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AMENDMENT #17 <br />Exhibit A, Statements of Work Page 21 of 42 Contract Number CLH18249-17 <br />Revised as of September 15, 2020 <br />Task <br />Number Task/Activity/Description *May Support PHAB <br />Standards/Measures Deliverables/Outcomes Due Date/Time Frame <br />Payment <br />Information and/or <br />Amount <br />1k Report actual expenditures for October 1, 2019 <br />through September 30, 2020 <br /> Submit actual expenditures using the <br />MCHBG Budget Workbook to DOH <br />contract manager <br />December 4, 2020 <br />1l Report actual expenditures for the six month <br />period from October 1, 2020 through March 31, <br />2021. <br /> Submit actual expenditures using the <br />MCHBG Budget Workbook to DOH <br />contract manager. <br />May 21, 2021 <br />1m Develop 2021-2022 MCHBG Budget Workbook <br />for October 1, 2021 through September 30, 2022 <br />using DOH provided template. <br /> Submit MCHBG Budget Workbook <br />to DOH contract manager <br />September 10, 2021 <br />MCHBG Assessment and Evaluation <br />2a Participate in project evaluation activities <br />developed and coordinated by DOH, as <br />requested. <br /> Documentation using report <br />template provided by DOH <br />September 30, 2018 <br />September 30, 2019 <br />September 30, 2020 <br />September 30, 2021 <br />Reimbursement for <br />actual costs, not to <br />exceed total funding <br />consideration. <br /> <br />See Program <br />Specific <br />Requirements and <br />Special Billing <br />Requirements. <br />2b Report program level strategy measure data <br />(CSHCN, UDS, ACEs). <br /> Documentation using report <br />template provided by DOH <br />January 15, 2018 <br />April 15, 2018 <br />July 15, 2018 <br />October 15, 2018 <br />2c Conduct a Maternal and Child Health (MCH) <br />Needs Assessment. <br /> Submit Needs Assessment <br />documentation to DOH contract <br />manager using templates provided <br />by DOH <br />May 24, 2019 <br />2d Explore health equity approaches to maternal and <br />child health and develop implementation plan <br /> Include health equity plan in 2020- <br />2021 MCHBG Action Plan using <br />DOH- provided template. <br />Draft August 16, 2020 <br />Final September 6, 2020 <br />MCHBG Implementation <br />3a Develop 2018-2019 MCHBG Action Plan for <br />October 1, 2018 through September 30, 2019 <br />using DOH-provided template. <br /> Submit MCHBG Action Plan to <br />DOH contract manager <br />Draft August 17, 2018 <br />Final- September 5, <br />2018 <br />Reimbursement for <br />actual costs, not to <br />exceed total funding <br />consideration. <br />Action Plan and <br />Progress Reports <br />3b Report activities and outcomes of 2017-2018 <br />MCHBG Action Plan using DOH- provided <br />template. <br /> Submit Action Plan monthly reports <br />to DOH contract manager <br />Monthly, on or before <br />the 15th of the following <br />month