HomeMy WebLinkAboutDoc 684 - Health Svcs Agrmt - StateDeschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701 -1960
(541) 388 -6570 - Fax (541) 385 -3202 - www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of December 30, 2009
DATE: December 16, 2009
FROM: Nancy England, Contract Specialist, Deschutes County Health Services, 322 -7516
TITLE OF AGENDA ITEM:
Consideration of Board Signature of Document #2009 -684, Amendment #4 to the Intergovernmental Financial
Agreement Award #128008 between the Local Public Health Department and the Oregon Department of Haman
Services for the financing of Local Public Health Services for fiscal year 2009 -2010.
PUBLIC HEARING ON THIS DATE? No.
BACKGROUND AND POLICY IMPLICATIONS:
The 2009 -2010 Intergovernmental Agreement for the financing of public health services, effective July 1,
2009, between the State of Oregon acting by and through its Department of Human Services and Deschutes
County, acting by and through its Deschutes County Human Services as the Local Public Health Authority
(LPHA), the entity designated, pursuant to ORS 431.375 (2).
Amendment #128008-4 modifies the Program Element Description for "Public Health Response to
H1N1 Influenza Vaccination Program as set forth in Exhibit 1 and provides funding for the
following:
1. Program Element #04 — Public Health Response to H1N1 Influenza Vaccination - $154,19:
is awarded for the H1N1 mass vaccination activities described in PE 4, Exhibit 1.
FISCAL IMPLICATIONS:
Maximum compensation is $154,192
RECOMMENDATION & ACTION REQUESTED:
Approval and signature of Document #2009 -684, Amendment #4 to the Intergovernmental Financial Agree] Went
Award #128008 between the Local Public Health Dept. and the Oregon State Department of Human Servict s is
requested.
ATTENDANCE:
DISTRIBUTION OF DOCUMENTS:
Connie Thies, Dept. of Human Services (DHS), Office of Contracts & Procurement, 500 Summer St., E -03,
Salem, OR 97301 -1080, ph: 503- 945 -6372, FAX: 503- 378 -4324; and to Nancy England, Health Services
Department, 2577 NE Courtney Dr., Bend, OR 97701, 322 -7516.
DESCHUTES COUNTY DOCUMENT SUMMARY
(NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be
on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board
agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be returned to
the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the
County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form
electronically to the Board Secretary.)
Date:
Please complete all sections above the Official Review line.
December 8, 2009
Department: Health Services, Public Health Division
Contractor /Supplier /Consultant Name:
Oregon State Department of Human Services
Contractor Contact: Connie Thies, Office of Contracts & Procurements
Contractor Phone #:
541- 945 -6372
Type of Document: Amendment
Goods and /or Services: Consideration and signature of document #2009 -684,
Amendment #4 to the 2009 -2010 Intergovernmental Agreement for the financing of
public health services, Agreement #128008.
Background & History: The 2009 -2010 Intergovernmental Agreement for the
financing of public health services, effective July 1, 2009, between the State of Oregon
acting by and through its Department of Human Services and Deschutes County, acting
by and through its Deschutes County Human Services as the Local Public Health
Authority (LPHA), the entity designated, pursuant to ORS 431.375 (2).
Amendment #128008 -4 modifies the Program Element Description for "Public Health
Response to H1 N1 Influenza Vaccination Program as set forth in Exhibit 1 and provides
funding for the following:
1. Program Element #04 — Public Health Response to H1 N1 Influenza Vaccination -
$154,192 is awarded for the H1 N1 mass vaccination activities described in PE 4,
Exhibit 1.
Agreement Starting Date:
July 1, 20091 Ending Date: ; June 30, 2010
Annual Value or Total Payment:
$154,192
Insurance Certificate Received (check box)
Insurance Expiration Date: County is Contractor
Check all that apply:
j— RFP, Solicitation or Bid Process
❑ Informal quotes ( <$150K)
® Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37)
1218/200!
Funding Source: (Included in current budget? ® Yes ❑ No
If No, has budget amendment been submitted? ❑ Yes 17 No
Is this a Grant Agreement providing revenue to the County? ❑ Yes ® No
Special conditions attached to this grant:
Deadlines for reporting to the grantor: r
If a new FTE will be hired with grant funds, confirm that Personnel has been notified that
it is a grant - funded position so that this will be noted in the offer letter: n Yes ❑ No
Contact information for the person responsible for grant compliance: Name:
Phone #: I
Departmental Contact and Title: Nancy England, Contract Specialist
Phone #:
541 - 322 -7516
Department Director Approval:
L i
Sign are Date
Distribution of Document: Nancy England, fax (541) 322 -7565, Include complete
information if document is to be mailed.
Official Review:
County Signature Required (check one): 1J BOCC ❑ Department Director (if <$25K)
❑ Administrator (if >$25K but <$150K; if >$150K, BOCC Order No.
Legal Review ` "a, Date 7 -Z
Document Number 2009 -684
12/8/2009
)rDHS
Oregon Department
of Human Services
Office of Contracts & Procurement
500 Summer St. NE, E -03
Salem, OR 97301 -1080
Phone: (503) 945 -5818
Fax: (503) 378 -4324
TTY: (503) 947 -5330
FAX BACK STATEMENT
Please complete the following statement and return it along with the completed
signature page(s) and the Data Certification page of this contract. If any changes
are made to the document, please return the Contract, in its entirety, via fax.
Thank you.
I
(Name) (Title)
received a copy of Agreement #:128008 -4, between the State of Oregon, acting by
and through the Department of Human Services, and Deschutes County Human
Services , by e -mail from Connie Thies on November 23, 2009.
On , I signed the printed form of the Contract without change. A
(Date)
copy of the signature page from this Contract containing my signature
and dated is included with this facsimile transmission.
(Date)
(Signature) (Date)
After all parties have signed, you will receive a copy of the document for your
records. If you have any questions, please call the contract specialist,
Phil McCoy at (503) 945 -5868.
Enclosure(s)
C: \Documents and Settings \nancye \Local Settings \Temporary Internet Files \OLK7 \128008 -4 Fax Back Statement.doc Revised: Dec. 5, 200
In compliance with the Americans with Disabilities Act, this document is available in
alternate formats such as Braille, large print, audiotape, oral presentation, and electronic
format. To request an alternate format, call the State of Oregon, Department of Human
Services, Office of Forms and Document Management at (503) 945 -7021, Fax (503 )
373 -7690, or TTY (503) 947 -5330.
Agreement #128008
FOURTH AMENDMENT TO DEPARTMENT OF HUMAN SERVICES
2009 -2010 INTERGOVERNMENTAL AGREEMENT FOR THE
FINANCING OF PUBLIC HEALTH SERVICES
This Fourth Amendment to Department of Human Services 2009 -2010 Intergovernmen al
Agreement for the Financing of Public Health Services, effective July 1, 2009 (as amended t ie
"Agreement "), is between the State of Oregon acting by and through its Department of Human Servic �s
( "Department ") and Deschutes County, acting by and through its Deschutes County Health Servic vs
( "LPHA "), the entity designated, pursuant to ORS 431.375(2), as the Local Public Health Authority 13r
Deschutes County.
RECITALS
WHEREAS the Department and LPHA wish to modify the set of Program Elements set forth in
Exhibit B "Program Element Descriptions" of the Agreement.
WHEREAS, the Department and LPHA wish to modify the Financial Assistance Award se:
forth in Exhibit C of the Agreement.
NOW, THEREFORE, in consideration of the premises, covenants and agreements contained
herein and other good and valuable consideration, the receipt and sufficiency of which is hereb:
acknowledged, the parties hereto agree as follows:
AGREEMENT
1. Exhibit B "Program Element Descriptions" is hereby modified as follows: Program Elemen t
04: Public Health Response to H1N1 Influenza Vaccination Program is hereby added as se:
forth in Exhibit 1 "Program Element Descriptions" attached hereto and incorporated therein the
Agreement by this reference.
2. Section 1 of Exhibit C entitled "Financial Assistance Award" of the Agreement is hereby
superseded and replaced in its entirety by Exhibit 2 attached hereto and incorporated herein by
this reference. Exhibit 2 must be read in conjunction with Section 4 of Exhibit C, entitled
"Explanation of Financial Assistance Award" of the Agreement.
3. LPHA represents and warrants to Department that the representations and warranties of LPHA
set forth in Section 2 of Exhibit E of the Agreement are true and correct on the date hereof wit'
the same effect as if made on the date hereof.
REVIEV1ED
&chi
M AL RIN K
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128008 -4 pgm.doc - Deschutes County
DC —20 09— 5 &6 =d.
4. Capitalized words and phrases used but not defined herein shall have the meanings ascribed
thereto in the Agreement.
5. Except as amended hereby, all terms and conditions of the Agreement remain in full force and
effect.
6. This Amendment may be executed in any number of counterparts, all of which when taker
together shall constitute one agreement binding on all parties, notwithstanding that all partie
are not signatories to the same counterpart. Each copy of this Amendment so executed sha]
constitute an original.
7. This Amendment becomes effective on the date of the last signature below.
THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK
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IN WITNESS WHEREOF, the parties hereto have executed this Amendment as of the dates se
forth below their respective signatures.
APPROVED:
STATE OF OREGON ACTING BY AND THROUGH ITS DEPARTMENT OF HUMAN SERVICES
(DEPARTMENT)
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: Tammy Baney, Chair
Title: Deschutes County Board of
Date: Commissioners
DEPARTMENT OF JUSTICE — APPROVED FOR LEGAL SUFFICIENCY
Approved by D. Kevin Carlson, Senior Assistant Attorney General per OAR 137 -045 - 0015(3) on August 11, 2009.
Copy of emailed approval on file at DHS -OC &P.
REVIEWED:
DEPARTMENT OF HUMAN SERVICES, PUBLIC HEALTH DIVISION
By:
Name: Rosemary Schaefer
Title: Program Support Manager
Date:
DEPARTMENT OF HUMAN SERVICES, OFFICE OF CONTRACTS & PROCUREMENT
By:
Name: Phillip G. McCoy, OPBC
Title: Contract Specialist
Date:
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EXHIBIT 1
PROGRAM ELEMENT DESCRIPTIONS
Program Element 04: Public Health Response to H1N1 Influenza Vaccination Program
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 ti
operate a vaccination program to respond to the H1N1 influenza pandemic. The Centers fo
Disease Control and Prevention (CDC) released guidelines to DHS and local health official:
with planning strategies for administering H1N 1 vaccines. LPHA will schedule, implemen
and provide follow up for vaccination clinics to provide efficient and prompt distribution o
H1N1 vaccination to persons residing in LPHA service area. LPHA have three options fo
providing services under this Agreement. LPHA may choose one or a combination of the
following three options:
a. Redistribution. LPHA may utilize the H1N1 Order Tracking Database to supply loca
private and public partner organizations living within LPHA service area with vaccine
allocated to LPHA.
b. Implement H1N1 Vaccination Clinics. LPHA may utilize H1N1 vaccine allocated tc
them via the CDC, as reflected on the H1N1 Order Tracking Database, to plan am,
implement immunization clinics for public clients residing or visiting the LPHA service.
area.
c. DHS Mass Vaccination Contract. LPHA may access the services of Contracto
Agencies via the state -wide DHS Mass Vaccination Contract. LPHA must abide by term:.
outlined in Section 4 of this document, "Responsibilities Regarding Mass Vaccinato
Contracted Services ".
2. Definitions Specific to H1N1 Influenza Vaccination Program.
CDC: U. S. Department of Health and Human Services, Centers for Disease Control anc.
Prevention.
DHS: Oregon Department of Human Services, Public Health Division
H1N1 LPHA Contact: This is an LPHA staff that has been designated as the primary point
of contact for DHS regarding H1N1.
H1N1 Order Tracking Database: This is an interne database created and maintained by thy:
Oregon DHS Public Health Immunization Program. It is used to display current allocations o
H1N1 vaccine to LPHA. The database reflects current allocations and allows LPHA to
designate recipients of H1N1 vaccine. The database is not publicly accessible and requires pre -
registration to view.
H1N1 Pandemic Influenza: Pandemic H1N1 is a novel strain of Influenza type "A" virus firs
identified in April 2009. It causes illness symptoms and severity that are similar to thos
resulting from seasonal flu infection. However, because it is a new virus, very few people hav
immunity, and, as a result many may become ill with this infection.
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Incident Command System Standard: The National Incident Management System'
standard for facilities, equipment, personnel, procedures, and communications operating withii
a common organizational structure, to perform domestic incident management activities ii
response to incidents, such as explosions, bioterrorism attacks, chemical releases, earthquakes
and tsunamis, which have significant public health impact.
Mass: A large, but non - specific amount or number
National Incident Management System (NIMS): The Federal Homeland Securit\
Administration's system for integrating effective practices in emergency preparedness an
response into a comprehensive national framework for incident management. The NIMS
enables emergency responders at all levels and in different disciplines to effectively manage
incidents no matter what the cause, size or complexity. More information can be viewed at
http://www.fema.gov/emergency/nims/index.shtm
Public Health Emergency Response (PHER) Grant: Funding provided by U.S. Departmen
of Health and Human Services, Centers for Disease Control and Prevention (CDC) for Publil.
Health Emergency Response (PHER). The purpose of the grant is to support and enhance the
DHS and local public health infrastructure that is critical to public health preparedness an
response.
VAR: Vaccine Administration Record. Record of vaccine administration which provide
information on the type of vaccine provided.
VIS: Vaccine Information Statement. Printed informational sheets for each type of vaccini .
licensed in United DHSs. According to the National Vaccine Safety Act, these forms an.
Federally- mandated to be provided to clients prior to being vaccinated. Available at
http: / /www.immunize.org /vis /vis alpha.asp
3. Procedural and Operational Requirements. All of LPHA's H1N1 influenza vaccinatioi
services and activities supported in whole or in part with funds provided under this Agreemen
shall be delivered or conducted in accordance with the following requirements:
a. Non - Supplantation. Funds provided under this Agreement for this Program Element shal .
not be used to supplant DHS, local, other non - federal, or other federal funds.
b. Audit Requirements. In accordance with federal guidance, each entity receiving fund-
shall audit its expenditures of PHER funding. Such audits shall be conducted by an entit■
independent of DHS and in accordance with the federal Office of Management and Budge
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 PREP.
cooperative agreement guidance and grants management policy may result in a requiremen
to repay funds to the federal treasury or the withholding of funds.
c. LPHA's shall either provide or ensure the provision of immunization clinics to members o
the public at designated vaccination clinics within the LPHA service area. LPHA shal
supply clinical, administrative, and logistical personnel, make facilities arrangements an
publicize for requested vaccination clinics within LPHA service area. The proposed clinic;
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may be held at a variety of community settings, to include: schools, health facilities
airports and bus terminals, public gathering places like auditoriums, and other location
deemed appropriate by LPHA.
d. LPHA shall provide services and comply with all requirements identified herein, shall abidt
by all policies and procedures established by DHS and all other state and federal laws
rules, and regulations, including priority groups identified by CDC and DHS guidelines.
e. LPHA shall comply with all requirements outlined in Appendix A " Oregon H1N1 Provide
Agreement" of this Program Element, including temperature monitoring and submission o
doses administered to the ALERT Immunization Information System.
f. LPHA shall administer H1N 1 vaccines in all available presentations for all appropriate
ages, as supplied by DHS, including the nasal spray.
g.
LPHA shall be responsible to report site locations, dates, schedules, and other pertinen:
details. These reports shall be in a format provided by DHS and shall be at least weekly o
more frequently as requested by DHS or if there are any changes.
h. LPHA shall appoint a single staff, the LPHA H1N 1 Contact, to coordinate H1N1 campaign
and vaccination efforts with DHS and with the DHS Mass Vaccinator Contract Agencies (i
LPHA choose to use that option). This LPHA staff will have an appropriate staff
designated as an alternate, to provide for business continuity.
LPHA shall maintain and update the H1N1 Order Tracking Database when shipping dose;
from allocation of H11\11 vaccine to a registered provider. No vaccine will be shipped t+l
unregistered providers within the LPHA boundaries. Doses of vaccine being distributed
beyond LPHA boundaries must remain within the boundaries of the DHS of Oregon.
LPHA that wishes to distribute H1N 1 vaccine beyond LPHA boundaries will notify th
H1N1 Research Analyst of the intended recipient and number of doses at: 971- 673 -0316 or
scott.rjeffries @DHS.state.or.us
4. LPHA Responsibilities Regarding DHS Mass Vaccinator Contracted Services
a. LPHA shall be responsible to ensure arrival of vaccine, clinical supplies, and required
forms at the designated location in a timely manner. This may include escort or securit
protection of vehicles transporting vaccine or clinical supplies from Public Provider or ship -
to site to location of the scheduled community immunization clinics.
b. LPHA shall be responsible for acquiring a location, advertisement of the clinic date and
time, contact with local media or government officials, securing the appropriate contract ,
permits, and local permissions to implement a scheduled community immunization clinic i 1
a non - disruptive and orderly fashion. LPHA is responsible for ensuring information aboi,t
clinics provided by mass vaccinators in the LPHA service area is included in report
provided to DHS about where the public can receive H1N1 vaccination for posting on th
DHS website.
c. LPHA shall transport staff, supplies, forms, signage and any necessary equipment to an 1
from each requested mass DHS vaccination contract clinic.
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d. LPHA shall submit to DHS a confirmation that Contractor invoice is appropriate to pay the
Contractor within nine calendar days of receiving completed Dose Batch Reporting form
from Contractor. Request for payment will include event details (location, time, date), and
an assurance that Contractor provided services to the number of clients reflected on the
invoice and returned any surplus vaccine and supplies. Reports will be used to reconcile
dose administration data with dose inventory data. Discrepancies will be resolved to the
satisfaction of DHS.
e. This report shall be forwarded to DHS with all completed, original client Vaccine
Administration Records (VAR), unless LPHA prefers an alternate DHS approved method
of dose reporting to the ALERT Information System (such as online entry, Barcode entry,
or IRIS data entry methods) and plans to retain their own original client VAR forms rather
than use the scannable VAR form.
5. LPHA Restrictions. The LPHA shall comply with the following restrictions, unless granted a
written and specific exception by DHS.
a. LPHA may not use these funds to establish an in -house billing system, however the funds
maybe used to contract with a third party billing firm.
b. LPHA using a DHS Mass Vaccination Contractor Agency (under that option) may solici
fee donations from clients if the following guidelines are followed:
i. Client may not be solicited or informed until after immunization services are rendered.
ii. Advertisement and publicity may not include solicitations for donations.
Solicitation is to be by provision of a pre- addressed envelope for clients to mail checl
or money order directly to the LPHA.
iv. Under no circumstance will LPHA or Contractor receive donations directly fron
clients, only donations mailed to LPHA may be accepted.
v. Solicitation must clearly state that it is an optional donation. Fee, Administration Fee
Charge, or similar verbiage are not to be used.
vi. Mass Vaccination Contractor Agency will not accept or solicit donations from clients,
but may provide the pre - printed envelopes for the LPHA whose service area contain
the clinic.
6. Billing, Payment, and Administrative Fees. Billing, Payment and Administrative Fees are
governed by federal guidelines viewable at: http: / /www.oregon.gov/ DHS /ph /imm /dots /H1N1PIanQA.pd'
a. LPHA or Mass Vaccinator Contractor operating under LPHA may screen for insurance
eligibility of clients and bill a third party payor for a vaccine administration fee provided at
community immunization clinic for those clients whose coverage can be billed by th
LPHA. In this case, the administration fee billed to a third party payor shall not exceed th
current established administration fee for the locality and coverage situation the dose was
administered in:
i. For clients who are privately insured by a 3`d party payor or covered by Medicart ,
$20.96 in Portland, $19.68 other localities in Oregon
ii. For clients who are covered by Medicaid, $15.58
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iii. For clients who are covered by another 3rd party payor, administration fee may only
charge the `usual and customary' fee that LPHA bills for seasonal influenza vaccine.
Clients whose 3rd party payor or private insurance rejects the claim may NOT be sent a
bill.
b. When accessing Contractor services under the DHS Mass Vaccination Contract, LPHA
shall provide DHS a roster of clients by name, date of service, and date of birth. This roster
will differentiate between clients whose insurance was billed and clients who were not able
to be billed or who did not have coverage to bill. LPHA shall submit all expenditure
reports to DHS using the DHS template.
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APPENDIX A
OREGON H1N1 PROVIDER AGREEMENT
Oregon H'1 N1 Flu Vaccine Registration
The HI Ni immunization provider agrees to the following_
Administer the H1N1 vaccine only according to the recommendations
of CDC's Advisory Committee on Immunization Practices.
• Store and handle the vaccine in accordance with the package insert
provided with the vaccine. Refrigerators used for H1 N1 vaccine must
be stored as follows:
• Units must not be used for anything except pharmaceuticals,
• Units must be equipped with a commercial grade thermometer.
• Units must not be dormitory style refrigerators.
• Temperatures must be read and logged at least once daily for
each refrigerator unit.
* Provide a current Vaccine Information Statement (VIS) to each
individual vaccinated, and answer questions about the benefits and
risk of vaccination. including different indications for live versus
inactivated vaccines.
• Record the date of administration. the anatomical site of
administration, the publication date of the current VIS, the date the VIS
was given to the patient/guardian, the vaccine type and lot number,
and the name of the immunization provider for each individual
vaccinated. The record must be kept for a minimum of three years
following vaccination.
I Information on doses administered must be submitted to the ALERT
Immunization Registry within 14 days of vaccine administration. Users
who currently submit information can use their regular format; other
submission options include on -line data entry or using ALERT
scannable forms. With the scan technique, providers will keep
photocopies of each double - sided completed form and mail originals to
the registry in postage -paid envelopes. OIP staff will scan data into
the registry. Postage paid envelopes will be provided.
Oregon Immunization ALERT is a statewide immunization
information system. The system contains immunization
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records of individuals who receive immunizations in
Oregon. from either public or private providers. ALERT
helps health care providers and other authorized users as
defined below to know an individual's immunization status.
State law and Oregon Administrative Rules cover collection and
release of information in ALERT. Under ALERTS law,
information is confidential and can only be shared with
authorized users, including an individual's health care provider.
school, childcare facility, insurer, local health department, or
parent if person is a minor. Though information is confidential,
the law allows providers to share this immunization information
with authorized users without consent. Information from ALERT
may not be used in any way to penalize an individual or
organization.
_r As a condition of receiving immunization information from
ALERT as a provider (defined in ORS 433.090), we agree to
the following:
Only access immunization information in ALERT for individuals
under our care.
o Read and abide by the ALERT Confidentiality Policy.
a Abide by all security policies and procedures, including
safeguarding our user identification number(s) and computer
password(s) against unauthorized use.
Permit the ALERT Director to monitor and audit our use of the
system.
• Report moderate and severe adverse events following vaccination to
the Vaccine Adverse Event Reporting System
(http:L ww.vaers.hhs.govscontact.htm).
in addition, the provider:
ik May not charge patients. health insurance plans, and other third party
payers for the vaccine, syringes or needles as these are provided at
no cost to the provider.
le May charge a fee for the administration of the vaccine to the patient,
their health insurance plan, or other third party payer. The
administration fee cannot exceed the regional Medicare vaccine
administration fee. For individuals enrolled in Medicaid, the
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administration fee is billed to Medicaid and cannot exceed the state
Medicaid administration fee.
• Is not obligated to provide H1N1 vaccine to those unable to pay the
administration fee, however. individuals who cannot afford the
administration fee should be referred to a public health department
clinic or affiliated public health provider for vaccination.
* Must report to the state health department the number of doses of
vaccine that were not able to be used because the vaccine expiration
date was exceeded or the vaccine was wasted for other reasons.
These doses must be destroyed in accordance to state regulations for
biological waste.
• Are strongly encouraged to provide an immunization record card to the
vaccine recipient or parentiguardian to provide a record of vaccination,
to serve as an information source if a Vaccine Adverse Event
Reporting System report is needed, and to serve as a reminder of the
need for a second dose of vaccine (if necessary). immunization cards
will be included in each shipment of ancillary supplies.
Agreement to receive communications about H1N1 from OIP via an
email listserve.
• H1N1 vaccine cannot be shared with any clinic or provider without
explicit permission from the local health department. tribal organization
or state agency. Any doses transferred between providers must be
reported to QIP weekly using state - supplied transfer form.
Communication:
The Immunization Program will periodically email or blast fax vaccine information
updates to registered sites to help them prepare. This will include information to
access required Agreement forms as well as H1N1 vaccine order forms. The
agreement will outline the terms and conditions of vaccine use as defined by federal
and state authorities.
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EXHIBIT 2
FINANCIAL ASSISTANCE AWARD
State of
Department of
Public Hea
Oregon Page 1 of 3
Human Services
th Services
1) Grantee
2) Issue Date
This Action
Name: Deschutes County Health Dept.
November 19, 2009
AMENDMENT
Street: 2577 N. E. Courtney
3) Award Period
City: Bend
From July1, 2009 Through June 30, 2010
State: OR Zip Code: 97701
4) DHS Public Health Funds Approved
Previous Increase/ Grant
Program Award (Decrease) Award
PE 01 State Support for Public Health
192,988
0
192,988
PE 03 TB Case Management
1.208
0
1,208
PE 04 P.H. Response to KIM Influenza Vaccination—PHER III
0
154,192
154,192
PE 07 HiV Prevention Services
28,832
0
28;832
HIV Prevention Block Grant Services
Ryan White Title II HIV i AIDS Services
PE 08 Ryan White—Case Management
84,318
0
84,318
PE 08 Ryan White—Support Services
21,082
0
21;082
PE 12 Pub. Health Emergency Preparednessi(July-Aug. 9)
17;452
0
17,452
( o`h)
PE 12 Pub. Health Emergency 10-June30)
115,809
0
115,809
(n)
PE12 Pub. HNh.Emcrg. Response FA1H1N1Yaccinadonu
121.187
0
121.197
(»)
PE12 Pub. HNzEmerg. Response -FA2H1N1Epid. &Swm
17.449
0
17,449
(P)
PE 12 Pub. Hith. Ernerg. Response FA3-H1N\ Vaccine Admin.
104.433
0
104,433
(r)
a) FOOTNOTES:
a) July-August 9th awards must be spent by 8/9/2009 and a report submitted for that period.
b)Ju|y-Sept. grant iy$1O789A and includes 833,590 of mininium Nutlltion Education and $7,420
for Breastfeeding Promotion
c) Oct -June grant is $466,206 and includes SS3.24'| of minimum Nutrition Education and $22.259
for BreastfeedimgPromotion
d) July September want is55.74O , October - June grant is $17,220
e)S\.OQU must he spent by December 31.2U09
f) The Funding Formula Includes 5 counties (Curry, Deschutes, Josephine, Klamath & Washington)
with tncreased awards that are contingent om successful completion nf May 20O9 initial SBHC
certification visit,
g) MCH Funds wiU not be shifted between categodes or fund type& The same program may be
funded hy more than one fund type, however, federal funds may not be used as rnatch for
other federal funds (such as Medicaid ).
6) Capital Outlay Requested in This Action:
Frior approval is required for Capital Outlay. Capita( Outtay is defuied as an expenditure for equip-
rnent withapuvckanepricoinexcesonf$5'OQUandolifeexpec1oncygraeter1hanonoyeer.
PROG.
PROGRAM ITEM DESCRIPTION COST APPROV
2009-2010 lntergovernmental Agreement for the Financing of Public Health Services
128008-4 pgm.doc - Deschutes County
Page 12 of 14 pages
State of Oregon Page 2 of 3
Department of Human Services
Public MemthServices
1) Grantee
2) Issue Date
This Action
Name: Deschutes County Heath Dept.
November 19, 2009
AMENDMENT
FY2]1O
Street: 2577 N. E. Courtney
3) Award Period
City: Bend
From July 1,2080 Through June 3Q.2D1U
State: OR Zip Code: Q77O1
4) DHS Public Health Funds Approved
Previous Increase/ Grant
Program Award (Decrease) Award
PE13 Tobacco Prevention &Education
113.150
0
113.150
PE 15 Healthy Communities
85,008
0
65.000
PE 39 Maternity Case Managernent
1.000
0
1,000
FAMILY HEALTH SERVICES
(e)
PE 40 Wornen, Infants and Children
634.105
0
634.105
FAMILY HEALTH SERVICES
(bcjW)
PE 40 WIC -- PEER Counseling
22.900
0
22.900
FAMILY HEALTH SERVCES
(d)
PE 41 Family Planning Agency Grant
147.684
0
147,684
FAMILY HEALTH SERVICES
(s )
PE 42 MCH-TitleV -- Flexibe Funds
41.171
0
41.171
FAMILY HEALTH SERVICES
(g )
PE 42 MCI--Tit(eV -- Child & Adolescent Health
17.644
0
17.044
FAMILY HEALTH SERVICES
(g )
PE 42 MCH/Perinatal Health -- General Fund
6.042
0
6.042
FAMILY HEALTH SERVICES
(Q )
PE 42 MCH!ChiId & Adolescent Hea!th -- General Fund
11,337
0
11.337
FAMILY HEALTH SERVICES
(g )
PE42 Babies First
19.131
0
19.131
FAMILY HEALTH SERVICES
(g )
PE 42 Oregon MothersCare
20.018
0
20'818
FAMILY HEALTH SERVICES
5) F0C)T NOTE S:
h) $1,803 is additional funding for the purchase of Satellite Phone Docking stations and Antennae
as follows: ASE 9505A Docking Station and iridium Fixed Mast Omni Directional Antennae. Items
oreavaUab(efnomVVoddCommnunicahumsCemter,Chand|er.4Z,http://vwwwwcc|p.com. Contact:
Curtis Patterson Funds must be obligated byO8M]0/2C0Q and liquidated by1031/2OUV
i)S3.QO0 increase is due to the CLHO approved funding forrnula revision.
j) S9.062 is for one-hn�*funding to local agencies v�thrate ofS2.QU per ass iAnedcaseload.
k) $2,035 is for Farm Drect Nutrition Educati•on funding.
|)91.4O8 is funding for ocal agencie& special prolects.
m) Additional $3.50B must be spent by September 3D,2OO9. Counties must submit DH8Health
Division Expenditure and Revenue Report by i0?2509 to verify that the funds have been spent.
n) Base Preparedne.ss Funding award revised to refiect CDC approved grant award
o) tH1N1 Funding for Vaccination, Antiviral DistributioniDispensinglAdministration and Community
Mitigation. Funthng must be tracked and reported separately
6) Capital Outlay Requested in This Action:
Prior approvai is required for Capital Outlay. Capital Qutlay is defined as an expenditure for equip-
nnentwithapuohasephceimwxcessuf$5.O0Oenda/ifeexpectaocygnemtorthanoneyear
PROG.
PROGRAM ITEM DESCRIPTION COST APPROV
2009-2010 Intergovernme tal Agreeme /oxnmmuxmxnumrnmuxcammervum
128008-4 pgm.doc - Deschutes County
Page 13 of 14 pages
State of Oregon Page 3 of 3
Department of Human Services
Public Health Services
1) Grantee
Name: Deschutes County Health Dept.
Street: 2577 N. E. Courtney
City: Bend
State: OR Zip Code: 97701
2) Issue Date
November 19, 2009
This Action
AMENDMENT
FY2010
3) Award Period
From July 1, 2009 Through June 30, 2010
4) DHS Public Health Funds Approved
Previous Increase/ Grant
Program Award (Decrease) Award
PE 43 Immunization Special Payments
FAMILY HEALTH SERVICES
45,351
0
45,351
( q )
PE 43 Immunization -- CDC (ARRA Stimulus Funding)
FAMILY HEALTH SERVICES
15207
0
15,207
( q )
PE 43 Immunization -- Public Health Emergency Response
FAMILY HEALTH SERVICES
1,453
0
1,453
( q )
PE 44 School Based Health Centers
FAMILY HEALTH SERVICES
183,000
0
183,000
( f,l,t )
TOTAL
5) FOOTNOTES:
p) H1N1 Funds for Epidemiology and Surveillance. Funds must
q) Funding for this program must be reported separately.
r) H1N1 funding for Vaccine Administration related activities. PHER
be tracked and reported separately.
s) $3.390 is for Chlamydia Screening; $1.617 is for High-Cost
t) 880.000 represents Option 1 Phase 1 Planning Grants to counties
u) H1N1 funding for mass vaccination activities described in PE
2.049.021
'154.192
2.203,213
be tracked and reported separately.
III Focus Area 3 funding must
Contraceptives.
with an existing SBHC.
4.
6) Capital Outlay Requested in This Action:
Prior approval is required for Capital Outlay. Capital Outlay is defined as an expenditure for equip-
ment with a purchase price in excess of $5,000 and a life expectancy greater than one year.
PROG.
PROGRAM ITEM DESCRIPTION COST APPROV
2009-2010 Intergovernmental Agreement for the Financing of Public Health Services
128008-4 pgm.doc - Deschutes County
Page 14 of 14 pages