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HomeMy WebLinkAboutWashington State Department of Health Amendment # 13MASON COUNTY PUBLIC HEALTH 2022-2024 CONSOLIDA1ED CONTRACT me. Cori\'( ac-\ :\\ 12-0\2. CONTRACT NUMBER: CLH31019 AMENDMENT NUMBER: 13 PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTII hereioafler referred to as "DOH", and MASON COUNTY PUBLIC HEALTII, a Local Health Jurisdiction, hereinafter referred to as ''LHJ'', pursuant to the Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any subsequent amendments thereto. IT IS MUTUALLY AGREED: That th e contract is hereby amended as follows: l. Exhibit A Statements of Work, includes the following statements of work, which are inco.1porated by this reference and located on the DOH Finance SbarePoint site in the Upload Center at the following URL: https://stateofwa.shan:po jnt.comlsitesldoh-ofsfundi~si~pa&Wh9me .aSJ>x?=el :9a9468Sda2d94d3ea80ac7fuc32e4d7c cg] Adds Statements of Wm:k for the following programs: Foundational Public Health Services (FPHS) -Effective July l , 2023 Infectious Disease Prevention Services-SSP -Effective July l, 2023 Office ofirorouoiution-Perinatal Hepatitis B -Effective Joly 1, 2023 Office of Immunization-Promotion of Immunizations to Improve Vaccination Rates -Effective July 1, 2023 OSS LMP Implementation-Effective Joly l, 2023 Recreational Shellfish Activities -Effective Joly I, 2023 cg] Amends Statements ofWoik for the following programs: Injwy & Violence Prevention Overdose Data to Action -Effective September 1, 2022 Office of Drinking Water Group A Program-Effective January 1, 2022 OSS LMP Implementation -Effective Januaty 1, 2 022. D Deletes Statements of Work for the following programs: 2. E.xhtbit B-13 Allocations, attached and incoiporated by this reference, amends and replaces E."lliibit B-12 Allocations as follows : IZI Increase of Sl,378,486 for a revised maximum consideration of SS,341.192. D Decrease of __ for a revised maximum consideration of __ . No change in the ma.~um consideration of_. D Exhibit B Allocations are attached only for informational putposes. Unless designated otherwise herein, the effective date of this amendment is the date of execution. ALL OTIIER TERMS AND CONDmONS 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. MASON COUNTY PUBLIC HEALTII STATE OF WASHINGTON DEPARTMENT OF HEALTH Signature: Signature: ,/,,I_ L _/ Date: Date: 07/24/23 EXHIBIT B-13 Mason County Public Health ALLOCATIONS Contract Number:CLH31019 Contract Term: 2022-2024 Date:June 1, 2023 Indirect Rate January 1, 2022 through December 31, 2022: 17.26% Indirect Rate January 1, 2023 through December 31, 2023: 18.44% BARS Funding Chart of Federal Award Assist Revenue Period Accounts Chart of Accounts Program Title Identification #Amend #List #*Code**Start Date End Date Start Date End Date Amount SubTotal Total FFY22 PHEP BP4 LHJ Funding NU90TP922043 Amd 7 93.069 333.93.06 07/01/22 06/30/23 07/01/22 06/30/23 $49,342 $49,342 $83,801 FFY21 PHEP BP3 LHJ Funding NU90TP922043 Amd 2 93.069 333.93.06 01/01/22 06/30/22 07/01/21 06/30/22 $34,459 $34,459 FFY22 Overdose Data to Action Prev NU17CE925007 Amd 10 93.136 333.93.13 09/01/22 08/31/23 09/01/22 08/31/23 $56,938 $106,938 $144,746 FFY22 Overdose Data to Action Prev NU17CE925007 Amd 7 93.136 333.93.13 09/01/22 08/31/23 09/01/22 08/31/23 $50,000 FFY21 Overdose Data to Action Prev NU17CE925007 Amd 4 93.136 333.93.13 01/01/22 08/31/22 09/01/21 08/31/22 $2,696 $37,808 FFY21 Overdose Data to Action Prev NU17CE925007 Amd 3 93.136 333.93.13 01/01/22 08/31/22 09/01/21 08/31/22 $35,112 FFY24 CDC PPHF Ops NGA Not Received Amd 13 93.268 333.93.26 07/01/23 06/30/24 07/01/23 06/30/24 $500 $500 $500 FFY24 CDC VFC Ops NGA Not Received Amd 13 93.268 333.93.26 07/01/23 06/30/24 07/01/23 06/30/24 $5,600 $5,600 $5,600 COVID19 Vaccines NH23IP922619 Amd 4 93.268 333.93.26 01/01/22 06/30/24 07/01/20 06/30/24 $354,803 $354,803 $354,803 COVID19 Vaccines R4 NH23IP922619 Amd 1 93.268 333.93.26 01/01/22 06/30/24 07/01/20 06/30/24 $354,803 $354,803 $354,803 FFY23 PPHF Ops NH23IP922619 Amd 7 93.268 333.93.26 07/01/22 06/30/23 07/01/22 06/30/23 $500 $500 $1,000 FFY22 PPHF Ops NH23IP922619 Amd 3 93.268 333.93.26 01/01/22 06/30/22 07/01/21 06/30/22 $500 $500 FFY19 COVID CARES NU50CK000515 Amd 2, 3 93.323 333.93.32 01/01/22 06/30/22 04/23/20 07/31/24 $65,595 $65,595 $65,595 FFY19 ELC COVID Ed LHJ Allocation NU50CK000515 Amd 3, 11 93.323 333.93.32 01/01/22 01/31/23 05/19/20 01/31/23 ($29,966)$213,061 $213,061 FFY19 ELC COVID Ed LHJ Allocation NU50CK000515 Amd 2, 11 93.323 333.93.32 01/01/22 01/31/23 05/19/20 01/31/23 $243,027 FFY20 ELC EDE LHJ Allocation NU50CK000515 Amd 7, 9 93.323 333.93.32 01/01/22 07/31/23 01/15/21 07/31/24 ($27,095)$867,729 $867,729 FFY20 ELC EDE LHJ Allocation NU50CK000515 Amd 3, 9 93.323 333.93.32 01/01/22 07/31/23 01/15/21 07/31/24 ($30) FFY20 ELC EDE LHJ Allocation NU50CK000515 Amd 2, 9 93.323 333.93.32 01/01/22 07/31/23 01/15/21 07/31/24 $894,854 FFY23 Vector-borne T2&3 Epi ELC FPH NGA Not Received Amd 12 93.323 333.93.32 08/01/23 09/30/23 08/01/23 09/30/23 $1,200 $1,200 $8,500 FFY22 Vector-borne T2&3 Epi ELC FPH NU50CK000515 Amd 12 93.323 333.93.32 08/01/22 07/31/23 08/01/22 07/31/23 $1,800 $4,550 FFY22 Vector-borne T2&3 Epi ELC FPH NU50CK000515 Amd 5, 12 93.323 333.93.32 08/01/22 07/31/23 08/01/22 07/31/23 $2,750 FFY21 Vector-borne T2&3 Epi ELC FPH NU50CK000515 Amd 5 93.323 333.93.32 06/01/22 07/31/22 08/01/21 07/31/22 $2,750 $2,750 FFY23 MCHBG LHJ Contracts B04MC47453 Amd 7 93.994 333.93.99 10/01/22 09/30/23 10/01/22 09/30/23 $67,694 $67,694 $118,464 FFY22 MCHBG LHJ Contracts B04MC45251 Amd 1 93.994 333.93.99 01/01/22 09/30/22 10/01/21 09/30/22 $50,770 $50,770 GFS-Group B (FO-SW)Amd 10 N/A 334.04.90 01/01/23 06/30/23 07/01/22 06/30/23 $6,469 $6,469 $12,938 GFS-Group B (FO-SW)Amd 1 N/A 334.04.90 01/01/22 06/30/22 07/01/21 06/30/22 $6,469 $6,469 SFY24 Drug User Health Program Amd 13 N/A 334.04.91 07/01/23 12/31/23 07/01/23 12/31/23 $2,500 $2,500 $2,500 State Drug User Health Program Amd 12 N/A 334.04.91 02/01/23 06/30/23 07/01/23 12/31/23 $5,000 $5,000 $5,000 LHJ Funding Period Funding Period Chart of AccountsStatement of Work DOH Use Only Page 1 of 2 EXHIBIT B-13 Mason County Public Health ALLOCATIONS Contract Number:CLH31019 Contract Term: 2022-2024 Date:June 1, 2023 Indirect Rate January 1, 2022 through December 31, 2022: 17.26% Indirect Rate January 1, 2023 through December 31, 2023: 18.44% BARS Funding Chart of Federal Award Assist Revenue Period Accounts Chart of Accounts Program Title Identification #Amend #List #*Code**Start Date End Date Start Date End Date Amount SubTotal Total LHJ Funding Period Funding Period Chart of AccountsStatement of Work DOH Use Only State TB Control-FPH Amd 9 N/A 334.04.91 10/01/22 06/30/23 07/01/21 06/30/23 $500 $500 $500 Rec Shellfish/Biotoxin Amd 13 N/A 334.04.93 07/01/23 12/31/24 07/01/23 06/30/25 $5,250 $5,250 $10,500 Rec Shellfish/Biotoxin Amd 1 N/A 334.04.93 01/01/22 06/30/23 07/01/21 06/30/23 $5,250 $5,250 Small Onsite Management (GFS)Amd 13 N/A 334.04.93 07/01/24 12/31/24 07/01/23 06/30/25 $53,636 $53,636 $98,636 Small Onsite Management (GFS)Amd 13 N/A 334.04.93 07/01/23 06/30/24 07/01/23 06/30/25 $45,000 $45,000 Wastewater Management-GFS Amd 1 N/A 334.04.93 07/01/22 06/30/23 07/01/21 06/30/23 $60,000 $60,000 $75,000 Wastewater Management-GFS Amd 1 N/A 334.04.93 07/01/22 06/30/23 07/01/21 06/30/23 $15,000 $15,000 FPHS-LHJ-Proviso (YR2)Amd 6 N/A 336.04.25 07/01/22 06/30/23 07/01/21 06/30/23 $1,266,000 $1,266,000 $1,603,116 FPHS-LHJ-Proviso (YR2)Amd 7 N/A 336.04.25 07/01/22 06/30/23 07/01/21 06/30/23 ($761,000)$0 FPHS-LHJ-Proviso (YR2)Amd 1 N/A 336.04.25 07/01/22 06/30/23 07/01/21 06/30/23 $761,000 FPHS-LHJ-Proviso (YR1)Amd 9 N/A 336.04.25 01/01/22 06/30/22 07/01/21 06/30/23 ($423,884)$337,116 FPHS-LHJ-Proviso (YR1)Amd 1 N/A 336.04.25 01/01/22 06/30/22 07/01/21 06/30/23 $761,000 FPHS-Local Health Jurisdiction Amd 13 N/A 336.04.25 07/01/23 06/30/24 07/01/23 06/30/25 $1,266,000 $1,266,000 $1,266,000 YR 25 SRF - Local Asst (15%) (FO-SW) SS Amd 11 N/A 346.26.64 01/01/23 12/31/23 01/01/23 12/31/23 $10,800 $10,800 $23,200 YR24 SRF - Local Asst (15%) (FO-SW) SS Amd 7 N/A 346.26.64 01/01/22 12/31/22 07/01/21 06/30/23 $1,400 $12,400 YR24 SRF - Local Asst (15%) (FO-SW) SS Amd 1 N/A 346.26.64 01/01/22 12/31/22 07/01/21 06/30/23 $11,000 Sanitary Survey Fees (FO-SW) SS-State Amd 11 N/A 346.26.65 01/01/22 12/31/23 07/01/21 12/31/23 $10,800 $23,200 $23,200 Sanitary Survey Fees (FO-SW) SS-State Amd 7, 11 N/A 346.26.65 01/01/22 12/31/23 07/01/21 12/31/23 $1,400 Sanitary Survey Fees (FO-SW) SS-State Amd 1, 11 N/A 346.26.65 01/01/22 12/31/23 07/01/21 12/31/23 $11,000 YR 25 SRF - Local Asst (15%) (FO-SW) TA Amd 11 N/A 346.26.66 01/01/23 12/31/23 01/01/23 12/31/23 $1,000 $1,000 $2,000 YR24 SRF - Local Asst (15%) (FO-SW) TA Amd 1 N/A 346.26.66 01/01/22 12/31/22 07/01/21 06/30/23 $1,000 $1,000 TOTAL $5,341,192 $5,341,192 Total consideration:$3,962,706 GRAND TOTAL $5,341,192 $1,378,486 GRAND TOTAL $5,341,192 Total Fed $2,218,602 Total State $3,122,590 *Catalog of Federal Domestic Assistance **Federal revenue codes begin with "333". State revenue codes begin with "334". Page 2 of 2 Exhibit A Statement of Work Contract Term: 2022-2024 DOH Program Name or Title : Foundational Public Health Services {FPHS) - Effective July 1, 2023 Local Health Jurisdiction Name: Mason Countv Public Health Contract Number: CLH3101 9 SOW Type: Original Revision # (for this SOW) Funding Source Federal Compliance Type of Payment D Federal <S elect One> ( check if applicable) D Reimburs em ent j:gJ State D FFATA (Transparency Act) [gJ Periodic Distribution D Other D Research & Dev elopment Period of Performance: July 1, 2 023 through June 30, 2024 Statement of Work Purpose: Per RCW 43 .70.512, Foundational Public Health Services (FPHS) funds are for the governmental public health system: local health j urisdictions, Department of Health, state Board of Health, sovereign tribal nations and Indian health programs. These funds are to build the system's capacity and increase the av ail ability of FPHS s ervices statewide. Revision Purpose: NI A Master Assistance BARS Allocation Index Listing Revenue LHJ Funding Period Current Change Total DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation FPHS-LOCAL HEAL TH JURISDICTION 99200840 NI A 33 6.04 .25 07/01 /23 06/30/24 0 1,266,000 1,266,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTALS 0 1,266,000 1,266,000 Payment Task # Activity Deliverables/Outcomes Due Date/Time Frame Information and /or Amount 1 FPHS funds to each LHJ -See below in Program Specific See below in Program Specific See below in Program Specific $628,000 Reguirements -Activity Special Instructions for details Reguirements -Deliverables Reguirements -Deliverables 2 Assessment Reinforcing Capacity -See below in Program Specific See below in Program Specific See be low in Program Specific $60,000 Reguir ements -Activity Special Instruction s for details Reguirements -Deliverables Reguirements -Deliv erables 3 Assessment-CHA/CHIP -See below in Program Specific See below in Program Specific See b elow in Program Specific $30,00 0 Reguirem ents -Activity Special Instructions for details Reguirements -Deliverables Reguirements -Deliv erab les 4 Lifecourse -Infrastructure & Workforce Capacity -See below in See below in Program Specific See below in Program Specific $360,000 Program Specific Reguirements -Activ ity S2 ecial Instructions for details Requirements -Deliverables Requirements -Deliverables Exhibit A, Statement of Work Page 1 of5 Contract Number CLH31019-Amendment 13 Task Payment # Activity Deliverables/Outcomes Due Date/Time Frame Information and/or Amount 5 CD -Hepatitis C -See below in Program Specific Requirements -See below in Program Specific See below in Program Specific $103,000 Activity Special Instructions for details Requirements -Deliverables Requirements -Deliverables 6 CD -Case Investigation Capacity -See below in Program Specific See below in Program Specific See below in Program Specific $85,000 Requirements -Activitv Special Instructions for details Requirements -Deliverables Requirements -Deliverables DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other fmance-related inquiry, may be sent to finance@doh .wa.gov . FPHS staff from DOH and the Washington State Association of Local Public Health Officials (WSALPHO) will coordinate and communicate together to build and assure common systemwide approaches per FPHS Steering Committee direction and the FPHS framework intent. • For LHJ questions about the use of funds: o Chris Goodwin, FPHS Policy Advisor, WSALPHO -cgoodwin@wsac.org, 564-200-3166 o Brianna Steere, FPHS Policy Advisor, WSALPHO -bsteere@wsac.org, 564-200-3171 The intent of FPHS funding is outlined in RCW 43 . 70 .512 . Foundational Public Health Services Defmitions and related information can be found here: www.doh .wa.gov/fphs . Stable funding and an iterative decision-making process -The FPHS Steering Committee's roles and responsibilities are outlined in the FPHS Committee & Workgroup Charter The Steering Committee is the decision making body for FPHS and operates under a consensus-based decision making model, outlined here. The Steering Committee use an iterative approach to decision making meaning additional tasks and/or funds may be added to a local health jurisdiction's (LHJ) FPHS Statement of Work (SOW) as funding decisions are made. Spending of FPHS funds -FPHS funds do not require pre-approval or pre-authorization to spend. FPHS funds are to assure FPHS services are available in each jurisdiction based on the FPHS Defmitions (link) and as r eflected in the SOW. Assurance includes providing FPHS as part of your jurisdiction's program operations, contracting with another governmental public health system partner to provide the service, or receiving the service through a new service delivery model such as cross-jurisdictional sharing or regional staff. FPHS funds are eligible starting at the beginning of each state fiscal year (July 1) regardless of when funds are received by the LHJ, even if the expenditure occurred before the LHJ's contract was signed. These funds are not intended for fee-based services such as select environmental public health services. As state funding for FPHS increases, other funds sources (local revenue, grants, federal block grants) should be directed to the implementation of additional important services and local/state priorities as determined by each agency/jurisdiction. Annual Allocations -The legislature appropriates FPHS funding on an annual basis and the FPHS Steering Committee allocates funds annually through the FPHS Concurrence Process for the State Fiscal Year (SFY): July -June. The Legislature appropriates FPHS funding amounts for each fiscal year of the biennium. This means that funds must be spent within that fiscal year and cannot be carried forward. Any funds not spent by June 30th each year must be returned to the State Treasury. Funding allocations reset and begin again at the start of the next fiscal year (July 1). This Statement of Work is for the period of July 1, 2023-June 30, 2024 and may be included in multiple Consolidated Contracts (Con Cons) which are based on the calendar year and renewed every three years. Exhibit A, Statement of Work Page 2 of5 Contract Number CLH31019-Amendment 13 Disbursement ofFPHS funds to LHJs -Unlike other ConCon grants, FPHS bill-back to DOH is NOT required. Half of the annual FPHS funds allocated by the Steering Committee to each LHJ are disbursed each July and January. The July payments to LHJs and access to FPHS allocation for all other parts of the governmental public health system occur upon completion of the FPHS Annual Assessment. Deliverables -FPHS funds are to be used to assure FPHS services statewide. The FPHS accountability process measures how funds are spent, along with changes in system capacity through the FPHS Annual Assessment, system performance indicators, and other data. DOH, SBOH and local health jurisdictions have agreed to complete: 1. Reporting of spending and spending projections. Process timelines and reporting template are provided by the FPHS Steering Committee via FPHS Support Staff. 2. FPHS Annual Assessment is due each July to report on the previous state fiscal year. Process and reporting template are provided by the FPHS Steering Committee via FPHS Support Staff. System results are published in the annual FPHS Investment Report available at www.doh .wa.gov/fphs . BARS Revenue Code: 336.04.25 BARS Expenditure Coding -provided for your reference. 562.xx BARS Expenditure Codes for FPHS activities: see below 10 FPHS Epidemiology & Surveillance 11 FPHS Community Health Assessment 12 FPHS Emergency Preparedness & Response 13 FPHS Communication 14 FPHS Policy Development 15 FPHS Community Partnership Development 16 FPHS Business Competencies 17 FPHS Technology 20 FPHS CD Data & Plannin_g 21 FPHS Promote Immunizations 23 FPHS Disease Investigation -Tuberculosis (TB) 24 FPHS Disease Investigation -Hepatitis C 25 FPHS Disease Investi_gation -Syphilis, Gonorrhea & HIV 26 FPHS Disease Investigation -STD (other) 27 FPHS Disease Investi_gation -VPD 28 FPHS Disease Investigation -Enteric 29 FPHS Disease Investigation -General CD 40 FPHS EPH Data& Planning 41 FPHS Food 42 FPHS Recreational Water 43 FPHS Drinking Water Quality 44 FPHS On-site Wastewater 45 FPHS Solid & Hazardous Waste 46 FPHS Schools 47 FPHS Temporary Worker Housing 48 FPHS Transient Accommodations 49 FPHS Smoking in Public Places 50 FPHS Other EPH Outbreak Investigations Exhibit A, Statement of Work Page 3 of5 Contract Number CLH3 l O 19-Amendment 13 51 FPHS Zoonotics (includes vectors) 52 FPHS Radiation 53 FPHS Land Use Planning 60 FPHS MCH Data & Planning 70 FPHS Chronic Disease, Injury & Violence Prevention Data & Planning 80 FPHS Access/Linkage with Medical, Oral and Behavioral Health Care Services Data & Planning 90 FPHS Vital Records 91 FPHS Laboratory -Centralized (PHSKC Only) 92 FPHS Laboratory Special References (i .e., RCWs, WACs, etc.): FPHS Intent -RCW 43 .70.512 FPHS Funding -RCW 43 .7 0.5 15 FPHS Committee & Workgroup Charter FPHS Steering Committee Consensus Decision Making Model Activity Special Instructions: Investments to Each LHJ: 1. FPHS Funds to Each LHJ These funds are allocated to be used to provide any programs and services within all of the FPHS Defmitions. Each LHJ is empowered to prioritize where and how to use these funds to maximize equitable, effective and efficient delivery of FPHS to every community in Washington. Use BARS expenditure codes from the list above that most closely align with expenditure made. Targeted Investments to Each LHJ: 2 . Assessment Reinforcing Capacity (FPHS definition G.2) Support LHJ assessment capacity with flexible funds to meet locally identified needs. BARS expenditure codes: 562.10 or 11 3. Assessment -CHA/CHIP (FPHS definitions G.3) Support any CHA/CHIP activity or service (e.g., data analysis, focus groups, report writing, process facilitation) and may be used to contract with other agencies for staff time or services . Use BARS expenditure codes: 562.11 4. Lifecourse -Infrastructure & Workforce Capacity (FPHS definitions D, E, F) Infrastructure and workforce investments t o each LHJ to meet fundamental needs in three areas: Maternal/Child/Family Health; Access/Linkage with Medical, Oral and Behavioral Health Services; and Chronic Disease, Injury and V iolence Prevention. Use BARS expenditure codes: 562.60 or 70 or 80 . Targeted Investments to Select LHJs -Assuring FPHS Available in Own Jurisdiction : 5. CD -Hepatitis C (FPHS definitions C.4.o-p) Address Hepatitis C cases per guidance developed by the FPHS CD SME Workgroup and DOH's Hepatitis C Prioritization document with particular emphasis on lab surveillance and investigation of acute cases. Use BARS expenditure codes: 562.24. Exhibit A, Statement of Work Page 4 of5 Contract Number CLH31019-Amendment 13 6. CD -Case Investigation Capacity (FPHS definitions C.2, C. 4) Support LHJ communicable disease capacity to conduct case investigation and follow up to reduce gaps and meet locally identified needs that address notifiable conditions responsibilities. Use BARS expenditure codes: 562.23-29. Exhibit A, Statement of Work Page 5 of5 Contract Number CLH3 l O 19-Amendment 13 Exhibit A Statement of Work Contract Term: 2022-2024 DOH Program Name or Title: Infectious Disease Prevention Services-SSP - Effective July 1, 2023 Local Health Jurisdiction Name: Mason County Public Health Contract Number: CLH3 IO 19 SOW Type: Original Revision # (for this SOW) Funding Source Federal Compliance Type of Payment D Federal Contractor ( check if applicable) 1:2] Reimbursement 1:2] State 0 FFATA (Transparency Act) D Other 0 Research & Development Period of Performance: July I, 2023 through December 31. 2023 Statement of Work Purpose: The purpose of this statement of work is to provide Syringe Service Programs to clients living in Mason County Revision Purpose: NI A Master Assistance BARS Allocation Index Listing Revenue LHJ Funding Period Current Change D Fixed Price Total DOH Chart of Accounts Master I ndex Title Code Number Code Start Date End Date Allocation Increase(+) Allocation SFY24 DRUG USER HEALTH PROGRAM 12401140 NI A 334.04.91 07/01 /23 12/31 /23 0 2,500 2,500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTALS 0 2,500 2,500 Task# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount Syringe To provide comprehensive Syringe Service Program (SSP) to All data is entered into DOH provided Data is entered into $2500-State Drug User Service people who use drugs (PWUD). This plan of action is database for tracking SSP activities database by the 15th of the Health Program directed to distribute syringes to communities that use drugs monthly. following month. (SSP) to prevent transmission of infectious disease. SSP programs will operate during scheduled hours to provide new harm reduction supplies and syringes to prevent transmission of disease. SSP will offer referrals to address social determinants of health. The contractor will enter all deliverable data into DOH orovided database for tracking SSP activities. DOH Program and Fiscal Contact Information for all ConCon S0Ws can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other finance-related inquiry, may be sent to finance@ doh .wa.gov. Exhibit A, Statement of Work Page I of2 Contract Number CLH31019-Amendment 13 PROGRAM SPECIFIC REQUIREMENTS 1. Definitions CONTRACTOR-For the purposes of this Statement of Work Only, the Entity receiving funds directly from Washington State Department of Health (DOH) for client services to prevent or treat conditions named in the statement of work will be referred to as contractor . 2. Contract Management - a. Fiscal Guidance i) Funding -The CONTRACTOR shall submit all claims for payment for costs due and payable under this statement of work by January 31, 2024 DOH will pay belated claims at its discretion, contingent upon the availability of funds. ii) Submission of Invoice Vouchers-On a monthly basis, the CONTRACTOR shall submit correct A19 invoice vouchers amounts billable to DOH under this statement of work and Expense Summary backup form. All A19 invoice vouchers must be submitted by the 25th of the following month. • The CONTRACTOR must provide all backup documentation as required based on the assigned risk level. DOH may ask for additional backup information to pay invoices based on the needs of the funding sources supporting the work. iii) Advance Payments Prohibited -DOH funds are "cost reimbursement" funds. DOH will not make payment in advance or in anticipation of services or supplies provided. This includes payments of "one-twelfth" of the current fiscal year's funding . iv) Payment of Cash or Checks to Clients Not Allowed -Where direct provision of service is not possible or effective, vouchers or similar programs, which may only be exchanged for a specific service ( e .g., transportation), shall be used to meet the need for such services. CONTRACTOR shall administer voucher programs to assure that recipients cannot readily convert vouchers into cash. v) Small and Attractive items -Each agency shall perform a risk assessment (both financial and operational) on the agency's assets to identify those assets that are particularly at risk or vulnerable to loss. Operational risks include risks associated with data security on mobile or portable computing devices that store or have access to state data. Assets so identified that fall below the state's capitalization policy are considered small and attractive assets. Agency shall develop written internal policies for managing small and attractive assets. Internal policies should take into consideration the Office of the Chief Information Officer (OCIO) IT Security Standard 141 Section 5.8 Mobile Computing and Section 8.3 Media Handling and Disposal at https://ocio.wa .gov/policies. The agency shall implement specific measures to control small and attractive assets in order to m inimi ze identified risks. Periodically, the agency should perform a follow up risk assessment to determine if the additional controls imp lemented are effective in managing the identified r isks. Agency must include, at a minimum, the following assets with unit costs of $300 or more: 1) Laptops and Notebook Computers 2) Tablets and Smart Phones Agencies must also include the following assets with unit costs of $1,000 or more: I ) Optical Devices, Binoculars, Telescopes, Infrared Viewers, and Rangefinders 2) Cameras and Photographic Projection Equipment 3) Desktop Computers (PC s) 4) Television Sets, DVD Players, Blu-ray Players, and Video Cameras (home type) b. Contract Modifications Notice of Change in Services -The CONTRACTOR shall notify DOH program staff, within 45 days, if any situations arise that may impede implementation of the services contained in the statement of work. DOH and the CONTRACTOR will agree to strategies for resolving any shortfalls. DOH retains the right to withhold funds in the event of substantial noncompliance. Exhibit A, Statement of Work Page 2 of2 Contract Number CLH31019-Amendment 13 Exhibit A Statement of Work Contract Term: 2022-2024 DOH Program Name or Title: lniurv & Violence P revention Overdose Data to Action -Effective September 1, 2022 Local Health Jurisdiction Name: Mason County Public Health Contract Number: CLH31019 SOW Type: Revision Revision # (for this SOW) 4 Funding Source Federal Compliance Type of Payment rgJ Federal Subrecipient (check if applicable) rgJ Reimbursement D State rgJ FFATA (Transparency Act) D Fixed Price D Other D Research & Development Period of Performance: September 1, 2022 through August 31, 2023 Statement of Work Purpose: The purpose of this statement of work (SOW) is to add level funding for Overdose Data to Action (OD2A) Year 3 Supplement. Mason County Public Health (MCPH) will support Strategy 5 -Integration of State and Local Prevention and Response Efforts, Strategy 6 -Establishing Linkages to Care, and Strategy 9 - Empowering Individuals to Make Safer Choices. Revision Purpose: The purpose ofthis revision is to make minor language edits to activity 5 . Master Assistance BARS Allocation Index Listing Revenue LHJ Funding Period Current Change Total DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation None Allocation FFY22 OVERDOSE DAT A TO ACTION PREV 77520272 93.136 333.93.13 09/01/22 08/3 1/23 106,938 0 106,938 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTALS 106,938 0 106,938 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information # and/or Amount 1. Strategy 5: Collect and analyz e opioid response plan data. Progress Report: Report data, findings, Quarterly progress reports Monthly invoices for Conduct continuous quality improvement on the opioid and analysis. Demonstrate how data to DOH for all tasks. actual cost reimbursement response plan and system . Data is colle cted on all response informs Mason County linkages to care will be submitted to activities in Mason County. This includes outreach events, and opioid response plan activities. Due Dates: DOH. trainings, naloxone distribution, overdoses, provider reports etc. Demonstrate how work aligns with OD2A September-November due This data is utilized to inform quality improvement for the logic model. December 9, 2022. Total of all invoices will community referral and linkage system. December-February due not exceed $106,938 2 . Strategy 6: Conduct continuous community education on Progress report: list training dates, March 10, 2023. through August 31 , 2023. March-May due June 9, opioid and other substance use risks and treatment resources locations, attendance, and objective of 2023 . (See Special Billing through group and individual trainings, outreach activities at trainings; lessons learned and successes Requirements below .) the syringe exchange, and other community activities as safety with outreach, education, and linkages to orecautions due to the pandemic allow (transit center, shelters, care. Share oro!ITess on forming Exhibit A, Statement of Work Page 1 of 4 Contract Number CLH3 l O 19-Amendment 13 Task Activity Deliverabl es/Outcomes Due Date/Time Frame Payment Inform ation # and/or Amount jail) to link individuals to care. Partner with community partnerships with community agencies. June-August fmal r eport agencies who are in regular contact with people who use drugs Share number of supplies distributed and for this funding period due to maintain awareness of community resources and increase at what locations. Share any successes and September 29, 2023. wraparound services. challenges in trying to engage with the Overdose data shows a significant shift from overdoses taking unhoused community. Demonstrate how place almost entirely in private residences to many happening work aligns with OD2A logic model. now in public locations. Outreach engagement supplies (emergency blankets, bats, gloves, socks, and nutrition shakes) will be distributed to build trust and rapport with the unhoused populat ion. These items will allow staff to be invited into encampments t o engage with individuals at risk of overdose who are not coming to harm reduction services in t own. ,., -'· Strategy 6: Support the Road to Recovery Behavioral Health Progress report: Report on the number of Transportation Program by continuing to subcontract with individuals served, miles travelled, types Gethsemane Ministries to provide out of county transportation of agencies coordinated with, and within Washington State for behavioral health and recovery ind ividual's demographics. supports (predominantly detox and in-patient treatment). There is also an in-county component in partnership with a local transportation program, the Patty Wagon. 4. Strategy 9: Print harm r eduction supplies such as the Mason Progress report: Share how many/what County Behavioral Health Resource Guide, Overdose kinds of supplies and materials have been Prevention and Response training pamphlets, and all other SUD distributed and where. Report on any related printed information. Purchase shirts for International response to materials. Demonstrate how Overdose Awareness Walk and Behavioral Health Resource work aligns with OD2A logic model. Fair. 5. Dependent on LHJ need, the county may purchase .me Progress report, if applicable: distribute naloxone under prevention strategies, with the intent a. Number of staff/volunteers trained to to distribute to populations at risk of witnessing or use and distribute naloxone kits experiencing an overdose. i . If possible, please share the descr iption/topics of the training Funding cannot be spent for naloxone until the LHJ submits a b. Number of kits purchased and in naloxone request form to DOH and receives written approval inventory from DOH. Reimbursement for naloxone purchases will be c. Number of people who received allowable after written approval is provided by DOH. naloxone kits and education on use i. If possible, please share the description/contents of the provided education d. Number of nasal kits distributed i. If applicable, the number of kits distributed through vending machines and settinQ:S for vendinQ: machine locations Exhibit A, Statement of Work Page 2 of4 Contract Number CLH31019-Amendment 13 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information # and/or Amount ii. If possible, please share an average/estimate of number of kits/doses given per person e. Number of intramuscular kits distributed i. If possible, please share an average/estimate of number of kits/doses given per person f. Number of overdose reversals reported i. If known, please share the number of doses used per overdose reversal g. Do you plan to make any changes/updates in implementation or to the implementation p lan? h. What have been successes/challenges in distribution? Please share any lessons learned or innovations. 6. Participate in quarterly calls w ith DOH and grant partners. Collaboration with grant partners and Share lessons learned and successes. More frequent one on one DOH to improve statewide efforts to calls w ith DOH when needed. address the opioid/all drug epidemic. DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Fin ance SharePoint site. Questions related to this SOW, or any other finance-related inquiry, may be sent to tinance@ doh .wa.gov. Federal Funding Accountability and Transparency Act (FFATA) (Applies to federal grant awards.) This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act). The purpose of the Transparen cy Act is to make information available online so the public can see how the federal funds are spent. To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Unique Entity Identifier (UEI) generated by SAM.gov. Information about the LHJ and this statement of work will be made available on USAS pending.gov by DOH as required by P.L. 109-282. Program Specific Requirements Restrictions on Funds (i.e., disallowed expenses or activities , indirect costs, etc.): • Subrecipients may not use funds for research . • Subrecipients may not use funds for clinical care except as allowed by law. • Subrecipients may use funds only for reasonable program purposes, including personnel, travel, supplies, and services. • Generally, subrecipients may not use funds to purchase furniture or equipment. • No funds may be used for: Exhibit A, Statement of Work Page 3 of4 Contract Number CLH31019-Amendment 13 o Publicity or propaganda purposes, for the preparation, distribution, or use of any material designed to support or defeat the enactment of legislation before any legislative body the salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence th e enactment of legislation, appropriations , regulation, administrative action, or Executive order proposed or pending before any legislative body. o In accordance with the United States Protecting Life in Global Health Assistance policy, all non-governmental organization (NGO) applicants acknowledge that foreign NGOs that receive funds provided through this award, either as a prime recipient or subrecipient, are strictly prohibited, regardless of the source of funds, from performing abortions as a method of family planning or engaging in any activity that promotes abortion as a method of family planning, or to provide fmancial support to any other foreign non-governmental organization that conducts such activities. See Additional Requirement (AR) 35 for applicability (https ://www.cdc.gov/grants/additional -requirements/index .html ). • Program funds cannot be used for implementing or expanding drug "take back" programs or other drug disposal programs (e.g. drop boxes or disposal bags), or directly funding or expanding direct provision of substance abuse treatment programs. Such activities are outside the scope of this Notice of Funding Opportunity (NOFO). As of November 2022, FFY22 Overdose Data to Action Funds may be used to purchase naloxone. Programs must receive prior approval from CDC, delivered as written approval from DOH, before purchasing naloxone. Monitoring Visits (i .e., frequency, type, etc.): DOH program staff may conduct site visits up to twice per funding year. Billing Requirements: Billing on an A19-1A invoice voucher must be received by DOH monthly. DOH m ust receive correct and complete invoices within 45 days of the end oftbe period of performance for this statement of work. Special Instructions: The following funding statement must be used for media (publications, presentations, manuscripts, posters, etc.) created using OD2A funding: This publication Gournal article, etc.) was supported by the Grant or Cooperative Agreement Number, NUl 7CE925007, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. Exhibit A, Statement of Work Page 4 of4 Contract Number CLH31019-Arnendment 13 Exhibit A Statement of Work Contract Term : 2022-2024 DOH Program Name or Title: Office of Drinking Water Group A Program - Effective Januarv 1, 2022 Local Health Jurisdiction Name: Mason County Public Health Contract Number: CLH31019 SOW Type: Revision Revision # (for this SOW) 3 Funding Source Federal Compliance Type of Payment ~ Federal Contractor ( check if applicable) D Reimbursement ~ State ~ FF AT A (Transparency Act) ~ Fixed Price D Other D Research & Development Period of Performance: January 1, 2022 through December 31, 2023 Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small community and non-community Group A water systems Revision Purpose : The purpose of this revision is to identify Data Sharing Information. Master Assistance BARS Allocation Index Listing Revenue LHJ Funding Period Current Change Total DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation None Allocation SANITARY SURVEY FEES (FO-SW) SS-STATE 24232522 NIA 346.26.65 01/0 1/22 12/3 1/23 23,200 0 23 ,200 YR 24 SRF -LOCAL ASST (15%) (FO-SW) SS 24239224 NIA 346.26.64 01 /01/22 12/3 1/22 12,400 0 12,400 YR 24 SRF -LOCAL ASST (15%) (FO-SW) TA 24239224 NIA 346.26.66 01 /0 1/22 12/3 1/22 1,000 0 1,000 YR 25 SRF -LOCAL ASST (15%) (FO -SW) SS 24239225 NIA 346.26.64 01 /01/23 12/31/23 10 ,800 0 10,800 YR 25 SRF -LOCAL ASST (15%) (FO-SW) TA 24239225 NIA 346.26.66 01 /01 /23 12/3 1/23 1,000 0 1,000 0 0 0 0 0 0 TOTALS 48,400 0 48,400 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and /or Amount # 1 Trained LHJ staff will conduct sanitary Provide Final* Sanitary Survey Reports Final Sanitary Survey Upon ODW acceptance of the Final Sanitary surveys of small community and non-to ODW Regional Office. Complete Reports must be received by Survey Report, the LHJ shall be paid $400 for community Group A water systems Sanitary Survey Reports shall include: the ODW Regional Office each sanitary survey of a non-community identified by the DOH Office of Drinking 1. Cover letter identifying significant within 30 calendar days of system with three or fewer connections. Water (ODW) Regional Office . deficiencies, significant findings, conducting the sanitary observations, recommendations, survey. Upon ODW acceptance of the Final Sanitary See Special Instructions for task activity. and referrals for further ODW Survey Report, the LHJ shall be paid $800 for follow-up. each sanitary survey of a non-community The purpose of this statement of work is to 2. Completed Small Water System system with four or more connections and each provide funding to the LHJ for conducting checklist. community system. sanitary surveys and providing technical 3. Updated Water Facilities Inventory (WFI). Exhibit A, Statement of Work Page 1 of 4 Contract Number CLH3 l O 19-Amendment 13 Task Activity Deliverables/Outcomes Due Date/Time Frame Pay ment Information and/or Amount # assistance to small community and non-4 . Photos of water system with text Payment is inclusive of all associated costs community Group A water systems. identifying features such as travel, lodging, per diem. 5. Any other supporting documents. Payment is authorized upon receipt and *Final Reports r eviewed and accepted acceptance of the Final Sanitary Survey Report by the ODW Regional Office. within the 30-day deadline. Late or incomplete reports may not be accepted for payment. 2 Trained LHJ staff will conduct Special Provide completed SPI Report and any Completed SPI Reports must Upon acceptance of the completed SPI Report, Purpose Investigations (SPI) of small supporting documents and phot os to be received by the ODW the LHJ shall be paid $800 for each SPI. community and non-community Group A ODW Regional Office. Regional Office within 2 water systems identified by the ODW working days of the service Payment is inclusive of all associated costs Regional Office. request. such as travel, lodging, per diem. See Special Instructions for task activity. Payment is authorized upon receipt and acceptance of completed SPI Report within the 2-working day deadline. Late or incomplete reports may not be accepted fo r payment. 3 Trained LHJ staff will p r ovide direct Provide completed TA Report and any Completed TA Report must Upon acceptance of the completed TA Report, technical ass istance (TA) to small supporting documents and photos to be received by the ODW the LHJ shall be paid for each t echnical community and non-community Group A ODW Regional Office. Regional Office within 30 assist ance activity as follows: water systems identified by the ODW calendar days of providing • Up to 3 hours of work: $250 Regional Office. technical assistance. • 3-6 hours of work: $500 • More than 6 hours of work: $750 See Special Instructions fo r task activity. Payment is inclusive of all associated costs such as consulting fee , trav el, lodg ing, per diem. Payment is authorized upon receipt and acceptance of complet ed TA Report within the 30-day deadline . Lat e or incomplete reports may not be accepted for payment. Exhibit A, Statement of Work Page 2 of4 Contract Number CLH310 19-Amendment 13 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount # 4 LHJ staff performing the activities under For training attended in person, prior to Annually For training attended in person, LHJ shall be tasks 1, 2 and 3 attend periodic required attending the training, submit an paid mileage, per diem, lodging, and survey training as directed by DOH. "Authorization for Travel (Non-registration costs as approved on the pre- Employee)" DOH Form 710-013 to the authorization form in accordance with the See Special Instructions for task activity. ODW Program Contact for approval (to current rates listed on the OFM Website ensure enough funds are available). httn ://www.ofm .wa.iwv/resources/travel.aso DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePo int site. Questions related to this SOW, or any other finance-related inquiry, may be sent to finance@doh.wa.gov. Federal Funding Accountability and Transparency Act (FFATA) (Applies to federal grant awards.) This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FF ATA or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent. To comply with this act and be eligible to perform th e activities in this statement of work, the LHJ must hav e a Unique Entity Identifier (UEI) generated by SAM.gov. Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282. Program Specific Requirements Data S haring The Office of Drinking Water will share water system information and files with the local health jurisdiction to support the work identified in this statement of work. To request water system data please contact the regional office with the name of the water system, water system ID#, specific information being requested and any timeline requirements. ff allowable, please give administrative staff 3 to 5 business days to provide records. Program Manual, Handbook, Policy References: Field Guide (DOH Publication 331-486). Special References: Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of work, ODW contracts with the LHJ to conduct sanitary surveys (and SPis and provide technical assistance) for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys (and SPis and provide technical assistance) for small community and non-community water systems with surface water sources, large water systems, and systems with complex treatment. LHJ staff ass igned to perform activities under tasks 1, 2, and 3 must be trained and approved by ODW prior to performing work. See special instructions under Task 4, below. Special Billing Requirements The LHJ shall submit quarterly invoices within 30 days following the end of the quarter in which work was completed, noting on the invoice the quarter and year being billed for. Payment cannot ex ceed a maximum accumulative fee of$46,400 for Task 1, and $2,000 for Task 2, Task 3 and Task 4 combined during the contracting period, to be paid at the rates specified in the Payment Method/Amount section above. When invoicing for sanitary surveys, bill half to BARS Revenue Code 346.26.64 and half to BARS Revenue Code 346.26.65. When invoicing for Task 1, submit the list ofWS Name, ID #, Amount Billed, Survey Date and Letter Date for which you are requesting payment. When invoicing for Task 2-3, submit the list of WS Name, ID #, TA Date and description of TA work performed, and Amount Billed. When invoicing for Task 4, submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A 19-lA Invoice Exhibit A, StatementofWork Page3 of4 ContractNumberCLH31019-Amendment 13 Voucher to DOH Grants Management, billing to BARS Revenue Code 346.26.66 under Technical Assistance (TA). Special Instructions Task 1 Trained LHJ staff w ill evaluate the water system for physical and operational deficiencies and prepare a Final Sanitary Survey Report which has been accepted by ODW. Detailed guidance is provided in the Field Guide for Sanitary Surveys, Special Purpose Investigations and Technical Assistance (Field Guide). The sanitary survey will include an evaluation of the following eight elements: source; treatment; distribution system; finished water storage; pumps, pump facilities and controls; monitoring, reporting and data verification; system management and operation; and certified operator compliance. If a system is more complex than anticipated or other significant issues arise, the LHJ may request ODW assistance. • No more than 4 surveys of non-community systems with three or fewer connections be completed between January 1, 2022 and December 31, 2022. • No more than 29 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 2022 and December 31 , 2022. • No more than O surveys of non-community systems with three or fewer connections be completed between January 1, 2023 and December 31, 2023. • No more than 27 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 2023 and December 31, 2023. The process for assignment of surveys to the LHJ, notification of the water system, and ODW follow-up with unresponsive water systems; and other roles and responsibilities of the LHJ are described in the Field Guide. Task2 Trained LHJ staff will perform Special Purpose Investigations (SPis) as assigned by ODW. SPls are inspections to determine the cause of positive coliform samples or the cause of other emergency conditions. SPls may also include sanitary surveys of newly discovered Group A water systems. Additional detail about conducting SPls is described in the Field Guide. The ODW Regional Office must authorize in advance any SPI conducted by LHJ staff. Task3 Trained LHJ staff will conduct Technical Assistance as assigned by ODW. Technical Assistance includes assisting water system personnel in completing work or verifying work has been addressed as required, requested, or advised by the ODW to meet applicable drinking water regulations. Examples of technical assistance activities are described in the Field Guide. The ODW Regional Office must authorize in advance any technical assistance provided by the LHJ to a water system. Task4 LHJ staff assigned to perform activities under tasks 1, 2, and 3 must be trained and approved by ODW prior to performing work. Ifrequired trainings, workshops or meetings are not available, not scheduled, or if the LHJ staff person is unable to attend these activities prior to conducting assigned tasks, the LHJ staff person may, with ODW approval, substitute other training activities to be determined by ODW. Such substitute activities may include one-on-one training with ODW staff, co-surveys with ODW staff, or other activities as arranged and pre-approved by ODW. LHJ staff may not perform the activities under tasks 1, 2, and 3 without completing the training that has been arranged and approved by ODW. Exhibit A, Statement of Work Page 4 of4 Contract Number CLH3 l O 19-Amendment 13 Exhibit A Statement of Work Contract Term: 2022-2024 DOH Program Name or Title: Office of Immunization-Perinatal Hepatitis B - Effective Julv 1, 2023 Local Health Jurisdiction Name: Mason County Public Health ContractNumber: CLH310 19 SOW Type: Original Revision # (for this SOW) Funding Source Federal Compliance Type of Payment [8J Federal Subrecipient ( check if applicable) l:8J Reimbursement D State [8J FFATA (Transparency Act) D Fixed Price D Other D Research & Development Period of Performance: July 1, 2023 through June 30, 2024 Statement of Work Purpose: The purpose of this statement of work (SOW) is to define required Perinatal Hepatitis B activ ities, deliverables, and funding Revision Purpose: NI A Master Assistance BARS Allocation Index Listing Revenue LHJ Funding Period Current Change Total DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation FFY24 CDC PPHF Ops 74310246 93.268 333 .93.26 07/0 1/23 06/30/24 0 500 500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTALS 0 500 500 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information # and/or Amount 1 1. In coordination with hospitals, health care providers, and Enter information for each case identified By the last day of each Reimbursement for actual health plans (if applicable), conduct activities to prevent into the Perinatal Hepatitis B Tracker month costs incurred, not to perinatal hepatitis B infection in accordance with the exceed total funding Perinatal Hepatitis B Prevention Program Guidelines, consideration amount. including the following: • Identification of hepatitis B surface antigen (HBsAG)- positive pregnant women and pregnant women with unknown HBsAg status. • Reporting ofHBsAg-positive women and their infants . • Case management for infants born to HBsAg-positive women to ensure administration of hepatitis B immune globulin (HBIG) and hepatitis B vaccine within 12 hours of birth, the completion of the 3-dose hepatitis B vaccine series, and post vaccination serologic testing. Exhibit A, Statement of Work Page 1 of2 Contract Number CLH31019-Amendment 13 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information # and/or Amount 2. Provide technical assistance to birthing hospitals to encourage administration of the hepatitis B birth dose to all newborns within 12 hours of birth, in accordance with Advisory Committee on Immunization Practices (ACIP) recommendations. 3. Report all perinatal hepatitis B investigations, including HBsAg-positive infants, in the Perinatal Hepatitis B Module of the Washington State Immunization Information Svstem. DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other finance-related inquiry, may be sent to finance@doh.wa.gov . Federal Funding Accountability and Transparency Act (FFAT A) (Applies to federal grant awards.) This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent. To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Unique Entity Identifier (UEI) generated by SAM.gov. Information about the LHJ and this statement of work will be made available on USASpending .gov by DOH as required by P.L. 109-282. Exhibit A, Statement of Work Page 2 of2 Contract Number CLH31019-Amendment 13 Exhibit A Statement of Work Contract Term: 2022-2024 DOH Program Name or Title: Office ofimmunization-Promotion of Immunizations to Improve Vaccination Rates -Effective July I, 2023 Local Health Jurisdiction Name: Mason County Public Health Contract Number: CLH31019 SOW Type: Original Revision # (for this SOW) Funding Source Federal Compliance Type of Payment ~ Federal Subrecipient (check if applicable) ~ Reimbursement D State ~ FFATA (Transparency Act) D Fixed Price D Other D Research & Development Period of Performance: July I, 2023 through June 30, 2024 Statement of Work Purpose: The purpose of this statement of work is to contract with local health to conduct activities to improve immunization coverage rates Revision Purpose: N I A Master Assistance BARS Allocation Index Listing Revenue LHJ Funding Period Current Change T otal DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation FFY24 CDC VFC Ops 74310241 93.268 333.93.26 07/01/23 06 /30/24 0 5,600 5,600 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTALS 0 5,600 5,600 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information # and/or Amount 1 Develop a proposal to improve immunization coverage rates for Written proposal summarizing project plan August 1, 2023 Reimbursement for actual a target population by increasing promotion activities and and method of assessing/observing change costs incurred, not to collaborating with community partners (can use pre and post in target population. exceed total funding qualitative or quantitative collection methods consideration amount. Exam2les of gualitative & guantitative methods/measures: (Template will be provided) • Surveys, Questionnaires, Interviews • Immunization coverage rates expressed in percentages • Observations (i.e., feedback from surveys/interviews , social media posts comments) • Analytic tools (i.e., google analytics measuring website traffic, page views etc.) Exhibit A, Statement of Work Page 1 of2 Contract Number CLH31019-Amendment 13 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information # and/or Amount 2 Upon approval of proposal, implement the plan to increase Written report describing the progress November 30, 2023 Reimbursement for actual immunization coverage rates w ith the target population made on reaching milestones for activities costs incurred, not to identified. identified in the plan (template will be March 31 , 2024 exceed total funding provided) consideration amount. .... Develop final report to include comparison of change or Final written report including measured June 15 , 2024 Reimbursement for actual ., improvement of targeted outcome from start of the and/or observed outcomes [what was costs incurred, not to project/intervention [This can be short-term or intermediate achieved as a result of the exceed total funding outcomes with overall goal to increase immunization rates] activity /intervention?]. consideration amount. Examples: • Increased partner knowledge on immunization (Template will be provided) guidelines • Change in attitudes about childhood vaccines • Increase in school district immunization coverage rates DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other fmance-related inquiry, may be sent to finance@doh.wa.gov . Federal Funding Accountabilitv and Transparency Act (FFATA) (Applies to federal grant awards .) This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent. To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Unique Entity Identifier (UEI) generated by SAM.gov. Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P .L. 109-282. Exhibit A, Statement of Work Page 2 of2 Contract Number CLH3 l O 19-Amendment 13 Exhibit A Statement of Work Contract Term : 2022-2024 DOH Program Name or Title: OSS LMP Implementation -Effective January 1, 2022 Local Health Jurisdiction Name: Mason County Public Health Contract Number: CLH3I0l9 SOW Type: Revision Revision # (for this SOW) 1 Funding Source Federal Compliance Type of Payment D Federal <Select One> ( check if applicable) [2J Reimbursement 0 State D FF AT A (Transparency Act) D Fixed Price D Other D Research & Development Period of Performance: January 1, 2022 through June 30, 2023 Statement of Work Purpose: The purpose of this statement of work is to fund implementation of the on-site sewage system (OSS) local manamgenet plan (LMP). Revision Purpose: The purpose ofthis revision is to change the period of performance from December 31, 2023 to June 30, 2023 to close out this concon for the end of the 21-23 biennium. Master Assistance BARS Allocation Index Listing Revenue LHJ Funding Period Current Change Total DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation None Allocation WASTEWATER MANAGEMENT -GFS 26701100 NI A 334.04.93 01 /01 /22 06/30/22 15,000 0 15,000 WAST EWATER MANAGEMENT -GFS 26701100 NIA 334.04.93 07/01/22 06/30/23 60,000 0 60,000 0 0 0 0 0 0 0 0 0 0 0 0 TOTALS 75,000 0 75,000 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information # and/or Amount 1 Local Management Plan Administration and Implementation Attend DOH-sponsored meetings. Report Due Date: $6,000 LHJ will participate in all grant-related meetings and conference Meet reporting requirements, including an June 15, 2022 calls sponsored by DOH. Final report will be submitted electronic copy of progress report and January 15, 2023 including documents used or produced for grant activities. mapping data to include: June 15, 2023 • Number of systems with known December 31, 2023 system type. • Number of s eptic systems with Task is ongoing throughout current inspections. the project period. • Number of septic failures . 2 On -Site Education Educational Presentations Attended by greater than 10 ,000 people. Report Due Date: $31,500 2A. Mason County Public Health (MCPH) staff will host a booth June 15 , 2022 the first full w eekend in October for Oysterfest. January 15, 2023 June 15 , 2023 December 31 , 2023 Exhibit A, Statement of Work Page 1 of3 Contract Number CLH3 l O 19-Amendment 13 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information # and/or Amount 2B. Modify and print maintenance manuals to be handed out to Task is ongoing throughout all new system owners, hand out at educational presentations and the project period. are available to professional providers to give to their customers. 3B. Twenty-five (25) $200 rebates for pumping or maintenance or $200 rebates for retrofitting tanks with risers and/or effluent filter. Each resident would be able to aualifv for two (2) rebates ,., .) Operation and Maintenance (O&M) Notification to Track contacts and increase in Report Due Date: $18,750 Homeowners maintenance. Progress will be reported on June 15, 2022 3A. Follow up on unsatisfactory maintenance reports and the report form. January 15, 2023 complaints (75 unsatisfactory reports and 20 complaints per June 15, 2023 month). December 31, 2023 Task is ongoing throughout the project period. 4 O&M Database Management Progress will be reported on the report Report Due Date: $12,750 4A. Continue truthing and creating record drawings form. June 15, 2022 January 15, 2023 4B. Maintenance of the O&M database. June 15, 2023 December 31, 2023 Task is ongoing throughout the proiect period. 5 Enhance GIS On-site Sewage Data Layer Mapping data as outlined in the "Marine Report Due Date: $6,000 LHJ will continue to develop and update on-site sewage system Recovery Area (MRA) OSS Data June 15, 2022 (OSS) and O&M data to enhance the Geographic Information Reporting Requirement" form. January 15, 2023 Systems (GIS) OSS Layer. Work will be done by GIS staff. June 15, 2023 December 31, 2023 Task is ongoing throughout the project period. DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint s ite. Questions related to this SOW, or any other finance-related inquiry, may be sent to finance@doh .wa.gov. Program Specific Requirements Restrictions on Funds: These funds can NOT be used for local match to federal grants. State funds from the Aquatic Lands Enhancement Account must be used to implement elements and activities of the local on-site sewage management plans that do not conflict with and are consistent with the goals, strategies, objectives, and actions of the Puget Sound Action Agenda. Special References: Exhibit A, Statement of Work Page 2 of3 Contract Number CLH31019-Amendment 13 WAC 246-272A and RCW 70A. l 10 Definitions: Failure: A condition of an on-site sewage system or component that threatens the public health by inadequately treating sewage or by creating a potential for direct or indirect contact between sewage and the public. Examples of failure include: (a) Sewage on the surface of the ground; (b) Sewage backing up into a structure caused by slow soil absorption of septic tank effluent; ( c) Sewage leaking from a sewage tank or collection system; ( d) Cesspools or seepage pits where evidence of ground water or surface water quality degradation exists; (e) Inadequately treated effluent contaminating ground water or surface water; or (f) Noncompliance with standards stipulated on the permit. Maintenance and Monitoring: The actions necessary to keep the on-site sewage system components functioning as designed. Periodic or continuous checking of an on-site sewage system, which is performed by observations and measurements, to determine if the system is functioning as intended and if system maintenance is needed. Monitoring also includes maintaining accurate records that document monitoring activities. Billing Requirements: I. Billings are submitted on an A 19-l A form, which is provided by DOH. 2. Al9-IA forms may be submitted monthly and must be submitted bi-monthly at minimum. Special Instructions: Semi-annual progress reports, including marine recovery area (MRA) mapping data, are due to DOH via email to mail to: Roger.Parker @doh .wa.gov and taylor.warren@doh.wa.gov. Progres s Report Due Dates: January 15 , 2022, June 15, 2022, December 31, 2022 June 15, 2023 and December 31, 2023. The report format will be provided by DOH and may be modified throughout the contract period via email announcement. Exhibit A, Statement of Work Page 3 of3 Contract Number CLH31019-Amendment 13 Exhibit A Statement of Work Contract Term: 2022-2024 DOH Program Name or Title: OSS LMP Implementation -Effective July 1, 2023 Local Health J urisdiction Name: Mason County Public Health Contract Number: CLH31019 Federal Compliance Type of Payment SOW Type: Original Revision # (for this SOW) Funding Source D Federal <Select One> (check if applicable) C8:] Reimbursement C8:J State D FF AT A (Transparency Act) D Fixed Price D Other D Research & Develooment Period of Performance: July 1, 2023 through December 31, 2024 Statement of Work Purpose: The purpose of this statement of work is to fund implemation of the on-site sewage system (OSS) local management plan (LMP). Note: ConCon statements of work with GFS funds must exhaust those funds before billing ALEA funds. GFS funds in the 07101 123-06130124 funding period cannot roll over into the next funding period. This funding allocation is for the 2023 -2025 state biennium. New statements of work with a period of performance of January 1, 2025 to June 30, 2025 will be issued in the next Consolidated Contract term. Revision Purpose: NI A Master Assistance BARS Allocation Index Listing Revenue LHJ Funding Period Current Change Total DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation SMALL ONSITE MANAGEMENT (GFS) 26701100 NI A 334.04.93 07101 123 06130124 0 45,000 45 ,000 SMALL ONSITE MANAGEMENT (GFS) 26701100 N I A 334.04.93 07101 /24 12/31 124 0 53,636 53 ,636 0 0 0 0 0 0 0 0 0 0 0 0 TOTALS 0 98,636 98,636 GOALS & MEASURABLE OBJECTIVES This table summarizes starting and target metrics achieved by implementing the tasks below. This data is reported on an ongoing basis in the semiannual progress reports. Description (e.g., "OSS compliance") Units Starting Targets (e.g. "systems") Amount OSS compliant with inspections in Marine Recovery Areas (MRAs) and/or Sensitive Areas (SA) (5118123) Percentage of OSS in compliance 33% 50% OSS compliant with inspections countywide (5118123) Percentage of OSS in compliance 32% 50% OSS failures identified/corrected in MRA/SA (1/1123-5118123) Number of OSS failures identified 34/34 100% and repaired/reolaced OSS failures identified/corrected countywide (1 11123 -5/18/23) Number of OSS failure identified 60/76 100% and repaired/replaced Exhibit A, Statement of Work Page 1 of 4 Contract Number CLH3 l O 19-Amendment 13 Task Payment Task/ Activity/Description Deliverables/Outcomes Due Date/Time Frame Information and/or # Amount Task 1. Grant Administration This task is to fund the required financial and reporting activities necessary to meet state DOH and Auditor requirements including administration ofLHJ local management plan and OSS LMP ITTant proITTam. 1.1 Bi-monthly Invoicing and Progress Reports Bimonthly/Monthly invoices Bimonthly/monthly for duration of Reimbursement up DOH Consolidated Contracts (ConCon) requires billing within contract period to $2,060 based on 60 days of completing work. LHJ will submit invoices through actual costs. the ConCon process and will send progress reports and deliverables to the LMP Contract Manager. Invoices must be submitted at least bi-monthly (per ConCon requirements) but no more frequently than monthly. Invoices will be reviewed for consistency with progress. The LMP Contract Manager may reauire monthlv invoices. 1.2 Semi-Annual Progress Reports Data about the following: Due July 15 and December 31 for Reporting periods are semiannually from January I -June 30 • Qualitative: the duration of the contract period and July I -December 31. Progress reports include data 0 Summary of work described in the outcome column. 0 Barriers to LMP Implementation • Quantitative: 0 OSS inventory metrics 0 Enforcement actions 0 Outreach and Education efforts Task 2. Local Management Plan Implementation This task includes all work done to implement the county's LMP excluding grant management tasks and inspection rebates/incentives. 2.1 Database Maintenance and Quality Assurance/Quality • Increase in percentage of known Report semi-annually, as scheduled Reimbursement up Control (QA/QC) systems in county (increase in in Task 1.2 to $64,086 based on Database maintenance and QA/QC is ongoing to ensure scanned county land records actual costs. accurate tracking methods for all OSS in the county. Specific pertaining to septic systems). tasks include: • Number of phone calls and emails • Adding new sites or correcting existing sites in received from unsatisfactory county OnlineRME for undocumented septic systems r eported by mailings. septic professionals. • All parcel information is current OnlineRME • Adding new sites for newly installed systems . • Updating sites with repairs completed based on feedback from property owners that received unsatisfactory letter from county. • Trothing RME parcel data with Assessors database annually. Exhibit A, Statement of Work Page 2 of4 Contract Number CLH31019-Amendment 13 Task Payment # Task/ Activity/Description Deliverables/Outcomes Due Dateffime Frame Information and/or Amount 2.2 Operations and Maintenance Program Administration a. Enforcement Protocol Report semi-annually , as scheduled • Mail inspection reminders to homeowners as needed . Number of new sewage related cases in Task 1.2 • Inspection Compliance tracking/mapping that staff responded to • Failure and repair tracking/mapping • Compliance enforcement b . Data on the following: • Complaint response • Number of OSS with current • O&M data reports about inventory and deficiencies inspections • Number of OSS failures and calculated risk using DOH- provided risk assessment. • Number ofrepairs • Number ofletters sent out for regular maintenance reminders • Number of letters sent out for unsatisfactory reports • Number of new sewage related cases that staff responded to 2.3 Education and Outreach • Booth setup at Oysterfest Report semi-annually, as scheduled Education and outreach is conducted for OSS owners, realtors, providing homeowners with in Task 1.2 etc. Specific tasks include: onsite sewage maintenance • Annual OysterFest early October information • Homeowner septic maintenance workshops • Number of attendees at septic • Annual Septic Blitz: multiple banners put up around workshops county and EDDM of25,000 flyers • Number of flyers sent EDDM for • Maintenance manuals for owners of new systems and to Septic Blitz hand out at educational presentations. • Number of maintenance manuals sent to owners of new systems and distributed at educational presentations. 2.4 Professional Development and Coordination a . Attendance and contribution at four Report semi-annually, as scheduled • The LHJ will participate in LMP and West Side ( 4) meetings per year in Task 1.2 Coordinators Meetings and will network between counties. • The LHJ will support professional development through b. Conference and Training participation 0 Attending DOH OSS Program trainings as available Task 3. Rebates Program Provide rebates to homeowners. 3.1 Rebates a. Provide draft and final process/policy a. Prior to issuing any rebates Reimbursement up Thirty-five (35) $350 rebates for pumping or maintenance or documents to DOH to $32,490 based on $350 rebates for retrofitting tanks with risers and/or effluent actual costs. Exhibit A, Statement of Work Page 3 of4 Contract Number CLH3 l O 19-Amendment 13 Task Payment # Task/ Activity/Description Deliverables/Outcomes Due Date/Time Frame Information and/or Amount filter. Each resident would be able to qualify for up to two (2) b. Number of rebates issued b. By grant closeout rebates. Budget Category Amount Personnel/Salaries $40,529 Fringe Benefits $21 ,957 Travel $0 Supplies $4,140 Contracts $0 Other $24,500 • Rebates Total Direct Charges $91,126 Indirect Charges (federally approved rate) $7,510 TOT AL -Not to Exceed $98,636 DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other finance-related inquiry, may be sent to finance@ doh .wa.gov. Exhibit A, Statement of Work Page 4 of4 Contract Number CLH3 l O 19-Amendment 13 DOH Program Name or Title: Recreational Shellfish Activities - Effective July L 2023 SOW Type: Original Revision # (for this SOW) Period of Performance: July 1, 2023 through December 31, 2024 Exhibit A Statement of Work Contract Term: 2022-2024 Funding Source Local Health Jurisdiction Name: Mason County Public Health Contract Number: CLH31019 Federal Compliance Type of Payment D Federal <Select One> (check if applicable) ~ Re imbursement ~ State D FFATA (Transparency Act) D Fixed Price D Other D Research & Development Statement of Work Purpose: The purpose of this statement of work (SOW) is to provide funds for shellfish harvesting safety. Revision Purpose: NI A Master Assistance BARS Allocation Index Listing Revenue LHJ Funding Period Current Change T otal DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation REC. SHELLFISH/BIOTOXIN 26402600 NI A 334.04.93 07/0 1/23 12/31 /24 0 5,250 5,250 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTALS 0 5,250 5,250 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information # and/or Amount 1 Biotoxin Monitoring Submit annual report on DOH approved Email Report to DOH by $4,800 • Collect monitoring samples on schedule according to format of activities for the year, including February 15 , 2024 Department of Health (DOH) Biotoxin Monitoring Plan, the number of sites monitored and samples coordinate deviations from the schedule with DOH, notify collected, and number and names of (See Special Instructions DOH in advance if samples cannot be collected. beaches posted with signs. below.) • Conduct emergency biotox in sampling when needed. • Post / remove recreational shellfish warning and / or classification signs on beaches and restock cages as needed. • Issue biotoxin news releases during biotoxin closures in Mason County. • This task may also include recruiting, training, and coordination of volunteers , and fuel reimbursement funds for volunteer biotoxin monitoring. Exhibit A, Statement of Work Page 1 of2 Contract Number CLH31019-Amendment 13 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information # and/or Amount 2 Outreach Submit annual report including the Email Report to DOH by $450 • Staff education al booths at local events. number of events staffed and amount of February 15 , 2024 • Distribute safe shellfish harvesting information. educational materials distributed. (See Special Instructions below.) DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other finance -related inquiry, may b e sent to finance@doh .wa.gov . Program Specific R equire ments Program Manual, Handbook, Policy References: Department of Health's Biotoxin Monitoring Plan Special References (i.e., RCWs, WACs, etc.): Chapter 246-280 WAC https://doh .wa.gov/community-and-environmentJshel lfi s h/recreational -shellfish https://doh .wa.gov/about-us/programs-and-services/environmental-public-health /environmental-health -and-safety/about-shellfish-program/about-biotoxins-and -illness-prevention- prQgr.am Special Instructions: Report for work performed in 2023 must be submitted via email to Liz Maier (l iz.maier@doh .wa.gov) by February 15, 2024. The report format will be provided by DOH and may be modified throughout the period of performance via email announcement. Exhibit A, Statement of Work Page 2 of2 Contract Number CLH3 IO 19-Amendment 13