VNA Health Lead Poisoning Agree
.
i3îi~ @UE
~<k.~
MEMORANDUM
June 25. 2004
TO:
The Honorable Mayor and City Council Members
FROM:
Michael C. Van Milligen, City Manager
SUBJECT: Iowa Department of Public Health (IDPH) Childhood Lead Poisoning
Funding and Agreement with the Visiting Nurse Association (VNA)
Public Health Specialist Mary Rose Corrigan recommends City Council approval of a
contract with the Dubuque County Board of Health for continued funding of the
Childhood Lead Poisoning Prevention Program and a renewed agreement with the VNA
for services related to the Childhood Lead Poisoning Prevention Program.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
(fUJI ~ ~
Michael C. Van Milligen
MCVM/jh
Attachment
cc: Barry Lindahl, Corporation Counsel
Cindy Steinhauser, Assistant City Manager
Mary Rose Corrigan, RN, Public Health Specialist
)
("
, ,
i3îi~mE
~<k.~
MEMORANDUM
June 18, 2004
FROM:
Michael C. Van Milligen, City Manager
Mary Rose corrigan,~ ~alth Specialist
TO:
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 Dubuque County
Board of 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, 2004.
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 to local
Boards of Health in the State based on numbers of children in a community and the
incidence of lead poisoning.
The Iowa Department of Public Health now 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.
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, training for employees,
and monies to do outreach and educátion in targeted neighborhoods.
The contract also includes 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.
BUDGET IMPACT
The FY 04 budget anticipated funding of $18,970, and is shown in the lead activity of
the Health Services Department. Due to changes in the Iowa Department of Public
Health funding, the contract has been increased to $19,730.
RECOMMENDATION
It is recommended that the City Council authorize the Mayor to sign the attached
resolution authorizing the City Manager to sign the subcontract with the Dubuque
County Board of 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 Dubuque County Board of Health and the agreement with the
Dubuque Visiting Nurse Association.
MRC/cj
cc: David Harris, Housing Services Manager
Kathaleen Lamb, Senior Housing Inspector
Kathy Ripple, VNA, Administrative Director
RESOLUTION NO. 268-04
A RESOLUTION AUTHORIZING THE CITY MANAGER OR HIS DESIGNEE TO
SIGN A CONTRACT WITH THE DUBUQUE COUNTY BOARD OF 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
support for activities relating to the local childhood lead poisoning prevention program in
Dubuque County; and
Whereas, the City of Dubuque will provide environmental and medical case
management of identified lead poisoned children in addition to community outreach and
education on the problem of childhood lead poisoning.
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 1. That the City of Dubuque, Iowa hereby approves the attached contract
between the Dubuque County Board of 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 offhe City of Dubuque, Iowa.
Passed, approved and adopted this 6th day of Ju 1 y
2004.
Terrance M. Duggan, Mayor
Attest:
Jeanne F. Schneider, City Clerk
SUBCONTRACT AGREEMENT FOR CHILDHOOD LEAD POISONING
PREVENTION SERVICES
BETWEEN
DUBUQUE CÓUNTY BOARD OF HEALTH
AND
THE CITY OF DUBUQUE, IOWA
WHEREAS, the Dubuque County Board of Health (County Board), as
Contractor, has entered into an Agreement (the Agreement) with the Iowa
Department of Public Health to perform childhood lead poisoning prevention
services as set forth in the Agreement, 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, THEREFORE, 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
,2004.
Michael C. Van Milligen
City Manager
AGREEMENT BETWEEN THE CITY OF DUBUQUE, IOWA,
AND THE VISITING NURSE ASSOCIATION
FOR THE CHILDHOOD LEAD POISONING PREVENTION PROGRAM (CLPPP)
Now on this 1 st day of July 2004, 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 1 st day of July 2004,
through the 30th day of June 2005.
CITY'S RESPONSIBILITIES. City agrees that it will provide the following
services for the CLPPP:
A.
B.
C.
1.
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).
2.
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.
3.
Provide compensation to the VNA during the term of this Agreement not
to exceed $14,280.00 for the performances of VNA's responsibilities as
set forth herein.
4.
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:
1.
Provide written quarterly reports on lead-related activities utilizing the Iowa
Quarterly Report Narrative Outline.
2.
Provide computer documentation of medical case management and
related activities into City's lead database system, STELLAR.
3.
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.
4.
Assist City with providing public education, lead coalition development and
activities, and outreach to the City of Dubuque residents about childhood
lead poisoning.
5.
Conduct home visits as needed to families\residents in order to provide
medical case management services.
1
7.
8.
9.
6.
Provide education and medical case management of children with
confirmed blood lead levels greater than or equal to 15 Jg\dL. Medical
case management includes:
assurance that chìldren 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 Jg\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.
2
CITY OF DUBUQUE, IOWA
BY:
Michael C. Van Milligen
City Manager
3
VISITING NURSE ASSOCIATION
BY:
Kathy Ripple
Administrative Director
SCHEDULE C
INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES
1. All policies of insurance required hereunder shall be with an insurer authorized to do
business in Iowa. All insurers shall have a rating of A of better in the current A.M. Best
Rating Guide.
2. All policies of insurance shall be endorsed to provide a thirty (30) day advance notice of
cancellation to the City of Dubuque if cancellation is prior to the expiration date. This
endorsement supersedes the standard cancellation statement on the Certificate of
Insurance.
3.
shall fumish a Certificate of Insurance to the City of Dubuque, Iowa
for the coverage required in Paragraph 6 below. Such Certificates shall include copies of
the following endorsements:
a) Thirty day notice of cancellation to the City of Dubuque.
b) Commercial General Liability policy is primary and non-contributing.
c) Commercial General Liability additional insured endorsement.
d) Governmental Immunities Endorsement.
e) Waiver of Recovery under workers compensation.
shall also be required to provide Certificates of
Insurance of all subcontractors and all sub-sub contractors who perform work or services
pursuant to the provisions of this contract. Said certificates shall meet the same
insurance requirements as required of
4. Each certificate shall be submitted to the contracting department of the City of Dubuque.
5. 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.
6. Contractor shall be required to carry the following minimum coverage/limits or greater if
required by law or other legal agreement:
a) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit
Products-Completed Operations Aggregate Limit
Personal and Advertising Injury Limit
Each Occurrence Limit
Fire Damage Limit (anyone occurrence)
Medical Payments
$2,000,000
$1,000,000
$1,000,000
$1,000,000
$ 50,000
$ 5,000
This coverage shall be written on an occurrence, not claims made, form per
project. All deviations or exclusions from the standard ISO commercial general
liability form CG 0001 or Businessowners BP 0002 shall be clearly identified.
Governmental Immunity endorsement identical or equivalent to form attached.
An additional insured endorsement identical or equivalent to ISO Form CG 2026
and include as additional insureds: "The City of Dubuque, including all its elected
and appointed officials, all its employees and volunteers, all its boards,
4
commissions and/or authorities and their board members, employees, and
volunteers."
b) WORKERS COMPENSATION & EMPLOYERS LIABILITY
Statutory for Coverage A
Employers Liability:
$100,000 each accident
$100,000 each employee-disease
$500,000 policy limit-disease
Policy shall include an endorsement waiving right of recovery against City
of Dubuque.
c) PROFESSIONAL LIABILITY:
d) UMBRELLA/EXCESS LIABILITY
$1,000,000
Coverage to be determined on a case-by-case basis by Finance Director.
5
POLICY NUMBER
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANG~S THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person Or Organization:
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.
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown
in the Schedule as an insured but only with respect to liability arising out of your operations or premises
owned by or rented to you.
CODvriQht. Insurance Services Office. Inc. 1994
CG 20 2611 85
6
CITY OF DUBUQUE, IOWA
GOVERNMENTAL IMMUNITIES ENDORSEMENT
1.
Nonwaiver of Governmentallmmunitv. 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 Coveraae. 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 Coveraae. 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 Chanae in Policv. The above preservation of governmental immunities shall not otherwise
change or alter the coverage available under the policy.
7
Iowa Department of Public Health
Sally j. Pederson
Lt. Governor
CONTRACT #: 5885LP05
PROJECT TITLE: Childhood Lead Poisoning
Prevention Program
FUNDING SOURCE OF lDPH:
FEDERAL: $19,730 -- 100.00%
STATE: $0 -- 0.00%
OTHER: -- 0.00%
FEDERAL CATALOG#: 93.197
MATCH REQUIRED: YESD NO[8] NAD
MAIL REPORTS TO:
Rita Gergely, Chief
Bureau of Lead Poisoning Prevention
Division of Environmental Health and Health Statistics
Iowa Department of Public Health
321 East 12th Street
Lucas State Office Building
Des Moines, lA 50319-0075
Mary Mincer Hansen, R.N., Ph.D.
Director
PROJECT PERIOD: July 1,2004 to June 30, 2005
CONTRACT PERIOD: July 1,2004 to June 30, 2005
CONTRACT AMOUNT: $19,730
FEDERAL TAX lD#: 426004597
CONTRACTOR:
Dubuque County Board of Health
c/o City of Dubuque Health Services Department, 1300
Main
City HalI Annex
Dubuque lA 52001
CONTRACT ADMINISTRATOR INFORMATION
NAME: Mary Rose Corrigan
PHONE: 563-589-4181 FAX: 563-589-4299
E-MAIL: health@cityofdubuque.org
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 September 22, 2003, as
posted on the Department's web at www.idph.state.ia.us (click on Availability of Funds Link:) or as
available by contacting Rita Gergely at 515/242-6340.
The parties hereto have executed this contract on the day and ar I t
For and on behalf of the Department:
By:
Tom Newton, Director, Division of Environmental Health
and Health Statistics
Date
Nick GoodIn , Chair, Board of Health
Date (./~ j;ý
I I'
Promoting and protecting the health of Iowans
Lucas State Office Building, 321 E, 12-" Street, Des Moines. IA 50319-0075 . 515-281-7689. www,;dph,state,;a,us
DEAF RELAY (Hearing or Speech Impaired) 711 or I 800-735-2942
SPECIAL CONDITIONS FOR CONTRACT #S88SLPOS
ARTICLE I - IDENTIFICATION OF PARTIES.
This contract is entered into by and between the Iowa Department of Public 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 Environmental Health and Health Statistics, is the Authorized State
Official for this contract. Any changes in the terms, conditions, or ammmts specified in this contract must be
approved by the Authorized State Official. Negotiations concerning 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
Mary Rose Corrigan has been designated by the CONTRACTOR to act as the Contract Administrator. This
individual is responsible for financial and administrative matters of this contract. Negotiations concerning
this contract should be referred to Mary Rose Corrigan; telephone 563-589-4181.
The primary agency subcontracted to carry out the responsibilities ofthe contract is: City of Dubuque Health
Services Department. The following individual(s) shall be considered key personnel:
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 Services.
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 oflead in the blood.
"Capillary" means a blood sample taken trom 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 (EEL) 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 (EEL) inspector/risk assessor" means a person who has met the requirements
of 64 1-70.5(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.
"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 contractor 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 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 (EEL) child" means any child who has had one venous blood lead level greater than or
equal to 20 micrograms per deciliter ( .1g1dL) or at least two venous blood lead levels of 15 to 19 .1g1dL.
"Elevated blood lead (EEL) inspection" means an inspection to determine the sources oflead 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 ofthe elevated blood lead (EBL) child.
"Elevated blood lead (EEL) 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 p~rform 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 I 0 ~gldL.
"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 offollow-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.
"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.
"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, contractors, 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 I 0 ~gldL 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 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.
"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.
"STELLAR" 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 111 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 ann for lead analysis.
CLPPP SERVICE AREA
The CLPPP service area is Dubuque County.
REQUIRED SERVICES
The contractor is responsible for blood lead testing, data management, environmental case management,
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 TESTING
The contractor shall assure that the State of Iowa Plan for Childhood Blood Lead Testing (January 2004) is
implemented within the CLPPP service area. The contractor shall assure that medical providers conduct
blood lead testing according 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 infonnation regarding the meaning of the
blood lead test 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 I 0 ~gldL, regardless
of whether the contractor did the testing. The written notice shall include infonnation 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.
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 training 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 oflead-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 by the DEPARTMENT. This 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 DEP ARTMEþlT 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 and 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 etTors 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 ~g/dL or at least two venous blood lead
. levels of 15 to 19 ~g/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 reported until the child has had one blood
lead level less than 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 15 to 19 ~g/dL - within 4 weeks after the report.
. Venous blood lead level of 20 to 44 ~g/dL - within 2 weeks after the report
. Venous blood lead level of 45 to 69 ~g/dL - within 1 week after the report
. Venous blood lead level greater than or equal to 70 ~g/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 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. The contractor 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 dwelIings until lead hazard remediation
is completed, regardless of whether the dwellings are owner-occupied or rental and 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 h~d remediation has been completed unless permission is
obtained in advance from the DEPARTMENT.
The contractor shall, to the extent possible, assist families who have lead-poisoned children in locating
resources for lead hazard remediation and/or alternative housing.
MEDICAL CASE MANAGEMENT
The contractor shall conduct medical case management as specified in this contract.
The contractor shall be enrolled as a Medicaid provider for services that can be reimbursed by Medicaid and
shall recover reimbursement from Medicaid for medical case management services and use the
reimbursement as program income.
Follow-up blood lead testine
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 Jg/dL - within 4 weeks after the report.
. Capillary blood lead level of 20 to 44 Jg/dL - within 1 week after the report
. Capillary blood lead level of 45 to 69 Jg/dL - within 48 hours after the report
. Capillary blood lead level greater than or equal to 70 Jg/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 10 to 14 Jg/dL - within 3 months. After two levels less than
10 Jg/dL or three levels less than 15 Jg/dL, testing should follow the routine testing schedule for
high-risk children.
. Venous blood lead level of 15 to 19 Jg/dL - within 3 months.
. . Venous blood lead level of20 to 44 Jg/dL - within 4 to 6 weeks.
. Venous blood lead level greater than or equal to 45 Jg/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
detennine 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 children
under the age of six years within the following timelines:
. Venous blood lead level of 20 to 44 Jg/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 Jg/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 llg/dL - Refer for emergency medical evaluation.
Home nursine: 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 IS to 19 llg/dL - within 4 weeks after the report.
. Venous blood lead level of 20 to 44 llg/dL - within 2 weeks after the report
. Venous blood lead level of 45 to 69 llg/dL - within I week after the report
. Venous blood lead level greater than or equal to 70 llg/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 llg/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 IS llg/dL receive a nutrition evaluation according to the following timelines:
.
Venous blood lead level of IS to 1911g/dL - within 4 weeks after the report.
Venous blood lead level of20 to 441lg/dL - within 2 weeks after the report
Venous blood lead level of 45 to 69 llg/dL - within I week after the report
Venous blood lead level greater than or equal to 70 llg/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 IS llg/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 llg/dL receive a developmental assessment according to the following timelines:
. Venous blood lead level of20 to 44 llg/dL - Refer within 2 weeks after the report.
. Venous blood lead level of 45 to 69 llg/dL - Refer within I week after the report
. Venous blood lead level greater than or equal to 70 llg/dL - Refer within 2 days after the report.
Care coordination
The contractor 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:
l.
A child has had two consecutive blood lead levels less than 10 llg/dL or three consecutive blood lead
levels less than IS llg/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 llg/dL immediately after a single capillary blood lead level greater than or equal to
IS llg/dL.
3.
A child has reached the age of six years and has a blood lead level less than 20 J!g/dL.
4.
A child has moved out of the CLPPP service area. The contractor shall immediately notifY the
appropriate local CLPPP agency in the area to which the child has moved and provide copies of all
environmental and medical case management records to the appropriate local CLPPP agency.
CIDLDREN 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 J!g/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.) staff that participate in the CLPPP.
ARTICLE VI - PERFORMANCE MEASURE
Not applicable.
ARTICLE VII - 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
Claim Voucher
Number
I original
Date Due
Within 45 days of month of expenditure
Expenditure Report
I original
Within 45 days of month of expenditure
Quarterly Narrative Report
I Electronic
10-25-2004
1-25-2005
4-25-2005
7-25-2005
STELLAR Quarterly Report
I Electronic
10-25-2004
1-25-2005
4-25-2005
7-25-2005
ARTICLE VIII- BUDGET:
The total approved budget for this contract period is detailed in Exhibit I. Services will be reimbursed at a
flat fee as specified on Exhibit I up to the amòunt of the contract.
The CONTRACTOR may change the number of any deliverable that the DEPARTMENT will reimburse
under this contract only after filing a written request for the revision and receiving written approval for this
change.
ARTICLE IX: PAYMENTS
l.
The DEPARTMENT provides contractual payments on the basis of reimbursement of actual
expenses in accordance with Iowa Code 421.40.
2.
The DEPARTMENT will not reimburse travel amounts in excess of limits established by Iowa
Department of Revenue and Finance.
a. Instate maximum allowable amounts for food are $8.00/breakfast, $9.00/1unch and
$18.00/dinner; lodging maximum $68 plus taxes per night and mileage maximum of$.29 per
mile.
Out of state maximum allowable amounts for meals are available upon request. There is no
restriction on airfare or lodging but the incurred expenditures are to be reasonable.
b.
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 - LOCAL BOARD OF HEALTH LINKAGE:
l.
As a condition ofthe 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.
2.
All work plan revisions must be approved by the DEPARTMENT prior to implementation.
ARTICLE XI - ADDITIONAL CONDITIONS
l.
Funds must be made available to reimburse subcontractor expenses no later than August I, 2004.
2.
Funds may not be spent for indirect costs, chelation or other medical treatment oflead poisoning,
lead hazard remediation, or blood lead analysis.
3.
On January 1,2005, April I, 2005, and June 1,2005, the DEPARTMENT may amend the contract to
revert funds that are estimated to be unused to the DEP AR TMENT and to reallocate the funds to
contractors with demonstrated special needs for childhood lead poisoning prevention services.
4.
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.
5.
The contractor must check Internet e-mail at least once each week for lead poisoning prevention
updates sent out by the DEPARTMENT.
6.
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.
7.
If the CONTRACfOR receives third-party reimbursement for a childhood lead poisoning prevention
service reimbursed by the DEPARTMENT and the total reimbursement exceeds the
CONTRACfOR'S cost to provide the service, then the CONTRACfOR shall document how the
excess reimbursement has been used to enhance lead program efforts.
EXHIBIT 1 -- EXPENDITURE REPORT FOR THE MONTH OF
CUNTKAlTUK: UUDUqUe county jjoara or neann \.-Vl~ lIV\,\.- 1 ftJOOJJ.ÆVJ ~v" H~~' ,~,~v~. ,~lY " ~~~. . .- --, ----
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) (Axe) to Date
Children Tested for Lead Poisoning (under 6 years) 2,850 $1 $2,850 $ $ $
Child CONTC or ACTIO event 342 $10 $3,420 $ $ $
Non-Medicaid Home Nursing Visits 26 $70 $1,820 $ $ $
Referrals for Nutrition Counseling 26 $10 $260 $ $ $
Referrals for Developmental Testing 13 $10 $130 $ $ $
Initial Inspection Events 13 $400 $5,200 $ $ $
EBL Investigation Follow-ups 75 $30 $2,250 $ $ $
Completed Lead Hazard Remediations 8 $50 $400 $ $ $
Coalition Meeting Hours 8 $40 $320 $ $ $
Education and Outreach Hours 56.00 $40 $2,240 $ $ $
Running Lab Batch 24 $10 $240 $
STELLAR Quarterly Report Submitted on Time 4 $75 $300
Narrative Quarterly Report Submitted on Time 4 $75 $300
TOTAL NA NA $19,730 NA NA
IDPH NOTE: Pay from 1352.
DOCUMENTATION OF PROGRAM INCOME
Amount for Amount
Month to Date
Program Income Earned $ $
Program Income Received $ $
Program Income Expended $ $
I certify that no funds have been spent on chelation or other medical treatment oflead poisoning, lead hazard remediation, collection of blood lead samples, or blood lead analysis.
SIGNATURE:
DATE: