Childhood Lead Poisoning Prevention Programs Contracts Copyright 2014
City of Dubuque Consent Items # 17.
ITEM TITLE: Childhood Lead Poisoning Prevention Programs Contracts
SUMMARY: City Manager recommending approval of a contract with the Dubuque
County Board of Health and the Iowa Department of Public Health for
continued funding of the Childhood Lead Poisoning Prevention Program, a
renewed agreement with the Visiting Nurse Association for services
related to the Childhood Lead Poisoning Prevention Program and Health
Homes Program, and an agreement with the Iowa Department of Public
Health for data sharing.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve
ATTACHMENTS:
Description Type
❑ Childhood Lead Poisoning Prevention Programs-MVM Memo City Manager Memo
❑ Memo Staff Memo
❑ IDPH Childhood Lead Poisoning Prevention Program Contract Supporting Documentation
❑ Lead Subcontract with County Board of Health Supporting Documentation
❑ Lead Subcontract with VNA Supporting Documentation
❑ Data Sharing Agreement Supporting Documentation
THE CITY OF Dubuque
UBE I
erica .i
Masterpiece on the Mississippi 2007-2012-2013
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Iowa Department of Public Health Childhood Lead Poisoning and Healthy
Homes Funding and Agreement with the Visiting Nurse Association and
the Dubuque County Board of Health and Data Sharing Agreement with
the Iowa Department of Public Health
DATE: August 11, 2015
Public Health Specialist Mary Rose Corrigan recommends City Council approval of a
contract with the Dubuque County Board of Health and the Iowa Department of Public
Health for continued funding of the Childhood Lead Poisoning Prevention Program, a
renewed agreement with the Visiting Nurse Association for services related to the
Childhood Lead Poisoning Prevention Program and Health Homes Program, and an
agreement with the Iowa Department of Public Health for data sharing. The contract is
for $6,454, the same as last year.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Mic ael C. Van Milligen
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Teri Goodmann, Assistant City Manager
Mary Rose Corrigan, Public Health Specialist
THE CITY OF Dubuque
DUB E 1114mericaCi i
1111.
Masterpiece on the Mississippi 2007-2012-2013
TO: Mike Van Milligen, City Manager
FROM: Mary Rose Corrigan, Public Health Specialist
SUBJECT: Iowa Department of Public Health (IDPH) Childhood Lead Poisoning and
Healthy Homes Funding and Agreement with the Visiting Nurse Association
(VNA) and the Dubuque County Board of Health and Data Sharing
Agreement with IDPH
DATE: August 11, 2015
INTRODUCTION
This memorandum provides information regarding a contract with the Dubuque County
Board of Health and the Iowa Department of Public Health (IDPH) for continued funding of
the Childhood Lead Poisoning Prevention Program (CLPPP), a renewed agreement with
the VNA for services related to the CLPPP and Healthy Homes Program, and an
agreement with the IDPH for data sharing.
BACKGROUND
In February 1994, the City Council approved a grant agreement authorizing the Health
and Housing Services Departments to contract with the Iowa Department of Public Health
for environmental follow-up and medical case management for children with lead
poisoning according to the Iowa Department of Public Health guidelines. The original
funding contract has been renewed annually. The latest contract ended June 30, 2015.
DISCUSSION
The Iowa Department of Public Health contracts with local Boards of Health for distribution
of their funds. This allows local Boards of Health to monitor public health funding, avoid
duplication of services and assure community health needs are addressed (see attached
contract.)
The subcontracted funds will allow the Health and Housing Services Departments to
provide additional follow-up of lead poisoned children through contracted nursing services
provided by the Dubuque Visiting Nurse Association, education for employees, and
monies to do outreach and education in targeted neighborhoods regarding lead poisoning
and healthy homes activities.
1
The contract also includes updated program performance standards, which we currently
strive to achieve through our existing protocols and outreach programs. The grant funds
will be reimbursed based on the specific activities outlined in the budget.
Also included is a Data Sharing Agreement with the IDPH that will allow the city access to
blood lead level surveillance data. This will allow the City to use the data for evaluation,
education, and grant writing purposes along with GIS application. The agreement has
been reviewed by Chris Kohlmann, Information Services Manager and Nikki
Breitsprecker, GIS Coordinator/Analyst.
BUDGETIMPACT
The FY16 budget anticipated funding of$6,000. The contract is for $6,454, the same as
FY15. The sub-agreement with the VNA will be paid utilizing funds from the IDPH grant.
RECOMMENDATION
It is recommended that the City Manager sign the attached subcontract with the Dubuque
County Board of Health, agreement with the Dubuque Visiting Nurse Association on
behalf of the City of Dubuque, and the IDPH Data Sharing Agreement.
MRC/cj
cc: Alvin Nash, Housing Services Manager
2
Iowa Department of Public Health
• IDPH Promoting and Protecting the Health of Iowans
Gerd W. Clabaugh, MPA Terry E. Branstad Kim Reynolds
Director Governor Lt. Governor
CONTRACT#: 5886LP03 PROJECT PERIOD: July 1, 2015-June 30, 2016
PROJECT TITLE: Childhood Lead Poisoning Prevention CONTRACT PERIOD: July 1, 2015-June 30, 2016
Program
FUNDING SOURCE OF IDPH: CONTRACT AMOUNT: $6454
FEDERAL: $0
STATE: $6454 STATE OF IOWA DEPT. OF ADMINISTRATIVE
OTHER:$0 SERVICES VENDOR#: 00002128749
FEDERAL CATALOG#: NA CONTRACTOR Name and Address:
Dubuque County Board of Health
MATCH REQUIRED: YES❑ NO❑ NAF-1 720 Central Ave.
Dubuque, IA 52002
FFATA REPORT REQUIRED YES❑ NO❑
CONTRACT ADMINISTRATOR:
Name: Patrice Lambert
Email: patrice.lambengdubuquecounty.us
IOWA CODE CHAPTER 8F DESIGNATION:
F-1This contract is covered by Iowa Code chapter 8F DESIGNATED AGENCY Name and Address:
Dubuque County Health Department
13047 City View Drive
❑ This contract is NOT covered by Iowa Code chapter 8F Dubuque, IA 52002
❑ At the time of execution, this contract is NOT covered Phone: 563-557-7396
by Iowa Code chapter 817, but if the Contractor executes Fax 563-587-3899
additional contracts with the Department, the aggregate of
which exceed$ 500,000,the contract may be covered
The Contractor agrees to perform the work and to provide the services described in the Special conditions for the
consideration stated herein. The duties, rights and obligations of the parties to this contract shall be governed by the
Contract Documents, which include the Special Conditions, General Conditions,Request for Proposal and Application.
The Contractor has reviewed and agrees to the General Conditions effective May 1, 2014 as posted on the Department's
Web site under Funding Opportunities: www.idphstate.ia.us or as available by contacting Kevin Officer at(515)242-
5902. The contractor specifies no changes have been made to the Special Conditions or General Conditions.
The parties hereto have executed this contract on the day and year last specified below.
For and on behalf of the Department: For and on behalf of the Contractor:
By: By
Ken Sharp,Director Dubuque County Board of Health Chair
Division of ADPER&EH
Lucas State Office Building, 321 E. 12th Street, Des Moines, IA 50319-0075 ■ 515-281-7689 ■ w Jdph.state.ia.us
DEAF RELAY(Hearing or Speech Impaired) 711 or 1-800-735-2942
SPECIAL CONDITIONS FOR CONTRACT#5886LP03
ARTICLE I—IDENTIFICATION OF PARTIES
Dubuque County Board of Health(hereinafter referred to as the CONTRACTOR)has demonstrated through
application to the DEPARTMENT that it is prepared to provide the activities and authority outlined per Iowa
Administrative Code(IAC)641 Chapter 72. The CONTRACTOR has designated Dubuque County Health
Department(hereinafter referred to as the DESIGNATED AGENCY),to carry out the activities as required in IAC
641-72.2(3) and described in this contract.
The address of the DESIGNATED AGENCY is: 13047 City View Drive,Dubuque, IA 52002
ARTICLE II—IDENTIFICATION OF AUTHORIZED STATE OFFICIAL:
Ken Sharp,Director,Division of Acute Disease Prevention,Emergency Response,&Environmental Health,is
the Authorized State Official for this contract. Any changes in the terms,conditions,or amounts specified in
this contract must be approved by the Authorized State Official. Negotiations concerning this contract should
be referred to Kevin Officer, Community Health Consultant, at kevin.officerAidyh.iowa.¢ov or 515-242-
5902.
ARTICLE III—DESIGNATION OF AUTHORITY,CONTRACT ADMINISTRATOR,AND KEY
PERSONNEL
The CONTRACTOR,as listed on the contract face sheet,is responsible for financial and administrative
matters of this contract.
The CONTRACTOR has designated the Contract Administrator listed on the contract face sheet the
authority to manage the contract,to assure compliance with all conditions,and to negotiate matters
concerning this project. The Contract Administrator will receive key communications from the
DEPARTMENT and will be responsible for keeping the CONTRACTOR and all authorized agencies
informed.
In addition to the CONTRACTOR and the Contract Administrator,additional individuals(s)as listed below
shall be considered key personnel and may sign claims.
Table A:
Name Title
Patrice Lambert Agency Director
Patrice Lambert Program Administrator
Bonnie Brime er Finance Manager
Laura Hankes Data Entry Clerk
Michelle Zurcher Nurse
Rose Corrigan,Ben Pothoff, Certified Elevated Blood Lead(EBL)Inspector/Risk Assessor
ARTICLE IV—STATEMENT OF CONTRACT PURPOSE
The purpose of this contract is to provide funds for the CONTRACTOR to ensure that childhood lead
poisoning prevention activities are conducted as specified in this contract and in compliance IAC 641
Chapter 72.
ARTICLE V-DEFINITIONS
DEFINITIONS
"Blood lead testing"means taking a capillary or venous sample of blood and sending it to a laboratory to
determine the level of lead in the blood.
"Capillary"means a blood sample taken from the finger or heel for lead analysis.
"Care coordination"means the process of linking the service system to the recipient and/or family,and
coordination of the various elements in order to achieve a successful outcome.
"CDC"means the Centers for Disease Control and Prevention.
"Certified elevated blood lead(EBL) inspection agency"means an agency that has met the requirements of
641-70.5(135)and that has been certified by the department.
"Certified elevated blood lead(EBL) inspector/risk assessor"means a person who has met the requirements
of 641-70.5(135)for certification or interim certification and who has been certified by the department.
"Chelation"means the administration of medication that binds lead so that it can be removed from the
body.
"Child health contractor"means an agency that has a contract with the Iowa Department of Public
Health for the Title V Child Health program.
"Childhood Lead Poisoning Prevention Program(CLPPP)service area"means the geographic area for
which the CLPPP has agreed to provide CLPPP services.
"Community partnership"means a collaborative relationship between entities to address healthy homes
issues and lead poisoning prevention in the CLPPP service area.
"Complete medical evaluation"means a history,physical examination,and testing for iron status as
described in Chapter 7 of Preventing Lead Poisoning in Young Children,CDC,October 1991.
"Data management"means all actions taken by the CONTRACTOR to manage blood lead data and case
management data. This includes,but is not limited to,documenting all case management actions such as
contact with the family or provider,EBL inspection,lead hazard remediation,home nursing or outreach
visits,nutrition evaluations,and developmental assessments in the Healthy Homes and Lead Poisoning
Surveillance System(HI LPSS)database,and providing all HHLPSS reports required by this contract.
"Developmental testing"means testing done by the local Early Access Program or Area Education
Agency to determine whether a child is developmentally delayed.
"Education and outreach"means seeking out and providing information regarding childhood lead
poisoning and healthy homes to members of populations who are at high risk for lead poisoning and those
who work for agencies that provide service to these high-risk populations;members of the general public,
including homeowners,landlords,Realtors,and members of community organizations,and health
professionals and para-professionals,including physicians,nurses,and laboratory technicians.
`Elevated blood lead(EBL) child"means any child who has had one venous blood lead level greater than or
equal to 20 micrograms per deciliter(µg/&)or at least two venous blood lead levels of 15 to 19 µg/&.
`Elevated blood lead(EBL) inspection"means an inspection to determine the sources of lead exposure for
an elevated blood lead(EBL)child and the provision within ten working days of a written report
explaining the results of the investigation to the owner and occupant of the residential dwelling or child-
occupied facility being inspected and to the parents of the elevated blood lead(EBL)child.
"Elevated blood lead(EBL) inspection agency"means an agency that employs or contracts with
individuals who perform elevated blood lead(EBL)inspections. Elevated blood lead(EBL)inspection
agencies may also employ or contract with individuals who perform other lead-based paint activities.
"Environmental case management"means providing elevated blood lead(EBL)inspections in all
dwellings associated with an EBL child and assuring that lead hazards identified at these dwellings.
"Follow-up blood lead testing"means blood lead testing that is conducted after a child has had at least
one capillary or venous blood lead level greater than or equal to 10 µg/&.
"HHLPSS"means the Healthy Homes and Lead Poisoning Surveillance System web based case
management program.
"Healthy homes planning"means assessing housing issues other than lead in the community, developing a
network of service providers that could assist with housing issues other than lead, and participating in a
state or local healthy homes and lead poisoning prevention program advisory group or coalition.
"Home nursing or outreach visit"means a home visit conducted by a nurse or social worker to provide
information to the caregiver of a lead-poisoned child regarding the health effects of lead poisoning,the
importance of good housekeeping and nutrition,and the importance of follow-up blood lead testing and to
assess the overall situation of the child and family to determine whether the child and/or family should be
referred for additional services.
"Laboratory"means a laboratory certified to perform either waived or non-waived blood lead analysis
according to the federal Clinical Laboratory Improvement Act of 1988(CLIA).
"Lead-based paint hazard"means hazardous lead-based paint,a dust-lead hazard, or a soil-lead hazard as
defined in 641—Chapter 70.
"Lead hazard remediation"means the control of lead hazards identified in the EBL inspection through
interim controls,renovation and remodeling,or lead abatement
"Local board of health"means a county,district,or city board of health.
`Medical case management"means all services necessary to evaluate the health and development of a child
with a blood lead level greater than or equal to 10 µg/dL and to treat any conditions identified in the
evaluation. Medical case management includes,but it not limited to,follow-up blood lead testing,medical
evaluation,home nursing or outreach visits,chelation,nutrition evaluation,developmental assessment,and
care coordination.
`Nutrition evaluation"means an evaluation conducted by a dietician to determine whether a child is
receiving a well-balanced and age-appropriate diet,with particular attention to the child intake of Vitamin C,
iron, and calcium.
"Quarterly narrative report"means a report of the contractor's healthy homes and childhood lead
poisoning prevention activities for the quarter that is developed according to guidelines provided by the
department and is provided to the department by the deadlines given in Article VII.
"Referral"means to direct the family of a lead-poisoned to a service for the family or the child and to
follow-up to assure that the family actually received the service.
"Venous"means a blood sample taken from a vein in the arm for lead analysis.
ARTICLE VI—DESCRIPTION OF WORK AND SERVICES
The CONTRACTOR shall ensure that childhood lead poisoning prevention services are conducted as
specified in this contract
CLPPP SERVICE AREA
The CLPPP service area is Dubuque County.
PROGRAM SERVICES
The CONTRACTOR shall ensure that the DESIGNATED AGENCY implements all of the program
services as described below, and as necessary,within the CLPPP service area. The program services
are medical case management(home nursing visits,referrals for nutrition counseling,and referrals for
developmental testing),environmental case management inspections for lead-poisoned children,
contacting property owners to determine if lead hazard remediation is completed,conducting
inspections to determine if lead hazard remediation is complete,and performing clearance testing to
assure that lead hazard remediation has been completed in a safe manner, and data management. The
CONTRACTOR shall ensure that the DESIGNATED AGENCY develops written protocols to
describe how each of these services will be provided. Templates provided by the DEPARTMENT
may be used to develop these protocols.
Reimbursable services also include the following activities; initial elevated blood lead(EBL)inspector/risk
assessor certification,and refresher elevated blood lead(EBL)inspector/risk assessor certification.
BLOOD LEAD TESTING
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
1. Implements the CHILDHOOD LEAD POISONING PREVENTIONPROGRAM CASE
MANAGEMENT PROTOCOLS(March 2015)within the CLPPP service area.
2. Conducts blood lead testing or ensures that medical providers conduct blood lead testing according to
this plan.
3. Provides a written notice of the results of blood lead testing to the caregivers of all children tested by
the DESIGNATED AGENCY. The written notice shall include information regarding the meaning
of the blood lead test result and the date when the child should be tested again.
4. Provides a written notice of the results of blood lead testing to the caregivers of all children in the
CLPPP service area who have blood lead levels greater than or equal to 10 µg/dl,,regardless of who
did the testing. The written notice shall include information regarding the meaning of the blood lead
test result,actions that the parents can take to reduce the child's blood lead level, and the date when
the child should be tested again. This may be waived if the CLPPP collaborates with health care
providers that provide this information to the parents. The CONTRACTOR shall ensure that the
DESIGNATED AGENCY notifies the DEPARTMENT of such agreements in writing.
DATA MANAGEMENT
The CONTRACTOR shall ensure:
1. The DESIGNATED AGENCY conducts data management as specified in this contract.
2. All case management actions taken by the DESIGNATED AGENCY and CLPPP subcontractors are
documented in the HHLPSS database. At a minimum, case management activities include contacts
made with the family or medical provider,EBL inspections, lead hazard remediations,home nursing
or outreach visits,nutrition evaluations, and developmental assessments
3. All reports specified in ARTICLE VII—REPORTS are provided by the deadlines given in this
contract.
4. Blood lead data collected by the DESIGNATED AGENCY, medical providers, clinics and labs
within your jurisdiction are reported to the DEPARTMENT. Blood lead data shall be reported to
the DEPARTMENT on a weekly basis and according to the reporting guidelines (Appendix I).
5. The DEPARTMENT is notified immediately of HHLPSS database errors and missing records.
6. All requests for CLPPP data needed to support the local CLPPP and fulfill the requirements of this
contract are submitted to the DEPARTMENT in a timely manner using the Lead Data Request form
(Appendix 11).
7. Records and data are managed according to the following:
A. Data Use. All records and data provided by this contract shall be used only for purposes as set
forth in the contract. The CONTRACTOR shall not use or permit others to use the records and
data in any way except for the purposes outlined in this contract.
B. Data Storage. All records and data received pursuant to this contract shall be stored in a secure
locked area with access restricted to project personnel for purposes only as set forth in section I
of this Contract. The data will be stored in compliance with the standards of. CONTRACTOR
shall comply with Department and State information technology standards.
➢ Data Backup Standard: Applicable to Entities which utilize data systems to process, store,
transmit or monitor information.
➢ Data Stewardship Standard: Applicable to Entities which utilize data systems to process,
store,transmit or monitor information.
➢ Interconnectivity Standard: Applicable to Entities which utilize data systems to process,
store,transmit or monitor information.
➢ Laptop Data Protection Standard: Applicable to Entities which utilize laptops to process,
store,transmit or monitor data.
➢ Removable Storage Encryption Standard: Applicable to Entities which utilize removable
storage devices to process, store, transmit or monitor information. Current state information
technology standards are accessible online at https://ocio.iowa.gov/standards.
C. Confidentiality. CONTRACTOR shall maintain the confidentiality of all confidential records
and data released pursuant to this Contract. CONTRACTOR shall not disclose any confidential
information contained in these records or data, including but not limited to names and other
identifying information of persons who are the subject of such records, either during the period
of this Contract or hereafter. All identifiable and personal indicators shall be kept strictly
confidential and shall not be used or released for any purpose.
CONTRACTOR shall not use the information from the records or data to establish contact with
the named person or his/her family without prior written approval from IDPH.
CONTRACTOR shall immediately report to IDPH any unauthorized disclosure of confidential
information. Such disclosure shall be grounds for immediate termination of this Contract.
D. Ownership. Records and data provided by IDPH to CONTRACTOR, and any files related by
linking these data files, pursuant to this Contract shall remain the property of the IDPH at all
times.
E. Re-release. CONTRACTOR may not re-release data provided by this contract without
expressed written permission from IDPH. Data provided by this contract is for use solely within
CONTRACTOR only for the purposes outlined in this contract.
F. Aggregate Data Publication. The CONTRACTOR agrees to provide a copy of all proposed
publications to IDPH at least thirty(30) days in advance of the proposed dissemination date.
The publication shall not be published in any format without the prior written consent of IDPH.
Any publication of aggregate data shall comply with IDPH confidentiality guidelines, including
IDPH Policy for Release of Confidential Public Health Records.
➢ If the CONTRACTOR is associated with an Iowa regent institution,the CONTRACTOR
agrees to comply with the conditions regarding publications and presentation contained in
Section 8(b)`T"of the General Conditions for Contracts with State Universities, effective
May 1, 2014.
➢ If CONTRACTOR is not associated with an Iowa regent institution, CONTRACTOR
agrees to provide a copy of the proposed publication to IDPH at least thirty(30) days in
advance of the proposed dissemination date. The publication shall not be published in any
format without the prior written consent of IDPH.
G. Data Linkage. CONTRACTOR may not link the data provided by this contract to any other
dataset without express written permission from IDPH.
The DEPARTMENT agrees to:
1. Provide the CONTRACTOR with a timeframe for submitting data or reports requested through the
Lead Data Request form.
2. Respond to CONTRACTOR requests for data needed to support the identification of children and
properties associated with blood lead levels greater than or equal to 5 micrograms per deciliter in a
reasonable timeframe.
ENVIRONMENTAL CASE MANAGEMENT
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
1. Maintains certification of individual inspectors as elevated blood lead(EBL)inspector/risk
assessors and agency certification as an elevated blood lead level(EBL)inspection agency. The
CONTRACTOR or DESIGNATED AGENCY and the certified individuals shall comply with the
provisions of Iowa Administrative Code 641-70.6(3).
2. Enrolls as a Medicaid provider for EBL inspection services,recovers reimbursement from Medicaid
for EBL inspections,and uses the reimbursement as program income.
3. Conducts elevated blood lead(EBL)inspections for any child under the age of six years who has
had one venous blood lead level greater than or equal to 20 µg/dL or at least two venous blood lead
levels of 15 to 19µg/&. EBL inspections shall be conducted for all addresses associated with the
child and for all addresses that the child moves to after the case is initially reported until the child
has had one blood lead level less than 10 µg/dL or three blood lead levels less than 15
µg/&. EBL inspections shall be conducted within the following times:
A. Two venous blood lead levels of 15 to 19µg/dL–within 4 weeks after the report.
➢ Venous blood lead level of 20 to 44µg/dL–within 2 weeks after the report.
➢ Venous blood lead level of 45 to 69µg/dL–within 1 week after the report.
➢ Venous blood lead level greater than or equal to 70 µg/dL – within 2 days after the
report.
4. Documents in BIII,PSS the reason why the DESIGNATED AGENCY was unable to complete
any inspection required by this contract.
5. Contacts the occupants and/or owners of dwellings where lead hazards have been identified
within 30 days of the initial inspection to check their progress towards making the dwelling lead-
safe.
6. Contacts the current owners of all dwellings where lead hazards were identified,but lead hazard
remediation has not been completed,at least once each year,until lead hazard remediation is
completed.
7. Continues follow up on all of these dwellings until lead hazard remediation is completed,
regardless of whether the dwellings are owner-occupied or rental and regardless of changes in
ownership.
8. Does not close an address associated with a lead-poisoned child where lead hazards have been
identified unless the lead hazard remediation has been completed or written permission has been
obtained in advance from the DEPARTMENT to close the address even though lead hazard
remediation has not been completed.
9. To the extent possible,assists families who have lead-poisoned children in locating resources for
lead hazard remediation and/or alternative housing.
10. Conducts clearance testing according to Iowa Administrative Code Chapter 641 70,Lead
Professional Certification,before verifying that lead hazard remediation has been completed in a
home associated with a lead-poisoned child.
The CONTRACTOR must adopt and enforce a local code that requires hazards to be repaired in the
homes of elevated blood lead(EBL)children. A model code is available at Iowa Administrative Code
641Chapter 68. CONTRACTORS may adopt this model code by reference.
Local regulations must be as protective as Iowa Administrative Code 641—Chapter 68. Local regulations
that were previously adopted must be updated to reflect safe dust lead levels and other items that have
changed since the local regulations were adopted.
MEDICAL CASE MANAGEMENT
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
1. Conducts medical case management as specified in this contract.
2. Is enrolled as a Medicaid provider for services that can be reimbursed by Medicaid,recovers
reimbursement from Medicaid for medical case management services,and uses the reimbursement
as program income.
Follow-un blood lead testing
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
1. Assures that providers in the CLPPP service area that conduct blood lead testing provide follow-
up blood lead testing for children under the age of six years within the timelines listed below. The
DESIGNATED AGENCY may also provide this follow-up blood lead testing.
A. Confirmatory venous blood lead testing
➢ Capillary blood lead level of 15 to 19 µg/dl,—within 4 weeks after the report.
➢ Capillary blood lead level of 20 to 44 µg/dl,—within 1 week after the report.
➢ Capillary blood lead level of 45 to 69 µg/dl,—within 48 hours after the report.
➢ Capillary blood lead level greater than or equal to 70 µg/dl,—immediately.
B. Follow-up testing after an elevated blood lead level for a child who has not been chelated
➢ Capillary or venous blood lead level of 10 to 14 µg/dl, — within 3 months. After two
levels less than 10 µg/dl, or three levels less than 15 µg/dl,, testing should follow the
routine testing schedule for high-risk children.
➢ Venous blood lead level of 15 to 19µg/dl,—within 3 months.
➢ Venous blood lead level of 20 to 44µg/dl,—within 4 to 6 weeks.
➢ Venous blood lead level greater than or equal to 45 µg/dl,—immediately.
C. Follow-up testing for a child who has been chelated
➢ At the end of chelation.
➢ Depending on the blood lead level,7 to 21 days after the end of chelation. The results of
this test will determine the need for additional chelation and the schedule for additional
blood lead testing.
Medical evaluations
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
1. Assures that providers in the CLPPP conduct medical evaluations for children under the age of six
years within the following timelines:
A. Venous blood lead level of 20 to 44 µg/dl,—Refer within 48 hours after the report so that the
service is received within 5 days.
B. Venous blood lead level of 45 to 69µg/dl,—Refer within 24 hours after the report so that the
service is received within 48 hours.
C. Venous blood lead level greater than or equal to 70 µg/dl,—Refer for emergency medical
evaluation.
Home nursing or outreach visits
The CONTRACTOR shall ensure that the DESIGNATED AGENCY provides home nursing or outreach
visits for children under the age of six years according to the following timelines:
1. Venous blood lead level of 15 to 19 µg/dl,—within 4 weeks after the report.
2. Venous blood lead level of 20 to 44 µg/dl,—within 2 weeks after the report.
3. Venous blood lead level of 45 to 69µg/dl,—within 1 week after the report.
4. Venous blood lead level greater than or equal to 70 µg/dl, — within 2 days after the report.
Ch el ati un
The CONTRACTOR shall ensure that the DESIGNATED AGENCY
1. Assures that children with two venous blood lead levels greater than or equal to 45 µg/dl,receive
chelation.
Nutrition Evaluation
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
1. Assures that children under the age of six years with a venous blood lead level greater than or equal
to 15 µg/dl,receive a nutrition evaluation according to the following timelines:
A. Venous blood lead level of 15 to 19 µg/dl,—Refer within 4 weeks after the report so that the
service is received within 6 weeks.
B. Venous blood lead level of 20 to 44 µg/dl,—Refer within 2 weeks after the report so that the
service is received within 4 weeks.
C. Venous blood lead level of 45 to 69 µg/dl,—Refer within 1 week after the report so that the
service is received within 2 weeks.
D. Venous blood lead level greater than or equal to 70 µg/dl,—Refer within 2 days after the report
so that the service is received with 1 week.
2. Contacts the DEPARTMENT for assistance if access to a dietitian cannot be assured for children
under the age of six years with a venous blood lead level greater than or equal to 15 µg/dl,.
Developmental Assessment
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
1. Assures that children under the age of six years with a venous blood lead level greater than or equal
to 20 µg/dl,receive a developmental assessment according to the following timelines:
A. Venous blood lead level of 20 to 44µg/dl,—Refer within 2 weeks after the report.
B. Venous blood lead level of 45 to 69µg/dl,—Refer within 1 week after the report
C. Venous blood lead level greater than or equal to 70 µg/dl,—Refer within 2 days after the report.
Care Coordination
The CONTRACTOR shall ensure that the DESIGNATED AGENCY provides care coordination or refers
the family to the local child health contractor for this service.
Medical Case Closure Guidelines
Medical cases shall be closed only in the following circumstances:
1. A child has had two consecutive blood lead levels less than 10 µg/dl,or three consecutive blood lead
levels less than 15 µg/dl,after the initial elevated blood lead level.
2. A child has had a capillary false positive blood lead level;that is a capillary or venous blood lead
level less than 10 µg/dl,immediately after a single capillary blood lead level greater than or equal to
15 µg/dl,.
3. A child has reached the age of six years and has a blood lead level less than 20 µg/&.
4. A child has moved out of the CLPPP service area. The CONTRACTOR shall ensure that the
DESIGNATED AGENCY immediately notifies IDPH.
CHILDREN OVER THE AGE OF SIX YEARS
The CONTRACTOR shall ensure that the DESIGNATED AGENCY contacts the department for specific
case management guidelines for a child over the age of six years who has a venous blood lead level
greater than or equal to 20 µg/&.
ARTICLE VII—REPORTS
The CONTRACTOR shall ensure that the DESIGNATED AGENCY prepares and submits the following
reports to the DEPARTMENT on forms and/or in the format approved by the DEPARTMENT:
Report Number Date Due
Claim Voucher 1 electronic Within 45 days of month of expenditure
HHLPSS Documentation to 1 electronic Within 45 days of month of expenditure
Support Expenditure Report
Quarterly Narrative Report 4 reports submitted through Submit with October claim
IowaGrants.gov Submit with January claim
Submit with April claim
Submit with July claim
Claim vouchers and quarterly narrative reports shall be filed via IowaGrants.gov. HHLPSS
documentation to support claim vouchers shall be uploaded to IowaGrants.gov Contract Document
component.
ARTICLE VIII—BUDGET
1. The total approved budget for this contract period is detailed in Exhibit 1. All services except for
initial EBL inspector certification and EBL inspector refresher training will be reimbursed at unit
cost rates specified in Exhibit 1,up to the contract award amount
2. Initial EBL inspector certification and EBL inspector refresher training will be reimbursed at actual
cost,up to the maximum amount shown in Exhibit 1 for each item. The Department will not
reimburse travel amounts in excess of limits established by Iowa Department of Administrative
Services: Instate maximum allowable amounts for food is $8.00/breakfast; $12.00/lunch;and
$23.00/dinner;lodging maximum of$83.00,plus taxes per night;and mileage maximum of$0.39 per
mile.
ARTICLE IX—PAYMENTS
1. Warrants will be made payable to the CONTRACTOR and mailed to the Contract Administrator at
the DESIGNATED AGENCY address. Warrants may be sent to an alternate address if requested
in writing from the CONTRACTOR.
2. Payments shall be made to the CONTRACTOR based on the claim vouchers submitted to the
DEPARTMENT by the DESIGNATED AGENCY.
3. Final payment may be withheld until all contractually required reports have been received and
accepted by the DEPARTMENT. At the end of the contract period,unobligated contract amount
funds shall revert to the DEPARTMENT.
ARTICLE X—ADDITIONAL CONDITIONS
1. Funds may not be spent for indirect costs, chelation or other medical treatment of lead poisoning, or
lead hazard remediation. Funds may not be spent for blood lead analyses that could be reimbursed
by Medicaid.
2. On January 1, 2016,April 1, 2016,and June 1, 2016,the DEPARTMENT may amend the contract to
revert funds that are estimated to be unused to the DEPARTMENT and to reallocate the funds to
contractors with demonstrated special needs for healthy homes and childhood lead poisoning
prevention services.
3. Payments may be withheld if the DESIGNATED AGENCY or personnel employed by the
DESIGNATED AGENCY are not in compliance with Iowa Administrative Code Chapter 641 70,
Lead Professional Certification.
4. The CONTRACTOR and/or DESIGNATED AGENCY must check IowaGrants.gov correspondences
at least once each week for lead poisoning prevention updates sent out by the DEPARTMENT.
5. XRF analyzers that were originally purchased,in part or in whole,with Iowa Department of Public
Health grant funds,are to be shared with other elevated blood lead(EBL)inspector/risk assessors
that have a contract with the Childhood Lead Poisoning Prevention program. This sharing is to be at
no cost other than their travel to pick up and deliver the machine. Programs are strongly encouraged
to also share the XRF analyzers with government and private,non-profit housing agencies that
employ appropriately certified inspector/risk assessors. Any fees received for sharing the machine
with government and private,non-profit housing agencies are considered program income that shall
be returned to the lead program and used to enhance lead program efforts.
6. The CONTRACTOR shall comply with Section 5 of the General Conditions for all subcontracts.
7. As a condition of the contract,the CONTRACTOR shall ensure that the DESIGNATED AGENCY
provides linkage with the local board of health in each county where services are provided. The
DESIGNATED AGENCY will ensure that the local board of health has been actively engaged in
planning for and evaluation of services. It will also maintain effective linkages with the local board
of health,including timely and effective communications and ongoing collaboration.
8. All work plan revisions must be approved by the DEPARTMENT prior to implementation.
9. Authorization-Each signatory to this contract or subsequent contract amendments represents and
warrants to the other parties that:
A. The signatory has the right,power, and authority to enter into this agreement and to bind the
party represented by the signatory to this agreement.
B. The party has the right,power,and authority to perform its obligations under the agreement;
and
C. The party has taken all requisite action(corporate,statutory,or otherwise)to approve execution,
delivery, and performance of this agreement and this agreement constitutes a legal,valid,and
binding obligation upon itself in accordance with its terms.
EXHIBIT 1 --EXPENDITURE REPORT FOR THE MONTH OF
CONTRACTOR:Dubuque County Board of Health CONTRACT:5886LP03 CONTRACT PERIOD:July 1,2015 to June 30,2016 Vendor Code:00002128749
Program Services-Unit Cost Reimbursement Line Number Reimbursement for Number Completed Reimbursement Balance
Description Budgeted Rate Completed for
Month Month to Date to Date
Non-Medicaid Home Nursing Visits 80 $ $ $
Refefrals for Nutrition Counseling 10 $ $ $
Refefrals for Developmental Testing 10 $ $ $
Non-Medicaid Initial Inspection Events 600 $ $ $
EBL Investigation CONTC Events 10 $ $ $
Completed Lead Hazard Remediations 10 $ $ $
EBL Investigation INSAB,INSAL INSAE Events 80 $ $ $
EBL Investigation Properties Passing Clearance Testing 300 $ $ $
Narrative Quarterly Report Submitted on Time 25 $ $ $
XRF Source Replacement 2000 $ $ $
Non-Medicaid Blood Lead Sample Collection 3 $ $ $
Child CONTC or ACTIO event 10 $ $ $
Education and Outreach,Community Partnerships,and 50 $ $ $
Healthy Homes Planning Hours
Non-Medicaid Blood Lead Analysis 18 $ $ $
Program Services-Cost Reimbursement Line Reimbursable Reimbursement
Description Expenses for
Month to Date
Initial EBL Inspector Certification Initial EBL
Inspector
Certification
Not to exceed$3,000 per certification Not to exceed
$3,000 per
certification
Reimbursement for Mouth $0.00
Total Budget-Program Services $0.00
APPENDIX I
Mandatory Reporting of
Blood Lead Level Results
APPENDIX I
Mandatory Reporting of Blood Lead Level Results
Iowa Administrative Code Sec. 641-1.6(3) states that for blood lead testing, "...analytical
results shall be reported to the department at least weekly in an electronic format specified by the
department."
We suggest you use the Lead Care Reporting Software available through Magellan, the company
which manufactures the LeadCareII machine. Here is a link to download the Lead Care
Reporting software (if clicking on the link doesn't work,just copy and paste into your browser):
htty://www.leadcare2.com/Product-Support/Reporting-Solutions
Also included in the link are some instructions on using the software developed by Magellan,
and the specifications for reporting for the State of Iowa. If you need additional help, IDPH can
connect you with other LeadCare II user locations.
Here are the pieces of information that are required for each result reported:
Name Date of Sample
Date of Birth Sample Type(Capillary or Venous)
Street Address or PO Box Numerical result
City Lab Name
State Provider Name and
Zip Facility Name
Race
Ethnicity
Sex
(This information is required by the Lead Poisoning Prevention Program at the federal Centers
for Disease Control.)
Critical things to keep in mind:
1) Iowa Code requires weekly reporting of all blood lead tests.
2) You must inform us immediately via phone call at 1-800-972-2026 or by fax at 1-515-
281-4529 of any test results at 20 or above. (These more critical levels require that our
staff or local public health staff follow up with the child's family and/or care provider in
a timely manner.)
3) Reporting must be done electronically in a format specified by the Department. We
currently accept three specified formats: HL7 (the standard reporting format used by
healthcare information systems),the XML format produced by the LeadCareII Software
manufactured by Magellan, Inc., and the Excel spreadsheet attached to your weekly
reminder.
4) Reporting must be done via a secure e-mail channel using the State of Iowa's Secure
Mail system. What follows is a set of instructions on using this system.
Sending Blood Lead Level Results via the State of Iowa's Secure Mail system
You will be receiving a scheduled message on Monday of each week as a reminder to report
your lead tests. The message will contain the image below and prompt you to click on a
hyperlink to read the message.
You have received a secure email from the State of Iowa.
1. When you click on the hyperlink, you will be taken to a login page where you will be
required to create an new account—THIS IS A ONE-TIME PROCESS
2. You will be guided step-by-step through this process; CAREFULLY READ THE
INSTRUCTIONS
NOTE: for additional details on Iowa.gov SecureMail, see the user guide at:
http://das.ite.iowa.aov/docs/infrastructure/External User Guide to Secure Email
System.pdf
3. DOCUMENT AND SAVE YOUR SecureMail CREDENTIALS FOR FUTURE USE
4. Login to your Iowa.gov SecureMail account
5. Open the newly received SecureMail message with "IDPH Lead Reporting" in the
subject line
Reporters that use the LeadCare*H software to create a reporting file
• just need to reply to the SecureMail message and
• attach the reporting file to the reply by clicking on the `Attach' button near the top of
the message window
• click the `Send' button to send the message
Reporters that use an Excel template for reporting:
• Stop using all previous reporting templates and spreadsheets
• When you access the SecureMail message, please open the attachment located at the
bottom of the screen and save this to a location with which you are familiar (Desktop
on your computer or afamiliar network location)—Ifyou are a laboratory that
currently submits an Excel template you should have received an example of this
template in a previous email from IDPH.
• Open the NEW TEMPLATE and enter your lead reporting information
• Save the template
• Attach the reporting file to the reply by clicking on the `Attach' button near the top of
the message window
• Click the `Send' button to send the message
Appendix II
Lead Data Request Form
LEAD DATA REQUEST
Date of request: Date required:
CONTACT INFORMATION:
Name:
Program:
e-mail:
Phone number:
SERVICE REQUEST:
Service Type:
Format of Data
Purpose :
Access to Data
Data Requested:
Submit completed form to Rob Walker at: Robert.Walker@IDPH.lowa.gov
THANK YOU: Your request will be processed in the order it was received.
SUBCONTRACT FOR HEALTHY HOMES AND CHILDHOOD LEAD POISONING
PREVENTION SERVICES
BETWEEN
DUBUQUE COUNTY BOARD OF HEALTH
AND
THE CITY OF DUBUQUE
WHEREAS, the Dubuque County Board of Health (County Board), as
Contractor, has entered into an Agreement (the Agreement) wit the Iowa Department of
Public Health to perform childhood lead poisoning prevention services as set forth in
the Agreement (Contract # 5883LP03), a copy of which is attached hereto; and
WHEREAS, County Board desires to enter into a subcontract with the City of
Dubuque (City) to perform the services required by the Agreement and City desires to
provide such services through its Health Services Department.
NOW, THERFORE, IT IS AGREED BY AND BETWEEN THE PARTIES AS
FOLLOWS:
1. City shall perform all of the services required of the Contractor in the
Agreement.
2. County Board shall pay City for its services in the same manner as County
Board as Contractor will be paid for its services under the Agreement.
Signed and dated the day of , 2015.
Richard Fairley, MD, Chair Michael C. Van Milligen
Dubuque County Board of Health City Manager
SUBCONTRACT
BETWEEN
THE CITY OF DUBUQUE, IOWA,
AND
THE DUBUQUE VISITING NURSE ASSOCIATION
FOR THE
HEALTHY HOMES AND CHILDHOOD LEAD POISONING PREVENTION PROGRAM
This Subcontract between the City of Dubuque, Iowa and The Visiting Nurse
Association is dated for reference purposes the 1st day of July, 2015.
Whereas, Dubuque County, Iowa (Contractor) has entered into Contract 5883LP03
with the Iowa Department of Public Health for Public Health (the Department) forthe Healthy
Homes (HH) and Childhood Lead Poisoning Prevention Program (CLPPP) (the Contract), a
copy of which is attached hereto, pursuant to which Contractor will provide the work and
services described in the Contract in accordance with the Special Conditions therein, and the
General Conditions, a copy of which is attached hereto; and
Whereas, the City of Dubuque, Iowa (City) is the Contract Administrator of the
Contracts; and
Whereas, it is necessary for City to subcontract for certain work and services; and
Whereas, City now desires to enter into this Subcontract with the Visiting Nurse
Association (VNA) to provide the work and services described herein upon the terms and
conditions set forth herein.
NOW, THEREFORE, IT IS AGREED BY AND BETWEEN CITY AND VNA AS
FOLLOWS:
SECTION 1. WORK AND SERVICES. City and VNA agree to provide the following work
and services (the Work and Services):
1.1. City's Responsibilities. City agrees that it will provide the following services forthe HH
& CLPPP:
(1) Submit reports/vouchers and other reporting requirements as required by the
Iowa Department of Public Health (IDPH), the Centers for Disease Control and
Prevention (CDC), and the Department of Housing and Urban Development (HUD).
(2) Provide for environmental investigations and environmental case management
for lead abatement\lead hazard reduction and healthy homes interventions in housing
units in the city of Dubuque, Iowa, and Dubuque County.
(3) Provide compensation to the VNA during the term of this Agreement not to
exceed $4,000 for the performances of VNA's responsibilities as set forth herein.
(4) Oversee and direct medical case management and educational/outreach
activities through verbal and written direction.
1.2. VNA's Responsibilities. VNA agrees to provide the following services for HH &
CLPPP during the term of this Agreement for the agreed compensation:
(1) Provide written quarterly reports on lead and healthy homes activities utilizing
the Iowa Quarterly Report Narrative Outline.
(2) Provide electronic documentation of medical case management and related
activities into City's lead and healthy homes database systems, HHLPSS, and
of educational activities performed for each month by the 10th of the following
month.
(3)
Provide for blood lead testing, medical case management, data management,
and community education as referenced in the attached IDPH contract
#5886LP03, dated July 1, 2015 -June 30, 2016.
SECTION 2. CONTRACT POLICIES AND REQUIREMENTS. In providing the Work and
Services, VNA agrees to comply with the requirements in the Contract, including the Special
Conditions, and the General Conditions, to the extent applicable to the Work and Services
described in Section 1.
SECTION 3. ACCESS TO BOOKS AND RECORDS. VNA to provide access, upon
reasonable notice, for the purpose of audit and examination, to its documents, papers, and
records, to the extent such documents, papers, and records are related to the Work and
Services, to the Department, Contractor, City, or any of their duly authorized representatives.
SECTION 4. COSTS TO BE REIMBURSED. Attached hereto is a line item CLLLP
Performance Measure budget of specific costs to be reimbursed under this Subcontract or
other cost basis for determining the amount of the Subcontract. The Healthy Homes activities
will be invoiced to the City for VNA staff time plus benefits at 32%.
SECTION 5. INCORPORATION OF THE CONTRACT. VNA agrees that all of the
provisions of the Contract, including audit requirements, are incorporated herein by this
reference and VNA shall have all of the same requirements, obligations and conditions as
Contractor with respect to VNA's Work and Services.
SECTION 6. PERIOD OF PERFORMANCE. Unless terminated as provided herein, the
Period of Performance for the Work and Services shall be from the the 1st day of July 2015,
through the 30th day of June, 2016.
SECTION 7. TERMINATION. Either party may terminate this Subcontract for any reason,
with or without cause, upon ten (10) days written notice to the other party. In the event of
termination, City shall compensate VNA for its Work and Services rendered through the date
of termination.
SECTION 8 INDEMNIFICATION.
(1) VNA agrees to defend, indemnify, and hold Department, City and Contractor,
and their officers, and employees harmless from and against any and all claims of any
kind arising out of or related to VNA's negligence in the performance of the Work and
Services pursuant to this Subcontract.
(2) City agrees to defend, indemnify, and hold VNA and its officers, and
employees harmless from and against any and all claims of any kind arising out of or
related to City's negligence in the performance of the Work and Services pursuant to
this Subcontract.
SECTION 9. INSURANCE. VNA shall at its expense maintain insurance with the same
coverage which Contractor is required to maintain under Par. 13 of the General Conditions.
CITY OF DUBUQUE, IOWA
By:
Michael C. Van Milligen
City Manager
VISITING NURSE ASSOCIATION
By:
Stacey Killian
Administrative Director
City of Dubuque Insurance Requirements for Professional Services
Insurance Schedule C
1. shall furnish a signed Certificate of Insurance to the City of Dubuque, Iowa for the
coverage required in Exhibit I prior to commencing work and at the end of the project if the term of work is
longer than 60 days. Providers presenting annual certificates shall present a Certificate at the end of each
project with the final billing. Each Certificate shall be prepared on the most current ACORD form approved
by the Iowa Department of Insurance or an equivalent. Each certificate shall include a statement under
Description of Operations as to why issued. Eg: Project# or Lease of premises at or
construction of
2. All policies of insurance required hereunder shall be with a carrier authorized to do business in Iowa
and all carriers shall have a rating of A or better in the current A.M. Best's Rating Guide.
3. Each Certificate shall be furnished to the contracting department of the City of Dubuque.
4. Failure to provide minimum coverage shall not be deemed a waiver of these requirements by the City
of Dubuque. Failure to obtain or maintain the required insurance shall be considered a material breach of
this agreement.
5. Subcontractors and sub subcontractor performing work or service shall provide a Certificate of
Insurance in accord with Exhibit 1.
6. All required endorsements to various policies shall be attached to Certificate of insurance.
7. Whenever a specific ISO form is listed,an equivalent form may be substituted subject to the
provider identifying and listing in writing all deviations and exclusions that differ from the ISO form.
8. Provider shall be required to carry the minimum coverage/limits,or greater if required by law or
other legal agreement, in Exhibit 1.
9. Whenever an ISO form is referenced the current edition of the form must be used.
City of Dubuque Insurance Requirements for Professional Services
Insurance Schedule C (continued)
Exhibit I
A) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit $2,000,000
Products-Completed Operations Aggregate Limit $1,000,000
Personal and Advertising Injury Limit $1,000,000
Each Occurrence $1,000,000
Fire Damage Limit(any one occurrence) $ 50,000
Medical Payments $ 5,000
a) Coverage shall be written on an occurrence, not claims made,form. All deviations from
the standard ISO commercial general liability form CG 0001, or Business owners form BP
0002,shall be clearly identified.
b) Include ISO endorsement form CG 25 04"Designated Location(s)General Aggregate Limit"
or CG 25 03 "Designated Construction Project(s)General Aggregate Limit"as appropriate.
c) Include endorsement indicating that coverage is primary and non-contributory.
d) Include endorsement to preserve Governmental Immunity. (Sample attached).
e) Include an endorsement that deletes any fellow employee exclusion.
f) Include additional insured endorsement for:
The City of Dubuque, including all its elected and appointed officials,all its employees
and volunteers, all its boards, commissions and/or authorities and their board members,
employees and volunteers. Use ISO form CG 2026.
B) AUTOMOBILE LIABILITY $1,000,000 (Combined Single Limit)
C) WORKERS'COMPENSATION& EMPLOYERS LIABILITY
Statutory benefits covering all employees injured on the job by accident or disease as prescribed by
Iowa Code Chapter 85 as amended.
Coverage A Statutory—State of Iowa
Coverage B Employers Liability
Each Accident $100,000
Each Employee-Disease $100,000
Policy Limit-Disease $500,000
Policy shall include an endorsement providing a waiver of subrogation to the City of Dubuque.
Coverage B limits shall be greater if required by Umbrella Carrier.
D) UMBRELLA LIABILITY $1,000,000
Umbrella liability coverage must beat least following form with the underlying policies included
herein.
E) PROFESSIONAL LIABILITY $1,000,000
Page 2 of 3 Schedule C, Professional Services April, 2013.Doc
City of Dubuque Insurance Requirements for Professional Services
Preservation of Governmental Immunities Endorsement
1. Nonwaiver of Governmental Immunity.The insurance carrier expressly agrees and states that the purchase
of this policy and the including of the City of Dubuque, Iowa as an Additional Insured does not waive any of the
defenses of governmental immunity available to the City of Dubuque, Iowa under Code of Iowa Section 670.4 as
it is now exists and as it may be amended from time to time.
2. Claims Coverage.The insurance carrier further agrees that this policy of insurance shall cover only those
claims not subject to the defense of governmental immunity under the Code of Iowa Section
670.4 as it now exists and as it may be amended from time to time.Those claims not subject to
Code of Iowa Section 670.4 shall be covered by the terms and conditions of this insurance policy.
3. Assertion of Government Immunity.The City of Dubuque, Iowa shall be responsible for asserting any
defense of governmental immunity,and may do so at any time and shall do so upon the timely written request of
the insurance carrier.
4. Non-Denial of Coverage.The insurance carrier shall not deny coverage under this policy and the insurance
carrier shall not deny any of the rights and benefits accruing to the City of Dubuque, Iowa under this policy for
reasons of governmental immunity unless and until a court of competent jurisdiction has ruled in favor of the
defense(s)of governmental immunity asserted by the City of Dubuque, Iowa.
No Other Change in Policy.The above preservation of governmental immunities shall not otherwise change or
alter the coverage available under the policy.
SPECIMEN
Preservation of Governmental Immunities Endorsement
1. Nonwaiver of Governmental Immunity. The insurance carrier expressly agrees and states
that the purchase of this policy and the including of the City of Dubuque, Iowa as an
Additional Insured does not waive any of the defenses of governmental immunity
available to the City of Dubuque, Iowa under Code of Iowa Section 670.4 as it is now
exists and as it may be amended from time to time.
2. Claims Coverage. The insurance carrier further agrees that this policy of insurance
shall cover only those claims not subject to the defense of governmental immunity under
the Code of Iowa Section 670.4 as it now exists and as it may be amended from time to
time. Those claims not subject to Code of Iowa Section 670.4 shall be covered by the
terms and conditions of this insurance policy.
3. Assertion of Government Immunity. The City of Dubuque, Iowa shall be responsible for
asserting any defense of governmental immunity, and may do so at any time and shall do
so upon the timely written request of the insurance carrier.
4. Non-Denial of Coverage. The insurance carrier shall not deny coverage under this policy
and the insurance carrier shall not deny any of the rights and benefits accruing to the
City of Dubuque, Iowa under this policy for reasons of governmental immunity unless and
until a court of competent jurisdiction has ruled in favor of the defense (s) of
governmental immunity asserted by the City of Dubuque, Iowa.
No Other Change in Policy. The above preservation of governmental immunities shall not
otherwise change or alter the coverage available under the policy.
SPECIMEN
AGREEMENT NUMBER: 588DSA061502
DATA SHARING AGREEMENT
BETWEEN
IOWA DEPARTMENT OF PUBLIC HEALTH
AND
CITY OF DUBUQUE, HEALTH SERVICES DEPARTMENT
This Data Sharing Agreement is between the Iowa Department of Public Health (IDPH)
and the CITY OF DUBUQUE, HEALTH SERVICES DEPARTMENT.
I. Purpose. The IDPH supports activities that benefit the health and well-being of
Iowans. IDPH routinely conducts surveillance of blood lead testing. Blood lead test
results are stored in the Healthy Homes and Lead Poisoning Surveillance System
(HHLPSS).The Health Services Department of the City of Dubuque requests lead
data from HHLPSS for its residents. The City of Dubuque requests the data on a
quarterly basis.The purpose of the request is to geo-code the lead data in order to
demonstrate needs and planning for lead poisoning prevention and lead hazard
reduction programs.
II. Legal Authority. IDPH coordinates the childhood lead poisoning prevention
program for the state of Iowa (per Iowa Code 135.105). IDPH is authorized to
disclose public health records to local public health agencies as necessary to
perform their duties (641 IAC 175.10 (2)(e), 1.17(3)(b)). Confidential information
transferred to other agencies shall maintain its confidential status and shall not be
rereleased by the receiving entity (IAC 641-175.10 (2)(e)).
III. Term. The term of this Agreement shall be from the June 1, 2015, until May 31,
2020, unless terminated early in accordance with section VI, letter I.
IV. Duties of the Parties.
A. Duties of IDPH. The Bureau of Environmental Services Lead Poisoning
Prevention Program conducts childhood blood lead level surveillance, data
management and maintenance of HHLPSS. IDPH agrees to supply City of
Dubuque with blood lead data for their residents.
07/01/2014 Iowa Department of Public Health
B. Duties of CITY OF DUBUQUE
1. Use. All records and data provided by this agreement shall be
used only for public health purposes as set forth in the agreement.
The CITY OF DUBUQUE shall not use or permit others to use the
records and data in any way except for the purposes outlined in this
agreement.
ii. Storage. All records and data received pursuant to this Agreement
shall be stored in a secure locked area with access restricted to
project personnel for purposes only as set forth in section 1 of this
Agreement. The records will be stored in compliance with the
standards of Security Rules for IDPH Data. CITY OF DUBUQUE
shall comply with Department and State information technology
standards.
(1) Data Backup Standard: Applicable to Entities which
utilize data systems to process, store, transmit or monitor
information.
(2) Data Stewardship Standard: Applicable to Entities which
utilize data systems to process, store, transmit or monitor
information.
(3) Interconnectivity Standard: Applicable to Entities which
utilize data systems to process, store, transmit or monitor
information.
(4) Laptop Data Protection Standard: Applicable to Entities
which utilize laptops to process, store, transmit or monitor data.
(5) Removable Storage Encryption Standard: Applicable to
Entities which utilize removable storage devices to process, store,
transmit or monitor information.
Current state information technology standards are accessible
online at http://das.ite.iowa.gov/standards/enterprise it/index.html.
Confidentiality. CITY OF DUBUQUE shall maintain the
confidentiality of all confidential records and data released pursuant
to this Agreement. CITY OF DUBUQUE shall not disclose any
confidential information contained in these records or data,
including but not limited to names and other identifying information
of persons who are the subject of such records, either during the
period of this Agreement or hereafter. All identifiable and personal
07/01/2014 Iowa Department of Public Health
3
indicators shall be kept strictly confidential and shall not be used or
released for any purpose.
CITY OF DUBUQUE shall not use the information from the records
or data to establish contact with the named person or his/her family
without prior written approval from IDPH.
CITY OF DUBUQUE shall immediately report to IDPH any
unauthorized disclosure of confidential information. Such
disclosure shall be grounds for immediate termination of this
Agreement.
iv. Destruction. The CITY OF DUBUQUE shall destroy all data
received from IDPH and any files created by linking these data files
at the termination of the project or in any case within two years of
execution of this agreement, unless need for further retention is
explained in the project description and approved in writing by
IDPH through addendum to this Agreement.. Destruction shall be
by means which render IDPH data and any files created by linking
the data files, unidentifiable and useless. The CITY OF DUBUQUE
shall provide notification to IDPH of the destruction of the records
by completing and returning the Confirmation of Destruction form.
v. Fees. The CITY OF DUBUQUE shall reimburse IDPH in
accordance with the attached fee schedule in Appendix B. The fee
per certificate copy or index search may change, as Iowa law
requires that fees be collected sufficient to cover the actual cost of
providing the certificates.
vi. Future Requests. All future data requests relative to the described
project shall make reference to the above agreement number.
vii. Modifications. If during the process of implementing this project
there is a modification to the project or if the project is terminated,
notice shall be sent to the IDPH explaining the modifications or
stating date of termination. CITY OF DUBUQUE shall not modify
the use of the IDPH records or data from that contained in section I
of this agreement without prior written approval from IDPH.
viii. Ownership. Records and data provided by IDPH to CITY OF
DUBUQUE, and any files related by linking these data files,
pursuant to this Agreement shall remain the property of the IDPH at
all times.
ix. Re-release. The CITY OF DUBUQUE may not re-release data
provided by this agreement without expressed written permission
07/01/2014 Iowa Department of Public Health
4
from IDPH. Data provided by this agreement is for use solely within
CITY OF DUBUQUE only for the purposes outlined in this
agreement.
x. Aggregate Data Publication. The CITY OF DUBUQUE agrees to
provide a copy of all proposed publications to IDPH at least thirty
(30) days in advance of the proposed dissemination date. The
publication shall not be published in any format without the prior
written consent of IDPH. Any publication of aggregate data shall
comply with IDPH confidentiality guidelines, including IDPH Policy
for Release of Confidential Public Health Records.
a) If the CITY OF DUBUQUE is associated with an Iowa regent
institution, the CITY OF DUBUQUE agrees to comply with
the conditions regarding publications and presentation
contained in Section 8(b) "1" of the General Conditions for
Contracts with State Universities, effective May 1, 2014.
b) If the CITY OF DUBUQUE is not associated with an Iowa
regent institution, the CITY OF DUBUQUE agrees to provide
a copy of the proposed publication to IDPH at least thirty
(30) days in advance of the proposed dissemination date.
The publication shall not be published in any format without
the prior written consent of IDPH.
xi. Data Linkage. The CITY OF DUBUQUE may not link the data
provided by this agreement to any other dataset without express
written permission from IDPH.
V. Indemnification. The CITY OF DUBUQUE agrees to indemnify and hold
harmless the State of Iowa and IDPH, its officers, employees and agents
appointed and elected and volunteers from any and all costs, expenses,
losses, claims, damages, liabilities, settlements and judgments, including
reasonable value of the time spent by the Attorney General's Office, and the
costs and expenses and reasonable attorneys' fees of other counsel required
to defend the State of Iowa or IDPH related to or arising from:
• Any breach of this agreement;
• Any negligent, intentional or wrongful act or omission of the CITY OF
DUBUQUE or agent or subcontractor utilized or employed by the CITY
OF DUBUQUE
• The CITY OF DUBUQUE's performance or attempted performance of
this Agreement, including any agent or subcontractor utilized or
employed by the CITY OF DUBUQUE;
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• Any infringement of any copyright, trademark, patent, trade dress, or
other intellectual property right; or
• Any failure by the CITY OF DUBUQUE to adhere to the confidentiality
provisions or this Agreement.
VI. Agreement Administration
A. Amendments. This Agreement may be amended in writing from time to time
by mutual consent of the parties. All amendments to this Agreement must be
in writing and fully executed by the parties.
B. Third -Party Beneficiaries. There are no third party beneficiaries to this
Agreement. This Contract is intended only to benefit the State, IDPH, and the
CITY OF DUBUQUE.
C. Integration. This Agreement represents the entire agreement between the
parties. The parties shall not rely on any representation that may have been
made which is not included in this Agreement.
D. Headings or Captions. The paragraph headings or captions used in this
Agreement are for identification purposes only and do not limit or construe the
contents of the paragraphs.
E. Supersedes Former Contracts or Agreements. This Contract supersedes
all prior Contracts or Agreements between the CITY OF DUBUQUE and IDPH
governing the use and transfer of the records and data which are the subject
of this Agreement.
F. Notice. Any and all notices, designations, consents, offers, acceptances or
any other communication provided for herein shall be given in writing by
registered or certified mail, return receipt requested, by receipted hand
delivery, by Federal Express, courier or other similar and reliable carrier
which shall be addressed to each party as set forth as follows:
If to the Agency: Iowa Department of Public Health
Bureau of Environmental Health Services
Carmily Stone, MPH
Bureau Chief
321 E. 12th Street
Des Moines, IA 50309
If to CITY OF DUBUQUE:
Mary Rose Corrigan
City Hall Annex
1300 Main St
Dubuque, IA 52001
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Each such notice shall be deemed to have been provided:
1. At the time it is actually received; or,
2. Within one day in the case of overnight hand delivery, courier or
services such as Federal Express with guaranteed next day delivery;
or,
3. Within five (5) days after it is deposited the U.S. Mail in the case of
registered U.S. Mail
From time to time, the parties may change the name and address of a party
designated to receive notice. Such change of the designated person shall be
in writing to the other party and as provided herein.
G. Severability. If any provision of this Agreement is determined by a court of
competent jurisdiction to be invalid or unenforceable, such determination shall
not affect the validity or enforceability of any other part or provision of this
Agreement.
H. Authorization. Each party to this Agreement represents and warrants to the
other parties that:
• It has the right, power and authority to enter into and perform its
obligations under this Agreement.
• It has taken all requisite action (corporate, statutory or otherwise) to
approve execution, delivery and performance of this Agreement, and this
Agreement constitutes a legal, valid and binding obligation upon itself in
accordance with its terms.
I. Termination. Either party may terminate this agreement upon thirty days
written notice to the other party. The unauthorized disclosure of confidential
information shall be grounds for immediate termination of this Agreement.
J. Successors in Interest. All the terms, provisions, and conditions of the
Agreement shall be binding upon and inure to the benefit of the parties hereto
and their respective successors, assigns and legal representatives.
V. Execution
IN WITNESS WHEREOF, in consideration of the mutual covenants set forth above and
for other goods and valuable consideration, the receipt, adequacy and legal sufficiency
of which are hereby acknowledged, the parties have entered into the above Agreement
and have causedteir duly authorized representatives to execute this Agreement.
For Recipient (Signature)
Date
Iowa Department of Public Health (Signature) Date
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Appendix A: Datasets, date range, and variables requested from each dataset.
Dataset: Healthy Homes and Lead Poisoning Surveillance System (HHLPSS)
Date Range: 2002 — 2014; 2015-2020 data on a quarterly basis.
Variables:
- Longitude
- Latitude
- Test Year
- Blood Lead Category
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