Laserfiche WebLink
Task *May Support PHAB Payment <br />Number Task! Activity/Description StandardsiMeasures Deliverables/Outcomes Due Date/Time Frame Information and/or <br />Amount <br />Id Report actual expenditures for October 1, 2014 -Submit actual expenditures using February 18,2015 the specified funding <br />December 31, 2014. the MCHBG Budget Workbook period. <br />(Sections A and B only) to See Program Specific <br />contract manager. Requirements and <br />Special Billing <br />Requirements. <br />MCHBG Assessment and Evaluation <br />2a Participate in statewide capacity and needs Documentation using report May 1,2015 Reimbursement for <br />assessment activities in preparation for next template provided by DOH. actual costs, not to <br />statewide 5 year plan, as requested. exceed total funding <br />2b Participate in project evaluation activities Documentation using report September 30,2015 consideration. <br />developed and coordinated by DOH, as template provided by DOH. See Program Specific <br />requested. Requirements and <br />Special Billing <br />Requirements. <br />MCHBG Implementation <br />3a Develop 2015-2016 MCHBG Action Plan for Submit MCHBG Action Plan to Draft -August 21, 2015 Reimbursement for <br />October 1, 2015 through September 30, 2016 DOH contract manager. Final-September 4, 2015 actual costs, not to <br />using DOH provided template. exceed total funding <br />3b Report activities and outcomes of2014-2015 Submit Action Plan quarterly January 15,2015 consideration. Action <br />MCHBG Action Plan using DOH provided reports to DOH contract manager. April 15,2015 Plan and Progress <br />template. July 15 ,2015 Reports must only <br />reflect activities paid <br />If LHJ chooses to bill on a for with funds <br />monthly basis, reports-are provided in this <br />I due on or before the 15 th statement of work for <br />of the following month. the specified funding <br />period. <br />See Program Specific <br />Requirements and <br />Special Billing <br />Requirements . <br />Children with Special Health Care Needs (CSHCN) <br />4a Complete Child Health Intake Form (CHIF) using Submit CHIF data into Secure January 15 ,2015 Reimbursement for <br />the CHIF Automated System on all infants and File Transport (SFT) website: April 15, 2015 actual costs, not to i <br />children served by the CSHCN Program as https://sft.wa.gov July 15,2015 exceed total funding I <br />referenced in CSHCN Program Manual. consideration. Action I <br />Exhibit A, Statements of Work Page 6 of19 Contract Number C17114