1. Getting the Money Local: Consolidated Agreement

2. DPH Key Budget Facts 2

3. DPH Contracts 828 Contracts & Contract Amendments SFY 14/15 681 Contracts 147 Amendments DPH contracts with Community & Faith-Based Organizations, hospitals, universities, and others 3

4. 4 DPH Contracts Continued Local Health Department (LHD) Agreements SFY 14/15 Funds to LHDs are called “Aid to County” (ATC) 85 Consolidated Agreements (one with each of 85 LHDs) 2166 Agreement Addenda (program-specific deliverables) 1434 Agreement Addenda Revisions (to account for charges in funding or deliverables)

5. 5 Accountability for Funding Consolidated Agreement Agreement Addenda IMOA between DMA and DPH Environmental Health Specialists are agents of the state and as such must enforce state laws under the supervision of DPH Create local standards for programs Approves qualifications of local health director applicants Sub-recipient monitoring Program monitoring Tracking health status indicators

6. 6 The Consolidated Agreement An agreement between the state and local health departments that spells out in legal terms what each party is accountable for Today’s focus is on DPH’s responsibilities The CA has multiple Agreement Addenda (AA). There can be no AA if there is not a signed CA in place

7. 7 Consolidated Agreement – Your Job LHDs must comply with applicable program rules contained in NCAC, as well as federal and state laws and regulations Requires performance of all deliverables spelled out in specific program agreement addenda Requires reporting of client data as specified in AAs and to a centralized automated data collection system Requires providing access to patient records by authorized DPH staff Administer and enforce all rules adopted by the Commission, ratified by the NCGA, or adopted by the local Board of Health Provide a copy of any rules adopted by the BOH or PH ordinances adopted by the County Commissioners within 30 days of adoption to LTAT (Phyllis Rocco) Have conflict of interest policies and P&P for Human Subject Clearance Conduct a CHA at least every 4 years and a SOTCH during the in- between years

8. 8 Consolidated Agreement – Your Job Continued Provide formal training for Board of Health members Provide Network & Internet access Incorporate basic elements of the NC PH logo and theme in communications funded with state monies Inform LTAT any time there is a legal name change of the agency Notify the Deputy Director 90 days in advance of any planned discontinuance of CC4C or OBCM

9. 9 The Consolidated Agreement Requires LHDs to…. Assure the state that expenditures of locally appropriated funds (MOE) are maintained for maternal health, child health, and family planning program activities equal to or greater than that reported on the Staff Time Activity report for the period 7-1-1984 through 6-3-1985.

10. 10 The Consolidated Agreement stipulates that... LHDs may not require a client to present identification that includes a picture of the client for immunization, pregnancy prevention, STDs, and CD services During the current contract period, the LHD may not use state or federal funds to reduce locally appropriated funds May not use personal health funds to fund environmental health programs or vice versa On-Site Wastewater reports are submitted monthly LHDs comply with Standards for Mandated Public Health Services & Administrative Procedures Manual for Federal Block Grant Funds LHDs maintain signed employee time records

11. 11 Consolidated Agreement Continued Purchase of Care rules Equipment rules Prior approval rules for use of PHP&R and MCH funds for things other than equipment Must execute because you receive federal funds Certification regarding Lobbying Debarment Drug-Free Workplace Environmental Tobacco Smoke WIC rules Shall comply with Local Government Budget & Fiscal Control Act Get approval from the state to subcontract services Shall have annual audit

12. 12 Consolidated Agreement Continued Prepare and maintain a Local Appropriations Budget Must report Local Earned Revenues For state and federal revenues only, must submit monthly report of actual state and federal expenditures to the DHHS Controller’s Office in the Aid- to-County database Shall adhere and comply with state & county personnel policies EHS shall be delegated authority by the state to administer and enforce state environmental health rules and laws Confidentiality must be maintained by all staff regarding any personal information gained while performing duties covered under the Consolidated Agreement Must uphold all applicable Civil Rights laws Title 6 & 7 ADA

13. 13 Consolidated Agreement – DPH’s Job Provide regular training and TA in preparation of the Consolidated Agreement and Agreement Addenda Conduct liaison activities with LHD for general problem-solving Provide high-level consultation and TA to local health directors regarding: Board Relations Management Teams and Staffing Policy Development Program Planning and Implementation Quality and Performance Improvement General Administration Consultation (budgeting, fiscal, administrative and management support) Provide coordination and support for training the PH workforce Provide TA and consultation per program areas Provide course coordination, consultation, and technical assistance on nursing practice and standards, P&P that crosses programs Act as the principal liaison between the public health system and DMA re: policy and reimbursement, and shall ensure compliance with DMA P&P Design and implement annual cost studies to assure appropriate cost-based Medicaid reimbursement

14. 14 Consolidated Agreement – DPH’s Job Continued Provide automated billing system to Medicaid, private insurers, and a data reporting system that is HIPAA compliant Provide Budgetary Estimates no later than February 14 th and final Funding Authorization each year after the state budget is certified. Exceptions exist with the process of allocating funds for the Food & Lodging program. Provide payments to the counties based on the timely submission of expenditure reports via the WIRM Assist the Department in complying with all applicable laws, regulations, and standards relating to the activities covered in the Consolidated Agreement Provide SLPH services at low cost Disburse funds to the counties on a monthly basis Disburse Food & Lodging funds based on NCAC T15A: 18A-.2900 Both parties may terminate the Consolidated Agreement with a 60-day written notice for reasons other than non-compliance

15. 15 Consolidated Agreement – DPH’s Job Continued Respond to non-compliance with the Consolidated Agreement If there is non-compliance with any part to the Consolidated Agreement by a local health department, then the state is to give the local health department a 60-day written notice to come into compliance If the deficiencies are not corrected within 60 days to the satisfaction of the state, then disbursement of funds can be suspended for that particular activity If still not corrected within the next 30 days, program funds may be permanently suspended until the department can provide evidence that they have been corrected If non-compliance with the Consolidated Agreement continues, then the state may cancel, terminate, or suspend the Consolidated Agreement in whole or in part Monitor CBOs, LHDs, or any other organization the state serves as a “pass through” federal funds and state funds and as specified in the DHHS Policy and Procedure manual regarding monitoring and as specified in the IMOA between DMA and DPH Assure retention of records as specified in the state’s Record Retention Policy