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Task <br />Task/Activity/Description *May Support PHAB Payment <br />Number Standards/Measures Deliverables/Outcomes Due Dateffime Frame Information and/or <br />Amount <br />Specific <br />Requirements and <br />Special Billing <br />Rc:quiremc:niS , <br />MCHBG Assessment and Evaluation <br />2a I Participate in project evaluation activities Documentation using report I 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 I 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 I Reimbursement for <br />October 1, 2018 through September 30, 2019 DOH contract manager Final September 5, 2018 actual costs, not to <br />usin2 DOH-provided temnlate. exceed total funding <br />3b Report activities and outcomes of 2017-2018 Submit Action Plan monthly Monthly, on or before consideration. <br />MCHBG Action Plan using DOH-provided reports to DOH contract manager the 15th of the following Action Plan and <br />template. 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 CLHl 8249