/or distributing those resources c. receiving and/or distributing resources that are being pre-deployed in anticipation of need (antivirals, vaccine, medical supplies and equipment) d. distributing and dispensing medications and/or other materials needed for protecting the public using traditional models (e.g., Points of Dispensing) and alternative models (e.g., closed business PODs, mobile response teams). LPHA shall document the ability to dispense prophylactic medication or vaccine to 100% of the population within 48 hours of the recognition of an incident. e. active disease surveillance; f. receiving reports of and responding to public health emergencies ( including food and water) twenty-four hours per day, seven days per week; g. coordinating and reporting LPHA, the state and tribal public health emergency response activities and medical countermeasure response activities; h. monitoring the impact of an emergency situation on identified vulnerable people or groups of people including those experiencing psychosocial consequences and facilitating actions to reduce the harmful impact on said people; i. implementing public health measures including, quarantine and restriction of movement; and j. Using paid and volunteer staff to increase capacity for investigating cases, contacts and mass prophylactic activities. k. LPHA shall provide to Department, at the time of the Annual Review of LPHA’s PHEP Program, satisfactory documentation that the procedures described above have been included in the appropriate plan. Additionally, LPHA shall document that established plans and procedures undergo review and revision according to the plan or procedures review requirements, or the county emergency management schedule, but not less than every five years after completion. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 52 of 148 pages 132011 pgm.DOC - Deschutes County 8. Emergency Response Time. a. LPHA shall establish and maintain a telephone number whereby, physicians, hospitals, other health care providers, and the public can phone to report public health emergencies within the LPHA service area. b. The telephone number shall be operational 24 hours a day, 7 days a week and be a nine digit telephone number available to callers from outside the local emergency dispatch. LPHA may use their 911 system in this process, but the ten-digit telephone number of the local 911 operators shall be listed in all instances and be provided to switchboard operators so that callers from outside the locality can contact LPHA through the local dispatch system. c. The LPHA telephone number described above shall be answered by a knowledgeable person or by a recording that clearly states the above mentioned 24/7 telephone number. LPHA shall list and maintain both the switchboard number and the 24/7 numbers on the HAN. d. All reports of public health emergencies shall be evaluated and acted on, including an appropriate response to the individual making the report and coordination between LPHA and other local public safety agencies, by a public health worker with the knowledge, skills and abilities to evaluate and manage public health emergency reports, within 30 minutes of receipt of the report. e. As local plans call for, demonstrated capability to notify primary, secondary, and tertiary staff to cover all incident management functional roles during a complex incident. f. Test and document the notification system twice a year, with at least one test being unannounced and occurring outside of regular hours. The test can be a drill or an exercise, or it may be demonstrated by a response to a real incident. Test results will be reviewed at the annual review. 9. Health Alert Network (HAN) and Redundant Communications. a. Funds provided under this Program Element may only be used to cover the following HAN related costs: i. Service charges related to public health network security as reflected in the 2006 Local Preparedness security enhancement assessment and recommendations. ii. Additional costs for emergency communications, including Internet access fees, cell phone charges for preparedness staff, radios, satellite telephone charges, the costs of upgrading computers for LPHA’s PHP Program staff. iii. Acquisition of standard office computer software and other standard computer hardware to improve LPHA’s capacity to communicate securely and redundantly in a public health emergency. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 53 of 148 pages 132011 pgm.DOC - Deschutes County iv. Training of local staff in support of technologies supporting HAN, including attendance of HAN 101, 201 and 301. v. The use of this funding to cover a cost not described above shall be pre- approved in writing by Department. b. Maintain, add, modify, and delete users in the local HAN user and county role directory and ensure local users are both trained and have the correct system license (end user, collaborator, or administrator - see HAN operations guide for license allocation per county.) c. Act as a single point of contact for all HAN issues, user group, and training to the state PHEP training unit and HAN staff. d. Serve as the county authority on all HAN related access (excluding hospitals and tribes) e. Resolve all non-technical issues related to user profiles and role-based groups f. LPHA shall submit the name of the local HAN Administrator to the State HAN Administrator or PHEP Liaison and notify of changes within 7 working days. g. Beginning July 1, 2010 LPHA shall conduct internal tests of the HAN Call Down alerting system two times to verify LPHA's ability to alert its staff with emergency response roles. These bi-annual notification exercises may be conducted within the scope of a functional or full scale exercise. h. LPHA shall record results of such testing, including date and time of test and interval between alert notification and 90% complete response. i. The designated LPHA HAN administrator will coordinate with the State HAN Administrator to ensure the roles and available system licenses are appropriately distributed with each county. j. LPHA Local HAN Administrator (s) shall post, publish and update plans and maintain the local and County HAN document library folders. k. LPHA Local HAN Administrator (s) shall perform general administration for all local implementation of the HAN system in their respective counties as specified in HAN Operating Guide attachment V: Administrator Roles and Responsibilities available on HAN. l. LPHA local HAN administrator (s) shall review their LPHA HAN users 2 times annually to ensure users are assigned their appropriate roles and that appropriate users are deactivated. The review shall be conducted during the same time frame as the semi-annual review and the annual review. m. LPHA shall comply with the terms and conditions of use of “Department Issued Satellite Phones,” set forth in Attachment 3 to this Program Element Description. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 54 of 148 pages 132011 pgm.DOC - Deschutes County 10. Exercise Requirements for all LPHAs . a. LPHA shall develop and conduct an exercise program that tests LPHA’s all hazard emergency response plans, adhering to HSEEP standards: 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. b. LPHA shall submit to Department for approval before December 1, 2010, a three-year Training and Exercise Plan. The three year period shall start December 1, 2010. 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, target 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. 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 two exercises per year and shall identify a cycle of exercises that increase in complexity from year one to year three, 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. c. LPHA shall review its three-year Training and related exercise Plan at least annually at the time of the Annual Review and update as necessary. Any revisions shall be submitted to Department for approval. d. At a minimum, LPHA shall, before June 30, 2011, develop and satisfactorily execute two public health preparedness exercises as outlined in the LPHA’s approved Training and Exercise Plan. LPHA shall submit to Department 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 Department an AAR documenting each exercise within 60 days of conducting the exercises. e. Disease outbreaks or other public health emergencies requiring a LPHA response may, upon Department’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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 55 of 148 pages 132011 pgm.DOC - Deschutes County 11. Public Information and Notification a. LPHA shall have the ability to create press releases and letters on file, for use in notifying the public of disease outbreaks or other public health emergencies. Such information shall describe public health actions and recommendations for preventing illness, injury or death. These documents may reference or be based upon documents from other sources, as appropriate. b. LPHA shall develop and maintain the capability to communicate and disseminate health risk information to the public in its service area. Development of the capability shall include designation of an individual with primary responsibility for coordinating communication of public health information. LPHA’s public health communication officer shall actively participate in statewide planning and coordination of public health messages. c. In connection with the Annual Review of LPHA’s PHEP Program, LPHA shall provide to Department copies of the press releases and letters for public health emergencies. LPHA shall provide Department with the name and contact information for LPHA’s public health communication officer by August 30, 2010. LPHA shall establish a user profile for the public information officer in the HAN. In connection with the Annual Review of LPHA’s PHEP Program, LPHA shall provide documentation to Department of LPHA’s participation in statewide public information planning. d. During the Annual Review, documentation of progress shall be provided in identifying local communities with special communication needs and establishing the communication channels and methods to reach them. 12. Training of LPHA Staff. a. LPHA 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 February 21, 2002, 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://oregon.gov/DHS/ph/lhd/reference.shtml b. The LPHA shall identify appropriate LPHA staff for training in preparedness for and response to bioterrorism, chemical, radiation, communicable diseases, and general emergency response. 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.fema.gov/emergency/nims/ c. LPHA’s public health communication officer shall be trained in the concept, development, and use of the Incident Command System Standard for the Public Information Officer role (as described in the Incident Command System Standard) and in the local development of a joint information system as described and required in the National Incident Management System. These standards can be viewed at: http://www.dhs.gov/xlibrary/assets/NIMS-90- web.pdf . Specific training in National Incident Management Systems (NIMS) Public Information Systems, IS-702, is available on-line at: http://training.fema.gov/emiweb/IS/is702.asp 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 56 of 148 pages 132011 pgm.DOC - Deschutes County d. LPHA’s public health communication officer shall receive the CDC’s Crisis and Emergency Risk Communication (CERC) By Leaders, For Leaders training, described at http://www.bt.cdc.gov/erc/part_man.pdf ; the staff person performing this function needs to meet this training requirement only once. e. All local HAN users assigned either a collaborator must complete HAN 201. All local HAN users assigned an administrators license must complete HAN 201 and 301. f. All local HAN users are required to attend HAN 101. g. LPHA shall enroll new staff with emergency response roles as users in the Learning Center within 30 days of hire. h. LPHA shall maintain training records for all local public health staff with emergency response roles. LPHA shall record public health preparedness courses taken by LPHA staff. i. LPHA may use funds from this agreement to support preparedness staff to attend state provided preparedness training, workshops, seminars, and exercises developed around state level plans and procedures. 13. Reporting Specific to this Program Element. In addition to the reporting requirements set forth in Section 8 of Exhibit E, LPHA shall provide the reports described below. a. Narrative Report (Twice Annually). i. LPHA shall provide narrative reports, in a form approved for this purpose by Department, to the Department on the status of local activities related to public health emergency preparedness. The first report shall be submitted no later than February 15, 2011. The Annual Review will serve as the second report. ii. In addition to any information required by other provisions of this Program Element to be included in the required reports, the reports shall, at a minimum, include the following: (A.) LPHA’s progress on review and revision of the LPHA ESF 8/Health and Medical all hazard plan including annexes referenced in section (3.e.i). (B.) LPHA’s progress on integrating planning and communication with county general emergency management, evidenced by, for example, meeting minutes or other documented communications. (C.) LPHA’s progress on required exercises and a discussion of LPHA’s participation in any other public health emergency exercises. (D.) LPHA’s progress on establishing mutual-aid agreements and procedures as referred to in (3.k.i) Mutual Aid Procedures. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 57 of 148 pages 132011 pgm.DOC - Deschutes County (E.) LPHA’s progress on public information planning, including establishment and development of the database of communities with special communication needs. (F.) LPHA’s progress on training, including hazardous-material, other worker- safety and NIMS training. (G.) The number of staff with public health emergency response roles documented in their job descriptions that passed NIMS IS-700 and IS 800 Training. (H.) A description of how NIMS-compliant ICS forms have been integrated into LPHA’s Emergency Operations Plan. (I.) A description of LPHA’s efforts to maintain accurate staff and contact information in the HAN, and the Learning Management System. (J.) A description of the mechanisms and results of internal testing of the public and non-public LPHA 24/7 ability to receive notice of potential public health emergencies. (K.) A description of LPHA’s internal testing results of biannual HAN notification exercises, (L.) LPHAs in the CRI region shall provide a completed local TAR by June 30, 2011 to the Department. Completion of the TAR includes providing necessary supporting documentation and references. b. General Budget and Expense Reporting. Using the budget template set forth in Attachment 1 (and available for download from the HAN document library: https://oregonhealthnetwork.org/ORHealthNetworkRM/GateStart.aspx attached hereto and incorporated herein by this reference, LPHA shall provide to Department by October 31, 2010, a budget using actual award amounts, detailing LPHA’s expected costs to operate its PHEP and PHER programs during the period of July 1, 2010, through June 30, 2011. LPHA shall submit to Department by January 15, 2011 and include, as part of the reports required by subsection a. above, expense-to-budget reports that detail expenses charged to funds provided under this Agreement for this Program Element. An expense-to-budget template set forth in Attachment 2 (available to be downloaded from the HAN document library at: https://www.oregonhan.org/login.login.cfm ), and attached hereto and incorporated herein by this reference, shall be the only form used to satisfy this requirement. The LPHA shall provide to the Department by August 31, 2011 the actual expense-to-budget report for the period of July 1, 2010 through June 30, 2011. c. H1N1 Pandemic Influenza Response Activities i. The LPHA shall at a minimum provide the Department with weekly electronic reports of identified sites for public vaccination. Reports shall be provided on a form developed with LPHA input and approved by the Department. These reports are due to the Department no later than close of business every 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 58 of 148 pages 132011 pgm.DOC - Deschutes County Thursday. Reports will project public vaccination sites for at least the seven day period beginning with the next Monday. ii. The LPHA shall provide the website address and LPHA response phone number for H1N1 response to the Department. iii. Periodic reports of LPHA H1N1 response activities as as requested, including financial reports d. Other Reports. The LPHA shall provide such other reports on LPHA’s PHEP as Department may reasonably request from time to time. 14. Performance Goals. LPHA shall implement its PHEP Program in a manner designed to achieve the following performance goals: 15. Public Health Emergency Plans. All of the components described below of LPHA’s jurisdictional Emergency Operations Plan, are complete, including submission to Department for the Annual Review by June 30, 2011, and LPHA’s ESF 8/Health and Medical Annex (to the jurisdictional Emergency Operations Plan), including procedures to address bioterrorism and small pox events. Plans are adopted by governing body of the jurisdiction by June 30, 2011 (if this requirement has not be satisfied previously). i. LPHA ESF 8/Health and Medical Annex ii. LPHA Hazard Vulnerability Assessment (HVA) iii. LPHA Emergency Communication Plan iv. LPHA Strategic National Stockpile Plan v. LPHA Pandemic Influenza Plan vi. LPHA Chemical Response Plan vii. LPHA Natural Disaster Response Plan viii. LPHA Radiation Event Response Plan ix. Biohazard Detections System (as applicable) x. LPHA will either directly develop and coordinate or support the development and coordination of the jurisdiction’s Behavioral Health Plan a. Minimum Emergency Response Times. i. At least 95% of calls to LPHA’s public health emergency reporting telephone number are responded to within 30 minutes by a public health worker with the knowledge, skills and abilities to evaluate and manage public health emergency reports. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 59 of 148 pages 132011 pgm.DOC - Deschutes County ii. At least 95% of calls to the LPHA non-public public health emergency reporting telephone number (for reporting by Department or other emergency response agencies) are responded to within 30 minutes by a public health worker with the knowledge, skills and abilities to evaluate public health emergency reports. iii. The time to complete the notification/alerting of the initial wave of personnel needed for emergency operations in response to a public health emergency is 60 minutes or less from the decision to conduct the notification. iv. The time to have the initial wave of personnel physically present to staff emergency operations in response to a public health emergency is 90 minutes or less from the decision to conduct the notification. v. The time to issue information to the public that emphatically acknowledges the event, explains and informs the public about risk, provides emergency courses of action and commits to continued communication is 60 minutes or less from the activation of the Emergency Operations Plan. vi. LPHA shall be able to document capability to provide countermeasures to 100% of population in their jurisdiction within 48 hours. b. Health Alert Network (HAN). i. At least 98% of LPHA staff with responsibilities for public health emergency response has accurate user profiles in the HAN. ii. At least 90% of LPHA staff with responsibilities for public health emergency response receives test or actual notifications/alerts using HAN. iii. All staff on the Secure HAN system is required to participate in 4 state and 2 local call down tests for a total of 6 annually and are required to keep both an updated system and alerting profile. c. Exercises and Response i. LPHA has plans for and satisfactorily conducts, by June 30, 2011, at least one tabletop or workshop/seminar; and exercises described above. ii. Documentation of the exercises shall demonstrate the involvement of county emergency management in exercises. d. Training. i. At least 90% of LPHA staff that have emergency response roles documented in their job descriptions is trained in incident management. ii. LPHA has trained 100% of its staff with emergency response roles identified in their position descriptions in emergency response training appropriate to their 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 60 of 148 pages 132011 pgm.DOC - Deschutes County emergency roles in compliance with the National Incident Management System requirements. iii. LPHA’s public health communication officer has received training in (a) the concept, development, and use of the Incident Command System Standard’s communication structure as described and required in the National Incident Management System and (b) CDC’s Crisis and Emergency Risk Communication (CERC) For Leaders training. iv. LPHA has a training program to ensure volunteers are trained in their role to provide mass prophylaxis. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 61 of 148 pages 132011 pgm.DOC - Deschutes County ATTACHMENT 1 TO PROGRAM ELEMENT #12 [for example purposes only] 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 62 of 148 pages 132011 pgm.DOC - Deschutes County ATTACHMENT 2 TO PROGRAM ELEMENT #12 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 63 of 148 pages 132011 pgm.DOC - Deschutes County 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 64 of 148 pages 132011 pgm.DOC - Deschutes 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 DHS-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 Department under the 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 the Department an approved Local Program Plan by no later than June 30 th of each year. The Department 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 Department 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 65 of 148 pages 132011 pgm.DOC - 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 Department and attached to this Program Element as Attachment 1 and incorporated herein by this reference. Modifications to the budget may only be made with Department 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 Department. e. LPHA must comply with Department’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 the Department, the Budget set forth in Attachment 1 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 Department. The reports must include, at a minimum, LPHA’sprogress during the quarter towards completing activities described in its Local Program Plan. Upon request by Department, LPHA must also submit reports that detail quantifiable outcomes of activities and data accumulated from community-based assessments of tobacco 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 66 of 148 pages 132011 pgm.DOC - Deschutes County ATTACHMENT 1 BUDGET 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 67 of 148 pages 132011 pgm.DOC - Deschutes County Program Element #15: Healthy Communities (HC) (formerly “Tobacco-Related and Other Chronic Disease Programs”); 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, asthma, cancer, diabetes, heart disease, and stroke. Incorporate the promotion of tobacco cessation, healthy eating and physical activity into chronic disease management systems. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 68 of 148 pages 132011 pgm.DOC - Deschutes County 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 Department 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 the Department 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. The Department 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 Department 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 Department and as set forth in Attachment 1 to this Program Element Description. . Modifications to the budget may only be made with Department 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 the Department. d. LPHA must attend all HC Program meetings, as reasonably required by the Department. LPHA must participate in HC Program evaluation activities, as reasonably required by the Department. e. LPHA must comply with Department’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 the Department-approved Budget, the provisions of the Agreement and this Program Element, the provisions of the Agreement and this Program Element shall control. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 69 of 148 pages 132011 pgm.DOC - Deschutes County 3. Reporting Requirements. LPHA must submit quarterly Local Program Plan reports on a schedule to be determined by Department. The reports must include, at a minimum, LPHA’s progress during the quarter in completing activities described in its Local Program Plan. LPHA must submit the following upon request by Department: 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 HC Program evaluation activities, as reasonably required by the Department. 4. Performance Measures. If LPHA completes fewer than 75% of the planned activities in its Local Program Plan for two consecutive calendar quarters in one state fiscal year, it will not be eligible to receive funding under this Program Element in the next state fiscal year. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 70 of 148 pages 132011 pgm.DOC - Deschutes County Attachment 1 Budget 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 71 of 148 pages 132011 pgm.DOC - 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 Counseling 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 Department of Human Services, Public Health Services financial assistance award document, is determined by the Department 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 72 of 148 pages 132011 pgm.DOC - 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 to assess and document each Applicant’s eligibility for WIC Services. vii. Certification Period: The time period during which a Participant is eligible for WIC Services based on his/her 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: Individual or group education session for the provision of Nutrition Education. xiii. Nutrition Education Plan: An annual plan developed by LPHA and submitted to and approved by the Department 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 of WIC 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 conditions that predispose persons to inadequate nutritional patterns or nutritionally related medical conditions. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 73 of 148 pages 132011 pgm.DOC - Deschutes County 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 the Department’s comprehensive statewide automated data tracking 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; (B.) 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 of WIC 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 PL105-394, 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: 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 74 of 148 pages 132011 pgm.DOC - 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 246.11, 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 Department 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 246.11; 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 2001 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 (RD) 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 WIC Services Requirements. By utilizing Department 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.105-394, 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 Department 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. (B.) 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 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 75 of 148 pages 132011 pgm.DOC - Deschutes County 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. (C.) 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. (D.) 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. (E.) 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 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. (F.) LPHA, in collaboration with Department, 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)(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. (G.) As a condition to receiving funds under the Agreement, LPHA must have on file with the Department 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. The Department reserves the right to approve or require modification to the Plan prior 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 (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 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 76 of 148 pages 132011 pgm.DOC - Deschutes County 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 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: The Department will conduct on-site monitoring of the LPHA biennially for compliance with all applicable Department and federal requirements as described in the WIC Manual. Monitoring will be conducted in accordance with 7CFR 246.19(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 the Department: 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 using the “Oregon Department of Human Services; Health Services Revenue and Expenditure Report (For All Programs except Bioterrorism)” form set forth in Exhibit C of this Agreement. 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 Caseload over any twelve (12) month period. ii. The Department reserves the right to adjust its award of NSA Funds, based on LPHA performance in meeting or exceeding Assigned Caseload. 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 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’ 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 77 of 148 pages 132011 pgm.DOC - Deschutes County 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 1.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 1 – October 31. iv. Farm Stand: A location at which a single, individual farmer sells his/her produce directly to consumers or a farmer who owns/operates such a farm stand. This is in contrast to a group or association of farmers 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 Farmers’ 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 the Department’s Farm Direct Nutrition Program Policy and Procedures in the WIC Manual, including but not limited to the following requirements: 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 78 of 148 pages 132011 pgm.DOC - Deschutes County (A.) Coupon Distribution: The Department 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: The Department will monitor the FDNP practices of LPHA. Department 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. Department 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 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. 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. 3. Breastfeeding Peer Counseling (BFPC) Services a. General Description of BFPC Services. The purpose of BFPC Services is to increase breastfeeding duration and exclusivity rates by providing basic Breastfeeding information, 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 79 of 148 pages 132011 pgm.DOC - Deschutes County b. Definitions Specific to BFPC Services. i. Peer Counselor: A paraprofessional support person with LPH who meets the qualifications as stated in the WIC Manual and provides basic Breastfeeding information 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: A Department 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 Department of Human Services, Public Health Services financial assistance award document, is determined by the Department using the WIC Peer Counseling funding formula. (add date once approved by CHLO MCH and CHLO Executive Committee.)This Assigned Peer Counseling Caseload is used as a standard to measure LPHA’s peer counseling caseload management performance and is used in determining 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 supervising/mentoring/coaching 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. (B.) LPHA shall recruit and select women from its community who meet the selection criteria in the WIC Manual to serve as Peer Counselors. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 80 of 148 pages 132011 pgm.DOC - Deschutes County 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 information. (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 Coordinator(s) participate in periodic conference calls sponsored by the Department. (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-term 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 1(e)(ii) above. (L.) Counting of BFPC Services Expenditures: LPHA shall not count expenditures from the BFPC Services funds toward either its LPHA 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 81 of 148 pages 132011 pgm.DOC - Deschutes County breastfeeding promotion and support targets or its one-sixth Nutrition Education requirement. (M.) Monitoring. The Department will do a review of BFPC Services as part of its regular WIC Services review of LPHA once every two years. The Department will conduct quarterly reviews of Peer Counseling Caseload. LPHA will cooperate with such Department monitoring. (N.) Performance Measures: (i.) LPHA shall serve at least 98% of its Assigned Peer Counseling Caseload over any twelve-month period. (ii.) The Department 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 of Exhibit E of the Agreement, LPHA shall submit the following reports: (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. The Department 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 82 of 148 pages 132011 pgm.DOC - Deschutes County Program Element #41: Family Planning Program (FPP) 1. General Description of the Family Planning Program (FPP) . Family Planning Services are the educational, clinical and social services necessary to aid individuals to determine freely the number and spacing of their children. This Program Element pertains to all Family Planning Services provided at the LPHA except for the Family Planning Expansion Project (FPEP). 2. Definitions Specific to the Family Planning Program. a. Ahlers & Associates: Vendor for data processing contracted by U.S. Department of Health and Human Services (HHS), Region X, Office of Family Planning. Contact information available from DHS-PHD-OFH Family Planning Program. b. Client Visit Record or CVR: Data collection tool for Family Planning encounters developed by HHS, Office of Population Affairs, Region X, Office of Family Planning, available from DHS-PHD-OFH Family Planning Program. c. Family Planning: When individuals can freely determine the number and spacing of their children. d. Family Planning Services: Clinical, informational, educational, social and referral services offered to anyone of reproductive age requesting family planning and reproductive health care. e. Federal Poverty Level (FPL) Guidelines: The poverty income guidelines prescribed by HHS, adjusted annually, and provided by the Department by April of each year, to be used by LPHA in determining income eligibility for applicants. f. Federal Title X Guidelines for Family Planning: 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. g. Federal Title X Program: A federal program designed to provide individuals the information and means to exercise personal choice in determining the number and spacing of their children. A broad range of effective and acceptable family planning methods and related preventive health services are available on a voluntary and confidential basis. Authorized under Title X of the Public Health Service Act (42 U.S.C § 300). The implementing regulations are found at 42 CFR Part 59. h. Program Income: Additional revenue generated by the provision of family planning services, such as client fees, donations and third party insurance reimbursement. i. Region X Infertility Prevention Project: A project of the Centers for Disease Control & Prevention (CDC) to control Chlamydia through the collaborative efforts of sexually transmitted disease clinics, and Family Planning providers and public health laboratories. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 83 of 148 pages 132011 pgm.DOC - Deschutes County 3. Procedural and Operational Requirements. All Family Planning 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: a. LPHA must comply with the Federal Title X Guidelines for Family Planning , and any subsequent program instructions issued by the Office of Population Affairs (OPA), 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 Guidelines for Family Planning and as specified by the Department.. Citation 42 CFR 59.5 (a)(1) 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 client data, in accordance with 42 USC 701-709, with respect to each individual receiving any service supported in whole or in part with Department funds provided under this Agreement. Citation 42 USC 701-709 c. Chlamydia Testing . Unless this requirement is waived by the Department , LPHA shall participate in the Region X Infertility Prevention Project for Chlamydia testing and adhere to that project’s standards for identifying, screening and testing candidates. Citation 42 CFR 59.5 (a)(1) 4. Reporting Requirements. In addition to the reporting obligations set forth in Section 8 of Exhibit E of this Agreement, LPHA shall submit to the Department or other recipient, as indicated, the following written reports: a. LPHA must submit an annual plan for Family Planning Services to the Department , covering the period of July 1 through June 30 of the succeeding year. The Department will supply the due date, required format and current service data for use in completing the plan. Title X Regulation 6.2 b. LPHA must submit to the Department a projected budget for Family Planning Services covering the period of July 1 through June 30 of the succeeding year. the Department will provide required format and due date. Citation 45 CFR 92.20 c. Client encounter data must be collected using the CVR and submitted to Ahlers & Associates on a monthly basis. The data is collected to meet federal requirements, aid in program management, including funding distribution, and assist in evaluation. The data is 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 84 of 148 pages 132011 pgm.DOC - Deschutes County used by Region X of the U.S. Department of Health and Human Services, the State Family Planning Program, and the LPHA. Citation 42 USC 701-709 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 Department 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 from Providing Family Planning Services with Funds Provided under this Agreement. Department 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 termination 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 Section 2.h. 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 performance of its programs.” These costs include, but are not limited to, “costs of operating and maintaining facilities, for administrative salaries, equipment, depreciation, etc.” Citation 42 USC 701-709 6. Sanctioned Providers. If DHS notifies LPHA that a Provider has been sanctioned under Public Law 100-93, LPHA may, consistent with 42 USC 701-709, no longer pay or reimburse such Provider with funds provided to LPHA under this Agreement. Citation 42 USC 701-709 7. Terms and Conditions Specific to LPHA Performance of Family Planning Services. All Family Planning 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 Program Instructions, the Title X Program Guidelines for Family Planning, and the Oregon Department of Human Services, Public Health Division, Office of Family Health, Family Planning Program manual. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 85 of 148 pages 132011 pgm.DOC - Deschutes County Program Element #42: Maternal and Child Health (MCH) Services 1. Purpose of MCH 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 Maternal and Child Health (MCH) services: · Maternal and Child Health (MCH) Services (or “MCH Service(s)”); · Oregon Mothers Care (OMC) Services; · Maternity Case Management (MCM) Services; · Clinical Prenatal Care (CPC) Services; and · Babies First! (B1st!) High Risk Infant (HRI) Services. If funds awarded to Grantee for MCH Services, in the Financial Assistance Award located at Exhibit B to the Agreement, are restricted to a particular MCH Service, those funds shall only be used by Grantee to support delivery of that specific service. 2. General Requirements a. Data Collection: Grantee must provide MCH client data, in accordance with Title V Section 506 [42 USC 706], to the Department with respect to each individual receiving any MCH Service supported in whole or in part with MCH Service funds provided under this Agreement. b. Administration: Grantee shall not use more than 10% of the Federal Title V funds awarded for a particular MCH 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: (1) 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)]. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 86 of 148 pages 132011 pgm.DOC - Deschutes County d. Sanctioned Care Providers: If Department notifies Grantee that a Provider has been sanctioned under Public Law 100-93, Grantee shall, consistent with Title V Section 504 [42 USC 704(b)(6)] , no longer pay or reimburse such Provider with MCH Services funds provided to Grantee under this Agreement e. Fees: Use of any fees collected for these services shall be dedicated to such services. f. 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. Grantee must collaborate with Department to develop the specific procedures that Grantee will implement to provide Medicaid application assistance to pregnant women and children who receive MCH 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)] . g. MCH Funds i. MCH funds shall be used for any service or activity described in this Program Element according to the following limitations: (A.) MCH/Title V Child and Adolescent Health Funds: A minimum of thirty percent (30%) of the total Grantee Federal Title V Funds are designated for services for infants, children, and adolescents (Title V, Section 505 [42 USC 705(a)(3)(A)]). (B.) MCH/Title V Flexible Funds: The remainder of the total Grantee Federal Title V Funds are designated for program or services for women, infants, children and adolescents. (C.) MCH/Perinatal Health State General Funds: Perinatal Health State General Funds shall be used by Grantee for public health services for women during the perinatal period (one year prior to conception through one year postpartum). (D.) MCH/Child and Adolescent Health State General Funds: Child and Adolescent Health State General Funds shall be used by Grantee 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. High Risk Infant HRI Services. State General Funds for HRI Services shall be limited to expenditures for that service. MCH Flexible Funds may also be used for activities connected with the HRI Services within the limitations described in subsection 2.g.i., above. iii. School-Based Health Centers. MCH Flexible Funds may also be used for School- Based Health Centers within limitations of subsection 2.g.i. above. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 87 of 148 pages 132011 pgm.DOC - Deschutes County 3. MCH Services Supported by MCH Flexible Funds a. Definitions Specific to this Section. i. MCH Services: Activities, functions, or services that support the optimal health outcomes for women during the perinatal time period, infants, children and adolescents. ii. MCH Flexible Funds: Federal Title V and State General Funds that can be used for any MCH Service within the scope of the limitations in 2.g.i. above. b. Procedural and Operational Requirements All MCH Services supported in whole or in part with MCH Flexible Funds provided under this Agreement must be delivered in accordance with the following procedural and operational requirements: i. Grantee shall submit a Triennial MCH Plan of the public health goals and services appropriate for the MCH population within the jurisdiction of the county. A Triennial MCH Plan shall include: (A.) Assessment of the health needs of the MCH population (B.) Goals, objectives, activities, and timelines (C.) Evaluation plan to measure progress and outcomes of the Plan. (D.) Projected use of MCH Flexible Funds and other funds supporting Plan activities and goals ii. Grantee shall provide MCH Services administered or approved by the Department that support optimal health outcomes for women, infants, children, and adolescents. (A.) Services administered by the Department include (but are not limited to): (I.) Perinatal health services: OMC Services, MCM Services, CPC Services; (II.) Infant and child health services: HRI Services, Child Care Consultation, Sudden Infant Death Syndrome/Sudden Unexplained Infant Death Follow- up, Oral Health including dental sealant services; and (III.) Adolescent health services: School-Based Health Centers; Coordinated School Health; and other adolescent preventive health services or programs. (B.) Grantee may provide other MCH services identified through the Triennial MCH Plan and local public health assessment, and approved by the Department. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 88 of 148 pages 132011 pgm.DOC - Deschutes County c. Reporting Obligations and Periodic Reporting Requirements In addition to the reporting requirements set forth in section 8 of Exhibit E of this Agreement, Grantee shall submit Annual Reports for the Triennial MCH Plan and collect and submit data for clients receiving MCH Services supported with funds from the Department under this Agreement... i. By May 1 st of each year, a progress report on the goals and activities of Triennial MCH Plan. ii. By May 1 st of each year, projected use of MCH Funds for the following state fiscal year (July 1 – June 30). iii. By April 1 st of each year, all client visit data for the previous calendar year must be entered into the Oregon Child Health Information Data System (ORCHIDS), if applicable or submitted in a format acceptable to Department, If Grantee pays Providers for Services, Grantee shall include client data from those Providers. 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. 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. Grantee must designate a staff member as its Oregon MothersCare Coordinator to work with Department on developing a local delivery system for OMC Services. Grantee’s Oregon MothersCare Coordinator must work closely with Department to promote consistency around the state in the delivery of OMC Services. ii. Grantee must follow the Oregon MothersCare Protocols, as described in the Department’s Oregon MothersCare Manual April, 2005, provided to Grantee 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 89 of 148 pages 132011 pgm.DOC - Deschutes County iii. As part of its OMC Services, Grantee must develop and maintain an outreach and referral system and partnerships for local prenatal care and related services. iv. Grantee or its OMC site designee must assist all women seeking OMC Services in accessing prenatal services as follows: (A.) Grantee must provide follow up services to clients and women referred to Grantee 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.) Grantee 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. Grantee 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. Grantee shall make available to all Low-Income pregnant women within the county assistance in applying for OHP coverage. vii. Grantee 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. Grantee shall designate a representative who shall attend OMC site meetings conducted by Department. ix. Except as specified below, Grantee shall deliver directly all OMC Services supported in whole or in part with financial assistance provided to Grantee under this Agreement. With the prior written approval of Department, Grantee 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, Grantee 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. Grantee shall submit the quarterly data to Department using OMC client tracking forms approved by Department for this purpose. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 90 of 148 pages 132011 pgm.DOC - Deschutes County 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, Prenatal/Perinatal 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, Grantee shall collect and submit client data for all clients and visits occurring during the calendar year on to the Department, regardless of whether an individual receiving services has delivered her baby. i. By April 1 st of each year, all client visit data for the previous calendar year must be entered into the Department’s electronic database for MCH services, using the Oregon Child Health Information Data System (ORCHIDS), or submitted in a format acceptable to the Department. If Grantee pays Providers for MCM Services, Grantee 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. Clinical Prenatal Care (“CPC”) Services a. General Description. CPC Services are comprehensive obstetric care services that begin as early as possible in the first trimester of pregnancy and up to the first two months of the postpartum period. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 91 of 148 pages 132011 pgm.DOC - Deschutes County b. Procedural and Operational Requirements. All CPC 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. CPC Services shall be provided only to Low-Income uninsured or OHP insured women either by contracted Providers or directly by Grantee. If Grantee implements CPC Services in whole or in part through contracted Providers, Grantee shall not pay these Providers for any CPC Service in excess of the applicable Medicaid rate. ii. Grantee shall not impose any fees or charges upon clients who receive CPC Services supported in whole or in part with funds provided under this Agreement. iii. Grantee shall collect and forward to Department, data for each client service, in a format approved by the Department. iv. CPC Services must be directed and/or provided by a physician, certified nurse midwife, or a nurse practitioner. Other providers may include registered nurses and other nursing personnel, physician assistants, social workers, and nutritionists. c. Reporting Obligations and Periodic Reporting Requirements. In addition to the reporting obligations set forth in section 8 of Exhibit E, of this Agreement, Grantee shall collect and report data to the Department, in a format acceptable to Department, all clients and visits occurring during the fiscal year, regardless of whether an individual receiving services has delivered her baby., i. Client and visit annual data reports shall be submitted to the Department no later than April 1 st of each year for the previous calendar year . If Grantee pays Providers for CPC Services, Grantee 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 of pregnancy at first visit, infant gestational age at delivery, infant birth weight, and infant feeding method. iii. All data elements must be collected when funds provided under this Agreement for CPC Services are used to pay for (in whole or in part) a CPC Service. 7. Babies First! High Risk Infant (“HRI”) Services a. General Description. The primary goal of HRI Services is to prevent poor health and early childhood development delay in infants and children who are at risk. HRI 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 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 92 of 148 pages 132011 pgm.DOC - Deschutes County outcomes for high-risk children. The definition of “Public Health Nurses” and client eligibility criteria are provided in OAR 410-138-0040. b. Procedural and Operational Requirements. All HRI 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. Grantee must designate a staff member as its HRI Coordinator ii. Home Visits. (A.) HRI 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. 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. (B.) HRI Services must be delivered in accordance with OAR 410-138-0040 (C.) HRI Services must include follow up on referrals made by the Department for Early Hearing Detection and Intervention, described in ORS 433.321 and 433.323. iii. Targeted Case Management. Grantee, as a provider of Medicaid services, shall comply with the billing policy and codes in OAR 410-138-0080 and 410-120-1400 through 410-120-1685. c. Reporting Obligations and Periodic Reporting Requirements In addition to the reporting requirements set forth in section 8 of Exhibit E of this Agreement, Grantee shall collect and report to the Department, in a format acceptable to Department, the following data on Grantee’s delivery of HRI Services: i. By April 1 st of each year, all client visit data for the previous calendar year must be entered into the Department’s electronic database for MCH services, using the Oregon 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 93 of 148 pages 132011 pgm.DOC - Deschutes County Child Health Information Data System (ORCHIDS), or submitted in a format acceptable to the Department. . 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 HRI Client Data Form provided by the Department lists details of the required data elements. iii. All data elements must be collected when funds provided under this Agreement for HRI Services are used to pay for (in whole or in part) a HRI Service. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 94 of 148 pages 132011 pgm.DOC - Deschutes County Program Element #43: Family Health Services (“FHS”) – Immunization Services Funds awarded under this Agreement for Family Health Services must only be used in accordance with and subject to the restrictions and limitations set forth to provide immunization services (“Immunization Services”) as described in detail below. 1. General Procedural and Operational Requirements, Fees. Use of any fees collected for purpose of Immunization Services shall be dedicated to 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. 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 http://www.oregon.gov/dhs/ph/imm/afix/index.shtml b. Billable Doses: Vaccine doses given to individuals who are insured for vaccines and can afford their insurer’s co-pay or deductible. c. Centers for Disease Control and Prevention or CDC: Federal Centers for Disease Control and Prevention. d. Delegate Agency: Immunization Provider providing Immunization Services pursuant to a subcontract of the LPHA for the purposes of providing immunization services to targeted populations. e. Exclusion Orders: Orders notifying a parent or guardian of non-compliance with the School/Facility Immunization Law, available for review at http://www.oregon.gov/dhs/ph/imm/ f. FamilyNet: An integrated, multi-program client data system supplied and maintained by the Department and used by the LPHAs. FamilyNet tracks client service data, including Immunization Services data, as well as data for other services provided by the LPHA. g. Forecasting: Determining vaccine doses that are due for an individual, based on the individual’s immunization history and age. h. IRIS/FamilyNet: The Immunization Services module for the FamilyNet data system. i. Monthly Vaccine Report or MVR: Monthly vaccine inventory report for vaccine accountability filled out by LPHA and submitted to Department covering LPHA and all Delegate Agencies. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 95 of 148 pages 132011 pgm.DOC - Deschutes County j. Oregon Immunization ALERT or ALERT: Department’s state-wide immunization registry. k. Public Provider Agreement: Signed agreement, required by CDC, between Department and any LPHA that receives State-Supplied Vaccine/IG. LPHA shall comply with the terms and conditions of the Public Provider Agreement, including submitting an annual Public Provider Profile that enumerates the population seen by the LPHA. The Department will maintain and have available for review the signed Public Provider Agreement and Public Provider Profile for Immunization Services at the Department’s office located at 800 NE Oregon St, Ste 370, Portland, OR 97232 l. Recall Postcards: Postcards sent to individuals who are due for an immunization. m. Self-automated LPHA: An LPHA that is using its own immunization data system and not using IRIS/FamilyNet. n. Service Areas: Geographic areas in Oregon served by Oregon immunization providers. o. State-Supplied Vaccine/IG: Vaccine or Immune Globulin provided by the Department 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, 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. p. Surveillance: The investigation, confirmation and reporting of communicable diseases and conditions. q. Tiered Ordering Frequency (TOF): A CDC process for ordering vaccines, where ordering frequency is linked to provider size, vaccine usage, and storage capacity. LPHA TOF available at: http://www.immalert.org . r. Vaccine Administration Record or VAR: A Department approved record documenting immunization screening questions asked of an individual receiving a vaccine and the data of the vaccines administered to the individual. s. Vaccine Adverse Events Reporting System or VAERS: Federal system for reporting adverse events to administered immunizations, available at http://vaers.hhs.gov/ t. Vaccine Eligibility: An individual’s eligibility for state-supplied vaccine. Information about vaccine eligibility is available at the Department website: http://www.oregon.gov/dhs/ph/imm/ u. Vaccine Information Statement or VIS: Information statement about each vaccine that is produced by CDC. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 96 of 148 pages 132011 pgm.DOC - Deschutes County 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 Department developed or approved VAR and report to the Department the appropriate eligibility of the client for State-Supplied Vaccine/IG, using the list of codes and the Vaccine Eligibility charts provided by the Department, Immunization Program, to the LPHA and posted on the website: http://www.oregon.gov/dhs/ph/imm / ii. LPHA will be billed quarterly by the Department for Billable Doses provided to those clients who are insured for vaccines and can afford their insurer’s co-pay or deductible. b. Vaccine Management & Accountability. LPHA shall track, store, and manage the supply and distribution of vaccine, according to Department and CDC guidelines set forth in the Public Provider Agreement and the Department’s Standard Operating Procedures (SOP) posted on the website: http://www.oregon.gov/dhs/ph/imm / Procedures include but are not limited to the following: i. 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. ii. Department-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. iii. 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. iv. 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 freezer 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 97 of 148 pages 132011 pgm.DOC - Deschutes County v. LPHA will follow all CDC and Department 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. 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 “D”, a copy of which is available from the Department’s Immunization Program at (971) 673-0300. i. LPHA shall complete a County Delegate Agency Vaccine Certification “D” for every Delegate Agency biennially. This Certification “D”, 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. ii. LPHA shall review each Delegate Agency on-site biennially using the Delegate Agency Review Tool, which Department will provide to LPHA. d. Vaccine Administration. i. Annually in accordance with a schedule determined by Department in consultation with LPHA or as requested by Department, 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. Department will maintain and have available for review the signed Immunization Program Public Provider Agreement and Public Provider Profile at the Department’s office located at 800 NE Oregon St, Ste 370, Portland, OR 97232. ii. All State-Supplied Vaccine/IG 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 Department’s Communicable Disease Summaries, as summarized in the Department’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://www.oregon.gov/dhs/ph/imm/ iii. 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 98 of 148 pages 132011 pgm.DOC - Deschutes County (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 HIPAA/ALERT signature requirement. At a minimum, LPHA must retain the Department’s “Vaccine Administration Record” or a Department approved equivalent as documentation. (C.) LPHA shall comply with state and federal statutory and regulatory retention schedules, available for review at the Department’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/IG, except for Billable Doses. Vaccine charges for Billable doses must not exceed the DHS published price list. (E.) LPHA shall not impose a charge for the administration of State-Supplied Vaccine/IG, 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 State-Supplied Vaccine/IG to a child seeking such vaccine due to the inability of the child’s parent or guardian or individual of record to pay an administration fee. All or a portion of VFC and 317 administration fees must be waived if the client is unable to pay for same. e. Immunization Rates and Assessments. Department shall provide annually to LPHA their AFIX rates and their population-based rate 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 Department in LPHA’s Service Area. Case management, in accordance with the Perinatal Hepatitis B Prevention Program Guidelines posted on the Department website at: http://www.oregon.gov/dhs/ph/imm/phepb/index.shtml 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 99 of 148 pages 132011 pgm.DOC - Deschutes County (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 15 months of age and post-serological testing by 18 months of age. LPHA shall submit such documentation, as applicable, to the Department 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 IRIS/FamilyNet or ALERT electronic forecast system, or a Department-approved forecasting algorithm. ii. LPHA must recall children who previously received vaccinations from LPHA, through the use of monthly recall postcards sent to their parents. Children who must be recalled include those less than five years old who have not received, when appropriate: 4 DTaP, 3 IPV, 1 MMR, 3 Hep B, up to 4 Hib, 1 Varicella or with no history of varicella disease, up to 4 PCV7, and 2 Hep A. At least two postcards must be sent for each past-due vaccine. Other additional methods of recall or reminders are encouraged. iii. LPHA must cooperate with the Department to recall a client if a dose administered by LPHA to such client is found by LPHA or the Department to have been mishandled and/or administered incorrectly, thus rendering such dose invalid. h. WIC/Immunization Integration. LPHA must assist and support the efforts of the Department 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 the Department'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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 100 of 148 pages 132011 pgm.DOC - Deschutes County ii. Confirm that, either 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://www.oregon.gov/DHS/ph/acd/ · http://www.oregon.gov/DHS/ph/phl/ · http://www.oregon.gov/dhs/ph/imm/ l. Adverse Events Following Immunizations. LPHA must complete and return a VAERS form to the Department if: i. An adverse event to immunization administration occurs, as listed in "Reportable Events Following Immunization”, available for review at http://www.vaers.org ii. The Department 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 the public prenatal programs. ii. LPHA shall work with hospitals within LPHA’s Service Area selected by the Department to strengthen hospital-based screening and documentation of every delivering woman’s hepatitis B serostatus. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 101 of 148 pages 132011 pgm.DOC - Deschutes County iii. LPHA shall, in accordance with a schedule determined by the Department in consultation with LPHA, develop and implement an action plan to work with hospitals identified by Department 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. School/Facility Immunization Law i. LPHA must comply with the Oregon School Immunization Law, Oregon Revised Statutes 433.235 — 433.284, available for review at http://www.oregon.gov/dhs/ph/imm/law/index.shtml 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 the Department no later than the second Friday of March of each year in which LPHA receives funding for Immunization Services under this Agreement. o. American Recovery and Reinvestment Act (ARRA) Stimulus Funds (one time only funding) i. LPHA shall work with local partners and Public Health Preparedness Liaisons to review and update local Mass Prophylaxis/ Strategic National Stockpile (SNS) Plans to ensure that mass vaccination plans are up-to-date in preparation for H1N1 response. ii. LPHA shall use ARRA funds to enhance the operations of mass and routine vaccination clinics. iii. LPHA shall cooperate regionally to identify five counties to lead in implementation of Immunization Information System Regional Trainings. iv. LPHA shall complete all ARRA reporting requirements, including submission of ARRA grant proposal to the Oregon Immunization Program by August 31, 2009, Final Summary Report by June 30, 2010, and meet all state and federal reporting requirements. 5. Performance Measures. LPHA shall meet the following performance measures: a. LPHA shall improve the 4:3:1:3:3:1 immunization series coverage rate by one (1) percentage point each year and/or maintain a rate of ³ 90% (4 DTaP, 3 IPV, 1 MMR, 3 Hep B, 3 Hib, 1 Varicella). b. LPHA shall reduce their Missed Shot rate by one (1) percentage point each year and/or maintain the rate of £ 10%. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 102 of 148 pages 132011 pgm.DOC - Deschutes County c. 95% of all state-supplied vaccines shall be coded correctly per age-eligibility guidelines. d. 80% of infants 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. e. 80% of all vaccine administration data shall be data entered within 14 days of administration. 6. Terms and Conditions Particular to LPHA Performance of the Immunization Services. a. LPHA shall reimburse the Department for the cost of wasted State-Supplied Vaccine/IG due to: i. Inadequate handling; including, but not limited to: theft/vandalism, lack of thermometers, power failure, or faulty equipment used in the storage and shipment of State-Supplied Vaccine/IG and/or Billables from LPHA to Department or Delegate Agency which does not maintain the vaccine according to manufacturer standards. ii. Untimely return (i.e., within 3-months of expiration) of State-Supplied Vaccine/IG, without prior authorization from the Department. b. The Department 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 any one quarterly billing period. The Department will not fill future vaccine orders following the third bill until payment is received for the delinquent billing period. c. LPHA must return to the Department, at LPHA’s expense, all styrofoam vaccine shipping containers received by LPHA from the Department. 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://www.oregon.gov/dhs/ph/imm/law/index.shtmllaw/index.cfm e. LPHA shall participate in State-sponsored immunization conference(s) and other training(s). LPHA shall receive dedicated funds for one person from the 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 the Department’s Immunization Program: 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 103 of 148 pages 132011 pgm.DOC - Deschutes County a. Monthly Vaccine Report: This report must be submitted by the 5th working day of every month and must contain separate vaccine inventory and administration data from all Delegate Agencies. b. Vaccine Orders: These orders must be submitted by the 5th working day of each month according to the Tiered Ordering Frequency (TOF) assigned by the Department. c. A copy of the completed Delegate Review Tool and Certificate “D” for each Delegate Agency must be sent to Department by the date determined by Department in consultation with LPHA, but in any event within two calendar months of the date that LPHA receives the request from Department for the completed Delegate Agency Review Tool and Certification “D”. d. LPHA shall submit vaccine administration data within 14 days of vaccine administration to the ALERT Registry via IRIS/FamilyNet, electronic data transfer, or barcode/hardcopy submission. 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 Area. e. LPHA shall complete and return a VAERS form to the Department if any of the conditions precedent set forth at Section 4.m. of this Program Element occur. f. LPHA shall complete and submit an Immunization Status Report as required in Section 4.o. of this Program Element. g. LPHA shall complete and submit an annual progress report for its triennial plan. The annual progress report shall be due at the beginning of the month corresponding to their assigned month for triennial agency review. Report format and county schedule is available for review at the Department's office located at 800 NE Oregon St, Ste 370, Portland, OR 97232. h. LPHA shall submit a written corrective action plan for any unsatisfactory responses to high-priority questions stemming from the triennial review site visit. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 104 of 148 pages 132011 pgm.DOC - Deschutes County Program Element #44: School Based Health Centers (SBHC) 1. School-Based Health Center (“SBHC”) Services a. Definitions Specific to SBHC 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 Standards for Certification for School-Based Health Centers (Department of Human Services). 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 the Department’s SBHC funding formula. ii. All SBHC Services must be delivered in accordance with the guidelines set forth in the Standards for Certification for SBHC (2000, revised 2005, revised 2009), a copy of which, including revisions, is available from Department or accessible on the Internet at.http://www.oregon.gov/DHS/ph/ah/sbhc/certification.shtml. The Standards for Certification for SBHC (2000, revised 2005, revised 2009) 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. Grantee must provide the oversight and technical assistance so that each SBHC in its jurisdiction meets the Standards for Certification for SBHC (2000, revised 2005, revised 2009). iv. Grantee shall assure to the Department that all certification documentation and subsequent follow-up items are completed by the requested date(s) in accordance with the Department’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, Grantee shall assure that all SBHC’s in its county jurisdiction: i. Submit annual client encounter data in a form acceptable to the Department and in accordance with the Standards for Certification for SBHC (2000, revised 2005, revised 2009) no later than July 15th for the preceding service year (July 1 –June 30), and 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 105 of 148 pages 132011 pgm.DOC - Deschutes County ii. Submit annual SBHC Key Performance Measure (KPM) data in a form acceptable to the Department and in accordance with the Standards for Certification for SBHC (2000, revised 2005) no later than October 1st for the preceding service year (July 1 –June 30). The current list of KPMs can be found at http://www.oregon.gov/DHS/ph/ah/sbhc/ in the folder titled SBHC Data Requirements. iii. Submit annual SBHC Billing, Revenue and Funding data in the form acceptable to the Department no later than October 1 st for the preceding service year (July 1-June 30). The current data collection form can be found at http://www.oregon.gov/DHS/ph/ah/sbhc/ in the folder titled SBHC Data Requirements iv. Submit annual SBHC hours of operation and staffing in the form acceptable to the Department no later than October 1 st for the current services year. The current data collection form can be found at http://www.oregon.gov/DHS/ph/ah/sbhc/ in the folder titled SBHC Data Requirements. v. Submit completed annual patient satisfaction survey data no later than June 1 st . 2. SBHC Planning Grants (for specific Grantees in 2009-2011) a. This section is applicable only to those Grantees who have received a Planning Grant from DHS. Current and potential Grantees will be notified if the 2009 Legislature approves and appropriates funds for SBHC Planning Grants. b. An SBHC planning grant is one-time funds to assist the Grantee in developing a strategic plan for implementing SBHC Services in the Grantee county jurisdiction. The following terms and conditions apply if the Department selects Grantee to receive a planning grant: i. Phase I (dates to be determined) Strategic Planning Grantee shall create and implement a collaborative 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 TBD. SBHC certification standards are available at http://www.oregon.gov/DHS/ph/ah/sbhc/certification.shtml . Grantee shall participate in monthly technical assistance calls at times mutually agreed to between DHS SBHC Program and Grantee Phase I Planning Grantees. In addition each SBHC site will have at least one technical assistance visit by a DHS SBHC Program staff member. ii. By TBD, Grantee 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 106 of 148 pages 132011 pgm.DOC - Deschutes County iii. Phase II (August 15, 2010-June 30, 2011) Strategic Planning (A.) Grantee shall implement the approved Phase I SBHC strategic plan and have the planned SBHC Services operational and ready for certification by Spring 2011. Sites must become certified in Spring 2011 to maintain current funding and to receive SBHC awards in accordance with the approved funding formula in effect and contingent on funds provided by the legislature. SBHC certification standards are available at: http://www.oregon.gov/DHS/ph/ah/sbhc/certification.shtml . (B.) Grantee shall participate in monthly technical assistance calls at times mutually agreed to between DHS SBHC Program and Grantee Phase II Planning Grantees. In addition, each SBHC site will have at least one technical assistance visit by a Department SBHC Program staff member. iv. Advance Phase (July 1, 2010- June 30, 2011) Strategic Planning (A.) Grantee shall create and implement a collaborative 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 2011. SBHC certification standards are available at http://www.oregon.gov/DHS/ph/ah/sbhc/certification.shtml . . (B.) Grantee shall participate in monthly technical assistance calls at times mutually agreed to between DHS SBHC Program and Advance Phase Planning Grantees. In addition, each SBHC site will have at least one technical assistance visit by a Department SBHC Program staff member. (C.) Grantee must become certified in Spring 2011 to maintain current funding and to receive SBHC awards in accordance with the approved funding formula in effect and contingent on funds provided by the legislature. SBHC certification standards are available at: http://www.oregon.gov/DHS/ph/ah/sbhc/certification.shtml . 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 107 of 148 pages 132011 pgm.DOC - Deschutes County DEPARTMENT OF HUMAN SERVICES 2010-2011 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES EXHIBIT C FINANCIAL ASSISTANCE AWARD 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 Department of Human Services Public Health Division Expenditure and Revenue Report (for all Programs Except Family Planning .) 3. Oregon Department of Human Services Public Health Services Expenditure and Revenue Report (for FAMILY PLANNING ONLY ). 4. Explanation of the Financial Assistance Award. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 108 of 148 pages 132011 pgm.DOC - Deschutes County FINANCIAL ASSISTANCE AWARD 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 109 of 148 pages 132011 pgm.DOC - Deschutes County 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 110 of 148 pages 132011 pgm.DOC - Deschutes County 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 111 of 148 pages 132011 pgm.DOC - Deschutes County 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 112 of 148 pages 132011 pgm.DOC - Deschutes County 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 113 of 148 pages 132011 pgm.DOC - Deschutes County 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 114 of 148 pages 132011 pgm.DOC - Deschutes County EXPLANATION OF FINANCIAL ASSISTANCE AWARD 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 the Department 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 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 of the 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 Department 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 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 Department has awarded financial assistance to LPHA under this Agreement. Each Program Element name and code set forth in this section of the Financial Assistance Award 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 Department and executed by the parties, the presence of an amount in this column will indicate the amount of financial assistance that was awarded by Department 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 of facilitating 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 of this Agreement. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 115 of 148 pages 132011 pgm.DOC - 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 Department and executed by the parties, the presence of an amount in this column will indicate the amount by which the financial assistance awarded by the Department 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 of this 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 Department to LPHA for the Program Element (or sub-element) identified on that line and is Department’s maximum obligation under this Agreement in support of services comprising that Program Element (or sub-element). In instances in which Department desires to limit or condition the expenditure of the financial assistance awarded by Department 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 Department 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 Department approves an LPHA request for, expenditure of the financial assistance provided hereunder for a capital outlay, the Department approval of LPHA’s capital outlay request will be set forth in this section of the Financial Assistance Award. This section contains a section heading that explains the Department requirement for obtaining Department approval for an LPHA capital outlay prior to LPHA’s expenditure of financial assistance provided hereunder for that purpose, and provides a brief Department definition of a capital outlay. The information associated with the Department approval of the LPHA 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 116 of 148 pages 132011 pgm.DOC - Deschutes County (iii.) Cost: The information presented in this column indicates the amount of financial assistance LPHA may expend to acquire the authorized item. (iv.) Program Approval: The presence of the initials of a Department official approves the LHPA 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 117 of 148 pages 132011 pgm.DOC - Deschutes County DEPARTMENT OF HUMAN SERVICES 2010-2011 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES EXHIBIT D SPECIAL TERMS AND CONDITIONS Enforcement of 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 Department’s Tobacco Prevention and Education Program (TPEP). b. Comply with the requirements set forth in OAR 333-015-0070 to 333-015-0085 using Department 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. “Department 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 333.010.0330(3)(b), LPHAs may use Ballot Measure 44 funds for these enforcement activities. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 118 of 148 pages 132011 pgm.DOC - Deschutes County 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 responsibility of the local government. Ballot Measure 44 funds may apply; see Section 2.h. above. 3. Department Responsibilities. Department 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 for 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 183.470. e. Issue final orders for all such case hearings. f. Pursue, within the guidelines provided in the Act and OAR 333.015.0070 – OAR 333.015- 0085, cases of repeat offenders to assure compliance with the Act. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 119 of 148 pages 132011 pgm.DOC - Deschutes County DEPARTMENT OF HUMAN SERVICES 2010-2011 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES EXHIBIT E 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, Department shall disburse the 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, Department may adjust monthly disbursements of financial assistance to meet LPHA program needs. ii. Department 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, Department may withhold monthly disbursements of financial assistance if any of LPHA’s reports required to be submitted to Department 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. Department may withhold the disbursements under this subsection until the reports have been submitted or corrected to Department’s satisfaction. Department 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 Department 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 an y 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. Department’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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 120 of 148 pages 132011 pgm.DOC - Deschutes County c. Recovery of Financial Assistance. i. Notice of Underexpenditure or Misexpenditure. If Department believes there has been an Underexpenditure (as defined in Exhibit A) of moneys disbursed under this Agreement, Department shall provide LPHA with written notice thereof and Department and LPHA shall engage in the process described in Section 1.c.ii. below. If Department believes there has been a Misexpenditure (as defined in Exhibit A) of moneys disbursed to LPHA under this Agreement, Department shall provide LPHA with written notice thereof and Department and LPHA shall engage in the process described in Section 1.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 the Department in full or notify the Department 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. (B) Appeals Process. If LPHA notifies Department that it wishes to engage in an appeal process, LPHA and the Department 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 the Department, and to give the Department the opportunity to reconsider its notice. LPHA and Department may negotiate an appropriate apportionment of responsibility for the repayment of an Underexpenditure. At LPHA request, Department 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 Department 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 the Department and LPHA reach agreement on the amount owed to Department, LPHA shall promptly repay that amount to Department by issuing payment to Department or by directing Department to withhold future payments pursuant to Section 1.c.ii.(C) below. If Department 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 and LPHA counsel approval, arbitration. (C) Recovery From Future Payments. To the extent that the Department is entitled to recover an Underexpenditure pursuant to Section 1.c.ii.(B), Department may recover the Underexpenditure by offsetting the amount thereof against future amounts owed to LPHA by Department, including, but not limited to, any amount owed to LPHA by Department under any other contract or agreement between LPHA and Department, present or future. Department shall provide LPHA written notice of its intent to recover the amounts of the Underexpenditure from amounts owed LPHA by Department as set forth in this Section 1.c.ii.(C), and shall identify the amounts owed by Department which the Department intends to offset, 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 121 of 148 pages 132011 pgm.DOC - Deschutes County (including the contracts or agreements, if any, under which the amounts owed arose) LPHA shall then have 14 calendar days from the date of Department's notice in which to request the deduction be made from other amounts owed to LPHA by Department and identified by LPHA. Department shall comply with LPHA’s request for alternate offset, unless the LPHA’s proposed alternative offset would cause the Department 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 Department and LPHA are unable to agree on which specific amounts, owed to County by Department, the Department may offset in order to recover the amount of the Underexpenditure, then the Department may select the particular contracts or agreements between Department and LPHA and amounts from which it will recover the amount of the Underexpenditure, within the following limitations: Department shall first look to amounts owed to LPHA (but unpaid) under this Agreement. If that amount is insufficient, then Department may look to any other amounts currently owing or owed in the future to LPHA by Department. In no case, without the prior consent of LPHA, shall the Department deduct from any one payment due LPHA under the contract or agreement from which Department is offsetting funds an amount in excess of twenty-five percent (25%) of that payment. The Department 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) the Department has to appeal a final written decision from the federal government, to: (i.) Make a payment to the Department in the full amount of the noticed Misexpenditure identified by the Department; (ii.) Notify the Department 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 the Department 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 b y this Section 1.c.iii.(A), Department may recover the amount of the noticed Misexpenditure from future payments as set forth in Section 1.c.iii.(C) below. (B) Appeal Process. If LPHA notifies Department 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: 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 122 of 148 pages 132011 pgm.DOC - Deschutes County (i.) Appeal from Department-Identified Misexpenditure. If the Department’s notice of Misexpenditure is based on a Misexpenditure solely of the type described in Section 13(b) or (c) of Exhibit A, LPHA and the Department shall engage in the process described in this Section 1.c.iii.(B)(I) to resolve a dispute regarding the noticed Misexpenditure. First, LPHA and Department 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 the Department, and to give the Department the opportunity to reconsider its notice. LPHA and Department may negotiate an appropriate apportionment of responsibility for the repayment of a Misexpenditure. At LPHA request, Department 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 Department 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 the Department and LPHA reach agreement on the amount owed to the Department, LPHA shall promptly repay that amount to Department by issuing payment to Department or by directing Department to withhold future payments pursuant to Section 1.c.iii.(C) below. If Department 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 and LPHA counsel approval, arbitration. (ii.) Appeal from Federal-Identified Misexpenditure. (a) If the Department’s notice of Misexpenditure of the type described in Section 13(a) of Exhibit 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 Department 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 Department 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 the Department pending the final federal decision resulting from the initial appeal If the LPHA does request, prior to the deadline set forth above, that the Department appeal, the Department shall appeal the determination of improper use, notice of disallowance or other federal identification of improper use of funds in accordance with the 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 123 of 148 pages 132011 pgm.DOC - Deschutes County 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 (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 Department shall cooperate with each other in pursuing the appeal. If the Grant Appeals Board or its equivalent denies the appeal then either LPHA, Department, 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 Department the amount of the noticed Misexpenditure (reduced, if at all, as a result of the appeal) by issuing payment to Department or by directing Department to withhold future payments pursuant to Section 1.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 Department 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 Department pursue an appeal prior to 30 days prior to the applicable federal appeals deadline, and if Department 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 Department the amount of the noticed Misexpenditure by issuing a payment to Department or by directing Department to withhold future payments pursuant to Section 1.c.iii.(C) below. (c) If LPHA does not request that Department 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 Department nevertheless appeals, LPHA shall repay to Department 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 Department or by directing Department to withhold future payments pursuant to Section 1.c.iii.(C) below. (d) Notwithstanding Section 1.c.iii.(A)(I) through (III), if the Misexpenditure was expressly authorized by a Department rule or a Department 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 Department, provided that: 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 124 of 148 pages 132011 pgm.DOC - Deschutes County (1) Where post-expenditure official reinterpretation of federal statutes or regulations results in a Misexpenditure, LPHA and Department will meet and negotiate in good faith an appropriate apportionment of responsibility between them for repayment of the Misexpenditure. (2) For purposes of this Section 1.c(iii)(B)(II)(d), a Department writing must interpret this Agreement or a Department rule and be signed by the Director of the Department or by one of the following DHS officers concerning services in the category where the officers are listed: Mental Health or Addiction Services: · Assistant Director, Administrator of the Office of Mental Health and Addiction Services · Deputy Administrator of the Office of Mental Health and Addiction Services Senior Services or Developmental Disability Services: · Assistant Director for Seniors and People with Disabilities · Deputy Assistant Director for Seniors and People with Disabilities · Office Administrators for the Assistant or Deputy Assistant Director for Seniors and People with Disabilities. Public Health Services: · Public Health Director · Deputy Public Health Director · Office Administrators for the Director or Deputy Director Department shall designate alternate officers in the event the offices designated in the previous sentence are abolished. Upon LPHA request, Department shall notify LPHA of the names of individual officers with the above titles. Department shall send Department writings described in this paragraph to LPHA by mail and email, and to CMHP directors by email. (3) 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 125 of 148 pages 132011 pgm.DOC - Deschutes County (4) If the Department writing is in response to a request from LPHA for expenditure authorization, the request must be in writing and signed by the director of a 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. (5) A Department 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 Department writing continues to apply to LPHA expenditures that were made in compliance with the writing and during the term of the writing. (6) The Department may revoke or revise a Department writing at any time if it determines in its sole discretion that the writing allowed expenditure in violation of this Agreement or law or any other applicable authority. (7) The Department rule does not authorize an expenditure that this Agreement prohibits. (C) Recovery From Future Payments. To the extent that Department is entitled to recover a Misexpenditure pursuant to Section 1.c.iii.(B)(I) or (II), Department may recover the Misexpenditure by offsetting the amount thereof against future amounts owed to LPHA by Department, including but not limited to, any amount owed to LPHA by Department under this Agreement or any amount owed to LPHA by Department under any other contract or agreement between LPHA and Department, present or future. Department shall provide LPHA written notice of its intent to recover the amount of the Misexpenditure from amounts owed LPHA by Department as set forth in this Section 1.c.iii.(C) and shall identify the amounts owed by Department that the Department intends to offset (including the contracts or agreements, if any, under which the amounts owed arose). LPHA shall then have 14 calendar days from the date of Department's notice in which to request the deduction be made from other amounts owed to LPHA by Department and identified by LPHA. Department shall comply with LPHA’s request for alternate offset, unless the LPHA’s proposed alternative offset would cause the Department to violate federal or state statutes, administrative rules or other applicable authority. In the event that Department and LPHA are unable to agree on which specific amounts are owed to LPHA by Department, that Department may offset in order to recover the amount of the Misexpenditure, then the Department may select the particular amounts from which it will recover the amount of the Misexpenditure, within the following limitations: Department shall first look to amounts owed to LPHA (but unpaid) under this Agreement. If that amount is insufficient, then Department may look to any other amounts currently owing or owed in the future to LPHA by Department. In no case, without the prior consent of LPHA, shall the Department deduct from any one payment due LPHA under the contract or agreement from which Department is offsetting funds an amount in excess of twenty-five percent (25%) of that payment. The Department may look to as many 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 126 of 148 pages 132011 pgm.DOC - Deschutes County future payments as necessary in order to fully recover the amount of the Misexpenditure. d. Additional Provisions related to parties rights/obligations with respect to Underexpenditures and Misexpenditures. i. LPHA shall cooperate with Department in the Agreement Settlement process. ii. Department'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 Department'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 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 Department to negotiate and execute any future contract with the other. (B) Nothing in this Section 1.c. 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 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 127 of 148 pages 132011 pgm.DOC - Deschutes County 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 Award and applicable Program Element Description. b. DHS represents and warrants as follows: i. Organization and Authority. DHS 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 DHS of this Agreement (1) have been duly authorized by all necessary action by DHS 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 DHS is a party or by which DHS 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 DHS 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 DHS and constitutes a legal, valid and binding obligation of DHS, enforceable in accordance with its terms subject to the laws of bankruptcy, insolvency, or other similar laws affecting the enforcement of creditors’ rights generally. c. Warranties Cumulative. The warranties set forth in this section are in addition to, and not in lieu of, any other warranties provided. 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 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 128 of 148 pages 132011 pgm.DOC - Deschutes County 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 of this 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 Department upon request. 5. Provider Monitoring. LPHA shall monitor each Provider’s delivery of Program Element services and promptly report to Department 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 Department 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. The Department, 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 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 Department 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 Department 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 Department 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 Department, utilize time/activity studies in accounting for expenditures of financial assistance provided hereunder for employee compensation. LPHA shall maintain accurate property records of non- 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 129 of 148 pages 132011 pgm.DOC - Deschutes County 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 information, and shall make such policies and procedures available to the Department for review and inspection as reasonably requested by Department. 7. Alternative Formats of Written Materials. In connection with the delivery of Program Element services, LPHA shall: a. Make available to a Client, without charge to the Client, upon the Client’s or the Department’s request, any and all written materials in alternate, if appropriate, formats as required by Department’s administrative rules or by Department’s written policies made available to LPHA. b. Make available to a Client, without charge to the Client, upon the Client’s or Department’s request, any and all written materials in the prevalent non-English languages in LPHA’s service area. c. Make available to a Client, without charge to the Client, upon the Client’s or Department’s request, oral interpretation services in all non-English languages in LPHA’s service area. d. Make available to a Client with hearing impairment, without charge to the Client, upon the Client’s or Department’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 Department under this Agreement, LPHA shall prepare and deliver to Department, no later than the 25 days following the end of the first, second and third quarters (or end of 3, 6, and 9 month periods) and 50 days following the end of the 4th 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 Department of Human Services, Public Health Division Expenditure and Revenue Report For All Programs Except for Family Planning.” 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 130 of 148 pages 132011 pgm.DOC - Deschutes County b. Expenditure reports for PE 41, must be substantially in the form set forth in Exhibit C titled "Oregon Department of Human Services 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 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, Department 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 of this Agreement, (b) termination by Department of Department’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, Department shall provide technical assistance to LPHA in the delivery of Program Element services to the extent resources are available to Department for this purpose. 11. Payment of Certain Expenses. If Department requests that an employee of LPHA, or a Provider or a citizen providing services or residing within LPHA’s service area, attend Department training or a Department 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, Department 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 as of the date the expense was incurred and only to the extent that Department 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 Department 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; 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 131 of 148 pages 132011 pgm.DOC - Deschutes County 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 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. Department Default. Department shall be in default under this Agreement upon the occurrence of any of the following events: a. Department 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 Department herein or in any documents or reports made by Department in connection herewith that are reasonably relied upon by LPHA to measure performance by Department 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 Department, with the termination effective as of the first day of the month following the notice period; ii. Upon 45 days advance written notice to Department, 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; 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 132 of 148 pages 132011 pgm.DOC - Deschutes County iii. Upon 30 days advance written notice to Department, if Department 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 iv. Immediately upon written notice to Department, 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. Department Termination. Department 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 Award: 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 Department does not obtain funding, appropriations and other expenditure authorizations from federal, state or other sources sufficient to meet the payment obligations of Department under this Agreement, as determined by Department in the reasonable exercise of its administrative discretion. Notwithstanding the preceding sentence, the Department 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 Department’s legislative authorization for expenditure of funds to such a degree that Department will no longer have sufficient expenditure authority to meet its payment obligations under this Agreement, as determined by Department 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 the Department 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 Department 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 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 133 of 148 pages 132011 pgm.DOC - Deschutes County with respect to the particular Program Element impacted by the loss of necessary licensure or certification; or vi. Immediately upon written notice to LPHA, if Department 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, Department shall have no further obligation to pay or disburse financial assistance to LPHA under this Agreement, whether or not Department 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 Department’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 Department’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, Department shall have (a) no further obligation to pay or disburse financial assistance to LPHA under this Agreement for administration of that Program Element service whether or not Department 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 pay or disburse any financial assistance to LPHA under this Agreement for such Program Element service, whether or not Department has paid or disbursed to LPHA all financial assistance described in the Financial Assistance Award for such Program Element service except (1) with respect to funds described in the Financial Assistance Award, to the extent Department’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 Department’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 of this Agreement through the termination date. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 134 of 148 pages 132011 pgm.DOC - Deschutes County c. Upon termination of Department’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. d. Disbursement Limitations. Notwithstanding subsections a. and b. above, under no circumstances will Department 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 the Department 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 Department’s right to enforce this Agreement against LPHA in accordance with its terms, with respect to financial assistance actually disbursed by Department 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 Department hereunder, LPHA’s obligation to cooperate with Department in the Agreement Settlement process; or Department’s right to recover from LPHA; in accordance with the terms of this Agreement; any financial assistance disbursed by Department 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. Funds Available and Authorized. The provision of financial assistance to the LPHA by the Department pursuant to this Agreement is conditioned upon the Department receiving funding, appropriations, limitations, allotment, or other expenditure authority, together with related funds, sufficient to allow the Department, in the exercise of its reasonable discretion, to meet its funding obligations under this Agreement. Nothing in this Agreement shall be construed to permit any violation of Article XI, section 7 of the Oregon Constitution or any other law regulating liabilities or monetary obligations of the State of Oregon. 17. Effect of Amendments Reducing Financial Assistance. If LPHA and Department 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 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 135 of 148 pages 132011 pgm.DOC - Deschutes County disbursed by Department under this Agreement or with respect to Program Element services actually delivered. 18. Resolution of Disputes over Additional Financial Assistance Owed LPHA After Termination. If, after termination of this Agreement, LPHA believes that Department disbursements of financial assistance under this Agreement for a particular Program Element are less than the amount of financial assistance that Department 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 Department with written notice thereof. Department 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 Department notifies LPHA that it wishes to engage in a dispute resolution process, LPHA and Department's Assistant Administrator shall engage in non- binding discussion to give Department 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 Department and LPHA reach agreement on the additional amount owed to LPHA, Department shall promptly pay that amount to LPHA. If Department 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. 19. 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. 20. Nothing in this Exhibit shall require LPHA or Department to act in violation of state or federal constitutions, statutes, regulations or rules. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 136 of 148 pages 132011 pgm.DOC - Deschutes County DEPARTMENT OF HUMAN SERVICES 2010-2011 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES EXHIBIT F STANDARD TERMS AND CONDITIONS 1. Notice. Except as otherwise expressly provided in this Agreement, any communications between the parties hereto or notices to be given hereunder shall be given in writing by personal delivery, facsimile, or mailing the same, postage prepaid to LPHA or Department at the address or number set forth below, or to such other addresses or numbers as either party may indicate pursuant to this Section. Any communication or notice so addressed and mailed shall be effective five (5) days after mailing. Any communication or notice delivered by facsimile shall be effective on the day the transmitting machine generates a receipt of the successful transmission, if transmission was during normal business hours of the recipient, or on the next business day, if transmission was outside normal business hours of the recipient. To be effective against Department, any notice transmitted by facsimile must be confirmed by telephone notice to Department’s Office of Contracts and Procurement (503) 373-7889. To be effective against LPHA, any notice transmitted by facsimile must be confirmed by telephone notice to the fax number as indicated below under “Notices to LPHA.” Any communication or notice given by personal delivery shall be effective when actually delivered. Notices to Department: Tom Engle, Community Liaison Program Manager Department of Human Services, Office of Health Services 800 NE Oregon St., Ste 930 Portland, Oregon 97232 Phone: 503-731-4017 Fax: 503-731-4078 Email: tom.r.engle@state.or.us Notices to LPHA: Mr. Scott Johnson Deschutes County Health Services 2577 NE Courtney Bend, Oregon 97701 Phone: (541) 322-7426 Fax: (541) 322-7465 Email: scottj@co.deschutes.or.us 2. Severability. The parties agree that if any term or provision of this Agreement is declared by a court of competent jurisdiction to be illegal or in conflict with any law, the validity of the remaining terms and provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular term or provision held to be invalid. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 137 of 148 pages 132011 pgm.DOC - Deschutes County 3. 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. 4. 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, “Claim”) 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 . 5. Compliance with Law. Both parties shall comply with all federal, state and local laws, regulations, executive orders and ordinances 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 the Department 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 Department, 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. 6. Assignment of Agreement, Successors in Interest. a. LPHA shall not assign or transfer its interest in this Agreement without prior written approval of Department. Any such assignment or transfer, if approved, is subject to such conditions and provisions as the Department may deem necessary. No approval by the Department of any assignment or transfer of interest shall be deemed to create any obligation of the Department 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 138 of 148 pages 132011 pgm.DOC - Deschutes County 7. No Third Party Beneficiaries. Department 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 Department to assist and enable Department 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 of this Agreement. 8. 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. 9. 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 of their authorized representative, hereby acknowledge that they have read this Agreement, understand it, and agree to be bound by its terms and conditions. 10. 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. 11. Construction. This Agreement is the product of extensive negotiations between Department 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. 12. 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. 13. 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 ANY SORT ARISING SOLELY FROM THE TERMINATION OF THIS AGREEMENT OF ANY PART HEREOF IN ACCORDANCE WITH ITS TERMS . 14. Ownership of Intellectual Property. a. Except as otherwise expressly provided herein, or as otherwise required by state or federal law, the Department 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 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 139 of 148 pages 132011 pgm.DOC - Deschutes County grants to the Department 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 (i) use, reproduce, prepare derivative works based upon, distribute copies of, perform and display the intellectual property, (ii) authorize third parties to exercise the rights set forth in Section 14.a(i) on the Department’s behalf, and (iii) sublicense to third parties the rights set forth in Section 14.a(i). b. If state or federal law requires that the Department or LPHA grant to the United States a license to any intellectual property, or if state or federal law requires that the Department or the United States own the intellectual property, then LPHA shall execute such further documents and instruments as Department may reasonably request in order to make any such grant or to assign ownership in the intellectual property to the United States or the Department. To the extent that the Department becomes the owner of any intellectual property created or delivered by LPHA in connection with the Program Element services, the Department 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. c. LPHA shall include in its Provider Contracts terms and conditions necessary to require that Providers execute such further documents and instruments as Department may reasonably request in order to make any grant of license or assignment of ownership that may be required by federal or state law. 15. Force Majeure. Neither Department 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 the Department 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. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 140 of 148 pages 132011 pgm.DOC - Deschutes County DEPARTMENT OF HUMAN SERVICES 2010-2011 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES EXHIBIT G REQUIRED FEDERAL TERMS AND CONDITIONS Unless exempt under 45CFR Part 87 for Faith-Based Organizations (Federal Register, July 16, 2004, Volume 69, #136), or other federal provisions, LPHA shall comply and, as indicated, cause all sub- contractors 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 cause all Providers to comply with all federal laws, regulations, executive orders applicable to the Agreement or to the delivery of Work. Without limiting the generality of the foregoing, LPHA expressly agrees to comply and cause 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, (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, (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, (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 Work in violation of 42 USC 14402. 2. Equal Employment Opportunit y If this Agreement, including amendments, is for more than $10,000, then LPHA shall comply and cause all Providers to comply with Executive Order 11246, entitled "Equal Employment Opportunity," as amended by Executive Order 11375, and as supplemented in DHS 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 cause 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 DHS, HHS and the appropriate 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 141 of 148 pages 132011 pgm.DOC - Deschutes County Regional Office of the Environmental Protection Agency. LPHA shall include and cause all Providers to include in all contracts 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 cause 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, 42 U.S.C. 6201 et seq. (Pub. L. 94-163). 5. Truth in Lobbying 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 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 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 subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients 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. 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. 6. HIPAA Compliance If the Work funded in whole or in part with financial assistance provided under this Agreement are covered by the Health Insurance Portability and Accountability Act or the federal regulations implementing the Act (collectively referred to as HIPAA), LPHA agrees to deliver the Work in compliance with HIPAA. Without limiting the generality of the foregoing, Work funded in whole or in part with financial assistance provided under this Agreement are covered by HIPAA. LPHA shall comply and cause all Providers to comply with the following: 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 142 of 148 pages 132011 pgm.DOC - Deschutes County 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 LPHA and DHS for purposes directly related to the provision of services to Clients which are funded in whole or in part under this Agreement. However, LPHA shall not use or disclose any Individually Identifiable Health Information about specific individuals in a manner that would violate DHS Privacy Rules, OAR 407-014-0000 et. seq., or DHS Notice of Privacy Practices, if done by DHS. A copy of the most recent DHS Notice of Privacy Practices is posted on the DHS web site at http://www.dhs.state.or.us/policy/admin/security/090_005.htm or may be obtained from DHS. b. Data Transactions Systems. If LPHA intends to exchange electronic data transactions with DHS 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 DHS and shall comply with the DHS EDI Rules. c. Consultation and Testing. If LPHA reasonably believes that the LPHA's or the DHS' data transactions system or other application of HIPAA privacy or security compliance policy may result in a violation of HIPAA requirements, LPHA shall promptly consult the DHS HIPAA officer. LPHA or DHS may initiate a request for testing of HIPAA transaction requirements, subject to available resources and the DHS 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 USC 6901 et. seq.). Section 6002 of that Act (codified at 42 USC 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, if applicable, cause a Provider to comply, with the applicable audit requirements and responsibilities set forth in the Office of Management and Budget Circular A-133 entitled “Audits of States, Local Governments and Non-Profit Organizations.” b. Sub-recipients shall also comply with applicable Code of Federal Regulations (CFR) sections and OMB Circulars governing expenditure of federal funds. State, local and Indian Tribal Governments and governmental hospitals must follow OMB A-102. Non- profits, hospitals, colleges and universities must follow 2 CFR Part 215. Sub-recipients shall monitor any organization to which funds are passed for compliance with CFR and OMB requirements. 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 Nonprocurement Programs” in accordance with Executive Orders 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 143 of 148 pages 132011 pgm.DOC - Deschutes County No. 12,549 and No. 12,689, “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 cause 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 workplace or while providing services to DHS 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 contract 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 contract, 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 DHS 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 contract 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 DHS 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; (x) Violation of any provision of this subsection may result in termination of the contract. 11. Pro-Children Act. LPHA shall comply and cause all sub-contractors to comply with the Pro-Children Act of 1994 (codified at 20 USC section 6081 et. seq.). 12. Medicaid Services. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 144 of 148 pages 132011 pgm.DOC - Deschutes County LPHA shall comply with all applicable federal and state laws and regulations pertaining to the provision of Medicaid Services under the Medicaid Act, Title XIX, 42 USC Section 1396 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 USC Section 1396a(a)(27); 42 CFR 431.107(b)(1) & (2). b. Comply with all disclosure requirements of 42 CFR 1002.3(a) and 42 CFR 455 Subpart (B). c. Maintain written notices and procedures respecting advance directives in compliance with 42 USC Section 1396(a)(57) and (w), 42 CFR 431.107(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 contract and any other Medicaid contract) 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 USC § 1396a(a)(68). 13. Agency-based Voter Registration. 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 to applicants for services. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 145 of 148 pages 132011 pgm.DOC - Deschutes County DEPARTMENT OF HUMAN SERVICES 2010-2011 INTERGOVERNMENTAL AGREEMENT FOR THE FINANCING OF PUBLIC HEALTH SERVICES EXHIBIT H 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 Contract in excess of the amount reasonable and necessary to provide quality delivery of _____________. b. If this Contract 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 Department of Human Services, 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 Department of Human Services 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 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 146 of 148 pages 132011 pgm.DOC - 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-122. 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 Department of Human services 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 Department of Human Service’s request, any and all written materials in alternate, if appropriate, formats as required by Oregon Department of Human Services administrative rules or by Oregon Department of Human Services 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 Department of Human Services’ 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 Department of Human Services’ 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, County’s or the Oregon Department of Human Services’ 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 Department of Human Services related to public health programs; and (d) 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 services under this 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 147 of 148 pages 132011 pgm.DOC - Deschutes County Contract. These laws, regulations and executive orders are incorporated by reference herein to the extent 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 Department of Human Services 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 of the State of Oregon, the Oregon Department of Human Services 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 Department of Human Services, subject to ORS chapter 180), save and hold harmless the State of Oregon, the Oregon Department of Human Services, 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 of the Provider, including but not limited to the activities of Provider or its officers, employees, Providers or agents under this Contract. 2010-2011 Intergovernmental Agreement for the Financing of Public Health Services Page 148 of 148 pages 132011 pgm.DOC - Deschutes County 8. Auto Insurance. Provider shall obtain, at Provider’s expense, and maintain in effect with respect to all occurrences taking place during the term of the Contract, automobile liability insurance with a combined single limit, or the equivalent of not less than $500,000 per occurrence for Bodily Injury, AND not less than $500,000 per occurrence for Property Damage, including coverage for owned, hired, or non-owned vehicles as applicable. 9. General Liability Insurance. Provider shall obtain, at Provider’s expense, and maintain in effect with respect to all occurrences taking place during the term of the Contract, comprehensive or commercial general liability insurance with a combined single limit, or the equivalent of not less than $500,000 per occurrence for Bodily Injury, AND not less than $500,000 per occurrence for Property Damage. This insurance shall include personal injury coverage and contractual liability coverage for the indemnity provided under this Contract. 10. Workers’ Compensation. Provider, its subcontractors, if any, and all employers providing work, labor or materials under the Contract are subject employers under the Oregon Workers’ Compensation Law and shall comply with ORS 656.017, which requires them to provide workers’ compensation coverage for all their subject workers. This shall include employers’ liability insurance with coverage limits of not less than $100,000 each accident. Providers who perform the work without the assistance of labor or any employee need not obtain such coverage. 11. Proof of Insurance, etc. Provider shall name the State of Oregon, the Oregon Department Human Services, LPHA, and their divisions, officers, and employees as additional insureds on any insurance policies required herein with respect to Provider’s activities being performed under the Contract. Such insurance shall be issued by an insurance company licensed to do business in the State of Oregon and shall contain a 30 day notice of cancellation endorsement. Provider shall forward to LPHA a certificate(s) of insurance (and if so requested by LPHA, a copy of the policy of insurance) indicating the coverage required by Sections 8 through 10 prior to commencement of the services under this Contract. In addition, in the event of unilateral cancellation or restriction by Provider’s insurance company of any insurance coverage required herein, Provider shall immediately notify LPHA orally of the cancellation or restriction and shall confirm the oral notification in writing within three days of notification by the insurance company to Provider. 12. Subcontracts. Provider shall include sections 1 through 11, in substantially the form set forth above, in all permitted subcontracts under this Contract.