VNA Agree IDPH Lead PoisoningMEMORANDUM
June 9,2003
TO:
FROM:
SUBJECT:
The Honorable Mayor and City Council Members
Michael C. Van Milligen, City Manager
iowa Department of Public Health (IDPH) Childhood Lead Poisoning
Funding and Agreement with the Visiting Nurse Association (VNA)
The Iowa Department of Public Health has applied for ongoing funds with the Centers
for Disease Control and Prevention (CDC) to distribute to local childhood lead poisoning
prevention programs. The funds are distributed throughout childhood lead poisoning
prevention programs in the State based on numbers of children in a community and the
incidence of lead poisoning.
The 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, training for employees, and monies to do outreach
and education in targeted neighborhoods.
Public Health Specialist Mary Rose Corrigan recommends City Council approval of the
contract with the Iowa Department of Public Health for continued funding of the
Childhood Lead Poisoning Prevention Program and a renewed agreement with the
Dubuque Visiting Nurse Association for services related to the Childhood Lead
Poisoning Prevention Program.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Michael C. Van Milligen
MCVM/jh
Attachment
cc: Barry Lindahl, Corporation Counsel
Cindy Steinhauser, Assistant City Manager
Mary Rose Corrigan, RN, Public Health Specialist
~ MEMORANDUM
TO: Michael C. Van Milligen,
FROM: Mary Rose Corrigan,~,~\Y' '*"'"Public Health Specialist
CITY OF DUBUQUE, IOWA
June 9,2003
SUBJECT: Iowa Department of Public Health (IDPH) Childhood Lead Poisoning
Funding and Agreement with the Visiting Nurse Association (VNA)
INTRODUCTION
This memorandum provides information regarding a contract with the Iowa Department
of Public Health for continued funding of the Childhood Lead Poisoning Prevention
Program (CLPPP) and a renewed agreement with the VNA for services related to the
CLPPP.
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 ends June
30, 2003.
DISCUSSION
Since that time, the Iowa Department of Public Health has applied for ongoing funds
with the Centers for Disease Control and Prevention (CDC) to distribute to local
childhood lead poisoning prevention programs. The funds are distributed throughout
childhood lead poisoning prevention programs in the State based on numbers of
children in a community and the incidence of lead poisoning.
The 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, training for employees, and
monies to do outreach and education in targeted neighborhoods.
The contract also includes program performance standards, which we currently stdve to
achieve through our existing protocols and outreach programs. The grant funds will be
reimbursed based on the spedfic activities outlined in the budget.
In cooperation with the VNA and the IDPH, we have agreed to conduct environmental
investigations on lead poisoned children residing in Dubuque County. We currently do
data management on children in Dubuque County. The VNA provides medical case
management for lead poisoned children in the County.
BUDGET IMPACT
The FY 04 budget anticipated funding of $20,106, and is shown in the lead activity of
the Health Services Department. However, due to the Centers for Disease and
Prevention (CDC) budget cuts, the contract has been reduced to $18,970.
RECOMMENDATION
It is recommended that the City Council authorize the Mayor to sign the attached
resolution authorizing the City Manager to sign the contract with the Iowa Department
of Public Health and the agreement with the Dubuque Visiting Nurse Association on
behalf of the City of Dubuque.
COUNCIL ACTION
Approve the attached resolution authorizing the City Manager or his designee to sign
the contract with the Iowa Department of Public Health and the agreement with the
Dubuque Visiting Nurse Association.
MRC/cj
cc: David Hards, Housing Services Manager
Kathaleen Lamb, Senior Housing Inspector
Kathy Ripple, VNA, Administrative Director
RESOLUTION NO. 199-03
A RESOLUTION AUTHORIZING THE CITY MANAGER OR HI8 DESIGNEE TO
SIGN A CONTRACT WITH TIlE IOWA DEPARTI¥1ENT OF PUBLIC HEALTH AND
AN AGREEMENT WITH THE DUBUQUE VISITING NURSE ASSOCIATION,
Whereas, the City of Dubuque has established such a local childhood lead
poisoning prevention program; and
Whereas, the Iowa Department of Public Health has offered to provide financial
SU '''
pport for act~wt~es relating to the local childhood lead poisoning prevention program in
the City of Dubuque; and
Whereas, the City of Dubuque witl provide environmental and medical case
management of identified lead poisoned children in addition to community outreach and
education on the problem of childhood lead po'son~ng.
Whereas, the City of Dubuque must provide medical case management for all lead
poisoned children in the city, and provide community outreach and education; and
Whereas, the City of Dubuque will enter into an agreement with the Dubuque
Visiting Nurse Association to provide medical case management of lead poisoned children
and conduct community outreach and education for the citizens of Dubuque.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
DUBUQUE, iOWA:
Section 't. That the City of Dubuque, iowa hereby approves the attached contract
between the Iowa Department of Public Health and the City of Dubuque, Iowa.
Section 2. That the attached Memorandum of Understanding by and between the
City of Dubuque, Iowa and the Dubuque Visiting Nurse Association is hereby approved.
Section 3. That the City Manager or his designee is hereby authorized and directed
to execute said contract and agreement on behalf of the City of Dubuque, Iowa.
Passed, approved and adopted this 16th day of June ,2003.
Terrance M. Duggan, Mayor
Attest:
Jeanne F. Schneider ·
City Clerk
/terrance M. D~
HL
AGREEMENT BETWEEN THE CITY OF DUBUQUE, IOWA,
AND THE VISITING NURSE ASSOCIATION
FOR THE CHILDHOOD LEAD POISONING PREVENTION PROGRAM (CLPPP)
Now on this 1st day of July 2003, it is agreed by and between the City of Dubuque, Iowa,
(City) and the Dubuque Visiting Nurse Association (VNA) as follow:
TERM. The term of this Agreement shall be from the 1st day of July 2003, through
the 30th day of June 2004.
CITY'S RESPONSIBILITIES. City agrees that it will provide the following services
for the CLPPP:
Submit quarterly reports and other reporting requirements as requested to
the Iowa Department of Public Health (IDPH) and the Centers for Disease
Control and Prevention. (CDC).
Provide for environmental investigations and environmental case
management for lead abatement\lead hazard reduction in housing units in
the city of Dubuque, Iowa, and Dubuque County.
Provide compensation to the VNA during the term of this Agreement not to
exceed $14,000.00 for the performances of VNA's responsibilities as set
forth herein.
Oversee and direct medical case management activities through verbal and
written direction.
VNA'S RESPONSIBILITIES. VNA agrees to provide the following services for
CLPPP during the term of this Agreement for the agreed compensation:
Provide written quarterly reports on lead-related activities utilizing the Iowa
Quarterly Report Narrative Outline.
Provide computer documentation of medical case management and related
activities into City's lead database system, STELLAR.
Provide blood lead screening and medical case management for follow-up
testing for children in the city of Dubuque following the recommendations of
the IDPH and the City of Dubuque Health Services Department.
Assist City with providing public education, lead coalition development and
activities, and outreach to the City of Dubuque residents about childhood
lead poisoning.
Conduct home visits as needed to families\residents in order to provide
medical case management services.
1
Provide education and medical case management of children with
confirmed blood lead levels greater than or equal to 15 pg\dL. Medical
case management includes:
· assurance that children are being screened\retested for lead and
case managed according to Iowa Department of Public Health
requirements;
assurance that children and parents receive nutritional counseling
and educational materials;
educate parents and families about major sources of lead and how to
prevent poisoning;
· assistance in interpreting blood lead levels;
refer all children with confirmed blood lead levels greater to or equal
to 20 IJg\dL to Keystone Area Education Agency for appropriate
developmental testing, evaluation and assessment; and
provide information about lead testing and follow-up, available
services, and resources for lead- poisoned children.
Provide information about lead poisoning and available services to local
pediatric health care providers.
Participate with City in securing additional funding for childhood lead
poisoning prevention activities.
Provide monthly work activity reports and invoices to the City Health
Services Department outlining services performed, by the 7th day of the
month following the previous month.
10.
Work towards achieving the program performance standards in conjunction
with the City's CLPPP, as outlined in the City's IDPH contract, Exhibit III.
D. INSURANCE. VNA agrees to provide insurance as set forth in the attached
Insurance Schedule.
E. INDEMNIFICATION. City agrees to save, defend, indemnify and hold harmless
VNA from and against any and all claims which may be made against VNA arising out of
this Agreement which are the result of the sole negligence of City, its officers, agents or
employees. VNA agrees to defend, hold harmless and indemnify City from and against
any and all claims which may be made against City arising out of this Agreement which
are the sole negligence of VNA, its officers, employees or agents.
F. TERMINATION. Either party may terminate this Agreement by giving sixty (60)
days written notice to the other party.
CITY OF DUBUQUE, IOWA
BY:
Michael C. Van Milligen
City Manager
VISITING NURSE ASSOCIATION
BY:
Kathy Ripple
Administrative Director
INSURANCE SCHEDULE
1. Any policy of insurance or certificate of insurance required hereunder shall be with
a carrier authorized to do business in Iowa and a carrier that has received a rating of A or
better in the current Best's Rating Guide.
2. The City of Dubuque shall be named as an additional insured in any insurance
policy required bY this Schedule, and any policy of insurance required hereunder shall
provide for a thirty-day notice to the City of any material change or cancellation of the
policy prior to its expiration date.
3. VNA shall have its insurance agent or company certify in writing that any policy of
insurance required herein with an aggregate limit of liability has not been reduced by
paid or reserved claims at the time of issuance of policy or certificate.
4. VNA shall furnish copies of the following policies to the City with limits not less
than the following, or greater if required by law, and shall also furnish certificates of
insurance from all independent contractors or subcontractors hired by VNA or any
independent contractor or subcontractor hired by the independent contractor or
subcontractor, which certificates shall provide evidence of coverage for the following with
limits not less than the following, or greater if required by law:
COMMERCIAL GENERAL LIABILITY:
General Aggregate Limit
Products-Completed Operation Aggregate Limit
Personal and Advertising Injury Limit
Each Occurrence Limit
OR
Combined Single Limit
Medical Payments
$2,000,000
$2,OOO,OOO
$1,000,000
$1,000,000
$2,000,000
5,000
Coverage is to include: occurrence form, premises/operations/products/competed
operations coverage, independent contractors' coverage, contractual liability, broad form
property damage, personal injury (hazards A-C and delete employment exclusions), City
of Dubuque named as an additional insured with 30 days' written notice of change or
cancellation.
PROFESSIONAL LIABILITY:
VNA shall furnish a certificate of insurance showing professional liability limits with
limits of not less than $1,000,000 during the term of the project.
WORKMEN'S COMPENSATION:
Coverage A: Statutory State of Iowa
Coverage B: Employers' Liability
$100,000 each accident
$100,000 each employee and disease
$100,000 policy limit and disease
Fields of Opportunities
THOMAS J. VILSACK
GOVERNOR
SALLY J. PEDERSON
LT. GOVERNOR
CONTRACT #: 5884LP03
PROJECT TITLE: Childhood Lead Poisoning
Prevention Program
FUNDING SOURCE OF IDPH:
FEDERAL: $15,893 -- 83.78%
STATE: $3,077 -- 16.22%
OTHER: $0 -- 0.00%
FEDERAL CATALOG #: 93.197
MATCH REQUIRED: YES[] NOIr] NA[--I
MAIL REPORTS TO:
Rita Gergely, Chief
Bureau of Lead Poisoning Prevention
Division of Health Protection and Environmental Health
iowa Department of Public Health
321 East 12t~ Street
Lucas State Office Building
Des Moines, lA 50319-0075
STATE OF IOWA
DEPARTMENT OF PUBLIC HEALTH
MARY MINCER HANSEN, RN, PhD
DIRECTOR
PROJECT PERIOD: July 1, 2003 to June 30, 2004
CONTRACT PERIOD: July 1, 2003 to June 30, 2004
CONTRACT AMOUNT: $18,970
FEDERAL TAX Il)g: 426004596
MATCH AMOUNT REQUIRED: $3,077
CONTRACTOR:
City of Dubuque
Health Services Division -- 1300 Main
City Hall Annex
Dubuque lA 52501
CONTRACT ADMINISTRATOR INFORMATION
NAME: Michael C. Van Milligan
PHONE: 563-589-4110 FAX: 563-589-4149
E-MAIL: ctymgr ~cityo fdubuque.org
The Contractor agrees to perform the work and to provide the services described in the Special conditions
for the consideration stal~xl 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 June 1, 2003, as posted on
the Department's web at www.idpkstate.ia.us or as available by contacting Rim Gergely at 515/242-
6340.
The parties hereto have executed this contract on the day and year last specified below.
For and on behalf of the Department:
By:
Tom Newton, Director, Division of Health Protection and
Environmental Health
Date
For and on behalf of the Contractor:
By_
Michael C. Van Milligan, City Manager
Date
LUCAS STATE OFFICE BUILDING [ 321 E. 12TH ST. / DES MOINES, IOWA 50319-0075
DEAF RELAY (HEARING OR SPEECH IMPAIRED) 1-800-735-2942 / INTERNET: HTTP://WWW.IDPH.STATE.IA.US!
DIRECTOR'S OFFICE DIV. OF ADMINISTRATION DIV. OF COMMUNITY HEALTH
DIV. OF HEALTH PROTECTION & ENVIRONMENTAL HEALTH
DIV. OF TOBACCO USE PREVENTION & CONTROL
515~281-6225
SPECIAL CONDITIONS FOR CONTRACT #5884LP03
ARTICLE I - IDENTIFICATION OF PARTIES.
This contract is entered into by and between the Iowa Department of Pubhc Health (hereinafter referred to as
the DEPARTMENT) and the CONTRACTOR, as identified on the contract face sheet.
ARTICLE H - IDENTIFICATION OF AUTHORIZED STATE OFFICIAL:
Tom Newton, Director, Division of Health Protection and 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 cuncern'mg this contract should be referred to Rita
Gergely, Chief, Bureau of Lead Poisoning Prevention, 515/242-6340
ARTICLE HI - DESIGNATION OF CONTRACT ADMINISTRATOR AND KEY
PERSONNEL
Michael C. Van Milligan has been designated by the CONTRACTOR to act as the Contract Administrator.
This individual is responsible for financial and administrative matters ofthis contract. Negotiations
concerning this contract should be referred to Michael C. Van Milligan; telephone 563-589-4110.
The following individual(s) shall be considered key personnel:
Name Title
Maxy Rose Corrigan RN Program Administrator
Ken TeKippe Finance Manager
Chris Johnson Data Entry Clerk
Michelle Lowe RN (Finley Tri-States Nurse
Health Group VNS)
Roger Benz 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 conduct childhood lead poisoning
prevention activities as specified in Article V, Description of Work and Scxvices.
ARTICLE V - DESCRIPTION OF WORK AND SERVICES:
The CONTRACTOR shall conduct childhood lead poisoning prevention services as specified in this article.
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 thai 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.
"CLPPP" means childhood lead poisoning prevention program.
"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 contmetor to manage blood lead data and case
management data. This includes, but is not limited to, entering blood lead test results for all individuals
under the age of 16 years in the CLPPP service area who receive blood lead testing from the CLPPP or any
other provider in the STELLAR database, 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 STELLAR database, and providing all STELLAR reports
required by this contract.
"Developmental testing" means testing done by the local Area Education Agency to determine whether a
child is developmentally delayed.
"Education and outreach" means seeking out and providing information regarding childhood lead poisoning
to members of populations who are at high risk for lead poisoning and those who work for agencies thai
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 (~g/dL) or at least two venous blood lead levels of 15 to 19 ~g/dL.
"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 ch'fid has had at least one
capillary or venous blood lead level greater than or equal to 10 [tg/dL.
"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
impomnce 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 detennine whether the child and/or family should be
referred for additional services.
"Lead-basedpaint 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 bealth.
"Local coalition" means a group convened by the contractor to address the issue of childhood lead
poisoning in the CLPPP service area. The local coalition should be composed of physicians, nurses, housing
officials, parents, centmctors, and representatives of neighborhoods where homes are being renovated.
"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 ~g/dL and to treat any conditions identified in the
evaluation. Medical case management includes, but it not lire'fred 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 childhood lead poisoning prevention
activities for the quarter that is developed according to guidelines provided by the department and is
provided to the department bythe deadlines given in Article VII.
"Quarterly update for supervisory database" means an extract of the contractor's STELLAR database that is
provided electronically to the department by the deadlines given in Article VI.
"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.
"STELL/~R" means the Systematic Tracking of Elevated Lead Levels and Remediation database, which is
provided by CDC at no charge.
"STELLAR Lab Batch" means the procedure in STELLAR that processes blood lead tests and sets dates for
follow-up blood lead tests, opens medical cases, and opens environmental cases.
"STELLAR quarterly report" means the procedure in STELLAR that compiles the contractor's activities for
the quarter into a data file that is submitted to the department electronically by the deadlines given in Article
VII.
"Venous" means a blood sample taken from a vein in the arm for lead analysis.
CLPPP SERVICE AREA
The CLPPP service area is Dubuque County.
REQUIRED SERVICES
The contractor is responsible for the following CLPPP services with the CLPPP service area: blood lead
testing, data management, environmental case managmment, medical case management, education and
outreach, and the local coalition within its service area. The contractor shall develop written protocols to
describe how each of these services will be provided. The contractor may use templates provided by the
department to develop these protocols.
BLOOD LEAD TESTIblG
The contractor shall assure that the State of Iowa Plan for Childhood BloodLead Testing (January 2001) is
implemented within the CLPPP service area. The contractor shall assure that medical providers conduct
blood lead testing accord'rog to this plan. The contractor may also conduct blood lead testing.
The contractor shall provide a written notice of the results of blood lead testing to the caregivers of all
children tested by the contractor. The written notice shall include information regarding the meaning of the
blood lead teat result and the date when the child should be tested again.
The contractor shall provide 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 ~tg/dL, regardless
of whether the contractor 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 ch'fid should be tested again.
The goals for blood lead testing are:
Increase the percentage of children in the CLPPP service area receiving at least one blood lead test
between the ages of 12 and 35 months from the current Iowa average of 45 percent to 60 percent by
June 30, 2004.
Increase the percentage of children in the CLPPP service area receiving at least one blood lead test
before the age of six years from the current Iowa average of 55 percent to 65 percent by June 30,
2004.
If the contractor does not meet this goal, the contractor shall document in writing the reasons why the goal
was not met and shall develop by June 30, 2004, a written plan with specific actions that the contractor has
taken and will take to increase the rate of blood lead testing in the CLPPP service area.
DATA MANAGEMENT
The contractor shall conduct data management as specified in this contract.
The contractor shall notify the department within 10 working days of assigning STELLAR data entry duties
to a new staff person. Contractor shall assure the department that new data entry staff has received
appropriate mining or work within the department to assure that new data entry staff receives appropriate
training.
The contractor shall install STELLAR on a computer network consisting of at least two computers that are
linked to the same server. The contractor shall allow the DEPARTMENT and other agencies providing
medical and environmental case management of lead-poisoned children in the CLPPP service area to access
the main STELLAR database via the software, PC Anywhere, or another software package approved in
advance bythe DEPARTMENT. Th/s software shall be installed on a computer that is continuously
available for the DEPARTMENT and other agencies for access. The CONTRACTOR may request that the
DEPARTMENT waive the requirement that STELLAR be installed on a network and that a computer be
continuously available for the DEPARTMENT and other agencies to access. The CONTRACTOR shall
make this request in writing. The DEPARTMENT will approve or deny these requests on a case-by-case
basis.
The contractor shall enter the results of blood lead testing for all individuals under the age of 16 years in the
CLPPP service area who receive blood lead testing from the CLPPP or any other provider in the STELLAR
database. The contractor shall document all case management actions taken by the contractor 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 STELLAR database and shall assure that all
CLPPP subcontractors also document all case management actions that they taken in STELLAR. The
contractor shall enter blood lead test results and case management actions into STELLAR on at least a
weekly basis. The contractor shall nm STELLAR Lab Batch at least every two weeks mad shall forward case
information to other agencies providing medical and environmental case management in the CLPPP service
area at least every two weeks.
The contractor shall provide all STELLAR reports by the deadlines given in this contract.
The DEPARTMENT will periodically review the CONTRACTOR STELLAR database for errors and notify
the CONTRACTOR of errors that must be corrected. The CONTRACTOR shall correct the errors by the
date specified in the notification and shall implement quality control measures to prevent data entry errors.
ENVIRONMENTAL CASE MANAGEMENT
The contractors shall maintain 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 shall be enrolled as a Medicaid provider for EBL inspection services and shall recover
reimbursement from Medicaid for EBL inspections and use the reimbursement as program income.
The contractor shall conduct 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 ttg/dL or at least two venous blood lead
levels of 15 to 19 [tg/dL. 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 repo~ted until the child has had one blood
lead level less then 10 ~g/dL or three blood lead levels less than 15 ~g/dL. EBL inspections shall be
conducted within the following times:
· Two venous blood lead levels of l5 to 19 gg/dL - within 4 weeks after the report.
· Venous blood lead level of 20 to 44 gg/dL - within 2 weeks afier the report
· Venous blood lead level of 45 to 69 }ag/dL - within 1 week after the report
· Venous blood lead level greater then or equal to 70 gg/dL - within 2 days after the report.
The contractor shall document in STELLAR the reason why the contractor was unable to complete any
inspection required by this contract.
The contractor shall contact the occupants end/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. The contr~or shall follow up on all dwellings where lead hazards were identified, but lead hazard
remediation has not been completed, at least once every six months until lead hazard remediation is
completed. The contractor shall continue to follow up on all of these dwellings until lead hazard remediatien
is completed, regardless of whether the dwellings are owner-occupied or rental end regardless of changes in
ownership. The contractor shall not close an address associated with a lead-poisoned child where lead
hazards have been identified unless the lead hazard remediation has been completed unless permission is
obtained in advence from the DEPARTMENT.
The contractor shall, to the extent possible, assist families who have lead-poisoned children in locating
resources for lead hazard remediation end/or alternative housing.
The goals for environmental case menagement are:
Complete environmental investigations for at least 99% of children having a single venous blood lead
level greater then or equal to 20 gg/dL or two venous blood lead levels from 15-19 gg/dL end for at
least 90% of homes associated with these children according to the required time lines.
Ensure that the most serious lead hazards are remediated within 30 days of the initial investigation in at
least 80% of homes where lead hazards are identified.
Ensure that less serious lead hazards are remediated within one year of the initial investigation in at least
60% of homes where lead hazards are identified.
MEDICAL CASE MANAGEMENT
The contractor shall conduct medical case management as specified in this contract.
The contractor shah be enrolled as a Medicaid provider for services that cen be reimbursed by Medicaid and
shall recover reimbursemem from Medicaid for medical case menagement services and use the
reimbursement as program income.
Each child with a venous blood lead level greater then or equal to 15 [tg/dL must have a written plan of care.
Follow-up blood lead testing
The contractor shall assure that providers in the CLPPP service 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
contractor may provide this follow-up blood lead testing.
Confirmatory venous blood lead testing
Capillary blood lead level of 15 to 19 [tg/dL - within 4 weeks after the report.
· Capillary blood lead level of 20 to 44 ~tg/dL - within 1 week after the report
· Capillary blood lead level of 45 to 69 ~tg/dL - within 48 hours after the report
· Capillary blood lead level greater than or equal to 70 [tg/dL - immediately.
Follow-up testing after an elevated blood lead level for a child who has not been chelated · Capillary or venous blood lead level of l0 to l4 gg/dL - within 3 months. After two levels less than
10 ~tg/dL or three levels less than 15 ~tg/dL, testing should follow the routine testing schedule for
high-risk children.
· Venous blood lead level of 15 to 19 ~tg/dL - within 3 months.
· Venous blood lead level of 20 to 44 [tg/dL - within 4 to 6 weeks.
· Venous blood lead level greater than or equal to 45 ~g/dL - immediately
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 assure that providers in the CLPPP provide conduct medical evaluations for childreaa
under the age of six years within the following timelines:
· Venous blood lead level of 20 to 44 ~g/dL - Refer within 48 hours after the report so that the service
is received within 5 days.
· Venous blood lead level of 45 to 69 gg/dL - Refer within 24 hours after the report so that the service
is received within 48 hours.
· Venous blood lead level greater than or equal to 70 gg/dL - Refer for emergency medical evaluation.
Home nursing or outreach visits
The contractor shall provide home nursing or outreach visits for children under the age of six years according
to the following timelines:
· Venous blood lead level of 15 to 19 [tg/dL - within 4 weeks aller the report.
Venous blood lead level of 20 to 44 [tg/dL - within 2 weeks after the report
· Venous blood lead level of 45 to 69 [tg/dL - within 1 week after the report
· Venous blood lead level greater than or equal to 70 ~tg/dL - within 2 days after the report.
Chelation
The contractor shall assure that children with two venous blood lead levels greater than or equal to 45 ~g/dL
receive chelation.
Nutrition evaluation
The contractor shall assure that children under the age of six years with a venous blood lead level greater
than or equal to 15 gg/dL receive a nutrition evaluation according to the following fimelines:
Venous blood lead level of 15 to 19 I~g/dL - within 4 weeks after the report.
· Venous blood lead level of 20 to 44 I~g/dL - within 2 weeks after the report
· Venous blood lead level of 45 to 69 I~g/dL - within 1 week after the repoxt
· Venous blood lead level greater than or equal to 70 gg/dL - within 2 days after the report.
The contractor shall contact the DEPARTMENT for assistance if access to a dietician cannot be assured for
children under the age of six years with a venous blood lead level greater than or equal to 15 pg/dL.
Developmental assessment
The contractor shall assure that children under the age of six years with a venous blood lead level greater
than or equal to 20 gg/dL receive a developmental assessment according to the following timelines:
· Venous blood lead level of 20 to 44 ~tg/dL - Refer within 2 weeks after the report.
· Venous blood lead level of 45 to 69 gg/dL - Refer within 1 week after the report
· Venous blood lead level greater than or equal to 70 [tg/dL - Refer within 2 days after the report.
Care coordination
The coniractor shall provide care coordination or refer 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 gg/dL or three consecutive blood lead
levels less than 15 pg/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 ~tg/dL immediately after a single capillary blood lead level greater than or equal to
15 ~g/dL.
3. A child has reached the age of six years and has a blood lead level less than 20 isg/dL.
4. A child has moved out of the CLPPP service area. The contractor shah immediately notify the
appropriate local CLPPP agency in the area to which the child has moved and provide copies of all
envkonmental and medical case management records to the appropriate local CLPPP agency.
Goals for Medical Case Management
The goals for medical case management are:
Follow-up blood lead testing
Ensure that at least 95% of children with capillary blood lead levels greater than or equal to 15 pg/dL
receive confirmatory venous blood lead measurements.
Ensure that at least 50% of children with blood lead levels of 10-14 gg/dL receive follow-up testing at
an average interval of 100 days.
Ensure that at least 80% of children with venous blood lead levels of 15 to 19 ~tg/dL receive blood lead
testing at an average interval of 100 days.
Ensure that at least 95% of children with venous blood lead levels greater than or equal to 20 [tg/dL
receive blood lead testing at an average interval of 50 days.
Other medical case management services
Ensure that at least 95% of children with confirmed blood lead levels greater than or equal to 15 gg/dL
receive a home nursing or outreach visit.
Ensure that at least 95% of children with confmned blood lead levels greater than or equal to 15 ~tg/dL
receive a nutrition evaluation.
Ensure that 100% of children with venous blood lead levels greater than or equal to 20 gg/dL receive a
complete medical evaluation fxom a physician.
Refer 100% of children with con£mned blood lead levels greater than or equal to 20 ~tg/dL to the local
Area Education Agency for the appropriate developmental testing.
Ensure that at least 95% of children with confirmed blood lead levels greater than or equal to 20 gg/dL
receive the appropriate developmental testing, evaluation, and assessment from their local Area
Education Agency.
Ensure that 100% of children with two venous blood lead levels greater than ur equal to 45 [tg/dL
receive appropriate chelation treatment.
Overall outcomes
Ensure that no more than 5% of children initially identified with blood lead levels of 10-14 pg/dL
eventually have venous blood lead levels greater than or equal to 20 [~g/dL
Ensure that no more than 10% of children initially identified with venous blood lead levels of 15-19
gg/dL eventually have venous blood lead levels greater than or equal to 20 [tg/dL
Ensure that at least 50% of children under the age of 3 years with venous blood lead levels greater than
or equal to 20 gg/dL have their blood lead levels drop to less than 20 gg/dL during their first nine
months of case management.
Decrease the average length of time for venous blood lead levels in children under the age of 3 years to
drop to less than 20 gg/dL f~om the current 30 weeks to 24 weeks by doing the following:
Develop a list of children under the age of 3 years who were identified as lead-poisoned after
July 1, 2002, and whose blood lead levels did not drop to less than 20 I~g/dL within 24 weeks.
For each case identified above, identify the reason why the child's blood lead level did not
drop (e.g, lack of cooperation from parents, medical provider, or property owner).
Develop and implement targeted health education activities and improvements in case
management to address the reasons for the failure of the blood lead levels to drop.
CHILDREN OVER THE AGE OF SIX YEARS
The contractor shall contact 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 gg/dL.
EDUCATION AND OUTREACH
The contractor shall provide education and outreach regarding childhood poisoning in the CLPPP service
area
LOCAL COALITION
The contractor shall establish a local coalition for the CLPPP service area. The coalition may be a
subgroup/work group of a larger umbrella coalition. However, participation in an umbrella coalition does
not meet this requirement unless a specific subgroup has been formed to deal with lead poisoning prevention
in the community. The coalition shall include citizens who are not part of agency (Health, Housing, Human
Services, etc.) staffthat paxticipate in the CLPPP.
ARTICLE VI - PERFORMANCE MEASURE
Not applicable.
ARTICI,E VH - REPORTS
The CONTRACTOR shall prepare and submit the following reports to the DEPARTMENT on forms and/or
in the format approved by the DEPARTMENT:
Report Number
Claim Voucher 1 original
Date Due
Within 30 days of month of expenditure
Expenditure Report
1 original
Within 30 days of month of expenditure
Quarterly Narrative Report
1 Electronic
10-24-2003
1-23-2004
4-23-2004
7-23-2004
STELLAR Quarterly Report
1 Electronic
10-24-2003
1-23-2004
4-23-2004
7-23-2004
ARTICLE VIH- BUDGET:
The total approved budget for this contract period is detailed in Exhibit 1. Services will be reimbursed at a
flat fee as specified on Exhibit 1 up to the amount of the contract.
The CONTRACTOR may change the number of any deliverable that the DEPARTMENT will reimburse
under th/s contract only after filing a written request for a contract amendment and receiving the fully
executed amendment
Final budget revision requests must be received by the DEPARTMENT before June 1, 2004.
ARTICLE IX: PAYMENTS
The DEPARTMENT provides contractual payments on the basis of reimbursement of actual expenses in
accordance with Iowa Code 421.40.
Maximum instate travel amounts allowed for food, lodging, and mileage must NOT exceed Iowa Department
of Revenue and Finance limits. (Food maximum of $35 per day; Lodging maximum $68 plus taxes per night
and mileage maximana of $.29 per mile).
Final payment may be withheld until all contractually required reperts 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- LOCAL BOARD OF HEALTH LINKAGE:
As a condition of the contract, the CONTRACTOR shall assure linkage with the local board of health in each
county where services are provided. The CONTRACTOR will assure 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.
ARTICLE XI - ADDITIONAL CON, meNs
1. Funds must be made available to reimburse subcontractor expenses no later than August 1, 2003.
Funds may not be spent for indirect costs, chelation or other medical treatment of lead poisoning,
lead hazard remediation, or blood lead analysis.
On January 1, 2004, April 1, 2004, and June 1, 2004, 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 childhood lead poisoning prevention services.
Final payments may be withheld if the agency or personnel employed by the agency are not in
compliance with Iowa Administrative Code Chapter 641--70, Lead Professional Certification.
The contractor must check Internet e-mail at least once each week for lead poisoning prevention
updates sent out by the DEPARTMENT.
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
govemmant 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.
If the CONTRACTOR receives third-patty reimbursement for a childhood lead poisoning prevention
service reimbursed by the DEPARTMENT and the total reimbursement exceeds the
CONTRACTOR'S cost to provide the service, then the CONTRACTOR shall document how the
excess reimbursement has been used to enhance lead program effoxts.
EXHIBIT i -- EXPENDITURE REPORT FOR THE MONTH OF
CONTRACTOR: City of Dubuque CONTRACT #5884LP03 CONTRACT PERIOD: July 1, 2003 to Jane 30, 2004
Reimbursable Budgeted Budgeted Budgeted Number Reimbursement Number Reimbursement Balance
Number Rate (A) Total (B) Completed for for Month Completed to Date (D) (B - D)
Month (C) (A x C) to Date
Children Tested for Lead Poisoning (under 6 years) 2,850 $1 $2,850 $ $ $
Home Nursing Visits 30 $60 $1,800 $ $ $
Referrals for Nutrition Counseling 30 $10 $300 $ $ $
Referrals for Developmental Testing 15 $10 $150 $ $ $
EBL Investigations 15 $300 $4,500 $ $ $
EBL Investigation Follow-ups 115 $30 $3,450 $ $ $
. Completed Lead Hazard Remediations 19 $50 $950 $ $ $
Coalition Meeting Hours 8 $40 $320 $ $ $
Education and Outreach Hours 96.25 $40 $3,850 $ $ $
Quarterly Narrative Report Received by Deadline 4 $100 $400 $ $ $
Quarterly STELLAR Report Received by Deadline 4 $100 $400 $ $ $
TOTAL NA NA $18,970 $ $ $
IDPH NOTE: Pay $3,077 from 1351, then $0 from 9212, and then $15,893.00 from 1352.
DOCUMENTATION OF PROGRAM INCOME DOCUMENTATION OF CONTRACTOR MATCIt
Amount for Amount to Contractor TOTAL
Month Date Match Balance REQUIRED
MATCH
PersonneI $ $ $ $
Fringe Benefits $ $ $ $
Travel $ $ $ $
Supplies $ $ $ $
Contractual $ $ $ $
Other $ $ $ $
TOTAL $ $ $ $3,077
Amount for Amount
Month to Date
Program Income Earned $ $
Program Income Received $ $
Program Income Expended $ $
I certify that no funds have been spent on indimet costs, chelation or other medical treatment of lead poisoning, lead hazard remediation, or blood lead analysis.
SIGNATURE: DATE: