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HomeMy WebLinkAboutAgenda - 04-17-2001-8ii ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: April 17, 2001 Action Agenda 4 Item No. ~~ SUBJECT: Renewal of Consolidated Agreement Between Department of Health and Human Services and the Health Department DEPARTMENT: Health PUBLIC HEARING: (Y/N) No ATTACHMENT(S): Consolidated Agreement INFORMATION CONTACT: Rosemary Summers, ext 2411 TELEPHONE NUMBERS: Hillsborough 732-8181 Chapel Hill 968-4501 Durham 688-7331 Mebane 336-227-2031 PURPOSE: To approve the annual consolidated agreement between the NC Department of Health and Human Services and the Orange County Health Department, which provides State and Federal funds to the Health Department to partially support mandated services BACKGROUND: The attached agreement stipulates the provisions for receiving state and federal support for the programs listed below. At this point in time, the state anticipates level funding for next year. Final guidance on budgetary amounts will be provided in July. General CSHS Orthopedic Maternal Health Child Health AIDS (Federal) Child Service Coordination Family Planning Breast 8 Cervical Cancer Immunization Action Plan Intensive Home Visiting Environmental Health Food and Lodging Block Grant that includes Communicable Disease, Adult Health and Health Promotion The County Attorney has reviewed the agreement and finds it satisfactory. FINANCIAL IMPACT: The state consolidated agreement is anticipated to provide $497,396 federal and state dollars to the county to provide specific services for fiscal year 2001-2002. This represents approximately 11 % of the overall health department budget. This does not include Medicaid revenue which is earned separately for services provided. RECOMMENDATION(S): The Manager recommends that the Board approve the agreement and authorizes the Chair to sign the agreements and assurances. Consolidated Agreement -Final CONSOLIDATED AGREEMENT BETWEEN THE STATE OF NORTH CAROLINA AS REPRESENTED BY THE STATE HEALTH DIRECTOR (Hereinafter called the "State") AND z Qrange County Health Department (Local Health Department/District/Public Health Authority -- Hereinafter called the "Department") FOR THE PURPOSE OF MAINTAINING AND PROMOTING THE ADVANCEMENT OF HEALTH IN NORTH CAROLINA This Agreement Shall Cover a Period From July 01, 2001 to June 30, 2002 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.) ~~on5olida[ed AgxF~mFnt - Final A. RESPONSIBILITIES OF THE DEPARTMENT 3 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. Departments 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 administer and enforce all rules that have been adopted by the Commission for Health Services, ratified by the State, or adopted by the Local Board of Health. 4. The Department shall provide to the State copies of 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. 5. The Department shall provide to the State a comprehensive community health assessment every biennium. The community assessment should be a collaborative effort with the local Healthy Carolinians Partnership and shall include a prioritization of community health problems, a narrative of the assessment findings, and a community action plan. 6. The Department shalt provide formal training for their Board of Health (BOH) members through the (ANCBH) Association. of NC Boards of Health. First priority will be given to training newly appointed members with the ultimate goal of having all BOH members trained through these orientation sessions as time and resources allow. Continuing education updates by ANCBH on topics of special interest are strongly encouraged after general board member orientation has been provided for all BOH Members. 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 Health Department Budgets. 3. The Department shall not use personal health program funds to support environmental health personnel 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. Funds for Childhood Lead Poisoning Prevention may be used to support both environmental health and child health activities. 6. The county shall submit monthly reports of On-Site Wastewater activities to the On-Site Wastewater Section in the format provided by the Section. 7. The Department shall comply with Standards for Mandated Public Health Services, 15A NCAC 25, Section .0200; and Administrative Procedures Manual for Federal Block Grant Funds, 1 NCAC 33, Sections .0100 - .1502, ~.l~f14t111lIiTEf.I ACS{'~'~'RI ~'ll~ - '~I I~I.~I 4 8. 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 Medicaid Cost Accountants with detailed labor cost per activity.. 9. The Department participating in Medicaid Reimbursement shall: a. Execute a Provider Participation Agreement with the Division of Medical Assistance. 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. No one shall be refused services solely because of an inability to pay. 10. Subject to the approval of the appropriate Section, a local health department may seek reimbursement for services covered by a program operating under 15A NCAC 24A rules 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. 11. Programs and services supported in whole or in part with federal funds must provide interpreter services at no charge to non-English speaking clients. Only those programs and services funded entirely with state and/or local funds, unless prohibited by State law or rule, may charge non-English speaking clients for interpreter services. No one shall be refused, services solely because of an inability to pay for interpreter services. 12. Subject to the availability of funds and approval of the Public Health Nursing and Professional Development Unit, a local health 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 limited to no more than $400.00 per participant upon successful completion of the course. b.. Nursing service personnel participating .in the Public Health Nurse Supervisors Training Course. Reimbursement is limited to no more than $600.00 per participant upon successful completion of the course. c. Community Health Assistants and Public Health Nurses attending certain pre- approved Continuing Education courses offered by the Public Health Nursing and Professional Development Unit. Reimbursement is limited to $50.00 per participant per event. 13. 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 Controllers Office staff with assistance of the Division of Public Health Program Staff. j ~:onsolidateri Agreement - Final 5 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, Fixed Assets Policy. ii. All equipment with an acquisition cost of $500.00 or more, and purchased with Women, Infants and Children (WIC) Program Funds, must be inventoried with the Women's and Children's Health Section. b. For Prior Approval Purposes i. All equipment purchased or leased with an acquisition cost exceeding $500.00, where there is an option to purchase with State/Federal funds, must receive prior written approval from the appropriate Section. ii. All medical equipment and computer equipment, regardless of cost and all other equipment with an acquisition cost of $500.00 or more, purchased with WIC Program Funds, must receive prior approval from the WIC Program Office. iii. 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.. 15. The Department agrees to execute the following Federal Certifications attached to this agreement 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 C. FISCAL CONTROL 1. The Department shall comply with the Local Govemment Budget and Fiscal Control Act, North Darolina 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 Govemment Commission. b. The Department shall execute written agreements with all parties who invoice the Department for payment for the provision of services to patients. c. When subcontracting, the following conditions must be met: i. The Department is not relieved of any of the duties and responsibilities provided in this agreement. ii. 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. iii. 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. ~7onsulidated Ayie~ement - Firiyl ~ 6 iv. 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: i. 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 ii. The Department proposes to subcontract fifty percent (50%) or more, or $50,000 which ever is greater, of the total state and federal funds made available through this agreement for a single public health service or program. iii. The Department proposes to subcontract for services in the Women, Infants and Children Program. e. The Department shall retain all Funding Authorizations, Local Health Department- .Local Appropriations Budget, revisians, Consolidated Agreement, Agreement Addenda, 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. 2. The Department shall prepare and maintain a Local Appropriatians Budget 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. a. The Department shall prepare budget revisions to their Local Appropriation budgets when appropriations will be increased or decreased. b. The Department shall submit all revisions to Local appropriations budgets prior to the end of the term specified in this agreement. Budget revisions received by the State after the end of the agreement period will be returned without action. 3. Departments having the WIC Program shall limit the total expenditures for July, August, and September (1St quarter of the State/County Fiscal Year) to no mare than one-fourth (1.14) of their total budget for the Agreement Period. If any encumbrances are recorded far July, August or September, to be paid in subsequent months, these expenditures must be accounted 'for in the 25°k limit imposed for July, August and September expenditures. 4. 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. Such revenue shall be used far the activity that generated the revenue, except in the WCH Section programs where there is some flexibility (see "b° below.) b. All earned revenue must be budgeted and spent in the program that earned it except, i Revenue generated by WCH Section Programs may be budgeted and expended in any WCH Section Program activity. ii Revenue generated by a local clinic or program that has no state funded activity budget (no state 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. CunSOli~facecl Agri=munt - Finel 7 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 74. e. When preparing Local Appropriation Budgets, i. Line item 9000 on the program budget form must be~used to budget the total of line items 101, 102 and 103. ii. Line item 102 on the program budget must be used to budget TXIX eamed revenues. iii. Line item 103 on the program budget must be used to budget other eamed revenues. f. When reporting expenditures: Line item 9000 on the Local Expenditure Report must be used to report the total of line items 101, 102, 103. ii. Line item 102 on the Local Expenditure Report must be used to report TXIX eamed revenues that were expended. iii. Line item 103 on the Local Expenditure Report must be used to report other eamed revenues that were expended. g. A local account shall be maintained for unexpended eamed revenues (i.e., TXIX fees, private Insurance or private pay (cash). 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 2001-2002 must equal or exceed the amount of Title XIX revenues eamed during FY 1999-2000. 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. 5. The Department shall submit a monthly report of actual expenditures of the Department according to instructions provided with Local Expenditure Reports, Form 2949 and Form 2950. a. The Department shall submit monthly expenditure reports for all programs to the State within 2D days from the end of the reporting month. Failure to meet the reporting deadline will result in the exclusion of those expenditures in the Steps Out payment far that month. The Department must submit monthly expenditure reports consecutively throughout the agreement period. If expenditure reports are not submitted on a consecutive basis, Steps Out payments cannot be made until the overdue expenditure reports are received. (i.e., A September services expenditure report received prior to October 20 will not be reimbursed unless the July and August services overdue expenditure reports are also received prior to October 20.) b. When reporting program activities that are funded by federal funds, these expenditures must be reported according to the authorized federal funding. This is extremely critical since payment of federal funds cannot~be made prior to their effective date (i.e., program A during the course of a state/county fiscal year is funded from two (2) separate Federal Fiscal Years- 3 months from FFY 01 and 9 months from FFY D2. _ In order to claim reimbursement of these federal funds, 3/12 of the Expenditures must occur and be reported in the 3 months of FFY 01 and 9/12 of the expenditures must occur and be reported in the 9 months of FFY 02. Cansulirlaten AUYeum?n' - °insl 8 c. The Department shall submit the final Expenditure Report for all programs to the State within 20 days after the end of the agreement period. Report is due by July 20. d. The Department shall have up to forty-five (45) days after the end of the agreement period to submit amended or corrected expenditure reports. Any such reports must be prepared for the specific month to be amended or corrected. Reports received after August 15'h will be returned without action. e. The Department shall refund to the State all unexpended State funds within 30 days after notification of overpayment.. When payment is not received by the State within 30 days, future payments to the Department may be reduced by the amount due or payments may be suspended until the refund is received by the State. f. The Department shall submit expenditure reports for Mosquito Control activity in accordance with 15A NCAC 188, Sections .0104 and .0107. g. The Department shall submit requests for payment for services provided under 15A NCAC 24 A rules to the Claims Processing Unit, Purchase of Medical Care Services, DHHS. h. 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. 6. The Department shall submit on an annual basis Staff Time Activity Report, 33$9, Environmental Health Report, 3738, and Food and Lodging Report, 3888. The reports shall accompany the final expenditure report and must be received by the State within 20 . days after the end of the agreement period. D: PERSONNEL POLICIES 1. The Department shall adhere to and fully comply with State personnel policies as found in North Carolina General Statute, Chapter 12f, 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 5alary'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 far 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 Environmental Health. ~;unsoli~ateu Agreement - Find 9 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 15A NCAC Section .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 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 1. The Department shall assure that no person, on the grounds of race, color, age, religion, sex, marital status, immigration status, or national origin (unless otherwise medically indicated) or otherwise qualified handicapped individual solely by reason of his/her handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity covered by this. agreement. 2. The Department shall complete HHS Farm 690, Assurance of Compliance with Title VI of the Civil Rights Act of 1964, Section 504 of~the Rehabilitation Act of 1973; Title IX of the Education Amendments of 1972, and the Age Discrimination Act of 1975. 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, upon request, technical assistance in the preparation of the Consolidated Agreement, Local Health Department -Local Appropriations Activity Budgets and Agreement Addenda. 2. The State shall provide to the Department estimates of Funding Allocations no later than the first week-of March each year to use in preparation of their local budget proposals. 3. The State shall provide an approved signed 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 INCAS) prior to the issuance of the final Funding Authorization. i_onsn! i:.ldteu Ary. C~~m~r:[ F' ii.:+l 10 4. The State shall provide funds to the Department upon receipt of this executed agreement and timely expenditure reports. Payment will be made to the Department according to the DHHS Controllers office Steps Out schedule issued December of each year for the following calendar year. 5. The State shall assist the Department to comply with all applicable laws, regulations, and standards relating to the activities covered in this agreement. 6. 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. 7. The State shall be assured that the Department maintains expenditure of locally appropriated funds (MOE) for maternal health, child health, and family planning program activities equal to, ar 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. This MOE shall be measured by salary equivalencies that are to be maintained in accordance with Section B.8 of this agreement. H. DISBURSEMENT OF FUNDS The State shall disburse funds to the Department as follows: 1. Monthly disbursements for each program activity will be based on monthly expenditures reported (due on the 20`" of each month), and shall be adjusted either upward or downward accordingly.. Reimbursement of approved expenditures for any report month cannot exceed one month's quotient of the total budget for the agreement period. 2. For departments receiving Rural Obstetrical Care Incentive funds, payment of such funds shall be made in one lump sum the month following receipt of the Funding Authorization. 3. Food and lodging fees will be disbursed to the department in one sum the month following receipt of the Funding Authorization. 4. Funds for Childhood LEad Poisoning Prevention will be disbursed once per year. The number of confirmed cases identified in each ccunty will determine the amount. A separate Agreement Addendum must be submitted in order to receive these funds. Funds for training will be disbursed upon request. 5. Subsequent to the notification of a Funding Authorization revision, increases or decreases in monthly payment amounts will be reflected in the month following this occurrence. 6. Payments shall be suspended when expenditure reports are not received by the time specified in C. 5. a. c. Payments will resume the month following the receipt of the delinquent expenditure reports according to the DHHS Controllers office schedule for Steps Out payments issued December of each year for the following calendar year,. 7. Total payment by program activity is limited to the total amount of the Funding Authorization. 8. Final payments will be made based on the Final monthly (June) expenditure report. Final payments will be equal to the difference between approved reported, expenditures and the sum of previous payments. Final payments should be made no later than the Steps Out period per the DHHS Controllers office schedule issued December of each year for the following calendar year, provided that an original signed copy of an expenditure report for ,~.~oranii~late~,i Ary~~wnwi,~ - .~~..~, 11 each month has been received by the DHHS Office of the Controller, and that the Staff Time Activity Report, 3389, Environmental Health Report, 3788, and Food and Lodging, 3888 have been received by the State. Months when Final Expenditure Reports are due may vary depending on the applicable fiscal year of the funding source (i.e., June, or September, or March for example.) AMENDMENT OF AGREEMENT 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 may be 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, (2) all other reasonable administrative remedies have been exhausted. 2. Subrecipient Monitoring -OMB Circular A-133, Audits of States, Local Government, and Non-Profit Organizations, was revised on June 24, 1997 to require that pass-through entities monitor the activities of their subrecipients as necessary to ensure that federal awards are used far authorized purposes in compliance with laws, regulations and the provision of contracts or grant agreements and that performance goals are achieved. DHHS Memorandum, subject: Subrecipient Monitoring, dated November 11, 1998, addresses the charge to OMB Circular A-133 and directs subordinates divisions to develop risk-based Subrecipient Monitoring Plans. ~:Gn5o1 i~fdLe~1 Aya'F~mFric - Ft ud1 12 In Compliance with the above DHHS Memorandum, DPH developed, and DHHS approved, a Subrecipient Monitoring Plan dated January 14, 2000. DPH is defined as a "Pass-through. entity" for the purposes of the Subrecipient Monitoring Plan. Local Health Departments are defined as a "Subrecipient agency" (i.e., not-for-profit or government agency ...receiving Federal funds.) The Department shall participate fully in "Subrecipient Monitoring" by DHHS-DPH should the Department be deemed high risk by nature of its risk assessment (component of the DPH Plan.) 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. 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 SIGNATURES Health Director Finance Officer Chairman of County Commissioners (When required) STATE OF NORTH CAROLINA ~y State Health Director or Authorized Agent Date Date Date Date 13 ASSURANCE OF COMPLIANCE ASSURANCE OF COMPLIANCE WITH 'TITLE VI OF THE CIVIL RIGHTS ACT OF 1964, 5ECTIQN 5q4 OF THE REHABILITATION ACT OF 1973. TITLE IX OF THE EDUCATION AMENDMENTS OF 1972, AND THE AGE DISCRIMINATION ACT OF 1975 The Applicant provides this assurance in consideration of and for the purpose of obtaining Federal grams, loans, contracts, property, discounts or other Federal financial assistance from the Departrnent of Health and Human Services. THE APPLICANT HEREBY AGREES THAT IT WILL COMPLY WITH: 1. Titre VI of the Civil Rights Act of 1964 (Pub. L 88.352), as amended, and all requirements Imposed by ar pursuant to Mte Regulation of The Department of Health and Human Services (45 C.F.R. PaR f!0), to the end that, in accordance with Title VI of that Ad and The Regulation, no person in the United States shah, on the ground of race, color, or natlonal origin. be excuded from participation in, be denied the benefits of, or be otherwise subjeclad to discrimination under any program or activity for which the Applicant receives Federal finandal assistance from the DepaM~erq. 2. Sedton 504 of the Rehabilitation Act of 1973 (Pub. L 93112). as amended. and ati requirements imposed by or pursuant oo the Regulation of the Department of Health and Human Services (45 C.F.R. Part 84), to the end that, in accordance with Secyiorl 504 of that Act end the Regulation. no otherwise qualified handCapped indvidual in the United States shall, solely by reason of his handicap, be exctuded from partiapatkm in, be denied the benefits of, ar t7e subjected tD discrimination under arty Program or activity for which the Applicant receives Federal firtajindal assistance from ttre Depar'trnent. 3. Title IX of the Educational Amendments at 197't (Pub. L 92.318). as amended, and all requirements imposed by or pursuant to tl~e Regulation of the Department of Health and Human Services (45 C.F.R. Part $B), b the end that, in axddarrce with Title IX and the Regulation, no person in the United States shell. On the basis of sex. be exduded from participation in, be died the benefits of, ar be otherwise subjected to discrimination under any education program or activity for whidr the A~IkslrR receives Federal financial assistance from the Department. 4. The Age Discrimination Act of 1975 (Pub. L 94135), as amended, and aY requirements unposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 91-, to ~e end that, in accordance with the Ad and the Regulation, no person in the United States shall. on the basis of age. be denied the benefits of, be excluded from partic>petion in, or be subjected to diacrirnination under any program ar activity for wtdCh the Applicant receives Federal finarrrial from tits Deparbment. The Applicant agrees that compliance with this asstr~rce cor~sbrtutes a condition of corrmnued receipt of Federal finarxtial assistance. and that it is binding upon the Applicant, its successors. transferees and assignees far itre period during whidt such asSi~lCe is provided. If any real Property or structure thereon is provided or improved with ttre aid of Federal financial assistance extended to the Applicant by the Department, this assurance shall obligate the Applicant, or in the case of any transfer of such property, arty transferee. for the period during which the real property or structure is used for a purpose for which the Federal tirrarxtial assistance is extended or for another purpose involving the provision of similar services or benefits. If any personal property is So provided, this assurance shay obligate the Applicant for the period during which it retains ownership dr possession of the property. The Applicant further recognizes and agrees that the United States shall have the right to seek judiaal enforcement of this assurance. The person or persons whose signature(s) appear(s) below islare authorized to sign This assurance. and conlnit the Applirartt to the shave provisions. Date Sir~+ature arrd Title of Authrorized Offidal Name of Applicant or Reapierd City. State. Zip Code Form HHS~690 5/97 r DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH CERTIFICATION REGARDING LOBBYING The undersigned 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 agenry, 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, cantinuatian, 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 W any person far 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. 3. The undersigned shall require that the language of this certification be included in the awazd document for subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) who receive federal funds of S 100,000.00 or more and that all subrecipients shall certify and disclose accordmgly. 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 3l, U:S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than S 10,000.00 and not mare than S 100,000.00 far each such failure. Signature Agency/Organization Title Date (Certification signature should be same as Contract signature.) 14 15 DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS (Note: The phrase "prospective lower tier participant," means providers under coatrect with the Division.) 1. 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 w: ~ entered into. if it is later determined that the prospective lower tier participant knowingly rendered an et:oneous 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 which 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 transactioq" "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 which this proposal is submitted for assistance in obtaining a copy of those regulations. S. The prospective lower tier participant agues 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. 7. A participant in~ a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded:trom covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency of which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List 8. Nothing contained in 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 coveted transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this trattsactioq in addition to other remedies available to the Federal Government, the department or agenry with which this transaction originated may pursue available remedies, including suspension, and/or debarment 16 Certification Regarding Debarment, Suspension, ineligibility and Voluntary Exclusion4Lower Tier Covered Transactions (1) The prospective lower tier participant certifies, by submission of this document, that neither it nor its principals is presently debarred, suspend, proposed for debarment, declared ineligible, nor voluntarily excluded from participation in this transaction by any Federal department or agency. (2) 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. Signature Title Agency/Organization Date (Certification signature should be same as Contract signature.) 17 DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH CERTIF1CATlON REGARDING DRUG-FREE WORKPLACE REQUIREMENTS I. By execution of this Agreement the Contractor certifies that it will provide adrug-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 adrug-free awareness program to inform employees about: (1) The dangers of drug abuse in the workplace; (2) The Contractor's polity 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 far 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; F. 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 agenry; and Making a goad faith effort to continue tomaintain adrug-free workplace through implementation of paragraphs (s~ (b)~ (~~ (d), (e). ~d (~• CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS Page 2 II. The site(s) for the performance of work done in connection with the specific agreement are listed below: (Street address) (City, county, state, zip code) 2. (Street address) (City, county, state, zip code) Contractor will inform the Department of any additional sites far performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment, suspension or termination of grants, ar government-wide Federal suspension or debarment (Section 4 CFR Part 85, Section 85.615 and $b.6x0). EXECUTED BY CONTRACTOR AUTHORIZED OFFICER ADDRESS (Certification signature should be same as Contract signature.) DATE ,:~ 19 DEPARTMENT OF HEALTH AND HUMAN SERVICES D]VISION OF PUBLIC HEALTH CERTIFICATION REGARDllVG ENVIRONMENTAL TOBACCO SMOKE Certification for Contracts, Grants, Loans and Cooperative Agreements Public Law 103-227, Part C-Environmental Tobacco Smoke, also known as the Pro-Children Act of 1994 (Act), requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the provision of health, day care, education, or library services to children under the age of 1$, 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 nvt 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 of alcohol treatrnent. Failure W comply with the provisions of the law may result in the imposition of a civil monetary penahy of up to $1,000.00 per day and/or the imposition of an administrative compliance order on the responsible entity. By signing and submitting this application, 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. Signature Title Agency/Organization Date (Certification signature should be same as Contract signature.)