HomeMy WebLinkAboutC2019-314 - 6/18/2019 - Approved r. r
DocuSign Envelope ID:B48BC221-5A7A-40E3-AF58-4907A2A6645D
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
CONTRACT No.HHS000114000001
AMENDMENT No. 01
The Department of State Health Services rDSHS" or "System Agency"), an administrative
agency within the executive branch of the State of Texas, and Corpus Christi-Nueces County
Public Health District(City) ("Grantee"),who are collectively referred to herein as the"Parties,"
to that certain Immunization/Locals Grant Program Contract effective September 1, 2018, and
denominated DSHS Contract No.HHS000114000001 (the"Contract"), now desire to amend the
Contract.
Whereas,the Parties desire to allot additional funds,revise the Statement of Work,add a Guidance
Document, and extend the term of the Contract to allow for successful completion of the Project;
and
Whereas, the Parties have chosen to exercise their option to amend the Contract in accordance
with Section 9.01 of Attachment C to the Contract.
Now,therefore,the Parties hereby amend and modify the Contract as follows:
1. Section III of the Contract, Duration, is hereby amended to reflect a revised termination date
of August 31,2020,unless renewed, extended, or terminated earlier pursuant to the terms and
conditions of the Contract.
2. Section IV of the Contract, Budget, is hereby amended to add funding for state fiscal year
2020 in the amount of $241,637.00, which is based on $134,125.00 state funds and
$107,512.00 federal funds. The total not-to-exceed amount of this Contract is increased to
$483,274.00. All expenditures under the Contract will be in accordance with Attachment B-
1,Fiscal Year 2020 Budget.
3. Attachment A of the Contract, Statement of Work, is hereby amended and replaced with
Attachment A-1, Revised Statement of Work. Attachment A-1 is applicable to the period
beginning on the effective date of this Amendment.
4. Attachment B of the Contract, Budget, is hereby supplemented with the addition of
Attachment B-1,Fiscal Year 2020 Budget.
5. Attachment F of the Contract, Federal Funding Accountability and Transparency Act, is
hereby supplemented for state fiscal year 2020 with the addition of Attachment F-1,Federal
Funding Accountability and Transparency Act.
6. Attachment H,Immunization/Locals Program Guidance Document,is attached hereto and
incorporated into the Contract as if fully set forth therein.
7. Grantee may not begin work or incur any expenses prior to the date on the System Agency's
Notice to Proceed ("NTP"). This Notice to Proceed may include an Amended or Ratified
System Agency Contract No.HHS000114000001 PagA NNE D
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Budget which will be incorporated into this Contract by a subsequent amendment, if amended.
Any work performed prior to the date on the NTP shall be at Grantee's sole risk.
8. This Amendment No. 01 shall be effective as of September 1, 2019.
9. Except as amended and modified by this Amendment No. 01, all terms and conditions of the
Contract shall remain in full force and effect.
10. Any further revisions to the Contract shall be by written agreement of the Parties.
Signature Page Follows
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DocuSign Envelope ID:B48BC221-5A7A-40E3-AF58-4907A2A6645D
Signature Page for Amendment No. 01
DSHS Contract No. HHS000114000001
Department of State of Health Corpus Christi-Nueces County
Services Public Health District
DocuSiyned by:
r—DocuSigned by:
By:l "M tU4 ��U
a A By: AMe e poAi( ie
�87AFD32AD9D24A9_. —4FC9D92742CE414...
Name: Imelda Garcia Name: Annette Rodriguez
Title: Associate Commissioner Title: Health Director
Date of ExecutionJune 18, 2019 Date of Execution: June 18, 2019
The following attachments are attached and incorporated as part of the Contract:
Attachment A-1 Revised Statement of Work
Attachment B-1 Fiscal Year 2020 Budget
Attachment F-1 Federal Funding Accountability and Transparency Act
(FFATA)
Attachment H Immunization/Locals Program Guidance Document
ATTEST: ItI/
RE SCCA HUERTA
CITY SECRETARY
Approved as to f I
G' do
Assistant ity Attorney
For City Attorney
Orct- 0�j1 HUKILLA.
ff Mint
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Attachment A-1
Revised Statement of Work
I. GRANTEE RESPONSIBILITIES
Grantee will:
A. Implement and operate an immunization program for children,adolescents,and adults,
with special emphasis on accelerating interventions to improve the immunization
coverage of children three (3) years of age or younger (birth to 35 months of age).
Grantee shall incorporate traditional and non-traditional systematic approaches
designed to eliminate barriers, expand immunization capacity, and establish uniform
operating policies, as described herein.
B. Be enrolled as a provider in the Texas Vaccines for Children("TVFC") and the Adult
Safety Net (ASN) Programs by the effective date of this Contract. This includes a
signed Deputization Addendum Form (EF11-13999).
C. Comply with written policies and procedures provided by DSHS in managing vaccines
supplied through the ASN and TVFC Programs, including guidelines for proper
storage,handling, and safeguarding of vaccines in the event of natural disaster.
D. Adhere to DSHS Immunization updated guidance according to Attachment H,
Immunization/Locals Program Guidance Document.
E. Maintain staffing levels to meet required activities of the Contract and ensure staff
funded by this Contract attend required training.
F. Report all notifiable conditions as specified in Texas Administrative Code ("TAC")
Title 25,Part I §§ 97.1-97.6, as amended, and as otherwise required by law.
G. Report all vaccine adverse event occurrences in accordance with the 1986 National
Childhood Vaccine Injury Act ("NCVIA") 42 U.S.C. § 300aa-25 (located at
http://vaers.hhs.gov/or 1-800-822-7967), as amended.
H. Sustain a network of TVFC/ASN providers to administer vaccines to program-eligible
populations by conducting the following activities:
1. Ensuring New Provider Checklist is completed;
2. Conducting quality assurance reviews;
3. Ensuring annual influenza pre-book survey is completed;
4. Conducting compliance site visits;
5. Conducting unannounced storage and handling visits; and
6. Ensuring providers adhere to the vaccine borrowing procedure.
I. Participate in audits and assessments through the following activities:
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1. Completing and submitting through Child Health Reporting System("CHRS")
all audits and assessments conducted on childcare facilities and Head Start
Centers;
2. Completing audits, assessments and retrospective surveys of public and private
schools;
3. Reviewing monthly reports to ensure data quality;
4. Reviewing the monthly Provider Activity Reports;
5. Reviewing the quarterly Consent Accepted Rate Evaluations; and
6. Conducting quality improvement assessments of Texas Immunization Registry
organizations.
J. Provide education and outreach activities regarding vaccines and vaccine-preventable
diseases, Texas Immunization Registry, and TVFC and ASN Programs to the
following:
1. American Indian Tribes;
2. Schools and childcare facilities;
3. Healthcare workers; and
4. Community and general public.
K. Not deny vaccinations to recipients because they do not reside within Grantee's
jurisdiction or because of an inability to pay an administration fee.
L. Be responsible for identification and case management of all hepatitis B surface antigen
("HBsAg")-positive pregnant women. Grantee shall ensure timely newborn post-
exposure prophylaxis ("PEP") with hepatitis B vaccine and hepatitis B immune
globulin ("HBIG"), timely completion of doses two and three of hepatitis B vaccine,
and timely completion of post-vaccination serologic testing ("PVST").
M. Be responsible for assessing and/or auditing coverage rates and/or compliance with
vaccine requirements at assigned schools and childcare facilities in accordance with the
Population Assessment Manual,which is distributed annually from DSHS.
N. Transfer(which may include shipping)overstocked vaccines and vaccines approaching
expiration to alternate providers for immediate use when instructed to do so by the
DSHS Public Health Region ("PHR") Immunization Program Manager to avoid
vaccine waste. Grantee is responsible for covering the cost to ship overstocked
vaccines and vaccines approaching expiration.
0. Receive written approval from DSHS before varying from applicable policies,
procedures, protocols, and/or work plans, and must update and disseminate its
implementation documentation to its staff involved in activities under this Contract
within forty-eight (48)hours of making approved changes.
P. Review monthly Contract funding expenditures and salary savings from any Contract-
paid staff vacancies and revise spending plan to ensure that all funds will be properly
expended under this Contract before the end of the Contract term.
Q. Submit out-of-state travel requests to the Immunization Unit for approval when
utilizing Contract funds or program income.
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R. Report the number of doses administered to underinsured children monthly,as directed
by DSHS.
S. Report the number of unduplicated underinsured clients served, as directed by DSHS.
T. Complete and submit Immunization Inter-Local Agreement Quarterly Report form,
utilizing the format provided by the DSHS Immunization Unit and available at
https://dshs.texas.gov/immunize/lhd.shtm, by the report due date. If the due date falls
on a weekend or state-approved holiday,the report is due the next business day.
Report Type Reporting Period Report Due Date
Programmatic 09/01/2019 to 11/30/2019 12/31/2019
Programmatic 12/01/2019 to 02/29/2020 03/31/2020
Programmatic 03/01/2020 to 05/30/2020 06/30/2020
Programmatic 06/01/2020 to 08/31/2020 10/31/2020
Submit quarterly reports electronically through Survey Gizmo following instructions
provided by the DSHS Immunization Unit and according to the time frames stated
above. Supplemental report documents(PEAR and AFIX reports,vacancy letters,etc.)
should be sent to dshsimmunizationcontracts@dshs.texas.gov.
II. PERFORMANCE MEASURES
The System Agency will monitor the Grantee's performance of the requirements in this
Attachment A-1 and compliance with the Contract's terms and conditions.
III. INVOICE AND PAYMENT
A. Grantee shall request monthly payments using the State of Texas Purchase Voucher
(Form B-13) at http://www.dshs.texas.gov/grants/forms.shtm and submitting
acceptable supporting documentation for reimbursement of the required
services/deliverables. Vouchers and supporting documentation shall be submitted to
System Agency no later than thirty (30) days after the last day of each month.
Documentation shall be submitted in a format approved by DSHS Immunization Unit.
At a minimum vouchers should include:
1. Grantee name, address, email address, vendor identification number or Social
Security number, and telephone number;
2. DSHS Contract or Purchase Order number;
3. Dates services were completed and/or products were delivered; and
4. The total invoice amount.
5. Supporting documentation must include:
a. Receipts with a zero balance for items such as hotel, rental car and fuel, taxi,
airline or mileage as documented by a readily available online mapping service;
b. Receipts for supplies,registration fees and other items ordered and paid for;
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c. A copy of the Personnel and Temporary Staff General Ledger for the period
which supports the budget items requesting reimbursement; and
d. Paid invoices to contractors for services received. Receipts for meals are not
required.
B. Voucher and supporting documentation shall be mailed or submitted by fax or
electronic mail to DSHS Claims Processing Unit at the address/number below,and also
sent via email to Tray Kirkpatrick, DSHS Contract Management Section, at
tray.kirkpatrick@dshs.texas.gov, and to the Immunization Unit at
dshsimmunizationContracts@dshs.texas.gov.
Department of State Health Services
Claims Processing Unit, MC 1940
P.O.Box 149347
Austin, Texas 78714-9347
Fax: (512)458-7442
Email: invoices@dshs.texas.gov and to CMSinvoices@dshs.texas.gov
C. Grantee will be paid on a cost reimbursement basis and in accordance with the
established state fiscal year Budget of this Contract.
(Remainder of Page Intentionally Left Blank)
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Attachment B-1
Fiscal Year 2020 Budget
Organization Name: Corpus Christi-Nueces County Public Health District (City)
Program ID: IMM/LOCALS
Contract Number:HHS000114000001
Budget Categories Budget for FY 2020
Personnel $141,376.00
Fringe Benefits $65,033.00
Travel $9,242.00
Equipment $0.00
Supplies $17,337.00
Contractual $0.00
Other $8,649.00
Total Direct Costs $241,637.00
Indirect Costs $0.00
Total $241,637.00
(Remainder of Page Intentionally Left Blank)
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Attachment H
Immunization/Locals Program Guidance Document
GRANTEE RESPONSIBILITIES
Instructions related to each required and suggested activity below can be found in the
Immunization Program Contractor's Guide.
1.PROGRAM& CONTRACT MANAGEMENT
1.1.PROGRAM MANAGEMENT
1.1.01 Implement and operate an Immunization Program as a Standard
Responsible Entity (Universal)
1.1.02 Identify at least one individual to act as the program Required
contact in the following areas: Activity
1. Immunization Program Manager,
2. RE Contract Coordinators,
3. RE School Compliance Coordinators,
4. RE Perinatal Hepatitis B Case Manager,
5. RE Disease Surveillance Coordinators,
6. RE Clinical Coordinators,
7. RE Texas Immunization Registry Coordinators,
8.RE TVFC&ASN Coordinators, and
9. RE Communications Coordinators
1.1.03 Attend all required trainings for each Area of Work as Required
specified in the Immunization Program Contractor's Activity
Guide.Ensure that the Immunization Program Manager
and TVFC and ASN Coordinator attend the annual
Immunization Unit mandatory in-person meeting
1.1.04 Comply with the DSHS Immunization Contractor's Guide Standard
for Local Health Departments which includes all (Universal)
immunization grant objectives and required activities. The
Immunization Contractor's Guide is Attachment A of the
ILA and will be attached to the executed contract
1.1.05 Annually complete one LHD Deputization Addendum Required
Form(EF 11-13999)for all Provider Identification Activity
Numbers (PIN) associated with the LHD Grantee to ensure
eligibility to provide immunization services to
underinsured children
1.1.06 Maintain staffing levels adequate to meet the required Standard
activities of this contract and to assure expenditure of all (Universal)
contract funds
1.1.07 Develop and implement an employee immunization policy Required
for Grantee's immunization program staff according to Activity
CDC recommendations
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1.1.08 Maintain a record of orientation (new staff) and ongoing Required
training for existing contract-funded staff involved in the Activity
provision of immunization services
1.1.09 Inform DSHS (in writing) of any changes (both departures Required
and arrivals) in LHD Medical Director, Immunization Activity
Program Manager and all other positions listed under
activity 1.1.02 within 30 days of staffing changes
1.1.10 Submit a written notification for contract-funded staff Required
positions that remain vacant more than 90 days Activity
1.1.11 Have a standard method to document all work time spent Standard
performing immunization activities for staff who are (Universal)
partially funded with immunization contract funds
1.1.12 Use the results of the community assessment conducted in Suggested
activity 4.7.01 to review and address an immunization need Activity
within the LHD jurisdiction
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1.2. PROGRAM COMPLIANCE
1.2.01 Comply with all applicable federal and state regulations Standard
and statutes as amended, (Universal)
including but not limited to:
1. Human Resources Code §42.043,VTCA;
2. Education Code §§38.001-38.002, VTCA;
3. Health and Safety Code §§12.032, 81.023,and 161.001-
161.009,VTCA;
4. TAC Title 25, Chapter 97;
5. TAC Title 25,Chapter 96;
6. TAC Title 25, Chapter 100;
7. 42 USC §§247b and 300 aa-25;
8. Omnibus Budget Reconciliation Act of 1993, 26 USC
§4980B
1.2.02 Ensure compliance with Health and Human Services Standard
(HHS)Deputization Guidance.Activities under this (Universal)
requirement shall be conducted in accordance with the
DSHS Immunization Contractor's Guide for Local Health
Departments
1.3.FINANCIAL MANAGEMENT
1.3.01 Agree DSHS reserves the right,where allowed by legal Standard
authority,to redirect funds in the event of financial (Universal)
shortfalls
1.3.02 Submit monthly invoices with appropriate supplemental Required
documentation and request monthly payments using the Activity
State of Texas Purchase Voucher(Form B-13)and in
accordance with the DSHS Immunization Contractor's
Guide for Local Health Departments
1.3.03 Agree DSHS will pay Grantee on a cost reimbursement Standard
basis (Universal)
1.3.04 Adhere to travel rates set by the State of Texas TexTravel Standard
(Universal)
1.3.05 Review monthly contract funding expenditures to ensure Standard
that all funds will be properly expended before the end of (Universal)
the contract period
1.3.06 Lapse no more than 5 percent of total funded amount of the Required
contract Activity
1.3.07 Submit requests to move more than 25%of the total Standard
contract amount between direct budget categories in writing (When
to the DSHS Contract Management Section(CMS) in Applicable)
Austin and obtain approval before monies can be
transferred
1.3.08 Expend funds consistently throughout the contract term, Suggested
approximately 25%per quarter Activity
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1.4.CONTRACT MANAGEMENT
1.4.01 Initiate the purchase of approved equipment purchases in Standard
the first quarter of the Contract term. Requests to purchase (When
previously approved equipment after the first quarter must Applicable)
be submitted to the contract manager. Changes to the
approved equipment budget category must be approved by
DSHS prior to the purchase of equipment. If a Grantee
would like to deviate from the approved equipment budget,
a written request to amend the budget is required
1.5.CONTRACT QUALITY ASSURANCE
1.5.01 Participate in remote and on-site technical assistance Required
Activity
1.5.02 Participate in on-site contract evaluation visits Required
Activity
1.6.CONTRACT ACCOUNTABILITY
1.6.01 Submit Corrective Action Plan (CAP) letter to Public Required
Health Region Program Manager and DSHS Contract Activity
Management Section(CMS)within 30 days after the date of
the written notification from DSHS CMS of the on-site
evaluation findings (if applicable)
1.6.02 Maintain property records for property and equipment Standard
funded or property provided by grant funds (Universal)
1.7.REQUIRED REPORTING
1.7.01 Complete and submit Immunization Inter-Local Agreement Required
(ILA)Quarterly Report and supplemental documents Activity
according to the formats, mechanisms,and timeframes
specified in the DSHS Immunization Contractor's Guide for
Local Health Departments
1.7.02 Report program income (PI)generated as a result of the Required
DSHS immunization contract activities on the quarterly Activity
financial status report(FSR)
1.7.03 Ensure all program income (PI) generated as a result of the Standard
DSHS immunization contract activities is expended in (Universal)
accordance with the DSHS Immunization Contractor's
Guide for Local Health Departments
1.7.04 Submit quarterly FSRs to Accounts Payable by the last Required
business day of the month following the end of each quarter Activity
for review and financial assessment. Submit the final FSR
no later than forty-five(45) calendar days following the end
of the applicable term
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2.FACILITY IMMUNIZATION ASSESSMENTS
2.1.CHILDCARE&SCHOOL COMPLIANCE
2.1.01 Assess and/or audit coverage rates and/or compliance with Standard
vaccine requirements at assigned schools and childcare (Universal)
facilities
2.1.02 Complete 100%of assigned childcare facility and Head Required
Start center audits and assessments. By July 15 of contract Activity
year, local health department staff will complete and
submit into CHRS 100%of assigned childcare audits
2.1.03 Complete 100%of assigned public and private school Required
audits,assessments,retrospective surveys, and validation Activity
surveys in accordance with the DSHS Immunization
Contractor's Guide for Local Health Departments
•By January 15 of contract year, local health department
staff will complete and submit to PHR 50%of assigned
validation surveys
• By February 15 of contract year(end of 2nd Q), local
health department staff will complete and submit to PHR
100%of assigned validation surveys
•By June 30 of contract year, local health department staff
will complete 100%of assigned school audits and submit
to PHR
2.2.CHILDCARE&SCHOOL COMPLIANCE QA
2.2.01 Provide education to school and childcare facilities with Required
high provisional, delinquency,and/or exemption rates at Activity
time of audit or when noncompliant records are identified.
Report education provided to school or childcare staff in
accordance with the DSHS Immunization Contractor's
Guide for Local Health Departments
2.2.02 Provide feedback to DSHS ACE Group regarding Required
trends/issues for school, college, and childcare vaccine Activity
requirements in accordance with the DSHS Immunization
Contractor's Guide for Local Health Departments
2.2.03 Contact schools/districts to remind them to report during Required
the Annual School Survey reporting period in accordance Activity
with the DSHS Immunization Contractor's Guide for
Local Health Departments
2.3.FIRST RESPONDER IMMUNIZATION ASSESSMENTS
2.3.01 Educate and inform first responder facilities on the use of Suggested
the Texas Immunization Registry to assess first responder Activity
immunization records and forecast any future
immunization needs. Use the First Responder
Immunization Toolkit(FRIT)to drive these activities
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3.MANAGING TVFC AND ASN PROVIDERS
3.1.PROVIDER RECRUITMENT
3.1.01 Recruit additional TVFC providers to administer vaccines Suggested
to program-eligible populations.The goal is to increase Activity
each local health department's provider enrollment by a
minimum of 5%
3.1.02 Ensure New Provider Checklist(11-15016)is completed Required
for all clinics that join the TVFC/ASN Program Activity
3.1.03 Collaborate with medical societies and/or local health Suggested
provider organizations to identify providers to recruit and Activity
enroll
3.2.PROVIDER RETENTION
3.2.01 Sustain a network(through re-enrollment)of TVFC Required
providers to administer vaccines to program-eligible Activity
populations
3.2.02 Promote TVFC and ASN Provider achievements: Suggested
-Implement incentives for provider sites that reach Activity
vaccination coverage rate goals
- Implement incentives to recognize sites during national
observances (i.e.NIIW,NIAM, and NIVW)
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3.3.PROVIDER EDUCATION
3.3.01 Provide a training for TVFC and ASN providers within the Suggested
LI-1D Grantee's jurisdiction on the policies outlined in the Activity
TVFC and ASN Provider Manual and recommended
procedures for implementing them. These include:
-procedures for following storage and handling guidelines
-procedures for vaccine management
-procedures for using the DSHS vaccine management
system(EVI)
-procedures for vaccine borrowing
-procedures for other compliance guidelines
-appropriate reporting of vaccine adverse events
-appropriate routine and emergency vaccine storage and
handling plans
-meeting the federal requirement that the most current
Vaccine Information Statements(VIS)(available at
(http://www.cdc.gov/vaccines/hcp/vis/index.html)must be
distributed to patients prior to patient vaccination
3.3.02 Notify providers of TVFC and ASN updates and changes Standard
to program policies and procedures. (Universal)
Notify TVFC/ASN providers of the following:
-CDC and DSHS Announcements
-TVFC/ASN Trainings
-Vaccine storage and handling policy updates
-Vaccine ordering changes
-Vaccine choice
3.3.03 Educate and assist TVFC and ASN providers on a Standard
quarterly basis with Provider Choice, as necessary (Universal)
3.3.04 Inform TVFC and ASN providers of the most up-to-date, Standard
DSHS-produced immunization information for their (Universal)
offices
3.3.05 Identify TVFC and ASN providers experiencing high Required
volumes of vaccine loss and develop process Activity
improvements/trainings aimed at reducing the amount of
vaccine loss (including wasted and expired)in their clinics
3.4.PROVIDER VACCINE MANAGEMENT
3.4.01 Utilize the DSHS Inventory Tracking Electronic Asset Required
Management System(iTEAMS)reports and other provider Activity
submitted reports to perform 100%of quality assurance
reviews on the following TVFC and ASN:
-monthly biological reports(doses administered and
current inventory),
-vaccine orders,
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-temperature logs and
-clinic hours of operation
from TVFC and ASN providers in LHD Grantee's
jurisdiction.Address all issues identified during review
3.4.02 Transfer vaccines that cannot be stored within provider Standard
offices(ex. accidental large orders) and vaccines (Universal)
approaching expiration between providers in LHD
Grantee's jurisdiction for immediate use
3.4.03 Ensure provider participation in vaccine ordering and Standard
inventory management using the Electronic Vaccine (Universal)
Inventory(EVI) system
-Educate providers regarding vaccine ordering policies
-Train providers to use the EVI system for inventory and
order entry
3.4.04 Assist TVFC and ASN providers in LHD Grantee's Standard
jurisdiction on the maintenance of appropriate vaccine (Universal)
stock levels.Activities under this requirement shall be
conducted in accordance with the DSHS Immunization
Contractor's Guide for Local Health Departments and the
current TVFC and ASN Program Operations Manual for
Responsible Entities
3.4.05 Train TVFC and ASN providers within LHD Grantee's Standard
jurisdiction to ensure that expired and spoiled/wasted (Universal)
vaccines are appropriately identified and entered into the
Electronic Vaccine Inventory(EVI) system
Train providers to complete returns to CDC's centralized
distributor within six months of product expiration
3.4.06 Ensure that 100%of TVFC providers within the LHD Required
Grantee's jurisdiction complete the annual influenza pre- Activity
book survey
3.5.PROVIDER QUALITY ASSURANCE
3.5.01 Utilize the CDC Provider Education Assessment and Reporting Required
(PEAR) system to document TVFC compliance site visits for all Activity
subcontracted clinics and non-LHD Grantee's clinics (as
applicable)
3.5.02 Utilize the CDC PEAR system and directly enter data into Required
PEAR to document TVFC unannounced storage and handling Activity
visits to a minimum of 10%of providers within the LHD
Grantee's jurisdiction
3.5.03 Utilize the CDC PEAR system and directly enter data into Required
PEAR to document TVFC contacts and other visits conducted at Activity
TVFC provider offices
3.5.04 Complete and document 100%of the follow-up activities for Required
TVFC quality assurance visits within required timeframes Activity
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3.5.05 Utilize the CDC assessment visit online tool and methodology to Required
assess immunization practices and coverage rates for all Activity
subcontracted entities and non-LHD Grantee's clinics (as
applicable)
3.5.06 Review 100%of re-enrollment applications from TVFC and Required
ASN providers in your jurisdiction by the DSHS specified Activity
deadline
3.5.07 Ensure that expired,wasted, and unaccounted-for vaccines Standard
(excluding flu)do not exceed 5%in TVFC provider clinics (Universal)
within the LHD Grantee's jurisdiction
3.5.08 Review monthly reports to ensure data quality. This includes: Required
-Identify sites that have not administered or ordered vaccine in Activity
the previous six months. Conduct a discussion and develop a
plan of action
-Identify sites that are suspended to ensure 90 days is not
exceeded
-Ensure enrollment and withdrawal forms are submitted
correctly and on time to the PHR staff
3.5.09 Review submitted reports to ensure data quality. This includes: Suggested
-Quarterly, review 25%of enrolled sites to ensure contacts are Activity
listed correctly in EVI
-Quarterly,review 25%of enrolled sites and provide education
for the Vaccine borrowing and Vaccine transfer forms
3.5.10 Review monthly data logger reports for 25%of providers in Suggested
LHD Grantee's jurisdiction to validate the accuracy of provider- Activity
submitted monthly temperature reporting forms
3.5.11 Review monthly data logger reports to validate the accuracy of Standard
provider-submitted monthly temperature reporting forms for all (Conditional)
providers within LHD Grantee's jurisdiction who experience a
vaccine loss as a result of temperature excursions
3.5.12 Conduct a monthly review of 10%of randomly selected Suggested
providers in LHD Grantee's jurisdiction to identify vaccine loss Activity
report forms that were completed in EVI but were not submitted
3.5.13 Conduct a quarterly review of 25%of providers in LHD Suggested
Grantee's jurisdiction to identify those that have adjusted more Activity
than 10%of their vaccine inventory
3.5.14 Conduct a quarterly review of 25%of providers in LHD Suggested
Grantee's jurisdiction to ensure the reported patient population Activity
matches the number of doses ordered
3.6.PROVIDER ACCOUNTABILITY
3.6.01 Track,report and follow up on vaccine fraud and abuse Standard
cases (Universal)
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3.6.02 Complete program evaluation activities with TVFC and Required Activity
ASN providers to address issues identified as
noncompliance issues
For all TVFC providers, document corrective action plans
in the CDC PEAR system as a contact
3.7.RE STAFF EDUCATION
3.7.01 Train LHD Grantee's staff to follow the policies and Required
procedures outlined in the TVFC &ASN Program Operations Activity
Manual for Responsible Entities. Provide training on TVFC
and ASN requirements and updates(as described in the TVFC
&ASN Program Operations Manual for Responsible Entities)
annually at a minimum
3.7.02 For personnel identified by DSHS, attend and/or complete the Required
following trainings: Activity
-CDC Immunization Trainings
-TVFC/ASN Annual Trainings
-Annual Responsible Entity Training
-Public Health Region(PHR)Trainings
3.7.03 Ensure that the TVFC &ASN Coordinator conducts quality Suggested
assurance on 10%of the temperature recording logs that were Activity
reviewed by their staff each quarter
3.8.RE COMPLIANCE
3.8.01 Comply with the current DSHS Immunization Standard
Contractor's Guide for Local Health Departments and the (Universal)
TVFC and ASN Operations Manual for Responsible
Entities
3.8.02 Receive regional approval for any vaccine transfers and Standard
document those transfers in EVI within 24 hours of the (Universal)
transfer occurring
3.8.03 Address general inquiries by providers about the Standard
TVFC/ASN Program, and ensure timely follow-up on (Universal)
requests for information
3.8.04 Ensure that providers within LHD Grantee's jurisdiction Required Activity
are adhering to the vaccine borrowing procedures
outlined in the TVFC and ASN Provider Manual
Report the number of borrowing forms submitted by
quarter in the Immunization Inter-Local Agreement
(ILA) Quarterly Report
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3.9 RE EMERGENCY RESPONSE
3.9.01 Communicate the importance of an Emergency Standard
Vaccine Storage and Handling Plan to all clinics in (Universal)
the LHD Grantee's jurisdiction.Provide technical
assistance to support the successful activation of each
clinic's Emergency Vaccine Storage and Handling
Plan
3.9.02 Transfer, accept,and store TVFC and ASN vaccines Standard
from clinics in the LHD Grantee's jurisdiction if there (Universal)
is a failure in the clinic's Emergency Vaccine Storage
and Handling Plan
3.9.03 Be prepared to pack and ship vaccine to other sites, Required Activity
as directed by the DSHS Immunization Unit
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4.EPIDEMIOLOGY & SURVEILLANCE
4.1.PERINATAL HEPATITIS B CASE IDENTIFICATION
4.1.01 Conduct identification and case management of Required Activity
perinatal hepatitis B cases
4.1.02 Determine the number of newborns that do not receive Required Activity
the first dose of the hepatitis B vaccine and/or HBIG
and work with those facilities to ensure all at-risk
infants receive the hepatitis B vaccine series and HBIG
within 12 hours of birth
4.1.03 Develop a surveillance system that includes prenatal Suggested Activity
care providers, obstetrical and gynecological care
providers, family practitioners, and labor and delivery
facilities to ensure all HBsAg-positive pregnant
women are reported to the DSHS Immunization Unit
within one week of diagnosis
4.1.04 Ensure timely follow-up and reporting of case status of Required Activity
possible moms as reported by DSHS within 2 weeks of
receipt of report
4.2.PERINATAL HEPATITIS B CASE MANAGEMENT
4.2.01 Contact and provide case management to 100%of the Required Activity
number of hepatitis B surface antigen-positive
pregnant women identified
4.2.02 Ensure timely newborn post-exposure prophylaxis Required Activity
(PEP)with hepatitis B vaccine and hepatitis B immune
globulin(HBIG)and report to DSHS within 2 weeks
of identification
4.2.03 Ensure timely completion of doses two and three of Required Activity
hepatitis B vaccine and report to DSHS within 2 weeks
of identification after each dose
4.2.04 Ensure timely completion of post-vaccination Required Activity
serologic testing(PVST)and report to DSHS within 2
weeks of identification
4.2.05 Case manage and report all household contacts under Required Activity
24 months of age in accordance with the DSHS
Immunization Contractor's Guide for Local Health
Departments and Perinatal Hepatitis B Prevention
Manual (including serologic testing and completion of
the full hep B vaccination series)
4.2.06 Refer all household contacts over 24 months of age Standard
and sexual partners of reported HBsAg-positive (Universal)
women for serologic testing to determine susceptibility
status in accordance with the DSHS Immunization
Contractor's Guide for Local Health Departments and
Perinatal Hepatitis B Prevention Manual
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4.3.PERINATAL HEPATITIS B REPORTING
4.3.01 For all cases documented as'lost-to-follow-up'on the Required Activity
Perinatal Hepatitis B case management form,report
the number and types of attempted activities performed
in locating the mother or guardian of the infant to the
DSHS Immunization Unit on the Perinatal Hepatitis B
case management form
4.3.02 Report to the DSHS Immunization Unit all infants Required Activity
born to HBsAg-positive women within 2 weeks of the
event
4.3.03 Report to the DSHS Immunization Unit the case status Required Activity
of possible exposed infants(born to women of
unknown or unconfirmed HBsAg status) as reported
by DSHS within 2 weeks of receipt of report
4.3.04 Ensure timely reporting of updates in case Required Activity
management as requested by DSHS within 2 weeks of
inquiry
4.4.PERINATAL HEPATITIS B EDUCATION
4.4.01 Require Perinatal Hepatitis B Case Manager to attend Required Activity
the biannual conference
4.4.02 Conduct educational training for hospital and Required Activity
healthcare providers within the Grantee's jurisdiction,
to increase mandatory screening and reporting of
hepatitis B surface antigen(IBsAg)-positive women
4.4.03 Educate delivery hospitals to ensure they verify Required Activity
prenatal HBsAg test results of pregnant women on
admission for delivery and test for HBsAg at delivery,
regardless of prenatal test results, as required by law
4.4.04 Educate prenatal care providers to ensure they are Required Activity
screening pregnant women for HBsAg status during
each pregnancy, implementing procedures for
documenting HBsAg screening results in prenatal
care records, and forwarding original laboratory
results to the delivery facility
4.4.05 Ensure all labor and delivery facilities develop Required Activity
standing orders and policies to administer the first
dose of the hepatitis B vaccine and HBIG to at-risk
infants within 12 hours of birth
4.4.06 Identify labor and delivery facilities that do not have Required Activity
standing orders and/or policies and educate providers
to establish standing orders and policies to administer
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to at-risk infants the first dose of the hepatitis B
vaccine and HBIG within 12 hours of birth
4.4.07 Promote the TVFC Program to birthing hospitals and Suggested Activity
encourage TVFC program enrollment
4.4.08 Provide training on the prevention of perinatal Required Activity
hepatitis B through vaccination and PVST to pediatric
care providers within the Grantee's jurisdiction
4.4.09 Provide trainings to delivery hospitals on reporting Suggested Activity
HBsAg-positive test results for women who have
delivered at their facilities using the LHD Grantee-
developed surveillance system
4.4.10 Work with partners, as appropriate,to ensure Standard
coordination of activities aimed at preventing (Universal)
perinatal hepatitis B transmission
4.5.DISEASE SURVEILLANCE
4.5.01 Complete investigation and document at least 90%of Required Activity
confirmed or probable reportable vaccine-preventable
disease (VPD) cases within thirty(30)days of initial
report to public health
4.5.02 Adhere to the DSHS Emerging and Acute Infectious Standard
Disease Guidelines and current Epi Case Criteria (Universal)
Guide in conducting all activities
4.5.03 Ensure all new VPD surveillance staff attend Required Activity
'Introduction to NBS'training and complete the
certification process in order to gain access to the
NBS system
4.5.04 Complete all data entry into the Texas National Standard
Electronic Disease Surveillance System(NEDSS) (Universal)
Base System(NBS) following the NBS Data Entry
Guidelines
4.5.05 Routinely review and follow up on all VPD Standard
laboratory reports received, including electronic lab (Universal)
reports(ELRs)generated through NBS in a timely
fashion
4.5.06 Verify and enter complete vaccination history in NBS Required Activity
on all VPD investigations with case status of
confirmed or probable. Complete vaccination history
can be assessed through the Texas Immunization
Registry,provider offices, school records, and/or
patient records
4.5.07 Initiate vaccine-based disease control activities by Standard
identifying population in need of a vaccination (Universal)
response and requesting vaccination services for that
population by contacting the DSHS Vaccine-
Preventable Disease(VPD) Surveillance Team Lead
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4.6.DISEASE SURVEILLANCE EDUCATION
4.6.01 Educate physicians, laboratories,hospitals, schools, Suggested
child-care staff,and other health providers on VPD Activity
reporting requirements
4.7.NEEDS ASSESSMENT
4.7.01 Community Assessment: Each LI-ID immunization Suggested
Grantee will conduct a community needs assessment Activity
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5. PROVIDING A VACCINE SAFETY NET
5.1.CLINIC ENROLLMENT
5.1.01 Enroll all eligible LHD clinics into the TVFC and ASN Required
Programs as providers Activity
5.1.02 Provide immunization services according to national Standard
standards for immunization practices for infants, (Universal)
children,adolescents, adults, and healthcare workers.
LHD clinics will comply with the National Childhood
Vaccine Injury Act of 1986
5.2.CLINIC STAFF TRAINING
5.2.01 Train all clinic staff on the policies outlined in the TVFC Required
and ASN Provider Manual and LHD procedures for Activity
implementing them. These include:
-procedures for following storage and handling
guidelines
-procedures for vaccine management
-procedures for using the DSHS vaccine management
system(EVI)
-procedures for other compliance guidelines
5.2.02 Develop clinic staff education requirements.Ensure that Required
persons who administer vaccines and staff that are Activity
involved in the vaccine administration process(including
those who screen immunization records and administer
vaccines)to follow Advisory Committee on
Immunization Practices(ACIP) standards for children
and adults and are knowledgeable on immunizations and
immunization practices
This can be accomplished by having staff complete the
most current CDC Pink Book(Epidemiology and the
Prevention of Vaccine Preventable Diseases)training and
appropriate Vaccine Education Online (VEO)modules
5.2.03 Develop eligibility screening and documentation policy Required
for all LHD clinics. Provide training to all staff on Activity
appropriate screening and documentation for TVFC
eligibility to ensure TVFC vaccine is administered only
to TVFC-eligible children. Implement policy and plan
for routine adherence to eligibility policies
5.2.04 Develop and implement a policy on the use of the Texas Required
Immunization Registry. Train LHD staff on conducting Activity
client searches in the Texas Immunization Registry and
how to effectively enter client demographic and
immunization information
5.3.CLINIC IMMUNIZATION PRACTICES
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5.3.01 Comply with current applicable state and federal standards, Standard
policies and guidelines for clinics (Universal)
5.3.02 Provide vaccines regardless of residency or ability to pay Standard
(Universal)
5.3.03 Adhere to clinical records retention schedule Standard
(Universal)
5.3.04 Explain the benefits of a"medical home" and assist the Standard
parent/guardian in obtaining or identifying the child's (Universal)
medical home
5.3.05 Discuss the next ACIP-recommended vaccines and refer Standard
the client to a medical home to complete the vaccination (Universal)
series
5.3.06 Maintain a list of current providers within the LHD's Standard
jurisdiction who accept children on Medicaid or CHIP and (Universal)
make this list available to clinic clients and families as
needed
5.3.07 Refer uninsured clients to Medicaid or the Children's Standard
Health Insurance Program(CHIP)as appropriate (Universal)
5.3.08 Ensure that all ACIP-recommended vaccines are routinely Standard
available and offered to TVFC patients (Universal)
5.3.09 Ensure that all vaccines listed on the ASN vaccine Standard
formulary are available and offered to eligible adult (Universal)
patients
5.3.10 Establish"standing orders" for vaccination in LHD Required
Grantee's clinics that are consistent with legal Activity
requirements for standing orders (including,but not limited
to,those found in the Texas Medical Practice Act)
5.3.11 Search for the client's immunization history at every client Standard
encounter. Compare all immunization histories (Texas (Universal)
Immunization Registry,TWICES or EMR system,
validated patient-held records, clinic medical record) and
enter into the Texas Immunization Registry all historical
immunizations not in the Registry at every client encounter
Review the client's record for vaccines due and overdue
according to the CDC recommended schedules at:
https://www.cdc.gov/vaccines/schedules/index.html
5.3.12 Offer updated Immunization History Report to the client or Standard
client's parent or guardian at every client encounter (Universal)
5.3.13 Follow and explain recommended guidelines for obtaining Standard
and submitting ImmTrac2 consent forms according to the (Universal)
instructions found at
http://www.dshs.texas.gov/immunize/immtrac/forms.shtm
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5.3.14 Report to the Texas Immunization Registry all Standard
immunizations administered to consented children (Universal)
(younger than 18 years of age)and consented adults in
LI-ID Grantee's clinics, either by entering data directly into
the Registry or through electronic data exchange via
TWICES or an electronic medical record(EMR) system
5.3.15 Verbally and with DSHS-produced literature, inform Standard
parents at LHD Grantee's clinics about the Texas (Universal)
Immunization Registry,the benefits of inclusion in the
Registry,and the importance of maintaining a complete
immunization history in the Registry
5.3.16 Update all demographic information, including address, Standard
email,and telephone number, at every client encounter in (Universal)
EMR and the Texas Immunization Registry
5.3.17 Verbally educate patients and parents/guardians about the Standard
benefits and risks of vaccination and distribute DSHS (Universal)
educational materials, as applicable, as part of this
conversation
5.3.18 Follow only medically supportable contraindications to Standard
vaccination (Universal)
5.3.19 Provide immunization services at times other than 8 am to Required
5 pm,Monday through Friday, at least once per month Activity
5.3.20 Institute infection control practices, including effective Standard
hand washing and management of hazardous waste (Universal)
5.3.21 Maintain confidentiality of client information Standard
(Universal)
5.3.22 Recommend the simultaneous administration of all needed Standard
vaccines for the patient (Universal)
5.3.23 Implement clinic policy on screening and documentation Standard
of eligibility for TVFC vaccines. The policy must be (Universal)
consistent with the TVFC requirements outlined in the
current TVFC and ASN Provider Manual
5.3.24 Participate in public health emergencies and exercises that Suggested
may require vaccine administration to the public or first Activity
responders
5.3.25 Conduct outreach activities to raise the immunization Suggested
coverage levels of uninsured adults by visiting sites such as Activity
homeless shelters,halfway houses, day labor sites or other
locations
5.3.26 Coordinate with community vaccinators to conduct annual Suggested
employee-based vaccination clinics for influenza vaccine Activity
administration
•
5.4.CLINIC VACCINE MANAGEMENT
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5.4.01 Ensure that all expired and spoiled/wasted vaccines are Required
appropriately identified and entered into the Electronic Activity
Vaccine Inventory(EVI) system for the LHD Grantee's
clinics
5.4.02 Submit returns for all vaccines distributed via CDC's Standard
centralized distributor back to the centralized distributor (Universal)
for returns processing
5.5.CLINIC QUALITY ASSURANCE
5.5.01 Ensure that appropriate routine and emergency vaccine Required
storage and handling plans are in place at each of the LHD Activity
Grantee clinic locations
5.5.02 Ensure that expired,wasted, and unaccounted-for vaccines Standard
(excluding flu)do not exceed 5 percent in LHD Grantee's (Universal)
clinics
5.5.03 Participate in all TVFC/ASN extended PEAR visits for Required
quality assurance Activity
5.6.CLINIC REPORTING
5.6.01 Conduct timely reporting of monthly clinic activities Required Activity
by recording vaccine inventory, doses administered,
temperature logs and other reportable activities by the
5th of each month as described in the TVFC/ASN
Provider Manual
5.6.02 Report all notifiable conditions as specified in the Standard
DSHS Immunization Contractor's Guide for Local (Universal)
Health Departments
5.6.03 Report all vaccine adverse events as specified in the Standard
DSHS Immunization Contractor's Guide for Local (Universal)
Health Departments
5.6.04 Report the number of unduplicated underinsured clients Required Activity
and the number of doses administered to underinsured
children monthly as specified in the DSHS
Immunization Contractor's Guide for Local Health
Departments
5.6.05 Conduct monthly reporting of doses administered to Required Activity
women veterans, as required in the ASN Program
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6. INCREASING USE OF THE TEXAS IMMUNIZATION REGISTRY
6.1.TEXAS IMMUNIZATION REGISTRY OUTREACH FOR IMMUNIZATION RECORDS
6.1.01 Conduct Texas Immunization Registry outreach to Suggested
organizations regarding missing vaccinations for children Activity
and adults for whom consent has been granted but who
do not have complete immunization records
6.2.TEXAS IMMUNIZATION REGISTRY OUTREACH FOR PATIENT CONSENTS
6.2.01 Conduct activities aimed at increasing the consent rate Suggested
for all age groups, including adults and individuals Activity
identified as recently moved in-state
6.2.02 Conduct at least twelve(12)outreach and educational Required
activities focused on 18-year-olds in high schools and Activity
colleges/universities in LHD Grantee's jurisdiction
6.3.TEXAS IMMUNIZATION REGISTRY OUTREACH TO USERS
6.3.01 Conduct outreach to existing Registry users who have Required
not logged into the Registry in the last 90 days Activity
6.3.02 Provide orientation to all new Texas Immunization Suggested
Registry organizations within the LI-ID Grantee's Activity
jurisdiction at least once a year and maintain
documentation of all technical assistance provided(e.g.,
telephone logs)
Provide education and training on the effective use of the
Texas Immunization Registry according to the
Guidelines for Increasing the Use of the Texas
Immunization Registry
Identify and assist newly registered providers and new
users reporting to the Texas Immunization Registry
6.4.TEXAS IMMUNIZATION REGISTRY USER EDUCATION
6.4.01 Provide education,training, and technical assistance to Suggested
promote the effective use of the Texas Immunization Activity
Registry by organizations
6.4.02 Identify and assist providers to establish electronic Required
affirmation of consent Activity
6.5.TEXAS IMMUNIZATION REGISTRY PROMOTION
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6.5.01 Promote the use of the Texas Immunization Registry to Required
organizations within the LHD Grantee's jurisdiction that are Activity
not currently enrolled in the Registry. Identify all providers
who administer vaccine in awardee's jurisdiction, including
both pediatric and adult immunization providers.Educate
them on their statutory requirement to report immunizations
and on the enrollment process
6.5.02 Provide education and technical assistance to birth Suggested
registrars on the effective use of the Texas Immunization Activity
Registry
6.5.03 Collaborate with prenatal healthcare providers, birth Suggested
registrars,hospital staff,pediatricians, and other entities to Activity
educate parents, expectant parents,and providers about the
Texas Immunization Registry and the benefits of
participation. This includes the dissemination of DSHS
educational materials as appropriate
6.6.TEXAS IMMUNIZATION REGISTRY PROGRAM QUALITY IMPROVEMENT
6.6.01 Review the monthly Provider Activity Report(PAR)to Required
identify organizations who are inactive or not routinely Activity
submitting immunization data or adding consented clients.
Prioritize these organizations for outreach activities
6.6.02 Review the quarterly Consent Accepted Rate Evaluation Required
(CARE)report to target organizations with largest client Activity
volume and/or lowest consent acceptance rate.Prioritize
these organizations for outreach activities
6.6.03 Conduct a minimum of 60 Texas Immunization Registry Required
organization quality improvement assessments per FTE Activity
each year as described in the Guidelines for Increasing the
Use of the Texas Immunization Registry. (For jurisdictions
with less than 60 orgs, conduct quality improvement
assessment visits to 100%of your orgs)
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7. EDUCATION AND PARTNERSHIPS
7.1 PUBLIC EDUCATION
7.1.01 Inform and educate the public about vaccines and vaccine- Required
preventable diseases Activity
7.1.02 Inform the general public about the TVFC and ASN Programs Required
and the eligibility criteria for qualifying for the programs Activity
7.2 PROVIDER EDUCATION
7.2.01 Educate and update providers on the most current ACIP Suggested
recommendations for all age groups Activity
7.2.02 Inform and highly recommend to the medical community and Suggested
local providers within the LHD Grantee's jurisdiction the most Activity
current Centers for Disease Control and Prevention(CDC)
Epidemiology and Prevention of Vaccine-Preventable Disease
(EPI-VAC)training
(https://www.cdc.gov/vaccines/ed/webinar-epv/index.html).
The most current"Pink Book,"titled Epidemiology and
Prevention of Vaccine-Preventable Diseases, can be found on
the CDC website at
http://www.cdc.gov/vaccines/pubs/pinkbook/index.html
7.2.03 Provide information to community healthcare employers Suggested
(hospitals,clinics, doctor offices, long-term care facilities) Activity
about the importance of vaccination of healthcare workers
7.2.04 Provide training relating to Standards for Child and Adolescent Suggested
Immunization Practices and Standards for Adult Immunization Activity
Practices to all immunization providers within LHD Grantee's
jurisdiction
7.2.05 Provide training opportunities and/or resources to assist Required
immunization providers in communicating with patients and/or Activity
parents(e.g.,making a strong recommendation, addressing
vaccine hesitancy,etc.)
7.3 STAFF EDUCATION
7.3.01 Work to ensure that all Immunization Program Grantee staff Standard
are knowledgeable about vaccines and VPDs (Universal)
7.3.02 Develop and implement a written communications and Required
customer service plan for Grantee's staff to ensure customers Activity
receive consistent, correct immunization information and
services in a courteous and friendly manner on a timely basis
7.3.03 Educate healthcare workers on the importance of keeping Required
themselves up-to-date with the vaccine schedule Activity
7.4 COALITION BUILDING
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7.4.01 Appoint an immunization coalition coordinator Suggested
Activity
7.4.02 Attend and participate in required coalition trainings Suggested
sponsored by DSHS Activity
7.4.03 Develop and maintain a planning group with the goal of Suggested
sustaining a coalition Activity
7.4.04 Engage and recruit community groups and immunization Suggested
stakeholders into a coalition Activity
7.4.05 Facilitate and host coalition meetings Suggested
Activity
7.4.06 Participate in monthly calls to provide updates on coalition Suggested
collaboration activities Activity
7.4.07 Provide signed letters of agreement and other documentation Suggested
of commitment to participate in coalition Activity
7.4.08 Document communications, group meetings, and planning of Suggested
activities that promote the best practices identified in contract Activity
agreement(documents are to be accessible during site visits)
7.5 COMMUNITY PARTNERSHIP
7.5.01 Plan and implement community education activities and Required
partnerships aimed at improving and sustaining Activity
immunization coverage levels
7.5.02 Conduct outreach and collaborative activities with American Required
Indian tribes, if applicable Activity
7.5.03 Participate in at least one collaborative meeting concerning Required
tribal health issues,concerns, or needs with American Indian Activity
tribal members, if applicable
7.5.04 Coordinate educational and other activities with local Suggested
Women,Infants, and Children(WIC)programs to ensure Activity
that children participating in WIC are screened and referred
to their"medical home" for vaccination using a documented
immunization history in accordance with the Standards for
Child and Adolescent Immunization Practices
7.5.05 Offer educational opportunities to all WIC Programs in the Suggested
service area, including information about online and Activity
satellite-broadcast continuing education opportunities from
the CDC Continuing Education website at
https://www.cdc.gov/vaccines/ed/index.html
7.5.06 Engage in education and partnerships aimed at reducing or Required
eliminating coverage disparities by race, ethnicity, and Activity
socioeconomic status
7.5.07 Maintain a contact list of providers, hospitals, schools, child- Required
care facilities, social service agencies, and community Activity
groups involved in promoting immunizations and reducing
vaccine-preventable diseases
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7.5.08 Participate in special initiatives as directed by the DSHS Required
Immunization Unit Activity
7.5.09 Implement the DSHS Immunization Ambassador Program Required
throughout Grantee's jurisdiction Activity
7.6 STAKEHOLDER ENGAGEMENT
7.6.01 Attend all Texas Immunizers and Stakeholders Working Required Activity
Groups (TISWG)and other designated stakeholder
meetings (these meetings can be attended remotely)
7.6.02 Host at least 1 immunization stakeholder meeting per Suggested
quarter(4 per contract year) Activity
7.7 MEDIA CAMPAIGNS
7.7.01 Distribute ASN information and educational materials at Required Activity
venues and clinics that serve eligible adults
7.7.02 Distribute TVFC information and educational materials at Required Activity
venues that parents of TVFC-eligible children might
frequent
7.7.03 Participate,when directed, in statewide media campaigns Required Activity
by distributing DSHS-developed and produced public
service announcements and materials to local television
and radio stations,newspapers,parent publications,
university newspapers,high school newspapers, and
neighborhood newspapers
7.7.04 Promote www.ImmunizeTexas.com,the Immunization Required Activity
Unit's website; and any other Immunization Unit
newsletters to providers in the LHD Grantee's jurisdiction
7.7.05 Use national immunization observances as opportunities to Required Activity
conduct specific education and promotional activities to
give emphasis to the importance and benefits of vaccines:
National Infant Immunization Week(NIIW),National
Immunization Awareness Month(NIAM), and National
Influenza Immunization Week(NIIW)
7.7.06 Share available federal, state,and/or local adolescent Required Activity
vaccination coverage and/or vaccine-uptake-related data
with partner organizations,adolescent immunization
providers, and other stakeholders
(Remainder of Page Intentionally Left Blank)
System Agency Contract No.HHS000114000001 Page 32 of 32
DocuSign Envelope ID:B48BC221-5A7A-40E3-AF58-4907A2A6645D
Fiscal Federal Funding Accountability and Transparency Act
(FFATA) CERTIFICATION
The certifications enumerated below represent material facts upon which DSHS relies when reporting
information to the federal government required under federal law. If the Department later determines
that the Contractor knowingly rendered an erroneous certification, DSHS may pursue all available
remedies in accordance with Texas and U.S. law. Signor further agrees that it will provide immediate
written notice to DSHS if at any time Signor learns that any of the certifications provided for below were
erroneous when submitted or have since become erroneous by reason of changed circumstances. If the
Signor cannot certify all of the statements contained in this section, Signor must provide written
notice to DSHS detailing which of the below statements it cannot certify and why.
Legal Name of Contractor: FFATA Contact#1 Name, Email and Phone Number:
Corpus Christi Nueces County Public Health Constance Sanchez, Constancep@cctexas.com,
District (City) 361-826-3227
Primary Address of Contractor: FFATA Contact#2 Name, Email and Phone Number:
1702 Horne Rd, Corpus Christi , TX Blandina Costley, BlandinaC@cctexas.com,
361-826-7252
ZIP Code:9-digits Required www.usps.com DUNS Number:9-digits Required www.sam.gov
78416-1902 - 069457786
State of Texas Comptroller Vendor Identification Number (VIN) 14 Digits
07460005741027
Printed Name of Authorized Representative Signature of Authorized Representative
DocuSigned by:
Annette Rodriguez
rAme4-4 PihkriTier
1rCODD2'42C E111...
Title of Authorized Representative Date
Health Director June 18, 2019
- 1 -
Department of State Health Services Form 4734—June 2013
DocuSign Envelope ID:B48BC221-5A7A-40E3-AF58-4907A2A6645D
Fiscal Federal Funding Accountability and Transparency Act
(FFATA) CERTIFICATION
As the duly authorized representative(Signor)of the Contractor, I hereby certify that
the statements made by me in this certification form are true, complete and correct to
the best of my knowledge.
Did your organization have a gross income, from all sources, of less than $300,000 in
your previous tax year? n Yes n No
If your answer is"Yes", skip questions "A", "B", and "C" and finish the certification.
If your answer is"No", answer questions "A" and "B".
A. Certification Regarding%of Annual Gross from Federal Awards.
Did your organization receive 80% or more of its annual gross revenue from federal
awards during the preceding fiscal year? n Yes n No
B. Certification Regarding Amount of Annual Gross from Federal Awards.
Did your organization receive $25 million or more in annual gross revenues from federal
awards in the preceding fiscal year? n Yes n No
If your answer is"Yes" to both question "A" and "B", you must answer question "C".
If your answer is "No" to either question "A" or "B", skip question "C" and finish the
certification.
C. Certification Regarding Public Access to Compensation Information.
Does the public have access to information about the compensation of the senior
executives in your business or organization (including parent organization, all branches,
and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d)
of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the
Internal Revenue Code of 1986? n Yes n No
If your answer is"Yes"to this question,where can this information be accessed?
If your answer is "No" to this question, you must provide the names and total
compensation of the top five highly compensated officers below.
Provide compensation information here:
-2 -
Department of State Health Services Form 4734—June 2013
Docu
i$ICUIED
Certificate Of Completion
Envelope Id:B48BC2215A7A40E3AF584907A2A6645D Status:Completed
Subject:Amending$483,274.00;HHS000114000001;Corpus Christi-Nueces Co A-1;DSHS IMM/LOCAL
Source Envelope:
Document Pages:45 Signatures:3 Envelope Originator:
Certificate Pages:2 Initials:0 Texas Health and Human Services Commission
AutoNav:Enabled 1100 W.49th St.
Envelopeld Stamping:Enabled Austin,TX 78756
Time Zone:(UTC-06:00)Central Time(US&Canada) PCS_DocuSign@hhsc.state.tx.us
IP Address: 167.137.1.18
Record Tracking
Status:Original Holder:Texas Health and Human Services Location:DocuSign
4/24/2019 8:29:32 AM Commission
PCS_DocuSign@hhsc.state.tx.us
Signer Events Signature Timestamp
Annette Rodriguez r—DocuSWn,dby Sent:4/24/2019 8:38:30 AM
annetter@cctexas.com A11t � Viewed:4/26/2019 10:06:45 AM
Health Director
—,Fc9092742 414.. Signed:6/18/2019 2:08:49 PM
City of Corpus Christi
Security Level:Email,Account Authentication
Signature Adoption:Pre-selected Style
(None) Using IP Address:64.201.138.51
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Docusgned by:Imelda Garcia Sent:6/18/2019 2:08:53 PM
ImeldaM.Garcia@dshs.texas.gov 1.11.1.14taortia Viewed:6/18/2019 2:40:00 PM
Associate Commissioner e7nro32ao9024n9.. Signed:6/18/2019 2:40:12 PM
Texas Health and Human Services Commission
Security Level:Email,Account Authentication Signature Adoption:Pre-selected Style
(None) Using IP Address: 107.77.218.72
Signed using mobile
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
CMU Mailbox Sent:4/24/2019 8:38:29 AM
cmucontracts@dshs.texas.gov COPIED
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Carbon Copy Events Status Timestamp
Mary Ann Graham COPIED Sent:4/24/2019 8:38:29 AM
maryann.graham@hhsc.state.tx.us Viewed:4/24/2019 8:40:33 AM
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Tray Kirkpatrick Sent:4/24/2019 8:38:29 AM
tray.kirkpatrick@dshs.texas.gov COPIED Viewed:4/24/2019 8:44:12 AM
Contract Manager
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jessica Hernandez COPIED Sent:4/24/2019 8:38:30 AM
jessicah2@cctexas.com Viewed:4/24/2019 10:40:10 AM
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 6/18/2019 2:08:53 PM
Certified Delivered Security Checked 6/18/2019 2:40:00 PM
Signing Complete Security Checked 6/18/2019 2:40:12 PM
Completed Security Checked 6/18/2019 2:40:12 PM
Payment Events Status Timestamps