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Home My WebLink AboutConsolidated Contract Amend 1KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT 2018 -2020 CONSOLIDATED CONTRACT CONTRACT NUMBER: CLH18249 AMENDMENT NUMBER: 1 PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as "DOH", and KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT hereinafter referred to as "LHJ", pursuant to the ModificationslWaivers clause, and to make necessary changes within the scope of this contract and any subsequent amendments thereto. IT IS MUTUALLY AGREED: That the contract is hereby amended as follows: 1. Exhibit A Statements of Work, attached and incorporated by this reference, are amended as follows: [gJ Adds Statements of Work for the following programs: • Chilqhood Lead Poisoning Prevention Program -Effective January 1, 2018 o Amends Statements of Work for' the following programs: o Deletes Statements of Work for the following programs : 2. Exhibit B-1 Allocations, attached arid incorporated by this reference, amends and replaces Exhibit B Allocations as follows: Increase of $2,000 for a revised maximum consideration of $81,038. Decrease of __ for a revised maximum consideration of __ o No change in the maximum consideration of __ . Exhibit B Allocations are attached only for informational purposes. 3. Exhibit C -l Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit C. Unless designated otherwise herein, the effective date of this amendment is the date of execution. ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force and effect. IN WITNESS WHEREOF, the undersigned has affixed his/her signature in execution thereof. KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT Page 10f6 STATE OF WASHINGTON DEPARTMENT OF HEALTH APPROVED AS TO FORM ONLY Assistant Attorney General 2018-2020 CONSOLIDATED CONTRACT EXHIBIT A STATEMENTS OF WORK TABLE OF CONTENTS AMENDMENT #1 DOH Program Name or Title: Childhood Lead Poisoning Prevention Program -Effective January 1, 2018 .............................................................. . Exhibit A, Statements of Work Revised as of January 16, 2018 Page 2 of6 Contract Number CLH18249-1 Exhibit A Statement of Work Contract Term: 2018-2020 AMENDMENT #1 DOH Program Name or Title: C hildhood Lead P oisoning Preventio n Frogram - Effective January 1, 2018 Local Health Jurisdiction Name: Ki ttitas Coun.!V P ubl ic He a lth Dcoartmeot Contract Number: CLH18249 SOW Type: Original Revision # (for t his SOW) Funding Source Federal Compliance Type of Payment o Federal <Select One> (check if applicable) ~ Reimbursement 18l State o FFATA (Transparency Act) D Fixed Price o Other o Research & Development Period of Performance: January 1, 2018 through June 30, 2018 Statement of Work Purpose: The purpose of this statement of work is to support local interventions with the case management of elevated blood lead levels in children 14 years 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 levels. Revision Purpose: NI A Chart of Accounts Program Name or Title C F DA# BARS Master Funding Period Current Change :rotal Revenue Index (LHJ Use Only) Consideration Increase (+) ~onsideration Code Code Start Date End Date SFYI Lead Environments of Children (proviso funds) N/A 334.04.93 25715110 01101118 I 06 /30118 0 2,000 2,000 TOTALS ----~ - Task Task! ActivitylDescription Number 1 Contact the provider to gather complete information on the assigned elevated blood lead case to conduct an environmental assessment a) Verify the blood lead level (BLL) is confirmed. Reference Centers for Disease Control and Prevention's (CDC's) confirmed case definition: ht!:Qs :ll wWWn.cdc.Mvl nndsslconditionsllead-elevated- blood-level~case-definition120 161 b) Call family and schedule a home visit c) Visit the child's residence (or other sites where the child spends significant amounts oftime) at least once d) Interview the caregivers using the Child Blood Lead Investigation Form and conduct an environmental assessment to identify factors that may impact the child's blood lead level e) Determine if the family lives in Section 8 or HUD Exhibit A, Statements of Work Revised as ofJanuary 16, 2018 -- *May Support PHAB StandardslMeasures Page 3 of6 0 2,000 2,000 - Payment Deliverables/Outcomes Due Date/Time Information Frame and/or Amount Submit the completed Monthly, by the $500 per home Child Blood Lead Investigation Foon 30th of the visit, up to two available through W A DOH following month (2) home visits indicating : per child a) Confirmed BLL b) Date LHJ contacted the family c) Date the environmental assessment was completed d) Date the interview was completed e) Specify if the home is Section 8 or HUD Housing and if the child is Medicaid enrolled f) (If applicable) If DOH assistance is requested , list the DOH contact and date contacted Contract Number CLH18249-1 Task Task! ActivitylDescription Number Housing. If the child is Medicaid enrolled collect the Provider One number f) Provide educational material to the child's caregivers in the family's primary language g) (Optional) If warranted, contact DOH to request technical or environmental investigation assistance with an X-ray fluorescent (XRF) analyzer Have the child retested following the Pedi atric Environmental Health Specialty Units (PEHSU) medical management guidelines. If the lead level remains ~5 flg/dL the LHJ will conduct a second home visit to connect the family to other service providers as needed. PEHSU medical management guidelines: htms :llwww.oehSU .netl L ibrarv/fuctslmedical-mtmlllt- childhood-lead-exQosure-lune-2013 .odf If the second lead level drops to <5 llg/dL, the LHJ has the option to : 1) Mail the child's caregivers a letter recommending a developmental and nutritional screening, the letter will include providers in the child's residential area. The LHJ may then close the case . (DOH will provide a template letter.); or 2) proceed to Task 2 and conduct a second home visit. 2 The purpose of the second home vi sit is to connect the family to other service providers as needed: a) LHJ staff will facilitate and guide the child 's caregiver in completing the WithinReach Developmental Screening Questionnaire online ht!R:/1 www.I!arenthelI!123.org/. The LHJ must provide a hard copy of the developmental screening in case it cannot be submitted online. In unusual, and DOH approved cases, in which the WithinReach assessment cannot be performed, the LHJ may refer the family to the child's physician or to another entity that is trained to administer developmental screening tests b) Encourage blood lead testing of other children less than 72 months of age and pregnant or nursing caregivers in the home c) If appropriate, refer the child's caregivers to the Exhibit A, Statements of Work Revised as of January 16 ,2018 *May Support PHAB StandardsIMeasures I I Page 4 of6 AMENDMENT #1 --. Payment Due DatelTime Information Deliverables/Outcomes Frame and/or Amount g) (If applicable) If the LHJ opts to close the case after verifying that the second lead level has dropped to <5 Ilg/dL, it must I submit a copy of the letter I mailed to the family Submit a written report summarizing I the environmental assessment lab test results and a Plan of Care that lists recommendations on how to remove and remediate lead exposure. Include the educational material provided to the family that addresses the child's needs. (DOH will provide a generic template .) The LHJ will provide a copy of the report to DOH, the . child's caregivers and provider. Submit an updated Plan of Care to Monthly, by the $500 per home DOH, the child's caregivers and 30th of the visit, up to two provider that includes: following month (2) home visits a) Completion date and results of per child the online WithinReach Developmental Screening Questionnaire b) Ifblood lead testing of at-risk family members was recommended, list the individuals c) The referral date and provider of the nutritional assessment, include all other referrals d) The members of the case management team, their Contract Number CLH18249-1 AMENDMENT #1 Payment Task Task! ActivitylDescription *May Support PHAB Deliverables/Outcomes Due Date/Time Information Number StandardslMeasures Frame and/or Amount Women, Infants , and Children (WIC) program or a involvement, and the case Registered Dietitian Nutritionist (RDN) for a information provided to them nutritional assessment and to other service providers as appropriate d) Coordinate services and communicate regularly with members of the case management team *For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at: h!tp:J/\Vww.ph aboaraorg!wp-conrentiuploadsfPHAB-Standaros-and-Measures-Version-l .O.pdf Program Specific Regu..irements/N arrative Program Manual, Handbook, Policy References A Targeted Approach to Blood Lead Screening in Children, Washington State 2015 Expert Panel Recommendations httpS j/www .doh.wa.gov/PortaIsJllDocwnerus/Pubsl334-383 .pdf Special References (RCWs, WACs, etc) Laboratories are required to report to the Dep artment of Health all Blood Lead test results (WAC 246-10 I -20 1). Elevated results (~5 mcg/dL) must be reported within 2 days; non- elevated results ::;5 mcg/dL need to be reported within one month . Monitoring Visits (frequency, type) Telephone calls with contract manager at least once every quarter. Definitions BLL-Blood Lead Level EBLL-Elevated Blood Lead Level PEHSU-Pediatric Environmental Health Specialty Units Special Billing Requirements Payment is contingent upon DOH receipt and approval of all deliverables and an acceptable written report to include a plan of care . Payment to completely expend the "Total Consideration" for a specific funding period will not be processed unt il 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. Exhibit A, Statements of Work Revised as of January 16 ,2018 Page 5 of6 Contract Number CLH18249-1 DOH Program Contact Araceli Mendez, Health Services Consultant Office of Environmental Public Health Sciences Washington State Department of Health Street Address: 310 Israel Rd SE, Tumwater, W A 98501 Telephone: 360-236-3392 I Fax: 360-236-3059 Email: araceli.mendez@doh.wa.gov DOH Fiscal Contact Victoria Reyes, Management Analyst 1 Assistant Secretary's Office Telephone: 360-236-3071 Exhibit A, Statements of Work Revised as of January 16, 2018 AMENDMENT #1 Page 6 of6 Contract Number CLH18249-1 EXHIBIT B-1 Kittitas County Public Health Department ALLOCATIONS Contract Number: CLHI8249 Contract Term : 2018-2020 Date: January 16,2018 Indirect Rate as of January 2018: 11.25% County Central Svcs & 29.5% Public Health Dept DOli Use Only BARS Statement of Work Chart of ACCOUDts Funding Chart of Federal Award Revenue Funding Period FUDding Period Period Accounts Chart of Accounts Pro~am Title Identification # Amend # CFDA* Code** Start Date End Date Start Date Eud Date Amount SubTotal Total FFYI8 CSS IAR SNAP ED Program Mgnt NGA Not Received N/A 10.561 333.10.56 01/01118 09/30/18 10/01117 09/30/18 $8,830 $8,830 $10 ,302 FFY17 CSS 1AR SNAP ED Program Mgnt CF NGA Not Received N/A 10.561 333.10.56 Ol I O 1/18 09 /30/18 10/01/\7 091301\8 $1,472 $1,472 FFYI7 EPR PHEP BPI LHJ Funding NU90TP92 I 889-0 I N/A 93.069 333.93.06 0 110 1/18 06/30/18 07101/17 07/02118 $1 9 ,833 $19 ,833 $19,83 3 FFYI7 317 Ops 5NH23IPOO0762-0S-00 N/A 93 .268 333.93.26 01 /01 /18 06 /30118 04101117 06/30/18 $6 16 $616 $6 16 FFY17 AFIX 5NH23IPOO0762-05-00 N/A 93.268 333 .93 .26 01 /0 1/18 06 /30 /18 04101/17 06130118 $2,226 $2,226 $2,226 FFYI7 YFC Ops 5NH23IPOO0762-05-00 N/A 93.268 333.93.26 0 110 1/18 06/30/18 04/01117 06130/18 $1 ,11 4 $1,114 $1,114 FFYI8 MCHBG LHJ Contracts B04MC31524 N/A 93.994 333.93 .99 Ol i O 1/1 8 09 /30 /18 1O101l17 09/30118 $33,147 $33,147 $33,147 GFS -Group B (FO-E) N/A N/A 334.04.90 01101118 06130118 07101/17 06/30/19 $5,000 $5,000 $5,000 SFYI Lead Environments of Children Amdl N/A 334.04.93 0 1101118 06/30/18 07/01117 06130/18 $2,00 0 $2,000 $2,000 YR 20 SRF -Local Asst (15%) (FS) SS N/A N/A 346.26 .64 0 1/01/18 12/3 1/20 07/01115 12131120 $2,400 $2 ,400 $2,400 Sanitary Survey Fees (FO-E) SS-State N/A N/A 346.26.65 01/01/1 8 12/3 1/20 07101117 12/31120 $2,400 $2,400 $2,400 YR 20 SRF -Local Asst (15%) (FS) T A N/A N/A 346.26.66 01101 /18 12/31120 07101/15 12/31120 $2,000 $2,000 $2,000 TOTAL $81,038 $81 ,038 Total consideration: $79,038 GRAND TOTAL $81,038 $2,000 GRANDTOTAL $81,038 Total Fed $67,238 Total State $13,800 *Catalog of Federal Domestic Assistance **Federal revenue codes begin with "333". State revenue codes begin with "334". Page 1 of 1 Exhibit C-1 Schedule of Federal Awards KITTITAS COUNTY HEALTH DEPT -SWY0010475-<17 CONTRACT CLH18249-Kittilas County Public Health Department CONTRACT PERIOD: 01/0112018·1213112020 DO H Federal C hart of Accounts Program Title BARS Aw!rdDate NGANot FFY18 CSS IAR SNAP-ED PROGRAM MGNT 333.10.56 Received NGANot FFY17 CSS IAR SNAP-ED PROGRAM MGNT CF 333.10.56 Received FFY17 EPR PHEP BP1 LHJ FUNDING 333.93.06 07118117 FFY17 VFC OPS 333.93.26 03103117 FFY17 AFIX 333.93,26 03103117 FFY17 317 OPS 33393.26 03/03/17 FFY18 MCHBG LHJ CONTRACTS 333.93.99 10/20117 TotalAmt Allocation Period Federal Start End Award Dale Date NGIiNot 01101118 Recelved 09130/18. NGI'Not 01/01/18 Received 09130118 $11,062,782 01101/18 06130/18 $1,201,605 01101118 06130/18 $1,672,289 01/01118 06/30/18 $575,969 01101118 06/30/18 $1,650,528 01101118 09130/18 TOTAL Contract Ami $8,830 $1,472 $19,833 $1,114 $2,226 $616 $33,147 $67,238 AMENDMENT #1 Date: January 16,2018 CFDA CFDA Program Title Federal Agency Name Federal Award Federal Grant Award Name Identification Number State Administrative Matching 10561 Grants for the Supplemental Nutrition ASSistance Program Department of Agriculture Food and NGA Not Received NGA Not Received Nutrition Service Stale AdmftliWallllll Mwc:h1ng 10.561 GraolS for IIle $u~f1I\iOml Nutrition Assistance Program Departmenl of Agriculture Food and NGA Not Received NGA Not Received Nutrition Service 93069 Public Health Emergency Preparedness Department of Health and Human HPP AND PHEP COOPERATIVE Services Centers for Disease Control NU90TP921 889-01 AGREEMENT and Prevention 93.268 Immuruzation Cooperative Agreements Department of Health and Human IMMUNIZATION GRANT AND Services Centers for Disease Control 5NH23IPOO0762-05-00 VACCINES FOR CHILDREN'S and Prevention PROGRAM 93.268 Immunization Cooperative Agreements Department of Health and Human IMMUNIZATION GRANT AND Services Centers for Disease Control 5NH23IPOO0762~5-00 VACCINES FOR CHILDREN'S and Prevention PROGRAM 93.268 Immunization Cooperative Agreements Department of Health and Human IMMUNIZATION GRANT AND SeMces Centers for Disease Control 5NH23IPOO0762~5-00 VACCINES FOR CHILDREN'S and Prevention PROGRAM Maternal and Child Health 93.994 Services Block Grant to the States Department of Health and Human MATERNAL AND CHILD HEALTH Services Health Resources and B04MC31524 SERVICES 5etVi/:.I$ ACmll1("",Uao Page 1 of 1 Kittitas County Review Form Grants & Contract Agreement -II Today's Date Agenda Date }}o rl' \ 8,2JJle; 03/06/2018 Fund/Department 116-Public Health Contract/Grant Information Contract /Grant Agency: Consolidated Contract Amendment 1 Period Begin Date: January I, 2018 I I Period End Date: 12/31/2020 Total Grant/Contract Amount: $81,038.00 (Increase of 2,000.00) Grant/Contract Number: CLH18249 Contract/Grant Summary: The Consolidated Contract Amendment Adds a Statement of Work for childhood lead Poisoning Prevention Program, Effective January I, 2018 through June 30, 2018. Department Head Signatur ~ A~ , Administrator Signature of Board of Health member Date Financial Information Total Amount $81,038 State Funds $13,800 Federal Funds $67,238 Percentage County Funds Matchin~Funds $ CFDA# In-Kind $ Explain Is Equipment being purchased? Who owns equipment? Grant/Contract Review Page 1 New Personnel being hired? I Contact HR hiring -reporting requirements Future impacts or liability to Kittitas County: Budget Information Budget Amendment Needed? YesD attach budget form No []I Why not New Division Created? Unknown if funding to be used Revenue Code 116.612.334.04.93.0 Pass Through Information Agency to Pass Through Amount to Pass Through $ Sub-Contract Approved Date: Prosecutor Review I Has the Prosecutor reviewed this agreement? [ YesD No D County Departments Im pacted Auditor Facilities Maintenance Information Services Human Resource Prosecutor Treasurer Submitted I Signature: Department: I Date: Assignment of Tracking Information Auditor's Office Human Resource Prosecutor's Office Who Signed the grant application I Reviewer I Date Grant/Contract Review Page 2