PSA between Kittitas County Public Health and Comm Health of Central WA

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Task *May Support PHAB Payment Number TaskJ Activity /Description StandardsIMeasures Deliverables/Outcomes Due Date/Time Frame Information and/or Amount 4b Administer allocated DOH Diagnostic and Submit completed Health 30 days after fonns are Plan and Progress Treatment funds for infants and children per Services Authorization fonns and completed. Reports must only CSHCN Program Manual when funds are used. Central Treatment Fund requests reflect activities paid directly to the CSHCN Program for with funds as needed. provided in this 4c Participate in the CSHCN Regional System and Submit Action Plan quarterly January 15,2015 statement of work for quarterly meetings as described in the CSHCN reports including number of April 15,2015 the specified funding Program Manual. regional meetings attended to the July 15,2015 period. DOH contract manager. See Program Specific Requirements and Special Billing Requirements. *For Information Only: Funding is not tied to the revised Standards/Measures listed here. This infonnation may be helpful in discussions of how program activities might contribute to meeting a StandardlMeasure. More detail on these andlor other Public Health Accreditation Board (PHAB) StandardslMeasures that may apply can be found at: http ://www .phaboard.org/wp-<--orueruluploadsIPH AB ~St:andards-and -Measures-Vers ion-I .O.pdf Program Specific ReguirementslNarrative Special Requirements Federal Funding Accountability and Transparency Act (FFATA) This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FF A TA or the Transparency Act). The purpose of the Transparency Act is to make infonnation available online so the public can see how the federal funds are spent. To comply with this act and be eligible to perfonn the activities in this statement of work, the LHJ must have a Data Universal Numbering System (DUNS®) number. Infonnation about the LHJ and this statement of work will be made available on http://USASpending.gov by DOH as required by P .L. 109-282. Program Manual, Handbook, Policy References Children with Special Health Care Needs Manual-hnp:l/www .doh .wa.g,ov/POrtal sl IIDQCumeDlsfPuhs'97~209-CSHCN ~Manulll.pdf Restrictions on .Funds (what funds can be used for which activities, not direct payments, etc) I. At least 30% of federal Title V funds must be used for preventive and primary care services for children and at least 30% must be used services for children with special health care needs. [Social Security Law, Sec. 505(a)(3)). 2. Funds may not be used for: a. Inpatient services, other than inpatient services for children with special health care needs or high risk pregnant women and infants, and other patient services approved by Health Resources and Services Administration (HRSA). b. Cash payments to intended recipients of health services . c. The purchase or improvement of land, the purchase, construction, or pennanent improvement of any building or other facility, or the purchase of major medical equipment. Exhibit A, Statements of Work Page 7 of 19 Contract Number C17l14