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Task *May Support PHAB Payment <br />Number Taskl ActivitylDescription StandardsflVleasures Deliverables/Outcomes Due DatelTime Frame Information and/or <br />Amount <br />Specific <br />Requirements and <br />Special Billing <br />Requirements. <br />MCHBG Assessment and Evaluation <br />2a Participate in project evaluation activities Documentation using report September 30,2018 Reimbursement for <br />developed and coordinated by DOH, as template provided by DOH actual costs, not to <br />requested. exceed total funding <br />2b Report program level strategy measure data Documentation using report January 15, 2018 consideration. <br />(CSHCN, UDS, ACEs). template provided by DOH April 15 ,2018 <br />July 15, 2018 See Program <br />Specific <br />Requirements and <br />Special Billing <br />Requirements . <br />MCHBG Implementation <br />3a Develop 2018-2019 MCHBG Action Plan for Submit MCHBG Action Plan to Draft August 17, 2018 Reimbursement for <br />October 1,2018 through September 30,2019 DOH contract manager Final September 5,2018 actual costs, not to <br />using DOH -provided template. exceed total funding <br />3b Report activities and outcomes of2017-2018 Submit Action Plan monthly Monthly, on or before consideration. <br />MCHBG Action Plan using DOH-provided I reports to DOH contract manager the 15 th of the following Action Plan and <br />template . I month Progress Reports <br />must only reflect <br />activities paid for <br />with funds provided <br />in this statement of <br />work for the <br />specified funding <br />period. <br />See Program <br />Specific <br />Requirements and <br />Special Billing <br />Requirements. <br />Exhibit A, Statements of Work Page 3 of28 Contract Number CLH18249