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AMENDMENT #10 Task Task! ActivitylDescription *May Support PHAB Deliverables/Outcomes Due Date/Time Frame Payment Information Number StandardslMeasures and/or Amount 8 a) In coordination with hospitals, health care a) Enter information for a) By the last day of each Reimbursement for providers, and health plans (if app licab Ie), each case identified into month actual costs incurred, conduct activities to prevent perinatal hepatitis B the Perinatal Hepatitis B not to exceed total infection in accordance with the Perinatal module of the WA funding consideration Hepatitis B Prevention Program Guidelines, Immunization amount. including the following: Information System 1) Identification of HBsAg-positive pregnant Funds available for women, and pregnant women with unknown b) Annual Perinatal Hepatitis b) December 15th this task*: HBsAg status B Outreach Summary 2) Reporting ofHBsAg-positive women and (DOH 348 268) January 2017 - their infants March 2017 3) Case management for infants born to FFY16 PPHF 317 Ops HBsAg-positive women to ensure administration -74110267 of hepatitis B immune globulin (HBIG) and hepatitis B vaccine within twelve (12) hours of April 2017 - birth, the completion of the 3-dose hepatitis B December 2017 vaccine series, and post-vaccination serologic FFY 1 7 3 17 Ops - testing. 74110271 b) Provide technical assistance to birthing *See Restrictions on hospitals to encourage administration of the Funds below hepatitis B birth dose to all newborns within twelve (12) hours of birth, in accordance with Advisory Committee on Immunization Practices (ACIP) recommendations. c). Report all perinatal hepatitis B investigations, including HBsAg-positive infants, in the Perinatal I Hepatitis B Module of the Washington State Immunization Information System. *For Information Only: Funding is not tied to the revised StandardslMeasures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at http ://www.phaboard.9r elwp-conren ri u ploads /P J-IAS-Srandards-and-Measurcs-Version -]_ 0 .pd f Program Specific Reguirements/Narrative • All LHJ staff who conducts VFC Compliance Site Visits and AFIX visits must participate in an annual VFC and AFIX training, conducted by DOH Office ofImmunization and Child Profile (OICP) staff or their designee. • All new LHJ site visit reviewers are required to have at least one (1) observational visit conducted by DOH OICP staff or their designee. DOH OICP staff (or designee) will periodically conduct observational VFC/ AFIX site visits with all other LHJ reviewers who conduct VFC Compliance Site Visits. Exhibit A, Statements of Work Revised as of November 15,2016 Page 20 of21 Contract Number C17114-10