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

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d. Meeting other federal matching funds requirements. e. Providing funds for research or training to any entity other than a public or nonprofit private entity. f. payment for any services furnished by a provider or entity who has been excluded Wlder Title XVIII (Medicare), Title XIX (Medicaid), or Title XX (social services block grant).[Social Security Law, Sec 504(b»). 3. If any charges are imposed for the provision of health services using Title V (MCH Block Grant) funds, such charges will be pursuant to a public schedule of charges; will not be imposed with respect to services provided to low income mothers or children; and will be adjusted to reflect the income, resources, and family size of the individual provided the services. [Social Security Law, Sec. 505 (I)(D»). Monitoring Visits (frequency, type) Telephone calls with contract manager at least one every other month . Special BlUing Requirements Payme-nl Is cootingent upon DOH receipt and approval of an del iverablcs and an acceptable A 19-1 A invoice voucher. Payment to completely expend the "Total Consideration" for a specific funding period will not be processed until all deliverables are accepted and approved by DOH. Invoices must be submitted a1 least quarterly and must be based on acrual allowable program cost's . aWing for services, on a monthly or quarterly fraction afthe "Total Consideration" will not be a~cepted or approved. Mcmtbly invoices on acroal allowable program costs will be accepted but an updated Action Plan Progress Report must also be submitted. DOH Program Contact Mary Dussol Healthy Communities Consultant Office of Healthy CommWlities Washington State Department of Health Street Address: 310 Israel Rd SE, Tumwater, W A 98501 Mailing Address: PO Box 47848, Olympia, WA 98504 Telephone: 360-236-3781/ Fax: 360-236-3646 Email: marv.dussol@doh.wa.gov Exhibit A, Statements of Work Page 8 of 19 Contract Number C 1 7114