NCDHHS - FY14 HEALTH CONSOLIDATED AGREEMENTConsolidated Agreement - FY14
CONSOLIDATED AGREEMENT
BETWEEN
THE STATE OF NORTH CAROLINA
AS REPRESENTED BY
THE STATE HEALTH DIRECTOR
(Hereinafter called the "State")
AND
New Hanover Countv Health Department
FOR THE PURPOSE OF
MAINTAINING AND PROMOTING THE ADVANCEMENT OF
PUBLIC HEALTH IN NORTH CAROLINA
This Amended Agreement Shall Cover a Period From
July 1, 2013 to June 30, 2014
and shall remain in force until the next Fiscal Year Agreement
is signed except as provided for in Section J. Termination.
NOW, THEREFORE, the State and the Department agree that the provisions and
clauses herein set forth shall be incorporated in and constitute the terms and conditions
applicable for activities involving State funding. (State funding or funds means state,
federal, and/or special funding or funds throughout this agreement.)
Consolidated AVeemant FYA
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A. RESPONSIBILITIES OF THE DEPARTMENT (LOCAL PUBLIC HEALTH UNIT)
1. The Department shall perform activities in compliance with applicable program rules contained in
the North Carolina Administrative Code, as well as all applicable Federal and State laws and
regulations.
2. The Department shall perform the activities specified in the Program Agreement Addenda for
State funded budgets. The Department must negotiate these Agreement Addenda in good faith to
the satisfaction of state representatives as part of the agreement execution. The Department will
meet or exceed the Agreement Addenda levels unless extenuating circumstances prevail and are
explained in writing to the state section, branch or program.
3. The Department shall report client, service, encounter, and other data as specified by applicable
program rules, Program Agreement Addenda for State funded budgets, and by North Carolina
Administrative Code.
4. The Department shall provide access to patient records to authorized staff from the Division of
Public Health for technical consultation, program monitoring, and program evaluation, as specified
by applicable program rules, Program Agreement Addenda for State funded budgets, and by North
Carolina Administrative Code.
5. The Department shall provide client, service, encounter, and other data through the states'
centralized automated systems for claims creation and submission for processing to the state's
Medicaid agency except as allowed by NCGS 130A 45.13 and SB245 passed in the 2011 session.
To ensure that such data is accurately linked to the specific client served in a manner that results
in a unique identifier from the DHHS Common Name Data Service except as allowed by SB245
passed in the 2011 session, the Department shall allow DPH to submit (on its behalf) the Social
Security Numbers of all clients to the Social Security Administration for verification.
6. The Department shall share data to support efforts of the public health system, represented by the
local health departments, local health programs, and the State, in order to meet public health
objectives while respecting the confidentiality and integrity of each agency's data and protecting
the privacy of individual client health information. Sharing data includes providing client
information allowed as permitted disclosures under the Health Insurance Portability and
Accountability Act of 1996, Public Law 104-91, HIPAA Administration Simplification Provisions
Sections 261 through 264, 45 CFR 164.512. Uses and disclosures for which consent,
authorization, or opportunity to agree or object is not required.
7. The Department shall administer and enforce all rules that have been adopted by the Commission
for Public Health, ratified by the NC General Assembly, or adopted by the Local Board of Health.
8. The Department shall provide to the State a copy of any rules adopted by the Local Board of
Health pursuant to G.S. 130A-39 and Public Health Ordinances adopted by the County
Commissioners, within 30 days of adoption. These rules/ordinances are to be sent to the Local
Technical Assistance and Training Branch (LTAT).
9. The Department shall have policies related to conflict of interest and policies and procedures for
Human Subjects Clearance. Each staff member shall receive a copy of these documents.
conwfi&W Agreemmt FYI4 Page 2 of 23
10. The Department shall provide to the State a comprehensive community health assessment (CHA)
at least every four years and a State of the County's Health Report each of the interim three years.
NC Division of Public Health will administer this four-year cycle. The CHA should be a
collaborative effort with local partners such as hospitals and community partnerships or the local
Healthy Carolinians Partnership (if such exists), and shall include collection of primary data at the
county level and secondary data from the state and other sources. The CHA shall include a list of
community health problems based on the findings and a narrative of the assessment findings and
priorities chosen (refer to accreditation activities regarding CHA or SOTCH). The CHA or
SOTCH is due by the first Monday of December. The agency is required to submit community
action plans to address the selected priority issues. These plans are due by the first Friday in June
following the December submission of the CHA. For action plans, the agency shall include a
minimum of two new evidence-based strategies (or expand current evidence-based strategies to
new target populations) to address at least two Healthy North Carolina 2020 objectives from
different focus areas. There are a total of 13 focus areas and 40 objectives within Healthy NC
2020. The evidence-based strategies (EBS) shall be highlighted in the Action Plan and shall
include a plan for staffing, training, implementation and monitoring/evaluation for each EBS.
Action Plans need to be turned in by local health departments for their CHA. NOTE that an action
plan is expected for every CHA priority selected. The CHA will include data analysis of those
indicators that are listed in the accreditation self-assessment.
11. The Department shall provide formal training for their Board of Health (BOH) members through
DHHS sponsored offerings. The LTAT Branch shall notify the Department no later than April 30
of the name of the contractor who is to provide this training during the upcoming fiscal year. First
priority should be given to training newly appointed members with the ultimate goal of having all
BOH members trained as time and resources allow. Continuing education updates on topics of
special interest are strongly encouraged after general board member orientation has been provided
for all BOH Members.
12. The Department shall provide Network/Internet access at the Local Health Department (or to the
county network where desired) at a minimum speed of a full T-1 line in order to:
• Connect with the North Carolina Health Alert Network (HAN), North Carolina Electronic
Disease Surveillance System (NCEDSS), North Carolina Immunization Registry (NCIR),
Health Information System (HIS)
• Rapidly communicate e-mail alerts to and from the NC State Division of Public Health
regarding bioterrorism and public health topics (outbreaks, emergency alerts, etc)
Access NCDPH training material and information used in self-study courses and PHTIN
programs
• Build steps of a secure infrastructure for remote data entry in the local health departments
• Report electronically all required Environmental Health Services Section inspection data in the
format and frequency specified by the division. Paper copies of inspection data are no longer
accepted,
The LHD will maintain the above-described minimum connection. The LHD may choose any
provider (ISP) that they wish. The LHD will also ensure security of a minimum of a T-1
connection at the LHD location. The LHD may utilize security products (i.e. firewalls) of their
choosing to maintain network connectivity and security integrity. The LHD network configuration
and security practices must allow communication with systems within the state network.
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13. The Department shall incorporate basic elements of the North Carolina Public Health logo an
themeline (slogan) into communication materials developed for programs and services that
depend, in whole or in part, upon state funding. Such communication materials could include:
letterhead, business cards, brochures, pamphlets, advertisements or announcements, signs and
marketing/promotional materials. The Department is encouraged to incorporate its own name with
the logo.
B. FUNDING STIPULATIONS
1. Funding for this agreement is subject to the availability of State, Federal, and Special Funds for the
purpose set forth in this agreement.
2. During the period of this agreement, the Department shall not use State, Federal or Special Project
funds received under this agreement to reduce locally appropriated funds as reflected in the Local
Appropriations Budget (see item C.2. below.)
3. The Department shall not use personal health program funds to support environmental health
programs nor use environmental health program funds to support personal health programs.
4. Fees generated by the Food and Lodging Fees Collection Program may only be used to support
State and Local food, lodging, and institution sanitation programs and activities.
5. The county shall submit monthly reports of On-Site Wastewater activities to the On-Site
Wastewater Branch in the Environmental Health Section of the Division of Public Health in the
format provided by the Section.
6. The Department shall comply with Standards for Mandated Public Health Services, 10A NCAC
46, Section .0200; and Administrative Procedures Manual for Federal Block Grant Funds, 1
NCAC 33, Sections.0100 - .1502.
7. The Department shall maintain signed employee time records to document the actual work activity
of each employee on a daily basis. The percentage of time each employee spends in each activity
shall be converted to dollars based upon the employee's salary and benefits at least on a monthly
basis. The computation shall support the charges for salaries and benefits to all federal and state
grants (as required in OMB Circular A87) as well as provide the documentation of detailed labor
cost per activity for preparation of Medicaid Cost Report.
S. For Departments participating in Medicaid Reimbursement, the Department shall:
a. Execute a Provider Participation Agreement with the Division of Medical Assistance. For
selected health departments receiving at least $5,000,000 in Medicaid receipts annually, as
identified by the Division of Medical Assistance, must sign, as part of their continuing
participation as a Medicaid provider, a Letter of Attestation affirming that: 1) detailed
information is provided to employees, contractors and agents about the Federal & State False
Claims Act and 2) written policies and procedures are in place to detect and prevent fraud,
waste and abuse.
b. Make every reasonable effort to collect its cost in providing services, for which Medicaid
reimbursement is sought, through public or private third party payors except where prohibited
by Federal regulations or State law; however, no one shall be refused services solely because
of an inability to pay.
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c. Establish one charge per clinical/support service for all payors (including Medicaid) based on
their costs. All Payors must be billed the same established charge, but the Department may
accept negotiated or other agreed upon lower amounts (e.g., the Medicaid reimbursement rate)
as payment in full.
9. Subject to the approval of the appropriate Section, a local health department may seek
reimbursement for services covered by a program operating under l OA NCAC 45 rules, Purchase
of Medical Care Services (POMCS), when those services are not supported by other state or
federal funds. All payment program rules and procedures as specified in the Purchase of Medical
Care Services Manual must be followed.
10. Provision of Interpreter Services: As required by Title VI of the Civil Rights Act, a local health
department that receives federal funds (either directly or through the Division of Public Health) for
any program or service must provide interpreter services at no charge to Limited English
Proficiency clients in all programs and services offered by the health department.
11. A local health department may not require a client to present identification that includes a picture
of the client for at least immunization, pregnancy prevention, sexually transmitted disease and
communicable disease services.
12. Subject to the availability of funds and approval of the Public Health Nursing and Professional
Development Unit, a Department may request reimbursement for:
a. Nursing service personnel participating in the "Introduction to Principles and Practices of
Public Health and Public Health Nursing" course. Reimbursement is $400.00 per participant
upon successful completion of the course. Reimbursement requests must be filed by the
agency within 1 year of completion.
b. Health Department Management/Supervision level staff participating in the "Management and
Supervision for Public Health Professionals" course. Reimbursement is $600.00 per
participant upon successful completion of the course. Reimbursement requests must be filed by
the agency within 1 year of completion.
13. Audits/Monitoring:
a. The Department shall have an annual audit performed in accordance with "The Single Audit
Act of 1984 as implemented by OMB Circular A-133." The audit report shall be submitted to
the Local Government Commission (LGC) by the County Administration (if single county
health department) or the District Health Department or Public Health Authority (if so
organized) within (six) 6 months following the close of the agreement. Audit findings referred
to the DHHS Controller's Office by LGC will be investigated and findings verified by the
DHHS Controller's Office staff with assistance of the Division of Public Health Program Staff.
b. All District Health Departments and Public Health Authorities must complete quarterly a
Fiscal Monitoring Report and submit to the DHHS Controller's Office based on the schedule
published by the DHHS Controller's Office.
14. Equipment is a type of fixed asset consisting of specific items of property that: (1) are tangible in
nature; (2) have a life longer than one year; and (3) have a significant value.
a. For Inventory Purposes
) Equipment must be accounted for in accordance with the North Carolina Department of
State Treasurer Policies Manual, Chapter 20, and Fixed Assets Policy.
ConssoU&ted Agnec=nt-FY14 Page 5 of 23
2). All equipment with an acquisition cost of $500.00 or more which is purchased with
Women, Infants and Children (WIC) Program Funds, must be inventoried with the
Women's and Children's Health Section.
For Prior Approval Purposes
1) All equipment purchased or leased with an acquisition cost exceeding $2500.00 (except in
WIC; see item ii below for WIC requirements), where there is an option to purchase with
State/Federal funds must receive prior written approval from the appropriate
Branch/Section. For PHP&R Grant funds only this is any purchase exceeding $2500 per
invoice (e.g., if the agency is purchasing a computer, monitor, printer, etc. totaling more
than $2500 or purchasing 6 computers at $500 each, this should be treated as one purchase
for purposes of prior approval.)
2) For WIC, all computer and medical equipment purchased or leased, must receive prior
written approval from the Branch regardless of cost. In addition, all other tangible assets
(non computer/medical) with an acquisition cost exceeding $500.00 must receive prior
approval.
3) The use of Women's and Children's Health Medicaid fees for capital improvements
requires prior written approval from the Women's and Children's Health Section.
C. For Accounting Purposes: The Department must utilize the depreciation schedule provided
by the State for all assets with an acquisition cost of $5,000 or greater. The accumulated
depreciation should be recorded in the general fixed assets account group.
15. The Department agrees to execute the following Consolidated Federal Certifications attached to
this agreement as applicable when receiving Federal funds:
a. Certification regarding Lobbying.
b. Certification regarding Debarment.
c. Certification regarding Drug-Free Workplace Requirements.
d. Certification regarding Environmental Tobacco Smoke
16. When administering the Women, Infants, and Children's Program (WIC), the Department must
adhere to the requirements set forth in Section 361 of the Healthy Hunger-Free Kids Act of 2010 which
amended Section 12(b) of the Richard B. Russell National School Lunch Act (NSLA), 42 USC 1760(b).
This Act requires the Department to support full use of the Federal administrative funds provided for the
WIC program. The Federal administrative funds are specifically excluded from budget restrictions or
limitations including, at a minimum, hiring freezes, work furloughs and travel restrictions.
17. Pursuant to the Federal Funding Accountability and Transparency Act (FFATA), the
Department is required to submit to the Division information that is reportable by the Division for all
qualified subawardees of federal funds. The Department will complete and submit the Federal Funding
Accountability and Transparency Act (FFATA) Data Reporting Requirement form provided by the
Division to determine the eligibility as a subawardee for reporting purposes. Information provided by the
Department will be used by the Division to report subawards (funding authorizations) equal to or greater
than $25,000 from each federal grant.
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The Department shall maintain an active record in the federal government's System for Award
Management (SAM). The data which the Department had entered in the federal government's Central
Contractor Registration (CCR) system has been migrated to SAM. To maintain an active SAM record, the
record must be updated no less than annually. To update the record in SAM, the Department must log in at
the SAM home page, www.sam.gov, and follow the instructions found there.
C. FISCAL CONTROL
1. The Department shall comply with the Local Government Budget and Fiscal Control Act, North
Carolina General Statute Chapter 159, Article 3.
a. The Department shall maintain a purchasing and procurement system in accordance with
generally accepted accounting practices and procedures set forth by the Local Government
Commission.
b. The Department shall execute written agreements with all parties who invoice the Department
for payment for the provision of services to patients. Exceptions may be permitted in cases
where the patient has a preference for a non-contracted provider and that provider verbally
agrees to abide by program requirements and to accept program payment as payment in full.
c. The Department, when subcontracting, must meet the following conditions:
1) The Department is not relieved of any of the duties and responsibilities provided in this
agreement.
2). The subcontractor will agree to abide by the standards contained herein or to provide such
information as to allow the Department to comply with these standards.
3). The subcontractor will agree to allow state and federal authorized representatives' access to
any records pertinent to its role as a subcontractor of the Department.
4). Upon request, the Department will make available to the State a copy of subcontracts
supported with State/Federal funds.
d. The Department must receive prior written approval from the state to subcontract when any of
the following conditions exist:
1) The Department proposes to subcontract to a single entity fifty percent (50%) or more of
the total state and federal funds made available through this agreement.
2) The Department proposes to subcontract fifty percent (50%) or more, or $50,000,
whichever is greater, of the total state and federal funds made available through this
agreement for a single public health service or program.
3) The Department proposes to subcontract for services in the Women, Infants and Children
(WIC) Program.
comolWatea Agmemont-FY14 Page 7 of 23
e. The Department shall mail a signed copy of all final public health Funding Authorizations to
the DPH Budget Office, 1931 Mail Service Center, Raleigh, NC 27699-1931. The
Department shall retain a copy of all Funding Authorizations, the monthly certified electronic
printed screen of the Expenditure Reports with any amendments (via the Aid-to Counties
Website), Consolidated Agreement, Agreement Addenda, Revisions and other financial
records in accordance with-the current Records Disposition Schedule for County and District
Health Departments issued by the NC Division of Archives and History, Department of
Cultural Resources and located on their website at:
http://www.ah.dcr.state.nc.us/records/local/default.htin.
f. The Department shall mail a signed original of the Food and Lodging Local Health Department
Budget Form (DPH EH 2948 (A)) to the Division of Public Health, Environmental Health
Section, Environmental Health Services Branch, 1632 Mail Service Center, Raleigh, NC
27699-1632.
2. The Department shall prepare and maintain a Local Appropriations Budget (reflecting the plans to
use local appropriations or earned fees) for each activity covered by this agreement in a manner
consistent with instructions provided in general budgetary guidance from the Division and the
specific guidance from the respective programs and enter that budget information into the
Electronic Aid to Counties Website for each activity funded under this agreement.
a. The Department shall do budget revisions to their Local Appropriation budgets when
appropriations will be increased or decreased and enter that information in the Electronic Aid
to Counties Website.
3. (Local Earned Revenues) The Department shall observe the following conditions when budgeting
and reporting earned revenues:
a. Locally appropriated funds may not be supplanted by earned revenues from persons, or public
or private third party payors.
b. All earned revenue (officially classified as local funds) must be budgeted and spent in the
program that earned it except,
1) Revenue generated by WCH Section Programs, except WIC, may be budgeted and
expended (consequently reported) in any WCH Section Program activity.
2) Revenue generated by a local clinic or program that has no state funded activity budget (no
state/federal funds) should be budgeted and associated expenditures reported in a state
program activity that most closely matches the deliverables of the respective state program.
This process will enable the collection of total expenditures in public health per program.
c. All fees collected shall be used in the current year or succeeding fiscal years,
d. Use of program income generated by the expenditure of Federal categorical funds will be
governed by applicable Federal regulations, including, but not limited to, 45 CFR 4.
e. Local Budgets for DHHS Reporting:
1) After preparing Local Budgets you must use the Allocation/County Line on the Electronic
Aid to Counties Website to show the approved local funding.
Line item 101 on the Electronic Aid to Counties Website must be used to budget local
appropriations for each program activity, if applicable.
Consolidated Agreement-FY14 Page 8 of 23
ii Line item 102 on the Electronic Aid to Counties Website must be used to budget Title
XIX Medicaid earned revenues for each program activity, if applicable.
iii Line item 103 on the Electronic Aid to Counties Website must be used to budget other
earned revenues (e.g., Home Health fees, patient fees (cash), other insurance payments,
and other grants and donations) for each program activity, if applicable.
iv Line item 104 on the Electronic Aid to Counties Website must be used to budget Local
funding associated with Teen Pregnancy activities, if applicable.
v Line item 106 on the Electronic Aid to Counties Website must be used to budget Local
funding for bioterrorism activities, if applicable.
vi Line item 107 on the Electronic Aid to Counties Website must be used to budget
Temporary Food Establishment (TFE) fees collected, if applicable.
Note: LHD shall report Local expenditures in the appropriate category (e.g., 101, 102,
103, 104, or 106) in the ZZZZ line item in the Aid to County Database and TFE fees
collected in Category 107 in the ZZZZ line item in the Aid to County Database.
£ When reporting local expenditures (local appropriations, Medicaid or other earned revenues) the
department must use the electronic Aid-to-Counties Website to report the pertinent month's actual
expenditures. (NOTE that an "actual expenditure" is one for which the item has been ordered,
received, invoiced and the check has been cut) or if the Agreement Addenda allows for drawing
down funds based on number of individuals screened or provided services, the actual number
screened or served multiplied by the per capita rate specified in the Agreement Addenda. The
Expenditure Reports must be submitted monthly in the electronic website format and certified in
the website to the DHHS Controller's Office.
1) Line item 101 on the Electronic Aid-to-Counties Website must be used to report local
appropriations that were expended on a monthly basis.
2) Line item 102 on the Electronic Aid-to-Counties Website must be used to report Title XIX
(Medicaid) earned revenues that were expended on a monthly basis.
3) Line item 103 on the Electronic Aid-to-Counties Website must be used to report other
earned revenues that were expended on a monthly basis.
4) Local funding for Teen Pregnancy Prevention Initiatives (104) and Bioterrorism (106) must
be reported on the Electronic Aid-to-Counties Website on a monthly basis.
5) Line item 107 must be used to report Temporary Food Establishment fees collected on a
monthly basis.
g. A local account shall be maintained for unexpended earned revenues [i.e., Title XIX fees,
private insurance or private pay {cashf]. Accounts shall be maintained in sufficient detail to
identify the program source generating the fees.
h. The amount of Title XIX fees budgeted and expended in FY 2013-2014 must equal or exceed
the amount of Title XIX revenues earned during FY 2012-2013. The state will not approve
program activity budgets that do not include an amount of Title XIX fees sufficient to meet the
requirements of this section. The State may waive this requirement if the Department provides
sufficient justification.
ComlWatod Agreement-FY14 Page 9 of 23
4. (State/ Federal Revenues only) The Department shall submit a monthly report of actual
expenditures (State and/or Federal) to the DHHS Controller's Office in the Electronic Aid-to-
Counties Website as referenced in 3.f. above - all reported in one system, but separated here for
clarity of instructions.
a. The Department shall submit a monthly Expenditure Report of the pertinent month's actual
expenditures for all programs via the Aid-to-Counties Website to the DHHS Controller's
Office no later than the dates published annually in November or December for the next
calendar year. The schedule reflects a general period of 15-20 days from the end of the
reporting month for submission of the Aid-to-Counties Website report, based on weekends and
holidays, to allow processing time for the payment. Failure to meet the reporting deadline, as
published, WILL result in the exclusion of those expenditures in the OSC E-Payment for that
month. Early submission may result in earlier payment to the Department. The Department
must submit these monthly Expenditure Reports, via the Aid-to-Counties Website,
consecutively throughout the agreement period.
The health director and the finance officer will approve the monthly Expenditure Report in the
Aid-to-Counties Website and the system will alert the staff in the DHHS Controller's Office
that expenditures have been approved and certified. The "Certification" verifies that the total
State and Federal expenditures reported are valid for the pertinent month's actual expenditures.
Local expenditures are part of the Expenditure Report, but are not included in the amount
verified in the "Certification." Local appropriations must be reported monthly along with the
State and Federal expenditures.
b. Departments shall keep expenditure reporting current and submit their certification of
expenditures per the published DHHS Controller's Office Schedule. Funding is based on an
Allocation Method, not a Contract Method, and counties receive reimbursement for services
provided during one month in the following month. Therefore, the last service month to be
paid in the SFY will be May services which are reported and paid in June.
A department's June, 2013 expenditure report will be paid in July, 2013 and will be paid
from a department's funding allocation for SFY 2013-14. Therefore a department will need
to submit all requests for adjustments, corrections, or amendments to expenditure reports
for fiscal year 12-13, with the May, 2013 expenditure report.
c. Expenditures of federal funds must be reported according to the funding period for a grant.
Care must be taken to be attentive to the service month/payment months for each grant as well
as the ending settlement date for a grant. (For example, a grant which ends November 30 will
have 6 servicelpayment months charged against it: 1) June 2012 service month/paid in July; 2)
July service month/paid in August; 3) August service month/paid in September; 4) September
service month/paid in October; 5) October service month/ paid in November; and 6) November
service month/paid either in December, or before the ending date of that grant's settlement
period. In this example the remaining 6 servicelpayment months will be December service
month/paid in January through May service month/paid in June, 2013.) For each Grant, the
budgetary estimate, funding authorization and agreement addendum will have service/payment
month dates listed.
ConsoGdatod Agreement-M4 Page 10 of 23
d. The Department shall submit the final LHD Expenditure Report (Electronic, via the Aid-to-
Counties Website) for all programs to the DHHS Controller's Office according to the schedule
published annually in November or December for the next Calendar Year by the DHHS
Controller's Office. The May Services/Paid in June will be the final report period paid
from the SFY. Services provided in June and reported in July will be paid out of the
next SFY.
e. The Department shall have the opportunity to submit amended expenditure reports in the
month following discovery of the error. A department should not wait to submit all
adjustments with the invoice submitted to the Controller's Office at the end of May as that will
not allow sufficient time for verification of the adjustments before the last payment in the state
Fiscal Year.
1) In accordance with item 4.c, above, each department must be mindful to keep current on
reporting adjustments against federal funds to ensure such adjustment is received in time to
be paid within the grant period for that grant.
2) The Department shall review their prior reimbursement claims against payments monthly.
3) Amended reports (with the exception of WIC, BFPO, FP and SFSP) must be submitted no
later than the next reporting date after the grant period ends in order to be paid. (Example:
if the grant period ends 9/30/13, the amended report must be received by the Controller's
Office no later than the next reporting date after that - i.e., October's reporting date.)
4) The only adjustments, if any, that should be submitted with the May service expenditure
report submitted in June would be any missed on the prior month's claim. If a department
waits until the May service month expenditure report submission to report adjustments, the
DHHS Controller's Office cannot guarantee those adjustments can be verified in time for
the June payment.
5) Any overpayments identified by either the State or the Department will be adjusted out of
the next month's claim for reimbursement by the DHHS Controller's Office. There is no
provision to carry forward funds from one State Fiscal Year to another; therefore, any
adjustment not included in the June (or earlier if grant period expires during the fiscal year)
payment should be paid from local funds. If reported to the State as an adjustment, the
payment will come from (and will therefore, reduce) the allocation for the next fiscal year.
f. The Department shall submit requests for payment for services provided under 10A NCAC
45.A rules to the Claims Processing Unit, Purchase of Medical Care Services, DHHS
Controller's Office.
g. The Department shall submit requests for reimbursement for nurse training to the Public
Health Nursing and Professional Development Unit. Form 3300 - Public Health Nurse
Training Activity must be used as the invoice for payment.
5. The Department shall maintain expenditures for maternal health, child health and family planning
programs per General Statute 130A-4.1(a). The amount of expenditures shall be calculated by the
State and provided to the Department as described in section G.21 of this document.
D. PERSONNEL POLICIES
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1. The Department shall adhere to and fully comply with State personnel policies as found in North
Carolina General Statute, Chapter 126, and 1 NCAC 8. Such policies include, but are not limited
to, the following:
a. Equal employment opportunity,
b. Affirmative action,
c. Policies for local government employment subject to the State Personnel Act,
d. "Local Classification and Salary Range,"
e. "Compensation Policy for Local Competitive Services Employees," and
f. "Recruitment and Selection Policy and Procedures. "
2. Environmental Health Specialists employed by the Department shall be delegated authority by the
State to administer and enforce State environmental health rules and laws as directed by the State
pursuant to G. S. 130A-4(b). This delegation shall be done according to 15A NCAC 10.0100.
a. Local health departments are responsible for sending their newly employed environmental
health specialists (interns) to centralized training within 180 days from date of employment.
b. Arrangements for centralized training for newly-employed environmental health specialists
will be handled by the Education and Training Staff, Division of Public Health. .
c. A local health department which is contracting with an environmental health specialist
employed by another department shall be responsible for assuring that all original documents,
correspondence, and other public records be maintained in the health department using the
contractor and the contract shall stipulate that the contractor shall be available for consultation
to the public being served.
3. The Department shall comply with Minimum Standard Health Department Staffing I OA NCAC
Section 46.0301(c), and shall assure that all nursing staff who provide public health services
funded by this agreement comply with this rule.
E. CONFIDENTIALITY
All information as to personal facts and circumstances obtained by Department personnel in
connection with the provision of services or other activity under this agreement shall be privileged
communication, shall be held confidential, and shall not be divulged without the client's, or
responsible person's, written consent; except as may be otherwise required by applicable law or
regulation. Such information may be disclosed in summary, statistical, or other form which does not
directly or indirectly identify particular individuals. Department employees must sign confidentiality
pledges documenting the knowledge of, and the agreement to maintain, personal and medical
confidentiality.
F:. CIVIL RIGHTS
The Department shall assure that no person, on the grounds of race, color, age, religion, sex,
marital status, immigration status, national origin or otherwise qualified handicapped individual,
solely by reason of his/her handicap (unless otherwise medically indicated), be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under any program or
activity covered by this agreement.
Consolidated Agreement-FY14 Page 12 of 23
2. The Department shall complete the attached Federal Certifications, including Nondiscrimination;
Drug-Free Workplace Requirements; Environmental Tobacco Smoke; Debarment, Suspension,
Ineligibility and Voluntary Exclusion Lower Tier Transactions; and Lobbying..
3. The American with Disabilities Act 1990 (ADA) makes it unlawful to discriminate in employment
against a qualified individual with a disability and outlaws discrimination against individuals with
disabilities in State and local government services and public accommodations. The Department
certifies that it and its principals and subcontractors will comply with regulations in ADA Title I
(Employment), Title II (Public Services), and Title III (Public Accommodations) in fulfilling the
obligations under this agreement.
G. RESPONSIBILITIES OF THE STATE
1. The State shall provide to the Department regular training, and, upon request, technical assistance
in the preparation of the Consolidated Agreement and Agreement Addenda.
2. The State shall conduct liaison activities with local health departments for general problem solving
and technical support.
3. The State shall provide high-level consultation, technical assistance, and advice to local health
directors. Broad content areas include, but are not limited to:
Board Relations
Management Teams/Staffing
Policy Development
Program Planning and Implementation
Quality/Performance Improvement
General Administrative Consultation, including consultation and technical assistance in
budgeting, fiscal, administrative and management support topic areas.
4. The State shall provide coordination and support for the education and training for the public
health workforce.
5. The State shall provide technical assistance and consultant services, as required, for specific health
program areas, including providing guidance and consultation about specific patient clinical issues,
when requested.
6. The State shall provide course coordination, consultation, and technical assistance on nursing
practice and standards, policies and procedures that cross programs.
7. The State shall provide support and consultation to the public health workforce in local health
departments, including regional public health consultants who offer technical assistance and
training on professional development; program planning, program evaluation and quality
assurance; data collection; and community assessment.
8. The State shall act as the principal liaison between the public health system and the state's
Medicaid agency on issues related to Medicaid reimbursed services provided by the state and local
public health agencies and shall cooperate with the state Medicaid agency to provide technical
assistance, guidance, and consultation to local health programs to ensure compliance with
Medicaid policies and procedures.
ConsaWated Agreement FY14 Page 13 of 23
9. The State shall design and implement annual cost studies to ensure appropriate cost-based
Medicaid reimbursement.
10 The State shall work with the NC Division of Information Resource Management to provide
automated systems and facilities via the Health Information System (HIS). HIS is currently used
to create and submit Medicaid claims, perform accounts receivables, and to collect other DPH
program-related data from client, service, encounter and other data on behalf of the local health
departments and other public health programs. The State shall provide business and. technical
support for the automated systems to the users of this system.
11. The State shall provide support and consultation to ensure that the Health Information System
(HIS) can generate standard transactions for public health Medicaid claims and for public health
claims to all insurers submitted on behalf of the local health departments per HIPAA [the
Administrative Simplification provisions of the Health Insurance Portability and Accountability
Act of 1996 (P.L. 104-91) subparts I through N, which define the standards for specific
transactions.]
12. The State shall responsibly use data reviewed and received in its role as a public health authority
and health oversight agency while respecting the confidentiality and integrity of the data and
securing and protecting the privacy of individual client health information (see Business Associate
Addendum to this Consolidated Agreement)
13. The State (DPH) shall provide to the Department "Budgetary Estimates of Funding Allocations"
no later than February 15 of each year to use in preparation of their local budget proposals per
current GS. The exception is the Food & Lodging distributions required by G.S. 130A-248(d).
The State will not enter budgetary estimates into the Aid to County Database, but shall provide to
the Department the Food & Lodging Local Health Department Budget Form" (DPH EN 2948 (A))
indicating the estimated funding allocation no later March 30"' for the state fiscal year in which
payment will be made.
14. The State (DHHS) shall provide a "Funding Authorization" to the Department after the receipt of
the Certified State Budget. Funds must be appropriately budgeted by the State in the NC
Accounting System (NCAS) prior to the issuance of the "Funding Authorization." If funds are
restricted through quarterly allotments for FYI 4, as they were in FYI 0, the initial Funding
Authorization will only include % of the annual amount for each specific activity involving State
funds.
15. The State (DPH) shall provide funds to the Department upon receipt of this executed agreement
and timely submissions of Expenditure Reports. Payment will be made to the Department
according to the DHHS Controller's Office E-Payment Schedule issued November or December of
each year for the following calendar year.
16. The State (DPH) shall provide Food & Lodging funds to the Department upon receipt of the
executed agreement addenda and the signed, completed, and approved Food & Lodging Local
Health Department Request for Payment Form (DPH EH 2948 (B)).
17. The State shall assist the Department to comply with all applicable laws, regulations, and
standards relating to the activities covered in this agreement.
18. The State reserves the right to conduct reviews, audits, and program monitoring to determine
compliance with the terms of this Agreement and its associated Agreement Addenda.
Consolidated Agmement-FY14 Page 14 of 23
19. The State shall be assured that the Department maintains expenditures of locally appropriated
funds (MOE) for maternal health, child health, and family planning program activities equal to, or
greater than, that reported on the Staff Time Activity Report for the period beginning July 1, 1984,
and ending June 30, 1985. This figure will be increased annually based on a federally accepted
inflation index (first updated FY 2000-2001 Agreement.) This revised baseline figure will be
calculated and provided to Departments for use in budget preparation.
20. For services of the State Laboratory :
a. Provide free or at cost mailers that meet the US Postal Service/DOT UN3373 Biologic
substance shipping and packaging regulations for samples submitted to the State Laboratory only
as ordered via the web-based mailroom ordering system;
b. Assure qualified personnel to process, analyze and report test results;
c. Assure that the State Laboratory maintains CLIA certification;
d. Submit invoices to the local health departments via electronic means; and
e. Collect interest (per N.C.G.S. 147-86.23 and 150-241.1) and a 10% late fee as appropriate;
H. DISBURSEMENT OF FUNDS
1. The State shall disburse funds to the Department on a monthly basis; monthly disbursements for
each program activity will be based on monthly expenditures reported.
2. The State shall disburse Food and Lodging funds in accordance with NCAC T15A:18A. 2900-
"Restaurant and Lodging Fee Collection and Inventory Program" in the month following receipt of
the signed, completed, and approved Food & Lodging Local Health Department Request for
Payment Form (DPH EN 2948 (B)). The exception is that Temporary Food Establishment (TFE)
fees MUST be collected by the Department and must be expended to support the food, lodging,
and institution sanitation programs and activities. Such fees shall be deemed to have been
disbursed to the Department upon their collection and shall be reported in the Aid to County
Database on the = line for Activity #874, Category 107 - Local Temporary Food
Establishment (TFE - State).
3. Payments shall be suspended when expenditure reports are not received by the time specified (see
CA.a.). Payments will resume the month following the receipt of the delinquent expenditure
reports according to the DHHS Controllers office schedule for OSC E-Payments issued in
November or December of each year for the following calendar year.
4. Total payment by program activity is limited to the total amount of the "Funding Authorization"
and any revisions received after the initial "Funding Authorization" notification.
5. Final payments for the SFY will be made based on the Final monthly (May services/ submitted in
June Report) Expenditure Report. Final payments will be equal to the difference between
approved reported expenditures and the sum of previous payments up to the limits of the approved
budget. Final payments should be made no later than the June OSC E-Payment period per the
DHHS Controller's Office schedule, provided that an Expenditure Report and certification, via the
Aid-to-Counties Website for each month have been received by the DHHS Office of the
Controller.
I. AMENDMENT OF AGREEMENT
ConsoGaatedASreement-FYZa Page 15 of 23
Amendments, modifications, or waivers of this agreement may be made at any time by mutual consent
of all parties. Amendments shall be in writing and signed by appropriate authorities.
J. PROVISION OF TERMINATION
Either party may terminate this agreement for reasons other than non-compliance upon sixty (60) days
written notice. If termination should occur, the Department shall receive payment only for allowable
expenditures.
The State may withhold payment to the Department until the State can determine whether the
Department is entitled to further payment or whether the State is entitled to a refund.
K. COMPLIANCE
1. The State shall respond to non-compliance with all terms of this agreement as follows:
a. Upon determination of non-compliance, the State shall give the Department sixty (60) days
written notice to come into compliance. If the deficiency is corrected, the Department shall
submit a written report to the State that sets forth the corrective action taken.
b. If the above deficiencies should not be corrected to the satisfaction of the State after the sixty
(60) day period, disbursement of funds for the particular activity may be temporarily suspended
pending negotiation of a plan of corrective action.
c. If the deficiency is still not corrected within the next thirty (30) days following temporary
suspension of funding, program funds may be permanently suspended until the Department can
provide evidence that the deficiencies have been corrected.
d. In the event of the Department's non-compliance with clauses of this agreement, the State may
cancel, terminate, or suspend this agreement in whole or in part and the Department maybe
declared ineligible for further State contracts or agreements. Such terminations for non-
compliance shall not occur until (1) the provisions of Section K-1 (a-c) have been followed,
documented, and have failed to provide a resolution, and (2) all other reasonable
administrative remedies have been exhausted.
2. Monitoring - OMB Circular A-133 (Audits of States, Local Government, and Non-Profit
Organizations) as revised on June 27, 2003 requires that pass-through entities monitor the activities of
their subcontractors as necessary to ensure that federal awards are used for authorized purposes in
compliance with laws, regulations and the provision of contracts or grant agreements and that
performance goals are achieved. North Carolina establishes comparable monitoring requirements for
State funds received by subrecipients in N.C.G.S.158-34, Annual independent audit: rules and
regulations, for local units of government. Also, DHHS-DPH must perform monitoring as required in
the DHHS Policy and Procedure Manual entitled "Monitoring of Programs" dated August 1, 2002 and
its Monitoring Plan dated January, 2006.
Additionally, each Local Health Department is required under Circular A-133, N.C.G.S.143-
6.2 and N.C.G.S.159-34 to perform monitoring of its subrecipients and to maintain records to
support such monitoring activities and results. Accordingly, the Department shall participate fully
in monitoring by DHHS-DPH and shall appropriately monitor its subrecipients to the extent
necessary based on the assessed level of risk.
3. If the Department or the State should be determined out of compliance with the provisions of the
agreement, either party may file a formal appeal with the Office of Administrative Hearings.
Consolidate Agreement-FYI 4 Page 16 of 23
L. RECORD RETENTION
In accordance with the State's basic records retention policy, records resulting from these Services shall
not be destroyed, purged or disposed of without the express written consent of the Division during the
period specified in the State's records retention policy and in accordance with state and federal law. State
basic records retention policy requires all grant records to be retained for a minimum of five years or until
all audit exceptions have been resolved, whichever is longer. If the contract is subject to Federal policy
and regulations, record retention may be longer than five years since records must be retained for a period
of three years following submission of the final Federal Financial Status Report, if applicable, or three
years following the submission of a revised final Federal Financial Status Report. Also, if any litigation,
claim, negotiation, audit, disallowance action, or other action involving this Contract has been started
before expiration of the five-year retention period described above, the records must be retained until
completion of the action and resolution of all issues which arise from it, or until the end of the regular
five-year period described above, whichever is later. Records for Temporary Assistance for Needy
Families (TANF) and MEDICAID and Medical Assistance grants and programs must be retained for a
minimum of ten years.
IN WITNESS WHEREOF, the Department and the State have executed this agreement in duplicate
originals, one of which is retained by each of the parties.
LOCAL SIGTURES
Health Director
or Authorized Agent
STATE OF NORTH CAROLINA
Date State Health Director
Date
-,►~~tz-- 3%7.~ 113
Finance Officer Date
Chair of County Commissioners (when required) Date
Consolidated ngmemW-FY14 Page 17 of 23
NORTH CAROLINA
DEPARTMENT OF HEALTH AND HUMAN SERVICES
BUSINESS ASSOCIATE ADDENDUM TO CONSOLIDATED AGREEMENT
This Agreement is made effective the 1 st day of JuN10--
(name 013, by and between
ctf.. of Local Health Department o `Covered Entity") and the Division of Public Health ("Business
Associate") (collectively the "Parties").
BACKGROUND
a. Covered Entity and Business Associate are parties to a Memorandum of Understanding "entitled" The
FY2014 Consolidated Agreement (the "MOU"), whereby Business Associate agrees to perform certain
services for or on behalf of Covered Entity.
b. Covered Entity is an organizational unit of the North Carolina Department of Health and Human Services
(the "Department") that has been designated in whole or in part by the Department as a health care
component for purposes of the HIPAA Privacy and Security Rules.
c. The relationship between Covered Entity and Business Associate is such that the Parties believe Business
Associate is or may be a "business associate" within the meaning of the HIPAA Privacy and Security Rules.
d. The Parties enter into this Business Associate Addendum to the MOU with the intention of complying with
the HIPAA Privacy and Security Rules provision that a covered entity may disclose electronic protected
health information or other protected health information to a business associate, and may allow a business
associate to create or receive electronic protected health information or other protected heath information
on its behalf, if the covered entity obtains satisfactory assurances that the business associate will
appropriately safeguard the information.
2. DEFINITIONS.
Unless some other meaning is clearly indicated by the context, the following terms shall have the following
meaning in this Agreement:
a. "Electronic Protected Health Information" shall have the same meaning as the term "electronic protected
health information" in 45 CFR 160.103, limited to the information created or received by Business
Associate from or on behalf of a Covered Entity.
b. "HIPAA" means the Administrative Simplification Provisions, Sections 261 through 264, of the federal
Health Insurance Portability and Accountability Act of 1996, Public Law 104-191.
c. "Individual" shall have the some meaning as the term "individual" in 45 CFR 160.103 and shall include a
person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).
d. "Privacy and Security Rules" shall mean the Standards for Privacy of Individually Identifiable Health
Information and Security Standards for the Protection of Electronic Protected Health Information in
accordance with 45 CFR part 160 and part 164, subparts A and E.
e. "Protected Health Information" shall have the same meaning as the term "protected health information" in
45 CFR 160.103, limited to the information created or received by Business Associate from or on behalf of
Covered Entity.
f. "Required By Law" shall have the same meaning as the term "required by law" in 45 CFR 164.103.
Consolidated Agreement-FY14 Page 18 of 23
g. "Secretary" shall mean the Secretary of the United States Department of Health and Hurnan Services or his
designee.
h. "Security Incident" shall have the same meaning as the term "security incident" in 45 CFR 164.304.
i. Unless otherwise defined in this Agreement, terms used herein shall have the same meaning as those terms
have in the Privacy and Security Rules.
3. OBLIGATIONS OF BUSINESS ASSOCIATE
a. Business Associate agrees to not use or disclose electronic protected health information or other protected
health '.nfe m-ation other than as permitted or required by this Agreement or as required by law.
b. Business Associate agrees to implement administrative, physical, and technical safeguards that reasonably
and appropriately protect the confidentiality, integrity, and availability of the electronic protected health
information and other protected health information thAt it creates, receives, maintains, or transmits on
behalf of a Covered Entity, as required by the Privacy and Security Rules.
c. Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to
Business Associate of a use or disclosure of electronic protected health information or other protected
health information by a Business Associate in violation of the requirements of this Agreement.
d. Business Associate agrees to report to Covered Entity (i) any use or disclosure of electronic protected
health information or other protected health information not provided for by this Agreement of which it
becomes aware and (ii) any security incident of which it becomes aware.
e. Business Associate agrees to ensure that any. agent, including a subcontractor, to whom it provides
electronic protected health information and/or other protected health information received from, or created
or received by Business Associate on behalf of Covered Entity (i) agrees to be bound by the same
restrictions and conditions that apply through this Agreement to Business Associate with respect to such
information, and (ii) agrees to implement reasonable and appropriate safeguards to protect such
information.
f. Business Associate agrees to provide access, at the request of Covered Entity, to electronic protected health
information and other protected health information in a Designated Record Set to a Covered Entity or, as
directed by a Covered Entity, to an individual in order to meet the requirements under 45 CFR 164.524.
g. Business Associate agrees, at the request of a Covered Entity, to make any amendment(s) to electronic
protected health information and other protected health information in a Designated Record Set that a
Covered Entity directs or agrees to pursuant to 45 CFR 164.526.
h. Unless otherwise prohibited by law, Business Associate agrees to make internal practices, books, and
records, including policies and procedures concerning electronic protected health information and other
protected health information, relating to the use and disclosure of electronic protected health information
and other protected health information received from, or created or received by Business Associate on
behalf of, Covered Entity available to the Covered Entity, or to the Secretary, in a time and manner
designated by the Secretary, for purposes of the Secretary determining Covered Entity's compliance with
the Privacy and Security Rules.
i. Business Associate agrees to document such disclosures of electronic protected health information and
other protected health information related to such disclosures as would be required for Covered Entity to
respond to a request by an individual for an accounting of disclosures of electronic protected heal
information and other protected health information in accordance with 45 CFR 164.528, and to provide this
information to Covered Entity or an individual to permit such a response.
Consolidated Agmnmt-FY14
4. PERMITTED S AND DISCLOSURES
Page 19 of 23
a. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the MOU
permits, Business Associate may use or disclose electronic protected health information and other protected
health information to perform functions, activities, or services for, or on behalf of, Covered Entity as
specified in the MOU, provided that such use or disclosure:
1) would not violate the Privacy and Security Rules if done by Covered Entity; or
2) would not violate the minimum necessary policies and procedures of the Covered Entity.
b. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the MOU
permits, Business Associate may use electronic protected health information and other protected health
information as necessary for the proper management and administration of the Business Associate or to
carry out the legal responsibilities of the Business Associate.
c. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the MOU
permits, Business Associate may disclose electronic protected health information and other protected health
information for the proper management and administration of the Business Associate, provided that:
1) disclosures are required by law; or
2) Business Associate obtains reasonable assurances from the person to whom the information is disclosed
that it will remain confidential and will be used or further disclosed only as required by law or for the
purpose for which it was disclosed to the person, and the person notifies the Business Associate of any
instances of which it is aware in which the confidentiality of the information has been breached.
d. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the MOU
permits, Business Associate may use electronic protected health information and other protected health
information to provide data aggregation services to Covered Entity as permitted by 45 CFR
164.504(e)(2)(i)(B).
e. Notwithstanding the foregoing provisions, Business Associate may not use or disclose electronic protected
health information or other protected health information if the use or disclosure would violate any term of
the MOU or by other applicable law or agreements.
5. TERM AND TERMINATION
a. Term. This Agreement shall be effective as of the effective date stated above and shall terminate when the
MOU terminates.
b. Termination for Cause. Upon Covered Entity's knowledge of a material breach by Business Associate,
Covered Entity may, at its option:
1) Provide an opportunity for Business Associate to cure the breach or end the violation, and terminate
this Agreement and services provided by Business Associate, to the extent permissible by law, if
Business Associate does not cure the breach or end the violation within the time specified by Covered
Entity;
2) Immediately terminate this Agreement and services provided by Business Associate, to the extent
permissible by law; or
3) If neither termination nor cure is feasible, report the violation to the Secretary as provided in the
Privacy and Security Rules.
c. Effect o Termination.
consolidated Agmement FYla Page 20 of 23
1) Except as provided in paragraph (2) of this section or in the MOU or by other applicable law or
agreements, upon termination of this Agreement and services provided by Business Associate, for any
reason, Business Associate shall return or destroy all electronic protected health information and other
protected health information received from Covered Entity, or created or received by Business
Associate on behalf of Covered Entity. This provision shall apply to electronic protected health
information and other protected health information that is in the possession of subcontractors or agents
of Business Associate. Business Associate shall retain no copies of the electronic protected health
information or other protected health information.
2) In the event that Business Associate determines that returning or destroying the electronic protected
health information or other protected health information is not feasible, Business Associate shall
provide to Covered Entity notification of the conditions that make return or destruction not feasible.
Business Associate shall extend the protections of this Agreement to such electronic protected health
information and other protected health information and limit further uses and disclosures of such
electronic protected health information and other protected health information for those purposes that
make the return or destruction infeasible, for so long as Business Associate maintains such electronic
protected health information and other protected health information.
6. GENERAL TERMS AND CONDITIONS
a. This Agreement amends and is part of the MOU.
b. Except as provided in this Agreement, all terms and conditions of the MOU shall remain in force and shall
apply to this Agreement as if set forth fully herein.
c. In the event of a conflict in terms between this Agreement and the MOU, the interpretation that is in
accordance with the Privacy and Security Rules shalt prevail. In the event that a conflict then remains, the
MOU terms shall prevail so long as they are in accordance with the Privacy and Security Rules.
d. A breach of this Agreement by Business Associate shall be considered sufficient basis for Covered Entity to
terminate the MOU for cause.
LOCAL SIGN~AT S
Health Director Date
Covered Entity (Local Health Dept)
STATE OF NORTH CAROLINA
Business Associate Date
(Division of Public Health)
Consolidated ASmcw&-FY14
Page 21 of 23
AMENDMENT TO THE NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN
SERVICES BUSINESS ASSOCIATE ADDENDUM TO CONSOLIDATED AGREEMENT
This document amends North Carolina Department of Health and Human Services Business Associate
Addendum to the Consolidated Agreement. This amendment is made effective the 1St day of July, 2012,
by and between Ow fla" , cr Ctm 4tai t h W. (name of Local Health Department or "Covered
Entity") and the Division of Public alth ("Business Associate') (collectively the "Parties") for the
purpose of specifying the breach reporting and notification requirements following an unauthorized
disclosure of unsecured Protected Health Information (PHI).
I. DEFINITIONS:
The terms defined below shall have the following meaning in this Amendment:
a. "Breach' 'means the acquisition, access, use, or disclosure of PHI in a manner not permitted
under the HIPAA Privacy Rule which compromises the security or privacy of the PHI. For the
purpose of this definition, "compromises the security or privacy of the PHI" means poses a
significant risk of financial, reputational, or other harm to the individual. A use or disclosure
of PHI that does not include the identifiers listed at § 164.514(e)(2), limited data set, date of
birth, and zip code does not compromise the security or privacy of the PHI.
Breach excludes:
• Any unintentional acquisition, access or use of PHI by a workforce member or person
acting under the authority of a Covered Entity (CE) or Business Associate (BA) if such
acquisition, access, or use was made in good faith and within the scope of authority and
does not result in further use or disclosure in a manner not permitted under the HIPAA
Privacy Rule.
• Any inadvertent disclosure by a person who is authorized to access PHI at a CE or BA to
another person authorized to access PHI at the same CE or BA, or organized health care
arrangement in which the CE participates, and the information received as a result of such
disclosure is not further used or disclosed in a manner not permitted under the HIPAA
Privacy Rule; or
A disclosure of PHI where a CE or BA has a good faith belief that an unauthorized person
to whom the disclosure was made could not have expected to use or further disclose that
information.
. "HPTECH Act" means the "Health Information Technology for Economic and Clinical Health
("HITECH") Act, Title XIII of Division A of the American Recovery and Reinvestment Act of
2009 (P.L. 111-5).
c. "Security breach" means an incident of unauthorized access to and acquisition of unencrypted and
un-redacted records or data containing personal information where illegal use of the personal
information has occurred or is reasonably likely to occur or that creates a material risk of harm to a
consumer. Any incident of unauthorized access to and acquisition of encrypted records or data
Consolidated Agmemens-FY14 Page 22 of 23
containing personal information along with the confidential process or key shall constitute a
security breach. Good faith acquisition of personal information by an employee or agent of the
business for a legitimate purpose is not a security breach, provided that the personal information is
not used for a purpose other than a lawful purpose of the business and is not subject to further
unauthorized disclosure.
d. "Unsecured protected health information" means protected health information (PHI) that is not
rendered unusable, unreadable, or indecipherable to unauthorized individuals through the use of
technology or methodology specified by the Secretary in the guidance issued under section
13402(h)(2) of Pub. L.111-5.
The following PHI shall not be regarded as Unsecured PHI:
Electronic PHI has been encrypted as specified in the HIPAA Security rule by the use of an
algorithmic process to transform data into a form in which there is a low probability of
assigning meaning without the use of a confidential process or key and such confidential
process or key that might enable decryption has not been breached. To avoid a breach of
the confidential process or key, these decryption tools should be stored on a device or at a
location separate from the data they are used to encrypt or decrypt. The following
encryption processes meet this standard:
- Valid encryption processes for data at rest (i.e. data that resides in databases, file
systems and other structured storage systems) are consistent with NIST Special
Publication 800-111, Guide to Storage Encryption Technologies for End User Devices.
Valid encryption processes for data in motion (i.e. data that is moving through a
network, including wireless transmission) are those that comply, as appropriate, with
NIST Special Publications 800-52, Guidelines for the Selection and Use of Transport
Layer Security (TLS) Implementations; 800-77, Guide to IPsec VPNs; or 800-113,
Guide to SSL VPNs, and may include others which are Federal Information Processing
Standards FIPS 140-2 validated.
The media on which the PHI is stored or recorded has been destroyed in the following
ways:
Paper, film, or other hard copy media have been shredded or destroyed such that the
PHI cannot be read or otherwise cannot be reconstructed. Redaction is specifically
excluded as a means of data destruction.
Electronic media have been cleared, purged, or destroyed consistent with NIST Special
Publications 800-88, Guidelines for Media Sanitization, such that the PHI cannot be
retrieved.
Consolidated Agreement FYl4
II.
Page 23 of 23
Reporting and Breach Notification Requirements
a. BA shall notify CE within twenty-four (24) hours of any suspected or actual incident, breach, or
intrusion involving the unauthorized access, acquisition, use or disclosure of Confidential
Information by Business Associate's employees.
b. BA shall, following the discovery of a breach of unsecured PHI, as defined in the HITECH Act or
accompanying regulations, notify CE of such breach pursuant to the terms of 45 CFR § 164.410
and cooperate in the CE's breach analysis procedures, including risk assessment, if requested. A
breach shall be treated as discovered by BA as of the first day on which such breach is known to
BA or, by exercising reasonable diligence, would have been known to BA. BA will provide such
notification to CE without unreasonable delay and in no event later than forty (45) calendar days
after discovery of the breach. Such notification will contain the elements required in 45 CFR §
164.410.
Signatures:
LOCAL SIGNATURES
STATE OF NORTH CAROLINA
Covered Entity (Local Health Dept)
Business Associate Date
(Division of Public Health)
FEDERAL CERTIFICATIONS
The undersigned states that:
1. He or she is the duly authorized representative of the Contractor named below;
2. He or she is authorized to make, and does hereby make, the following certifications on behalf of the Contractor, as set out herein:
a. The Certification Regarding Nondiscrimination;
b. The Certification Regarding Drug-Free Workplace Requirements;
c. The Certification Regarding Environmental Tobacco Smoke;
d. The Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered
Transactions; and
e. The Certification Regarding Lobbying;
3. He or she has completed the Certification Regarding Drug-Free Workplace Requirements by providing the addresses at which the
contract work will be performed;
4. [Check the applicable statement]
❑ He or she has completed the referenced Standard Form SF-LLL, Disclosure of Lobbying Activities because the Contractor
has made, or has an agreement to make, a payment to a lobbying entity for influencing or attempting to influence an
officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member
of Congress in connection with a covered Federal action;
He or she has of completed the referenced Standard Form SF-LLL, Disclosure o Lobbying Activities because the
Contractor has not made, and has no agreement to make, any payment to any lobbying entity for influencing or attempting
to influence any officer or employee of any agency, any Member of Congress, any officer or employee of Congress, or any
employee of a Member of Congress in connection with a covered Federal action.
5. The Contractor hal quire its subcontractors, if any, to make the same certifications and disclosure.
*A Ilk 1)l r-cC r
Signature Title
Contracting Agency's Legal Name
Date
[This Certification must be signed by a representative of the Contracting Agency who is authorized to sign contracts.]
1. Certification Regarding Nondiscrimination
The Contractor certifies that it will comply with all Federal statutes relating to nondiscrimination. These include but are not limited
to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national
origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which prohibits
discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits
discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which
prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating
to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g)
Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or
financing of housing; (h) the Food Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political
beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this Agreement.
I. Certification Regarding Drug-Free Workplace Requirements
The Contractor certifies that it will provide a drug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or
use of a controlled substance is prohibited in the Contractor's workplace and specifying the actions that will be
taken against employees for violation of such prohibition;
(b) Establishing a drug-free awareness program to inform employees about:
( 1) The dangers of drug abuse in the workplace;
(2) The Contractor's policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;
(c) Making it a requirement that each employee be engaged in the performance of the agreement be given a copy of the
statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the
agreement, the employee will:
(1) Abide by the terms of the statement; and
(2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no
later than five days after such conviction;
(e) Notifying the Department within ten days after receiving notice under subparagraph (d)(2) from an employee or
otherwise receiving actual notice of such conviction;
{fj Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to
any employee who is so convicted:
(1) taking appropriate personnel action against such an employee, up to and including
termination; or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program
approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate
agency; and
(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a),
(b), (c), (d), (e), and (fl•
2. The sites for the performance of work done in connection with the specific agreement are listed below (list all sites; add
additional pages if necessary):
Street Address No. 1: Z6.2,SOU-4) UA' 3)a- Ckt_
City, State, Zip Code: 3 \n l r'l41,, . n & ai~4 a)
Street Address No. 2:
City, State, Zip Code:
3. Contractor will inform the Department of any additional sites for performance of work under this agreement.
4. False certification or violation of the certification may be grounds for suspension of payment, suspension or termination of
grants, or government-wide Federal suspension or debarment. 45 C.F.R. 82.510.
III. Certification Regarding Environmental Tobacco Smoke
Public Law 103-227, Part C-Environmental Tobacco Smoke, also known as the Pro-Children Act of 1994 (Act), requires that smoking
not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for
the provision of health, day care, education, or library services to children under the age of 18, if the services are funded by Federal
programs either directly or through State or local governments, by Federal grant, contract, loan, or loan guarantee. The law does not
apply to children's services provided in private residences, facilities funded solely by Medicare or Medicaid funds, and portions of
facilities used for inpatient drug or alcohol treatment. Failure to comply with the provisions of the law may result in the imposition of
a civil monetary penalty of up to $1,000.00 per day and/or the imposition of an administrative compliance order on the responsible
entity.
The Contractor certifies that it will comply with the requirements of the Act. The Contractor further agrees that it will require the
language of this certification be included in any subawards that contain provisions for children's services and that all subgrantees shall
certify accordingly.
IV. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier
Covered Transactions
Instructions
[The phrase "prospective lower tier participant" means the Contractor.]
I . By signing and submitting this document, the prospective lower tier participant is providing the certification set out below.
2. The certification in this clause is a material representation of the fact upon which reliance was placed when this transaction
was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the department or agency with which this
transaction originate may pursue available remedies, including suspension and/or debarment.
3. The prospective lower tier participant will provide immediate written notice to the person to whom this proposal is submitted
if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.
4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant,"
"person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the
meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549, 45 CFR Part 76.
You may contact the person to whom this proposal is submitted for assistance in obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be
entered into, it shall not knowingly enter any lower tier covered transaction with a person who is debarred, suspended,
determined ineligible or voluntarily excluded from participation in this covered transaction unless authorized by the
department or agency with which this transaction originated.
6. The prospective lower tier participant further agrees by submitting this document that it will include the clause titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower Tier Covered Transaction,"
without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered
transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from covered transaction, unless it knows
that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility
of its principals. Each participant may, but is not required to, check the Nonprocurement List.
8. Nothing contained i the foregoing shall be construed to require establishment of a system of records in order to render in
good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed
that which is normally possessed by a prudent person in the ordinary course of business dealings.
9. Except for transactions authorized in paragraph 5 of these instructions, if a participant in a covered transaction knowingly
enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from
participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency
with which this transaction originated may pursue available remedies, including suspension, and/or debarment.
Certification
a. The prospective lower tier participant certifies, by submission of this document, that neither it nor its principals is
presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any Federal department or agency.
b. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective
participant shall attach an explanation to this proposal.
V. Certification Regarding Lobbying
The Contractor certifies, to the best of his or her knowledge and belief, that:
1. No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee
of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, continuation,
renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting
to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this Federally funded contract, grant, loan, or cooperative agreement,
the undersigned shall complete and submit Standard Form SF-LLL, "Disclosure of Lobbying Activities," in accordance with
its instructions. Standard Form SF-LLL and its instructions are located at the following URL:
htty.//ww,w.whitehouse.gov/omb/assets/omb/Jgants/sflllig.pdf
The undersigned shall require that the language of this certification be included in the award document for subawards at all
tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) who receive federal
funds of $100,000.00 or more and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section
1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less
than $10,000.00 and not more than $100,000.00 for each such failure.
Maintenance of Effort Schedule - local health departments
Citation: 130A-4.1; Consolidated Agreement clause G(19)
Local Health
MOE Baseline-
Updated Baseline-
Department
1985
CPI * - 2013-14
Alamance
$
215,751
$
461,708
Albemarle District
$
47,803
$
102,298
Alexander
$
33,308
$
71,278
Anson
$
27,096
$
57,985
Appalachian District
$
56,663
$
121,258
Beaufort
$
63,029
$
134,881
Bladen
$
19,564
$
41,866
Brunswick
$
122,285
$
261,690
Buncombe
$
166,104
$
355,462
Burke
$
83,689
$
179,095
Cabarrus
$
250,406
$
535,869
Caldwell
$
59,226
$
126,743
Carteret
$
16,843
$
36,044
Caswell
$
31,809
$
68,071
Catawba
$
127,542
$
272,940
Chatham
$
50,121
$
107,259
Cherokee
$
11,705
$
25,049
Clay
$
1,580
$
3,381
Cleveland
$
243,917
$
521,983
Columbus
$
85,858
$
183,737
Craven
$
113,647
$
243,205
Cumberland
$
458,294
$
980,748
Dare
$
22,597
$
48,358
Davidson
$
100,199
$
214,425
Davie
$
38,546
$
82,489
Duplin
$
84,922
181,732
Durham
$
439,506
$
940,543
Edgecombe
$
157,941
$
337,994
Forsyth
$
508,138
$
1,087,415
Franklin
$
65,012
$
139,125
Gaston
$
342,765
$
733,517
Graham
$
3,949
$
8,451
Granville-Vance District
$
170,160
$
364,142
Greene
$
78,527
$
168,048
Guilford
$
1,605,509
$
3,435,790
Halifax
$
118,024
$
252,572
Harnett
$
69,651
$
149,052
Haywood
$
82,684
$
176,943
Henderson
$
109,750
$
234,866
Hertford
$
3,517
$
7,525
Hoke
$
25,698
$
.54,994
Hyde
$
12,355
$
26,439
Iredell
$
36,698
$
78,535
Jackson
$
11,822
$
25,299
Johnston
$
196,475
$
420,457
Jones
$
22,851
$
48,901
Lee
$
57,470
$
122,986
Lenoir
$
120,667
$
258,227
Lincoln
$
78,475
$
167,937
Macon
$
27,277
$
58,373
Madison
$
55,718
$
119,237
MTW District
$
97,748
$
209,181
Mecklenburg
$
375,712
$
804,024
Montgomery
$
24,389
$
52,192
Moore
$
36,243
$
77,560
Nash
$
124,412
$
266,241
New Hanover
$
128,664
$
275,340
Northampton
$
71,678
$
153,391
Onslow
$
63,147
$
135,135
Orange
$
258,834
$
553,905
Pamlico
$
11,162
$
23,887
Pender
$
-
$
-
Person
$
42,878
$
91,759
Pitt
$
164,404
$
351,825
Randolph
$
81,302
$
173,986
Richmond
$
50,348
$
107,746
Robeson
$
225,422
$
482,403
Rockingham
$
157,370
$
336,771
Rowan
$
178,268
$
381,493
RPM District
$
48,315
$
103,395
Sampson
$
37,229
$
79,670
Scotland
$
12,388
$
26,509
Stanly
$
23,625
$
50,558
Stokes
$
41,687
$
89,211
Surry
$
49,658
$
106,268
Swain
$
10,674
$
22,842
Toe River District
$
49,658
$
106,268
Transylvania
$
66,417
$
142,133
Union
$
25,573
$
54,726
Wake
$
758,321
$
1,622,807
Warren
$
8,551
$
18,298
Wayne
$
271,847
$
581,752
Wilkes
$
73,909
$
158,164
Wilson
$
59,617
$
127,581
Yadkin
$
20,687
$
44,270
TOTAL:
$
10,583,276
$
22,648,210
Notes:
Adjusted for inflation, 1985 through 2012, based upon changes in Consumer
Price Index (CPI). Adjustment factor equals 214%
Reference for calculating CPI changes:
httl2://www.bls.gov/data/inflation calculator.htm
s armo .
North Carolina Department of Heal a Human Services
Division of Public Heal
Pat McCrory
Governor
TO: Local Health Directors and Nursing Directors
FROM: Joy F. Reed, EdD, RN, FAAN~ ' -
Branch Head LocaI Technical Assistance and Training
Public Health Nursing & Professional Development Unit
DATE- February 15, 2013
SUBJECT: Public Health Nurse Training Funds
Aldona Z. Wos, M.D.
Ambassador (Ret.)
Secretary DHHS
Laura Gerald, M.D., M.P.H.
State Health Director
The protocol for reimbursement under the Public Health Nurse Training Funds is an integral component in the 2013-
14 Consolidated Agreement with each local health department (see B-12 Funding Stipulations in the Consolidated
Agreement). In order to be reimbursed from the training funds, the attached form (DHHS 3300) will need to be
completed for individuals for whom the agency is requesting reimbursement.
I . County name
2. Name(s) of Participant(s)
3. Title of Course attended
4. Dates of attendance (month and year)
5. Amount requested
6. Health Director's signature and date
7. Name and telephone number of person preparing the form DHHS 3300
You may request reimbursement upon notification of successful completion of the Introduction to Principles and
Practices of Public Health and Public Health Nursing course (reimbursement is $400), or the Management and
Supervision for Public Health Managers and Supervisors course (reimbursement is $600), but reimbursement must
be requested within one year of successful completion of either course.
All reimbursements are based on availability of funds.
Please submit the completed form directly to Public Health Nursing and Professional Development Unit, 1916 Mail
Service Center, Raleigh, NC 27699-1916.
Attachment: Form DHHS 3300
www.ncdhhs.gov a www.publicheakh.nc.gov
Tel 919-707-5000 - Fax 919-8704829
r Location: 5605 Six Forks Road • Raleigh, NC 27609' fl'
Mailing Address: 1931 Mail Service Center - Raleigh, NC 27699-1931
North
An Equal Opportunity / Affirmative Action Employer ~m~~ "blic ~r°eAth
~i~
N.C. Department of Health and Human Services
Page of
CONSOLIDATED AGREEMENT
Public Health Nursing Training Funds
Reimbursement Request
Public Health Nursing &
Professional Development
Office, Section, or Branch
Contractor (County Name)
Name(s) of Participant(s)
*Amount Requested: $
Health Director Signature
Contact Person Signature
Telephone Number
This form is to be used when requesting reimbursement. Submit this reimbursement request directly to:
Public Health Nursing & Professional Development
DHHS - Division of Public Health
1916 Mail Service Center
Raleigh, NC 27699-1916
Reviewed by:
FY 2013-2014
NIA
Contract Number
Public Health Nurse Training
Activity
Course attended Date Attended (Mo. & Yr.)
Date
DHHS 3300 (Revised 01/06)
PHNPD (Review 01/09) Initials Date