Childhood Lead Poisoning Prevention Programs Contracts 2016 Copyright 2014
City of Dubuque Consent Items # 17.
ITEM TITLE: Childhood Lead Poisoning Prevention Programs Contracts
and Subcontracts
SUMMARY: City Manager recommending approval of a contract with the
Dubuque County Board of Health and the Iowa Department
of Public Health for continued funding of the Childhood
Lead Poisoning Prevention Program, and a renewed
agreement with the Visiting Nurse Association for services
related to the Childhood Lead Poisoning Prevention
Program and Healthy Homes Program.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve
ATTACHMENTS:
Description Type
Childhood Lead Poisoning Prevention Programs-MVM City Manager Memo
Memo
Staff Memo Staff Memo
State Lead Contract with County Supporting Documentation
Subcontract- County & City Supporting Documentation
Subcontract- City &VNA Supporting Documentation
Insurance Schedule C Supporting Documentation
THE CITY OF Dubuque
DUB E i"
Masterpiece on the Mississippi 2007.2012.2013
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Iowa Department of Public Health Childhood Lead Poisoning and Healthy
Homes Funding and Agreement with the Visiting Nurse Association and
the Dubuque County Board of Health
DATE: August 30, 2016
Public Health Specialist Mary Rose Corrigan recommends City Council approval of a
contract with the Dubuque County Board of Health and the Iowa Department of Public
Health for continued funding of the Childhood Lead Poisoning Prevention Program, and
a renewed agreement with the Visiting Nurse Association for services related to the
Childhood Lead Poisoning Prevention Program and Healthy Homes Program. The
contract is for $6,454, the same as last year.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
v
Mic ael C. Van Milligen
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Teri Goodmann, Assistant City Manager
Mary Rose Corrigan, Public Health Specialist
NU�
OF Du�buquue
B E
Masterpiece on the Mississippi
TO: Mike Van Milligen, City Manager
FROM: Mary Rose Corrigan, Public Health Specialist
SUBJECT: Iowa Department of Public Health (IDPH) Childhood Lead Poisoning and
Healthy Homes Funding and Agreement with the Visiting Nurse Association
(VNA) and the Dubuque County Board of Health
DATE: August 24, 2016
INTRODUCTION
This memorandum provides information regarding a contract with the Dubuque County
Board of Health and the Iowa Department of Public Health (IDPH) for continued funding of
the Childhood Lead Poisoning Prevention Program (CLPPP), a renewed agreement with
the VNA for services related to the CLPPP and Healthy Homes Program.
BACKGROUND
In February 1994, the City Council approved a grant agreement authorizing the Health
and Housing Services Departments to contract with the Iowa Department of Public Health
for environmental follow-up and medical case management for children with lead
poisoning according to the Iowa Department of Public Health guidelines. The original
funding contract has been renewed annually. The latest contract ended June 30, 2016.
DISCUSSION
The Iowa Department of Public Health contracts with local Boards of Health for distribution
of their funds. This allows local Boards of Health to monitor public health funding, avoid
duplication of services and assure community health needs are addressed (see attached
contract.)
The subcontracted funds will allow the Health and Housing Services Departments to
provide additional follow-up of lead poisoned children through contracted nursing services
provided by the Dubuque Visiting Nurse Association, education for employees, and
monies to do outreach and education in targeted neighborhoods regarding lead poisoning
and healthy homes activities.
The contract also includes updated program performance standards, which we currently
strive to achieve through our existing protocols and outreach programs. The grant funds
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will be reimbursed based on the specific activities outlined in the budget.
BUDGETIMPACT
The FY17 budget anticipated funding of$6,400. The contract is for $6,454, the same as
FY16. The sub-agreement with the VNA will be paid utilizing funds from the IDPH grant.
RECOMMENDATION
It is recommended that the City Manager sign the attached subcontract with the Dubuque
County Board of Health, agreement with the Dubuque Visiting Nurse Association on
behalf of the City of Dubuque.
MRC/Ih
cc: Alvin Nash, Housing Services Manager
Kim Glaser, Lead and Healthy Homes Program Manager
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Iowa Department of Public Health
• IDPH Promoting and Protecting the Health of Iowans
Gerd W. Clabaugh, MPA Terry E. Branstad Kim Reynolds
Director Governor Lt. Governor
CONTRACT #: 5887LP03 PROJECT TITLE: FY 17 Childhood Lead Poisoning
Prevention Program
Contractor LEGAL NAME AND ADDRESS: PROJECT PERIOD:
Dubuque County Board of Health July 1, 2016-June 30, 2017
720 Central Ave.
Dubuque, IA 52001
STATE OF IOWA DEPT. OF ADMINISTRATIVE CONTRACT PERIOD:
SERVICES VENDOR#: 00002128749 July 1, 2016-June 30, 2017
IOWA CODE CHAPTER SF DESIGNATION: TOTAL CONTRACT AMOUNT: $ 6454
❑ This contract is covered by Iowa Code chapter 8F FUNDING SOURCE:
FEDERAL: $0
® This contract is NOT covered by Iowa Code STATE: $6454
chapter 8F OTHER:$0
Interagency State: $0
❑ At the time of execution, this contract is NOT Interagency Federal: $0
covered by Iowa Code chapter 817, if the Contractor Private/Fees/Other: $0
executes additional contracts with the Department, the
aggregate of which exceed$ 500,000,the contract will Federal Subrecipient Addendum Needed? YES❑
be covered NOD
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 Iowa Department of Public Health General Conditions Effective
July 1, 2016 as posted on the Department's Web site under Funding Opportunities: http://idph.iowa.gov/or as
available by contacting Kevin Officer at telephone (515) 242-5902. The Contractor specifies no changes have
been made to the Special Conditions or General Conditions.
The parties hereto have executed this contract on the day and year last specified below.
For and on behalf of the Department: For and on behalf of the Contractor:
Patrice Lambert
By: By
Ken Sharp, Director Dubuque County Board of Health
Division of ADPER&EH Date (required if not a digital signature):
Lucas State Office Building, 321 E. 12th Street, Des Moines, IA 50319-0075 ■ 515-281-7689 ■w Jdph.iowa.gov
DEAF RELAY(Hearing or Speech Impaired) 711 or 1-800-735-2942
Special Conditions for Contract 05887LP03
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 II- Designation of Authorized State Official:
Ken Sharp, Director, Division of Acute Disease Prevention, Emergency Response, and Environmental
Health are the Authorized State Official for this contract. Any changes in the terms, conditions, or
amounts specified in this contract must be approved by the Authorized State Official. Negotiations
concerning this contract should be referred to Kevin Officer, Community Health Consultant, at
kevin.officerAidnh.iowa.eov or 515-242-5902.
Article III- Designation of Contract Administrator and Agency:
Patrice Lambert 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: Kevin Officer, Contract Manager, at
kevin.officerAidnh.iowa.gov or (515) 242-5902.
It is the Contractor's sole responsibility to ensure appropriate individual(s)have registered within
IowaGrants. The Contractor acknowledges that all assigned individuals to the Grant Tracking site have
full rights (add, modify, and delete)for all Grant Tracking components including contractual forms,
reporting forms, and claims submission.
The Contract Administrator designates Bonnie Brimeyer as the Grantee Contact in IowaGrants
(www.IowaGrants.gov) who shall regulate and assign access of appropriate individuals to this grant site.
Article IV— Key Personnel:
The following individual(s) shall be considered key personnel for purposes of this contract:
Department Personnel
Name Title Email Address
Carmily Stone Bureau Chief Carmily.Stone@idph.iowa.gov
Kevin Officer Contract Manager Kevin.Officer@idph.iowa.gov
Key Contractor Personnel
Name Title Email Address
Patrice Lambert Agency Director patrice.lambert@dubuquecounty.us
Patrice Lambert Program Administrator patrice.lambert@dubuquecounty.us
Bonnie Brimeyer Finance Manager bonnie.brimeyer@dubuquecounty.us
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Laura Hankes Data Entry Clerk lhankes@cityofdubuque.org
Michelle Zurcher Nurse Michelle.Zurcher@unitypoint.org
Mary Rose Corrigan, Certified Elevated Blood mcorriga@cityofdubuque.org,
Joe Blasen, Kim Glaser, Lead (EBL) jblasen@cityofdubuque.org,
MadelineCairney Inspector/Risk Assessor kglaser@cityofdubuque.org,
mcairney@cityofdubuque.org
The Contractor shall notify the department in writing within ten (10) working days of any change of Key
Personnel identified in this section.
Article V - Statement of Contract Purpose:
The purpose of this contract is to provide funds for the Contractor to ensure that childhood lead
poisoning prevention activities are conducted as specified in this contract and in compliance IAC 641
Chapter 72.
ARTICLE VI - DEFINITIONS
DEFINITIONS
"Blood lead testing"means taking a capillary or venous sample of blood and sending it to a laboratory
to determine the level of lead in the blood.
"Capillary"means a blood sample taken from the finger or heel for lead analysis.
"Care coordination"means the process of linking the service system to the recipient and/or family,
and coordination of the various elements in order to achieve a successful outcome.
"CDC" means the Centers for Disease Control and Prevention.
"Certified elevated blood lead(EBL) inspection agency"means an agency that has met the
requirements of 641-70.5(13 5)and that has been certified by the department.
"Certified elevated blood lead(EBL) inspector/risk assessor"means a person who has met the
requirements of 641-70.5(135)for certification or interim certification and who has been certified by
the department.
"Chelation"means the administration of medication that binds lead so that it can be removed from
the body.
"Child health Contractor"means an agency that has a contract with the Iowa Department of Public
Health for the Title V Child Health program.
"Childhood Lead Poisoning Prevention Program (CLPPP) service area" means the geographic area
for which the CLPPP has agreed to provide CLPPP services.
"Community partnership"means a collaborative relationship between entities to address healthy
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homes issues and lead poisoning prevention in the CLPPP service area
"Complete medical evaluation"means a history, physical examination, and testing for iron status as
described in Chapter 7 of Preventing Lead Poisoning in Young Children, CDC, October 1991.
"Data management"means all actions taken by the Contractor to manage blood lead data and case
management data This includes,but is not limited to, documenting all case management actions such
as contact with the family or provider, EBL inspection, lead hazard remediation,home nursing or
outreach visits, nutrition evaluations, and developmental assessments in the Healthy Homes and Lead
Poisoning Surveillance System (HHLPSS)database, and providing all HHLPSS reports required by this
contract.
"Developmental testing"means testing done by the local Early Access Program or Area Education
Agency to determine whether a child is developmentally delayed.
"Education and outreach"means seeking out and providing information regarding childhood lead
poisoning to members of populations who are at high risk for lead poisoning and those who work for
agencies that provide service to these high-risk populations;members of the general public, including
homeowners, landlords, Realtors, and members of community organizations, and health professionals
and para-professionals,including physicians, nurses, and laboratory technicians.
"Elevated blood lead(EBL) child"means any child who has had one venous blood lead level greater
than or equal to 20 micrograms per deciliter(gg/dL)or at least two venous blood lead levels of 15 to 19
gg/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 child has had at
least one capillary or venous blood lead level greater than or equal to 10 gg/dL.
"HHLPSS" means the Healthy Homes and Lead Poisoning Surveillance System web based case
management program.
"Home nursing or outreach visit"means a home visit conducted by a nurse or social worker to provide
information to the caregiver of a lead-poisoned child regarding the health effects of lead poisoning,the
importance of good housekeeping and nutrition, and the importance of follow-up blood lead testing and
to assess the overall situation of the child and family to determine whether the child and/or family should
be referred for additional services.
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"Laboratory"means a laboratory certified to perform either waived or non-waived blood lead
analysis according to the federal Clinical Laboratory Improvement Act of 1988 (CLIA).
"Lead-based paint hazard"means hazardous lead-based paint, a dust-lead hazard, or a soil-lead hazard
as defined in 641 Chapter 70.
"Lead hazard remediation"means the control of lead hazards identified in the EBL inspection
through interim controls, renovation and remodeling, or lead abatement.
"Local board of health"means a county, district, or city board of health.
"Medical case management"means all services necessary to evaluate the health and development of a
child with a blood lead level greater than or equal to 10 gg/dL and to treat any conditions identified in
the evaluation. Medical case management includes, but is 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 VIII.
"Referral"means to direct the family of a lead-poisoned child to a service for the family or the child
and to follow-up to assure that the family actually received the service.
"Venous"means a blood sample taken from a vein in the arm for lead analysis.
Article VII - Description of Work and Services:
CLPPP SERVICE AREA
The CLPPP service area is Dubuque County.
DESIGNATED AGENCY
Dubuque County Health Department
13047 City View Drive
Dubuque,IA 52002
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PROGRAM SERVICES
In compliance with the Department approved work plan within IowaGrants, the Contractor shall ensure
that the Designated Agency, identified above,implements all of the program services as described below,
and as necessary, within the CLPPP service area. The program services are medical case management
(home nursing visits, referrals for nutrition counseling, and referrals for developmental testing),
environmental case management inspections for lead-poisoned children, contacting property owners to
determine if lead hazard remediation is completed, conducting inspections to determine if lead hazard
remediation is complete, and performing clearance testing to assure that lead hazard remediation has
been completed in a safe manner, and data management. The Contractor shall ensure that the Designated
Agency develops written protocols to describe how each of these services will be provided. Templates
provided by the Department may be used to develop these protocols.
Reimbursable services also include the following activities; initial elevated blood lead(EBL)
inspector/risk assessor certification, and refresher elevated blood lead(EBL)inspector/risk assessor
certification.
BLOOD LEAD TESTING
The Contractor shall ensure that the Designated Agency:
• Implements the CHILDHOOD LEAD POISONING PREVENTION PROGRAM CASE
MANAGEMENT PROTOCOLS(March 2015)within the CLPPP service area.
• Conducts blood lead testing or ensures that medical providers conduct blood lead testing
according to this plan.
• Notifies caregivers of the results of blood lead testing of all children tested by the Designated
Agency. The notification shall include information regarding the meaning of the blood lead test
result and the date when the child should be tested again.
• Notifies caregivers of the results of blood lead testing of all children in the CLPPP service area
who have blood lead levels greater than or equal to 10 gg/dL, regardless of who did the testing.
The notification shall include information regarding the meaning of the blood lead test result,
actions that the parents can take to reduce the child's blood lead level, and the date when the
child should be tested again. This may be waived if the CLPPP collaborates with health care
providers that provide this information to the parents. The Contractor shall ensure that the
Designated Agency notifies the Department of such agreements in writing.
DATA MANAGEMENT
The Contractor shall ensure:
1. The Designated Agency conducts data management as specified in this contract.
2. All case management actions taken by the Designated Agency and CLPPP subcontractors
are documented in the HHLPSS database. At a minimum, case management activities
include contacts made with the family or medical provider, EBL inspections, lead hazard
remediation, home nursing or outreach visits, nutrition evaluations, and developmental
assessments.
3. All reports specified in ARTICLE VIII—REPORTS are provided by the deadlines given in
this contract.
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4. Blood lead data collected by the Designated Agency, medical providers, clinics and labs
within your jurisdiction are reported to the Department. Blood lead data shall be reported to
the Department on a weekly basis and according to the reporting guidelines in Appendix I.
5. The Department is notified immediately of HHLPSS database errors and missing records.
6. All requests for CLPPP data needed to support the local CLPPP and fulfill the requirements
of this contract are submitted to the Department in a timely manner using the Lead Data
Request form in Appendix II.
7. Records and data are managed according to the following:
i. Data Use. All records and data provided by this contract shall be used only for purposes
as set forth in the contract. The Contractor shall not use or permit others to use the
records and data in any way except for the purposes outlined in this contract.
ii. Data Storage. All records and data received pursuant to this contract shall be stored in a
secure locked area with access restricted to project personnel for purposes only as set
forth in section I of this Contract. The data will be stored in compliance with the
standards of. Contractor shall comply with Department and State information technology
standards.
a. Data Backup Standard: Applicable to Entities which utilize data systems to
process, store, transmit or monitor information.
b. Data Stewardship Standard: Applicable to Entities which utilize data systems to
process, store, transmit or monitor information.
c. Interconnectivity Standard: Applicable to Entities which utilize data systems to
process, store, transmit or monitor information.
d. Laptop Data Protection Standard: Applicable to Entities which utilize laptops to
process, store, transmit or monitor data.
e. Removable Storage Encryption Standard: Applicable to Entities which utilize
removable storage devices to process, store, transmit or monitor information.
Current state information technology standards are accessible online at
httys://ocio.iowa.gov/standards.
iii. Confidentiality. Contractor shall maintain the confidentiality of all confidential records
and data released pursuant to this Contract. Contractor shall not disclose any confidential
information contained in these records or data, including but not limited to names and
other identifying information of persons who are the subject of such records, either
during the period of this Contract or hereafter. All identifiable and personal indicators
shall be kept strictly confidential and shall not be used or released for any purpose.
Contractor shall immediately report to IDPH any unauthorized disclosure of confidential
information. Such disclosure shall be grounds for immediate termination of this Contract.
iv. Ownership. Records and data provided by IDPH to Contractor, and any files related by
linking these data files, pursuant to this Contract shall remain the property of the IDPH at
all times.
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V. Re-release. Contractor may not re-release data provided by this contract without
expressed written permission from IDPH. Data provided by this contract is for use solely
by the Contractor and only for the purposes outlined in this contract.
vi. Aggregate Data Publication. The Contractor agrees to provide a copy of all proposed
publications to IDPH at least thirty (30) days in advance of the proposed dissemination
date. The publication shall not be published in any format without the prior written
consent of IDPH. Any publication of aggregate data shall comply with IDPH
confidentiality guidelines, including IDPHPolicy for Release of Confidential Public
Health Records.
a. If the Contractor is associated with an Iowa regent institution,the Contractor
agrees to comply with the conditions regarding publications and presentation
contained in Section 8(b) "f' of the General Conditions for Contracts with State
Universities, effective May 1, 2014.
b. If Contractor is not associated with an Iowa regent institution, Contractor agrees
to provide a copy of the proposed publication to IDPH at least thirty(30) days in
advance of the proposed dissemination date. The publication shall not be
published in any format without the prior written consent of IDPH.
vii. Data Linkage. Contractor may not link the data provided by this contract to any other
dataset without express written permission from IDPH.
The Department agrees to:
• Provide the Contractor with a timeframe for submitting data or reports requested through the
Lead Data Request form.
• Respond to Contractor requests for data needed to support the identification of children and
properties associated with blood lead levels greater than or equal to 5 micrograms per deciliter in
a reasonable timeframe.
ENVIRONMENTAL CASE MANAGEMENT
The Contractor shall ensure that the Designated Agency:
• Maintains certification of individual inspectors as elevated blood lead(EBL)inspector/risk
assessors and agency certification as an elevated blood lead level (EBL) inspection agency. The
Contractor or Designated Agency and the certified individuals shall comply with the provisions
of Iowa Administrative Code 641-70.6(3).
• Enrolls as a Medicaid provider for EBL inspection services, recovers reimbursement from
Medicaid for EBL inspections, and uses the reimbursement as program income.
– Conducts elevated blood lead(EBL)inspections for any child under the age of six years
who has had one venous blood lead level greater than or equal to 20 gg/dL or at least two
venous blood lead levels of 15 to 19 gg/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 gg/dL or
three blood lead levels less than 15 gg/dL. EBL inspections shall be conducted within the
following times:
• Two venous blood lead levels of 15 to 19 gg/dL–within 4 weeks after the report.
• Venous blood lead level of 20 to 44 gg/dL–within 2 weeks after the report.
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• Venous blood lead level of 45 to 69 gg/dL—within 1 week after the report.
• Venous blood lead level greater than or equal to 70 gg/dL — within 2 days
after the report.
• Documents in HHLPSS the reason why the Designated Agency was unable to complete any
inspection required by this contract.
• Contacts the occupants and/or owners of dwellings where lead hazards have been identified
within 30 days of the initial inspection to check their progress towards making the dwelling
lead-safe.
• Contacts the current owners of all dwellings where lead hazards were identified, but lead
hazard remediation has not been completed, at least once each year.until lead hazard
remediation is completed.
• Continues follow up on all of these dwellings until lead hazard remediation is completed. If
lead hazard remediations still exist after 10 years and no child less than 6 years live in the
dwelling, and the dwelling is not a child-occupied facility, the Contractor may discontinue
follow up activities.
• Does not close an address associated with a lead-poisoned child where lead hazards have been
identified unless the lead hazard remediation has been completed or written permission has
been obtained in advance from the Department to close the address even though lead hazard
remediation has not been completed.
• To the extent possible, assists families who have lead-poisoned children in locating resources
for lead hazard remediation and/or alternative housing.
• Conducts clearance testing according to Iowa Administrative Code Chapter 641 70, Lead
Professional Certification,before verifying that lead hazard remediation has been completed in
a home associated with a lead-poisoned child.
The Contractor must adopt and enforce a local code that requires hazards to be repaired in the
homes of elevated blood lead(EBL) children. A model code is available at Iowa Administrative
Code 641 Chapter 68. Contractors may adopt this model code by reference.
Local regulations must be as protective as Iowa Administrative Code 641 Chapter 68. Local
regulations that were previously adopted must be updated to reflect safe dust lead levels and other
items that have changed since the local regulations were adopted.
MEDICAL CASE MANAGEMENT
The Contractor shall ensure that the Designated Agency:
• Conducts medical case management as specified in this contract.
• Is enrolled as a Medicaid provider for services that can be reimbursed by Medicaid,
recovers reimbursement from Medicaid for medical case management services, and uses the
reimbursement as program income.
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Follow-un blood lead testing
The Contractor shall ensure that the Designated Agency:
• Assures that providers in the CLPPP service area that conduct blood lead testing provides
follow-up blood lead testing for children under the age of six years within the timelines listed
below. The Designated Agency may also provide this follow-up blood lead testing.
Confirmatory venous blood lead testing
• Capillary blood lead level of 15 to 19 gg/dL—within 4 weeks after the report.
• Capillary blood lead level of 20 to 44 gg/dL—within 1 week after the report.
• Capillary blood lead level of 45 to 69 gg/dL—within 48 hours after the report.
• Capillary blood lead level greater than or equal to 70 gg/dL—immediately.
Follow-un 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 gg/dL — within 3 months. After two
levels less than 10 gg/dL or three levels less than 15 gg/dL, testing should follow the
routine testing schedule for high-risk children.
• Venous blood lead level of 15 to 19 gg/dL—within 3 months.
• Venous blood lead level of 20 to 44 gg/dL—within 4 to 6 weeks.
• Venous blood lead level greater than or equal to 45 gg/dL—immediately.
Follow-un testing for a child who has been chelated
• At the end of chelation.
• Depending on the blood lead level, 7 to 21 days after the end of chelation. The results of
this test will determine the need for additional chelation and the schedule for additional
blood lead testing.
Medical evaluations
The Contractor shall ensure that the Designated Agency:
• Assures that providers in the CLPPP conduct medical evaluations for children under the age
of six years within the following timelines:
• Venous blood lead level of 20 to 44 gg/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 ensure that the Designated Agency provides 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 gg/dL—within 4 weeks after the report.
• Venous blood lead level of 20 to 44 gg/dL—within 2 weeks after the report
• Venous blood lead level of 45 to 69 gg/dL—within 1 week after the report
• Venous blood lead level greater than or equal to 70 gg/dL — within 2 days after the
report.
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Chelation
The Contractor shall ensure that the Designated Agency
• Assures that children with two venous blood lead levels greater than or equal to 45 gg/dL
receive chelation.
Nutrition Evaluation
The Contractor shall ensure that the Designated Agency:
• Assures 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 timelines:
• Venous blood lead level of 15 to 19 gg/dL—Refer within 4 weeks after the report so that
the service is received within 6 weeks.
• Venous blood lead level of 20 to 44 gg/dL—Refer within 2 weeks after the report so that
the service is received within 4 weeks.
• Venous blood lead level of 45 to 69 gg/dL— Refer within 1 week after the report so that
the service is received within 2 weeks.
• Venous blood lead level greater than or equal to 70 gg/dL—Refer within 2 days after the
report so that the service is received with 1 week.
• Contacts the Department for assistance if access to a dietitian cannot be assured for children
under the age of six years with a venous blood lead level greater than or equal to 15 gg/dL.
Developmental Assessment
The Contractor shall ensure that the Designated Agency:
• Assures 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 gg/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 gg/dL— Refer within 2 days after the
report.
Care Coordination
The Contractor shall ensure that the Designated Agency provides care coordination or refers the family
to the local child health Contractor for this service.
Medical Case Closure Guidelines
Medical cases shall be closed only in the following circumstances:
1. A child has had two consecutive blood lead levels less than lOgg/dL or three consecutive
blood lead levels less than 15 gg/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 lOgg/dL immediately after a single capillary blood lead level greater than
or equal to 15 gg/dL.
3. A child has reached the age of six years and has a blood lead level less than 20gg/dL.
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4. A child has moved out of the CLPPP service area. The Contractor shall ensure that the
Designated Agency immediately notifies IDPH.
CHILDREN OVER THE AGE OF SIX YEARS
The Contractor shall ensure that the Designated Agency contacts the department for specific case
management guidelines for a child over the age of six years who has a venous blood lead level greater
than or equal to 20 gg/dL.
Article VIII—Reports:
The Contractor shall complete and submit the following reports in the grant site located in IowaGrants.
qF
Report Title Form Frequency/Type Date Due
Claim Voucher Monthly/electronic Within 45 days of month of
expenditure
Documentation to Claim Voucher monthly/electronic Within 45 days of month of
expenditure
Quarterly Narrative Report Quarterly/electronic Submit with October claim
Submit with January claim
Submit with April claim
Submit with July claim
Article IX - Budget:
1. All services listed in Exhibit 1 under Program Services—Unit Cost Reimbursement Line Items
will be reimbursed at the budget rates specified up to the amount of the contract.
2. All services listed in Exhibit 1 under Program Services—Cost Reimbursement Line Items will
be reimbursed up to the maximum amount specified,up to the amount of the contract.
Article X - Payments:
1. The Contractor shall complete and submit a monthly claim in the grant site located in
IowaGrants within 45 days of the month of expenditures. Payments shall be made to the
Contractor based on the claim vouchers submitted to the Department by the Designated Agency.
2. The Department provides contractual payments on the basis of reimbursement of actual expenses
in accordance with Iowa Code 8A.514.
3. The Department will not reimburse travel amounts in excess of limits established by Iowa
Department of Administrative Services.
a. Instate maximum allowable amounts for food are $8.00/breakfast, $12.00/lunch and
$23.00/dinner; lodging maximum $83.00 plus taxes per night and mileage maximum of
$0.39 per mile.
12
4. Warrants will be made payable to the Contractor and mailed to the Contract Administrator at the
Designated Agency address. Warrants may be sent to an alternate address if requested in writing
from the Contractor.
5. Payments may be withheld if the Designated Agency or personnel employed by the
Designated Agency is not in compliance with Iowa Administrative Code Chapter 641
70, Lead Professional Certification.
6. 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 XI—Additional Conditions
1. 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.
2. All work plan revisions must be approved by the Department prior to implementation.
3. Funds may not be spent for indirect costs, chelation or other medical treatment of lead poisoning,
or lead hazard remediation. Funds may not be spent for blood lead analyses that could be
reimbursed by Medicaid.
4. On January 1, 2017, April 1, 2017, and June 1, 2017, 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.
5. The Contractor and/or Designated Agency must check IowaGrants.gov correspondences at least
once each week for lead poisoning prevention updates sent out by the Department.
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. Authorization- Each signatory to this contractor subsequent contract amendments represents and
warrants to the other parties that:
a. The signatory has the right,power, and authority to enter into this agreement and to bind
the party represented by the signatory to this agreement
13
b. The party has the right,power, and authority to perform its obligations under the agreement;
and
c. The party has taken all requisite action(corporate, statutory, or otherwise)to approve
execution, delivery, and performance of this agreement and this agreement constitutes a
legal, valid, and binding obligation upon itself in accordance with its terms.
14
EXHIBIT 1 —PROGRAM BUDGET RATES
Program Services - Unit Cost Reimbursement Line Description Budget Rate
Non-Medicaid Home Nursing Visits 80
Referrals for Nutrition Counseling 10
Referrals for Developmental Testing 10
Non-Medicaid Initial Inspection Events 600
EBL Investigation CONTC Events 10
Completed Lead Hazard Remediations 10
EBL Investigation INSAB, INSAI, INSAE Events 80
EBL Investigation Properties Passing Clearance Testing 300
Narrative Quarterly Report Submitted on Time 25
XRF Source Replacement 2000
Non-Medicaid Blood Lead Sample Collection 3
Child CONTC or ACTIO event 10
Education/Outreach and Community Partnerships Planning& Meeting 50
Hours
Non-Medicaid Blood Lead Analysis 18
Program Services - Cost Reimbursement Line Description :i&:::
Initial EBL Inspector Certification Not to exceed
$3,000 per
certification
EBL Inspector Refresher Training, CLPPP Meetings, Trainings, and Not to exceed
Conferences $1,500 per
person
15
APPENDIX I
Mandatory Reporting of
Blood Lead Level Results
16
APPENDIX I
Mandatory Reporting of Blood Lead Level Results
Iowa Administrative Code Sec. 641-1.6(3) states that for blood lead testing, "...analytical results shall
be reported to the department at least weekly in an electronic format specified by the department."
We suggest you use the Lead Care Reporting Software available through Magellan, the company which
manufactures the LeadCareII machine. Here is a link to download the Lead Care Reporting software (if
clicking on the link doesn't work,just copy and paste into your browser):
htty://www.leadcare2.com/Product-Support/Reporting-Solutions
Also included in the link are some instructions on using the software developed by Magellan, and the
specifications for reporting for the State of Iowa. If you need additional help, IDPH can connect you
with other LeadCare II user locations.
Here are the pieces of information that are required for each result reported:
Name Date of Sample
Date of Birth Sample Type(Capillary or Venous)
Street Address or PO Box Numerical result
City Lab Name
State Provider Name and
Zip Facility Name
Race
Ethnicity
Sex
(This information is required by the Lead Poisoning Prevention Program at the federal Centers for
Disease Control.)
Critical things to keep in mind:
1) Iowa Code requires weekly reporting of all blood lead tests.
2) You must inform us immediately via phone call at 1-800-972-2026 or by fax at 1-515-281-4529
of any test results at 20 or above. (These more critical levels require that our staff or local public
health staff follow up with the child's family and/or care provider in atimely manner.)
3) Reporting must be done electronically in a format specified by the Department. We currently
accept three specified formats: HL7 (the standard reporting format used by healthcare
information systems), the XML format produced by the LeadCareII Software manufactured by
Magellan, Inc., and the Excel spreadsheet attached to your weekly reminder.
4) Reporting must be done via a secure e-mail channel using the State of Iowa's Secure Mail
system. What follows is a set of instructions on using this system.
Sending Blood Lead Level Results via the State of Iowa's Secure Mail system
17
You will be receiving a scheduled message on Monday of each week as a reminder to report your lead
tests. The message will contain the image below and prompt you to click on a hyperlink to read the
message.
You have received a secure email from the State of Iowa.
1. When you click on the hyperlink, you will be taken to a login page where you will be required to
create an new account—THIS IS A ONE-TIME PROCESS
2. You will be guided step-by-step through this process; CAREFULLY READ THE
INSTRUCTIONS
NOTE: for additional details on Iowa.gov SecureMail, see the user guide at:
http://das.ite.iowa.aov/docs/infrastructure/External User Guide to Secure Email Svstem
.pdf
3. DOCUMENT AND SAVE YOUR SecureMail CREDENTIALS FOR FUTURE USE
4. Login to your Iowa.gov SecureMail account
5. Open the newly received SecureMail message with "IDPH Lead Reporting" in the subject line
Reporters that use the LeadCare*H software to create a reporting file
• just need to reply to the SecureMail message and
• attach the reporting file to the reply by clicking on the `Attach' button near the top of the
message window
• click the `Send' button to send the message
Reporters that use an Excel template for reporting:
• Ston using all previous reporting templates and spreadsheets
• When you access the SecureMail message, please open the attachment located at the bottom
of the screen and save this to a location with which you are familiar (Desktop on your
computer or a familiar network location)—If you are a laboratory that currently submits an
Excel template you should have received an example of this template in a previous email
from IDPH.
• Open the NEW TEMPLATE and enter your lead reporting information
• Save the template
• Attach the reporting file to the reply by clicking on the `Attach' button near the top of the
message window
• Click the `Send' button to send the message
18
Appendix II
Lead Data Request Form
19
LEAD DATA REQUEST
Date of request: 0 Date required: 0
++++++++++++++++++++++++++++++++++++++++++++++++++
CONTACT INFORMATION:
Name
Program:
e-mail:
Phonenumber:
++++++++++++++ ++ ++ ++ + . ++ ++ + + ++ + + ++ + + + + + + + + + + + + + + + +
SERVICE REQUEST:
Service Type:
Format of Data
Purpose :
Access to Data
Data Requested:
Submit completed form to Rob Walker at: Robert.Walker@IDPH.lowa.gov
THANK YOU: Your request will be processed in the order it was received.
20
SUBCONTRACT FOR HEALTHY HOMES AND CHILDHOOD LEAD POISONING
PREVENTION SERVICES
BETWEEN
DUBUQUE COUNTY BOARD OF HEALTH
AND
THE CITY OF DUBUQUE
WHEREAS, the Dubuque County Board of Health (County Board), as Contractor,
has entered into an Agreement (the Agreement) wit the Iowa Department of Public
Health to perform childhood lead poisoning prevention services as set forth in the
Agreement (Contract # 5887LP03), a copy of which is attached hereto; and
WHEREAS, County Board desires to enter into a subcontract with the City of
Dubuque (City) to perform the services required by the Agreement and City desires to
provide such services through its Health Services Department.
NOW, THERFORE, IT IS AGREED BY AND BETWEEN THE PARTIES AS
FOLLOWS:
1. City shall perform all of the services required of the Contractor in the
Agreement.
2. County Board shall pay City for its services in the same manner as County
Board as Contractor will be paid for its services under the Agreement.
Signed and dated the
day of i, . , 2016.
Patrice Lambert M' hael C. Van Milligen
Dubuque County Board of Health
City Manager
SUBCONTRACT
BETWEEN
THE CITY OF DUBUQUE, IOWA,
AND
THE DUBUQUE VISITING NURSE ASSOCIATION
FOR THE
HEALTHY HOMES AND CHILDHOOD LEAD POISONING PREVENTION PROGRAM
This Subcontract between the City of Dubuque, Iowa and The Visiting Nurse
Association is dated for reference purposes the 1st day of July, 2016.
Whereas, Dubuque County, Iowa (Contractor) has entered into Contract 5887LP03
with the Iowa Department of Public Health for Public Health (the Department) for the
Healthy Homes (HH) and Childhood Lead Poisoning Prevention Program (CLPPP) (the
Contract), a copy of which is attached hereto, pursuant to which Contractor will provide the
work and services described in the Contract in accordance with the Special Conditions
therein, and the General Conditions, a copy of which is attached hereto; and
Whereas, the City of Dubuque, Iowa (City) is the Contract Administrator of the
Contracts; and
Whereas, it is necessary for City to subcontract for certain work and services; and
Whereas, City now desires to enter into this Subcontract with the Visiting Nurse
Association (VNA) to provide the work and services described herein upon the terms and
conditions set forth herein.
NOW, THEREFORE, IT IS AGREED BY AND BETWEEN CITY AND VNA AS
FOLLOWS:
SECTION 1. WORK AND SERVICES. City and VNA agree to provide the following work
and services (the Work and Services):
1.1. City's Responsibilities. City agrees that it will provide the following services for the
HH & CLPPP:
(1) Submit reports/vouchers and other reporting requirements as required by the
Iowa Department of Public Health (IDPH), the Centers for Disease Control and
Prevention (CDC), and the Department of Housing and Urban Development (HUD).
(2) Provide for environmental investigations and environmental case
management for lead abatement\lead hazard reduction and healthy homes
interventions in housing units in the city of Dubuque, Iowa, and Dubuque County.
(3) Provide compensation to the VNA during the term of this Agreement not to
exceed $4,000 for the performances of VNA's responsibilities as set forth herein.
(4) Oversee and direct medical case management and educational/outreach
activities through verbal and written direction.
1.2. VNA's Responsibilities. VNA agrees to provide the following services for HH &
CLPPP during the term of this Agreement for the agreed compensation:
(1) Provide written quarterly reports on lead and healthy homes activities utilizing
the Iowa Quarterly Report Narrative Outline.
(2) Provide electronic documentation of medical case management and related
activities into City's lead and healthy homes database systems, HHLPSS,
and of educational activities performed for each month by the 10th of the
following month.
(3)
Provide for blood lead testing, medical case management, data
management, and community education as referenced in the attached IDPH
contract #5887LP03, dated July 1, 2016 -June 30, 2017.
SECTION 2. CONTRACT POLICIES AND REQUIREMENTS. In providing the Work and
Services, VNA agrees to comply with the requirements in the Contract, including the
Special Conditions, and the General Conditions, to the extent applicable to the Work and
Services described in Section 1.
SECTION 3. ACCESS TO BOOKS AND RECORDS. VNA to provide access, upon
reasonable notice, for the purpose of audit and examination, to its documents, papers, and
records, to the extent such documents, papers, and records are related to the Work and
Services, to the Department, Contractor, City, or any of their duly authorized
representatives.
SECTION 4. COSTS TO BE REIMBURSED. Attached hereto is a line item CLLLP
Performance Measure budget of specific costs to be reimbursed under this Subcontract or
other cost basis for determining the amount of the Subcontract. The Healthy Homes
activities will be invoiced to the City for VNA staff time plus benefits at 32%.
SECTION 5. INCORPORATION OF THE CONTRACT. VNA agrees that all of the
provisions of the Contract, including audit requirements, are incorporated herein by this
reference and VNA shall have all of the same requirements, obligations and conditions as
Contractor with respect to VNA's Work and Services.
SECTION 6. PERIOD OF PERFORMANCE. Unless terminated as provided herein, the
Period of Performance for the Work and Services shall be from the the 1st day of July
2016, through the 30th day of June, 2017.
SECTION 7. TERMINATION. Either party may terminate this Subcontract for any reason,
with or without cause, upon ten (10) days written notice to the other party. In the event of
termination, City shall compensate VNA for its Work and Services rendered through the
date of termination.
SECTION 8 INDEMNIFICATION.
(1) VNA agrees to defend, indemnify, and hold Department, City and Contractor,
and their officers, and employees harmless from and against any and all claims of
any kind arising out of or related to VNA's negligence in the performance of the
Work and Services pursuant to this Subcontract.
(2) City agrees to defend,, indemnify, and hold VNA and its officers, and
employees harmless from and against any and all claims of any kind arising out of
or related to City's negligence in the performance of the Work and Services
pursuant to this Subcontract.
SECTION 9. INSURANCE. VNA shall at its expense maintain insurance with the same
coverage which Contractor is required to maintain under Par. 13 of the General Conditions.
CITY OF DUBUQUE, IOWA VISITING NURSE ASSOCIATION
By:
By:
Michael C. Van Milligen Stacey Killian
City Manager Administrative Director
City of Dubuque Insurance Requirements for Professional Services
Insurance Schedule C
1. shall furnish a signed Certificate of Insurance to the City of Dubuque, Iowa for the
coverage required in Exhibit I prior to commencing work and at the end of the project if the term of work
is longer than 60 days. Providers presenting annual certificates shall present a Certificate at the end of
each project with the final billing. Each Certificate shall be prepared on the most current ACORD form
approved by the Iowa Department of Insurance or an equivalent. Each certificate shall include a
statement under Description of Operations as to why issued. Eg: Project# or Project Location at
or construction of
2. All policies of insurance required hereunder shall be with a carrier authorized to do business in Iowa and
all carriers shall have a rating of A or better in the current A.M. Best's Rating Guide.
3. Each Certificate shall be furnished to the contracting department of the City of Dubuque.
4. Failure to provide minimum coverage shall not be deemed a waiver of these requirements by the City of
Dubuque. Failure to obtain or maintain the required insurance shall be considered a material breach of
this agreement.
5. Consultants shall require all subconsultants and sub-subconsultants to obtain and maintain during the
performance of work insurance for the coverages described in this Insurance Schedule and shall obtain
certificates of insurances from all such subconsultants and sub-subconsultants.Consultants agree that it
shall be liable for the failure of a subconsultants and sub-subconsultants to obtain and maintain such
coverages.The City may request a copy of such certificates from the Consultants.
6. All required endorsements to various policies shall be attached to Certificate of insurance.
7. Whenever a specific ISO form is listed,an equivalent form may be substituted subject to the provider
identifying and listing in writing all deviations and exclusions that differ from the ISO form.
8. Provider shall be required to carry the minimum coverage/limits,or greater if required by law or other
legal agreement,in Exhibit I. If provider's limits of liability are higher than the required minimum limits
then the provider's limits shall be this agreement's required limits.
9. Whenever an ISO form is referenced the current edition of the form must be used.
Page 1 of 3 Schedule C Professional Services May 2016
City of Dubuque Insurance Requirements for Professional Services
Insurance Schedule C (continued)
Exhibit I
A) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit $2,000,000
Products-Completed Operations Aggregate Limit $1,000,000
Personal and Advertising Injury Limit $1,000,000
Each Occurrence $1,000,000
Fire Damage Limit(any one occurrence) $ 50,000
Medical Payments $ 5,000
a) Coverage shall be written on an occurrence, not claims made,form. The general liability
coverage shall be written in accord with ISO form CG0001 or business owners form BP0002.
All deviations from the standard ISO commercial general liability form CG 0001,or Business
owners form BP 0002,shall be clearly identified.
b) Include ISO endorsement form CG 25 04"Designated Location(s)General Aggregate Limit'
or CG 25 03"Designated Construction Project(s)General Aggregate Limit'as appropriate.
c) Include endorsement indicating that coverage is primary and non-contributory.
d) Include endorsement to preserve Governmental Immunity.(Sample attached).
e) Include an endorsement that deletes any fellow employee exclusion.
f) Include additional insured endorsement for:
The City of Dubuque,including all its elected and appointed officials,all its employees
and volunteers,all its boards,commissions and/or authorities and their board members,
employees and volunteers. Use ISO form CG 2026.
B) AUTOMOBILE LIABILITY $1,000,000(Combined Single Limit)
C) WORKERS'COMPENSATION&EMPLOYERS LIABILITY
Statutory benefits covering all employees injured on the job by accident or disease as prescribed by
Iowa Code Chapter 85 as amended.
Coverage A Statutory—State of Iowa
Coverage B Employers Liability
Each Accident $100,000
Each Employee-Disease $100,000
Policy Limit-Disease $500,000
Policy shall include an endorsement providing a waiver of subrogation to the City of Dubuque.
Coverage B limits shall be greater if required by Umbrella Carrier.
D) UMBRELLA LIABILITY $1,000,000
Umbrella liability coverage must be at least following form with the underlying policies included
herein.
E) PROFESSIONAL LIABILITY $1,000,000
a) Provide evidence of coverage for 5 years after completion of project.
F) CYBER LIABILITY $1,000,000
Coverage for First and Third Party liability including but not limited to lost data and
restoration, loss of income and cyber breach of information.
Yes No
Page 2 of 3 Schedule C Professional Services May 2016
City of Dubuque Insurance Requirements for Professional Services
Preservation of Governmental Immunities Endorsement
1. Nonwaiver of Governmental Immunity.The insurance carrier expressly agrees and states that the
purchase of this policy and the including of the City of Dubuque, Iowa as an Additional Insured does
not waive any of the defenses of governmental immunity available to the City of Dubuque, Iowa
under Code of Iowa Section 670.4 as it is now exists and as it may be amended from time to time.
2. Claims Coverage.The insurance carrier further agrees that this policy of insurance shall cover only
those claims not subject to the defense of governmental immunity under the Code of Iowa Section
670.4 as it now exists and as it may be amended from time to time.Those claims not subject to
Code of Iowa Section 670.4 shall be covered by the terms and conditions of this insurance policy.
3. Assertion of Government Immunity.The City of Dubuque, Iowa shall be responsible for asserting any
defense of governmental immunity, and may do so at any time and shall do so upon the timely
written request of the insurance carrier.
4. Non-Denial of Coverage.The insurance carrier shall not deny coverage under this policy and the
insurance carrier shall not deny any of the rights and benefits accruing to the City of Dubuque, Iowa
under this policy for reasons of governmental immunity unless and until a court of competent
jurisdiction has ruled in favor of the defense(s)of governmental immunity asserted by the City of
Dubuque, Iowa.
No Other Change in Policy.The above preservation of governmental immunities shall not otherwise
change or alterthe coverage available under the policy.
SPECIMEN
Page 3 of 3 Schedule C Professional Services May 2016