Consolidated Contract - Laserfiche WebLink

Home Browse Search

Health Services Authorization (HSA) Fonn httrdfwww.doh. wa.(i()v/Po rtals/ I.lDocuments/Pubsl9 ) 0-002 -ApprovedllSAdocx Restrictions on Funds (what funds can be used for which activities, not direct payments, etc) 1. 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. 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 under 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 (l)(D)]. Monitoring Visits (frequency, type) Telephone calls with contract manager at least one every quarter, and annual site visit. Special Billing Requirements Payment is contingent upon DOH receipt and approval of all deliverables and an acceptable A19-1A 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 monthly by the 30th of each month following the month in which the expenditures were incurred and must be based on actual allowable program costs. Billing for services on a monthly fraction of the "Total Consideration" will not be accepted or approved. DOH Program Contact Mary Dussol Community Consultant Office of Family and Community Health Improvement Washington State Department of Health Street Address: 310 Israel Rd SE, Tumwater, WA 98501 Mailing Address: PO Box 47848, Olympia, W A 98504 Telephone: 360-236-3781 / Fax: 360-236-3646 Email: marv.dussol@doh.wa.gov Exhibit A, Statements of Work Page 5 of28 Contract Number CLH18249