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Restrictions on Funds (i.e., disallowed expenses or ac vities, indirect costs, etc.): <br />1. At least30% of federalTitle V fundsmustbe used i rrpreventive andprimarycare services forchildren andatleast30To mustbe used services forchildren with <br />specialhealthcare needs. [Social Security Law, Sec 505(a)(3)]. <br />2. Funds maynotbe usedfor: <br />a. Inpatient sewices, other than inpatient services or children with special health care needs or higb risk pregnant women and infants, and otherpatient services approved by <br />Health Resources and Sewices Administration t SRSA)" <br />b. Cash payments to intended recipients of health ervices. <br />c. Thepurchaseorimprovementofland,thepurcl ase,construction,orpermanentimprovementofanybuildingorotherfacility, orthepurchaseofmajormedical <br />equipment. <br />d. Meeting otherfederalmatchingfundsrequirem nts. <br />e. . providing fundsforresearch oitraining to any ntityotherthanapublic ornonprofitprivate entity. <br />f. paymenttbranyservicesfumisheduyapro,nid rorentitywhohasbeenexciudedunderTitleXVlll(Medicare),TitleKX(N4edicaid),orTitle)o((socialservicesblock <br />grant).fsocial Security Law, Sec 504O)]. <br />3. Ifanychargesareimposedfortheprovisionofheal lhservices usingTitle V MCHBlockGrant)funds,suchchargeswill bepursuanttoapublic scheduleofcharges; will not <br />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 t he individual <br />provided the services. [Social Security Law, Sec. 5( :t (1) (D)]. <br />Monitoring Visits: Telephone calls with DOH contract nanagerasneeded. <br />Billing Requirements: payment is contingent upon DO I receipt and approval of all deliverables and an acceptable Al 9 -1 A invoice voucher. Payment to compietely expend the <br />of the "TotalConsideration" will notbe accepted orapp oved. <br />Special Instructions: ContactDOH contractmanagert ,rlow forapprovalof expensesnot reflected in approvedbudgetworkbook. <br />MCHBG funds may be expended on CoVID-l 9 respon 3 activities that align with matemal arrd child health priorities. Examples may include: <br />r providingsupportineducatingtheMCHpopu itionaboutCOVID-lgthroughpartnershipswithotherlocalagencies,medicalproviders,andhealthcareorganizations. <br />. Working closely with state and local emergenc ,preparedness staff to assure that the needs of the MCH population are represen ted' <br />. Funding infrastructure that supports the respon e to coviD-l9. For example, Public HealthNurses who are routinely supported through the Title V program maybe able <br />to be mobilized, using Title Vfunds or separat , emergency funding, to support a call center or deliver health services. <br />r partnering with parent networks and health ca1 , providers to provide accura te and reliable infonnation to all famillies. <br />. EngagJng community leaders, including faith-l ased leaders, to educate community members about strategies forpreventing illness <br />Restrictions listed above continue to apply. <br />Exhibit A, Statement of Work <br />Template Created SePtemb er 2021 <br />Page 3 of3 ContractNumberCLH3 I 0 I 5