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Exhibit A <br />Statement of Work <br />Contract Term: 2018-2020 <br />AMENDMENT #8 <br />DOH Program Name or Title: Chil dhoo d Lead P o is oning. Prevent i on Program - <br />Effective January 1, 2018 <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br />Contract Number: CLH18249 <br />SOW Type : Revision Revision # (for this SOW) 2 Funding Source Federal Compliance Type of Payment <br />D Federal <Select One> (check if applicable) [8J Reimbursement <br />Period of Performance: January 1, 2018 through June 30. 2019 [8J State D FFATA (Transparency Act) D Fixed Price <br />D Other D Research & Development <br />Statement of Work Purpose: The purpose ofthis statement of work is to support local interventions with the case management of elevated blood lead levels in children 14 years <br />of age and younger. The focus of this program in 2018 is to build local capacity statewide to provide standard case management services to all children with elevated blood lead <br />levels. <br />Revision Purpose: The purpose of this revision is to decrease SFY2 funding and update the DOH Program Contact. <br />Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total <br />Revenue Index (LBJ Use Only) Consideration Decrease (-) Consideration <br />Code Code Start Date End Date <br />SFYI Lead Environments of Children (proviso funds) N IA 334.04.93 25715110 ovo1118 I 06/30/18 <br />SFY2 Lead Environments of Children (proviso funds) N IA 334.04 .93 25715120 01101118 I 06/3011 9 <br />TOTALS <br />Task Task/Activity/Description *May Support PHAB Deliverables/Outcomes Number <br />1 Contact the provider to gather complete information on <br />the assigned elevated blood lead case to conduct an <br />environmental assessment <br />a) Verify the blood lead level (BLL) is confirmed. <br />Reference Centers for Disease Control and <br />Prevention's (CDC's) confirmed case definition: <br />ht!Os://wwwn.cdc .gov/nndss/conditions/lead- <br />elevated-blood-levels/case-definition/2016/ <br />b) Call family and schedule a home visit. If <br />interpretation services are needed, contact DOH <br />at lead@doh.wa.gov. Note: Interpretation services <br />will not be reimbursed through the ConCon <br />process. <br />c) Visit the child's residence (or other sites where <br />the child spends significant amounts of time) at <br />least once <br />Exhibit A, Statements of Work <br />Revised as of March 15 , 2019 <br />Standards/Measures <br />Submit the updated Child Blood <br />Lead Investigation Form via <br />Washington Disease Reporting <br />System (WDRS) available through <br />WA DOH indicating: <br />a) Confirmed BLL <br />b) Date LHJ contacted the family <br />c) Date the environmental <br />assessment was completed <br />d) Date the interview was <br />completed <br />e) Specify if the home is Section 8 <br />or HUD Housing and if the <br />child is Medicaid enrolled <br />t) (If annlicable) IfDOH <br />Page 3 of 10 <br />2,000 0 2,000 <br />1,500 -1,500 0 <br />3,500 -1 ,500 2,000 <br />Due Date/Time Payment <br />Information and/or Frame Amount <br />Submit as Reimbursement of up <br />needed within 60 to $500 maximum <br />days after per home visit, per <br />completion. child. Up to two (2) <br />home visits per child <br />not to exceed total <br />funding <br />consideration. <br />Note: this excludes <br />indirect costs <br />Contract Number CLH18249-8