Laserfiche WebLink
Task *May Support PHAB Payment <br />Number Task! Activity /Description Standardsfl\feasures Deliverables/Outcomes Due Date/Time Frame Information and/or <br />Amount <br />Children with Special Health Care Needs (CSHCN) <br />4a Complete Child Health Intake Form (CHIF) Submit CHIF data into Secure File January 15, 2018 Reimbursement for <br />using the CHIF Automated System on all infants Transport (SFT) website: April 15,2018 actual costs, not to <br />and children served by the CSHCN Program as https://sft.wa.gov July 15, 2018 exceed total funding <br />referenced in CSHCN Program Manual. consideration. <br />Ensure client data is collected on all children Action Plan and <br />served by CSHCN contractors, including Progress Reports <br />neurodevelopmental centers, regional must only reflect <br />maxillofacial coordinators, and the DOH activities paid for <br />Newborn Screening Program. with funds provided <br />4b Administer requested DOH Diagnostic and Submit completed Health Services 30 days after forms are in this statement of <br />Treatment funds for infants and children per Authorization forms and Central completed. work for the <br />CSHCN Program Manual when funds are used. Treatment Fund requests directly specified funding <br />to the CSHCN Program as needed. period. <br />4c Participate in the CSHCN Regional System and Submit Action Plan monthly Monthly, on or before <br />quarterly meetings as described in the CSHCN reports including number of the 15th of the following See Program <br />Program Manual. regional meetings attended to the month Specific <br />DOH contract manager. Requirements and <br />Special Billing <br />Requirements. <br />*For Information Only: <br />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 <br />Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) StandardslMeasures that may apply can be found at: <br />hnp;/!www.phaboard.org/wp-contenVuploadsIPHAB-Standards-and-Measures-Version -I .D.pdf <br />Program Specific Reguirements/Narrative <br />Special Requirements <br />Federal Funding Accountability and Transparency Act (FFATA) <br />This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act). <br />The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent. <br />To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data Universal Numbering System (DUNS®) number. <br />Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282. <br />Program Manual, Handbook, Policy References <br />Children with Special Health Care Needs Manual-http ://www .doh. wa.govJPQrtals1JlDocUJDen~slPubsl9?O-20 9 -CSHCN-Manual.pdf <br />Exhibit A, Statements of Work Page 4 of28 Contract Number CLH18249