HomeMy WebLinkAboutResolution - 2021-R0145 - Amendment No.3 to Contract HHS000109800001 with DSHS 4.27.2021Resolution No. 2021-R0145
Item No. 6.3.2
April 27, 2021
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and
on behalf of the City of Lubbock, Amendment No. 3 to Contract No. HHS000109800001, the
Immunization/Locals Grant Program Contract, by and between the City of Lubbock and the
State of Texas' Department of State Health Services, and all related documents. Said
Amendment is attached hereto and incorporated in this resolution as if fully set forth herein
and shall be included in the minutes of the City Council.
Passed by the City Council on
ATTEST:
April 27, 2021
t1l
DANIEL M. POPE, MAYOR
-4Q I d." 0111*c -- - - -
Reb cca Garza, City Se et
APPROVED AS TO CONTENT:
-,Z Z2
Bill Ho erton, Deputy r
anager
APPROVED AS TO FORM:
Ry Bro e, Assistant City Attorney
RES.Amend No. 3 Contract No. HHS000109800001 DSHS
4.14.21
DocuSign Envelope ID: B06B0177-84C5-47A1-A996-C36604CB5F55 Resolution No. 2021-R0145
DEPARTMENT OF STATE HEALTH SERVICES
CONTRACT NO. HHS000109800001
AMENDMENT No. 3
The Department of State Health Services ("DSHS" or "System Agency") and City of Lubbock
("Grantee"), collectively referred to herein as the "Parties," to that certain Immunization/Locals
Grant Program Contract effective September 1, 2018 and denominated DSHS Contract No.
HHS000109800001 (the "Contract"), as amended, now desire to further amend the Contract.
WHEREAS, the Parties desire to revise the Legal Authority, Statement of Work, and Budget,
replace the Guidance Document that delineates Grantee's responsibilities under the Contract, and
extend the term of the Contract to allow for successful completion of the Project;
WHEREAS, DSHS has chosen to exercise its option to extend the Contract in accordance with
SECTION III, DURATION, of the Contract for an additional one-year term;
WHEREAS, DSHS desires to add funding for Coronavirus Disease 2019 (COVID-19) activities;
and
WHEREAS, DSHS desires to add funds for the additional one-year term.
Now, THEREFORE, the Parties hereby amend and modify the Contract as follows:
1. SECTION I1 of the Contract, LEGAL AUTHORITY, is revised to read as follows:
This Contract is authorized by and in compliance with the provisions of the Public Health
Services Act Section 317, 42 U.S. Code Section 247B, Texas Health and Safety Code
Chapter 12, and Texas Government Code Chapter 791, the Interlocal Cooperation Act.
2. SECTION III of the Contract, DURATION, is hereby amended to reflect a revised
termination date of August 31, 2022, unless renewed, extended, or terminated pursuant to
the terms and conditions of the Contract. The new term of the Contract begins on
September 1, 2021 and ends on August 31, 2022 (the "Third Renewal Term," "Fiscal
Year 2022," or "FY 2022").
3. SECTION IV of the Contract, BUDGET, is hereby amended to add a one-time, lump sum of
COVID-19 funds to the Contract of EIGHTY-EIGHT THOUSAND, SEVEN HUNDRED
NINETY-EIGHT DOLLARS ($88,798.00) and the amount of Two HUNDRED THIRTY -Two
THOUSAND, ONE HUNDRED FIFTEEN DOLLARS ($232,115.00) for FY 2022. The
Contract shall not exceed the amount of ONE MILLION, FORTY -Two THOUSAND, Two
HUNDRED FIFTY-EIGHT DOLLARS ($1,042,258.00). All expenditures of the additional
funds must conform with ATTACHMENT B-3, REVISED BUDGET.
DSHS Contract No. HHS000109800001 Page 2 of 30
Amendment 3
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4. ATTACHMENT A-1 of the Contract, REVISED STATEMENT OF WORK, is hereby amended
to add the following new schedule for required quarterly reports due in the Third
Renewal Term under Section I. GRANTEE RESPONSIBILITES, Subsection T., after the
fiscal year 2021 reporting schedule added by AMENDMENT NO. 2:
Report Type
Reporting Period
Report Due Date
Programmatic
09/01/2021 to 11/30/2021
12/31/2021
Programmatic
12/01/2021 to 02/28/2022
03/31/2022
Programmatic
03/01/2022 to 05/30/2022
06/30/2022
Programmatic
06/01/2022 to 08/31/2022
10/31/2022
5. ATTACHMENT A-1 of the Contract, REVISED STATEMENT OF WORK, is hereby amended
to add the following Section:
IV. COVID-19 VACCINATION ACTIVITES FUNDING
This section regards funding to local health departments currently under immunization
contracts to facilitate COVID-19 vaccination and recruitment activities. The fundamental
purpose of this funding will be to support the purchase of CDC and DSHS approved
infrastructure, staff, and equipment to facilitate COVID-19 vaccination opportunities and
uptake in the identified jurisdiction. Allocation could also be utilized to develop provider
recruitment and its associated expenses allowable under the federal funding agency for
FY 2021 and FY 2022.
6. ATTACHMENT B-2 of the Contract, FISCAL YEAR 2021 BUDGET, is hereby
supplemented with the addition of ATTACHMENT B-3, REVISED BUDGET.
7. ATTACHMENT H-1 of the Contract, IMMUNIZATION/LOCALS PROGRAM GUIDANCE
DOCUMENT, is hereby deleted in its entirety and replaced with ATTACHMENT H-2,
IMMUNIZATION/LOCALS PROGRAM GUIDANCE DOCUMENT.
8. This Amendment No. 3 shall be effective upon the date of the last signature.
9. Except as modified by this Amendment No. 3, all terms and conditions of the Contract, as
amended, shall remain in full force and effect.
10. Any further revision to the Contract shall be by written agreement of the Parties.
SIGNATURE PAGE FOLLOWS
DSHS Contract No. HHIS000109800001 Page 3 of 30
Amendment 3
Docu5ign Envelope ID: B06B0177-84C5-47A1-A996-C36B04CB5F55
SIGNATURE PAGE FOR AMENDMENT No. 3
DSHS CONTRACT No. HHS000109800001
DEPARTMENT OF STATE OF HEALTH
SERVICES
Date of Execution:
CITY OF LUBBOCK
By: _ "IV
Daniel M. Pope
Mayor
Date of Execution: April 27, 2021
THE FOLLOWING ATTACHMENTS ARE ATTACHED AND INCORPORATED AS PART OF THE
CONTRACT:
ATTACHMENT B-3 REVISED BUDGET
ATTACHMENT F-3 FEDERAL FUNDING ACCOUNTABILITY AND
TRANSPARENCY (FFATA)
ATTACHMENT H-2 IMMUNIZATION/LOCALS PROGRAM GUIDANCE
DOCUMENT
ATTACHMENTS FOLLOW
DSHS Contract No. HHS000109800001 Page 4 of 30
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ATTACHMENT B-3
REVISED BUDGET
Organization Name: City of Lubbock
Program ID: IMM/LOCALS
Contract Number: HHS000109800001
Budget for FY
COVID-19
2022
Budget for FY
Budget
2021 -2022
Total A-3
Categories
September 1,
Upon
Amendment
Budget
2021 -August
No.3 Execution -
August 31, 2022
Personnel
$148,969.00
$0.00
$148,969.00
Fringe
$63,535.00
$0.00
$63,535.00
Travel
$1,680.00
$0.00
$1,680.00
Equipment
$0.00
$0.00
$0.00
Supplies
$9,509.00
$1,625.00
$11,134.00
Contractual
$8,422.00
$87,173.00
$95,595.00
Other
$0.00
$0.00
$0.00
Total Direct
$232,115.00
$88,798.00
$320,913.00
Indirect
$0.00
$0.00
$0.00
Total
$232,115.00
$88,798.00
$320,913.00
Remainder of page intentionally left blank
DSHS Contract No. HHS000109800001 Page 5 of 30
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ATTACHMENT F-3
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. It the
Slanor cannot certify all of the statements contained in this section, Signor must provide written
Legal Name of Contractor:
FFATA Contact # 1 Name, Email and Phone Number.
Primary Address of Contractor:
FFATA Contact#2 Name, Email and Phone Number:
ZIP Code: 9-digits Required www.usps.com
DUNS Number: 9-digits Required www.sarn.gov
State of Texas Comptroller Vendor Identification Number (VIN)14 Digits
Printed Name of Authorized Representative
Signature of Authorized Representative
Title of Authorized Representative
Date
Department of State Health Services
Form 4734 - June 200
DSHS Contract No. HHS000109800001
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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? ❑ Yes ❑ 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 Retrardins % 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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 Reeardine 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? ❑ Yes ❑ 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 4134 — June 2013
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ATTACHMENT H-Z
IMMUNIZATION/LOCALS PROGRAM GUIDANCE DOCUMENT
GRANTEE RESPONSIBILITIES
1. PROGRAM & CONTRACT MANAGEMENT
1.L 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 contact in
Required
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 hnmunization Registry Coordinators;
8. RE TVFC & ASN Coordinators; and
9. RE Coalition Coordinators
1.1.03
Attend all required trainings for each Area of Work as specified
Required
in the Immunization Program Contractor's Guide. Ensure that
Activity
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 for -
Standard
Local Health Departments which includes all immunization
(Universal)
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 Form
Required
(EF11-13999) for all Provider Identification Numbers (PIN)
Activity
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 activities
Standard
of this contract and to assure expenditure of all contract funds
(Universal)
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1.1.07
Develop and implement an employee immunization policy for
Required
Grantee's immunization program staff according to CDC
Activity
recommendations
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 and
Required
arrivals) in LHD Medical Director, Immunization Program
Activity
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 positions
Required
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 partially
(Universal)
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
1.2. PROGRAM COMPLIANCE
1.2.01 Comply with all applicable federal and state regulations and Standard
statutes as amended, including, but not limited to: (Universal)
1. Texas Human Resources Code §42.043;
2. Texas Education Code §§38.001-38.002;
3. Texas Health and Safety Code §§12.032-12.033, 81.023,
and 161.001-161.009;
4. Texas Administrative Code (TAC) Title 25, Chapter 97;
5. TAC Title 25, Chapter 96;
6. TAC Title 25, Chapter 100;
7. 42 USC §§247b and 300aa-25;
8. Omnibus Budget Reconciliation Act of 1993; and
9. 26 USC §4980B
1.2.02 Ensure compliance with Health and Human Services (HHS) Standard
Deputization Guidance. Activities under this requirement (Universal)
shall be conducted in accordance with the DSHS
Immunization Contractor's Guide for Local Health
Departments
1.3. FINANCIAL MANAGEMENT
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1.3.01
Agree DSHS reserves the right, where allowed by legal
Standard
authority, to redirect funds in the event of financial shortfalls
(Universal)
1.3.02
Submit monthly invoices with appropriate supplemental
Required
documentation and request monthly payments using the State
Activity
of Texas Purchase Voucher (Forni 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 basis
Standard
(Universal)
1.3.04
Adhere to travel rates set by the State of Texas TexTravel
Standard
unless the LHD has their own travel policy.
(Universal)
1.3.05
Review monthly contract funding expenditures to ensure that all Standard
funds will be properly expended before the end of the contract
(Universal)
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 contract Standard
amount between direct budget categories in writing to the (When
DSHS Contract Management Section (CMS) in Austin and Applicable)
obtain approval before monies can be transferred
1.3.08 Expend funds consistently throughout the contract term, Suggested
approximately 25% per quarter Activity
1.4. CONTRACT MANAGEMENT
1.4.01 Initiate the purchase of approved equipment purchases in the first
Standard
quarter of the Contract term. Requests to purchase previously
(When
approved equipment after the first quarter must be submitted to the
Applicable)
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 QUAtxr) 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
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1.6. CONTRACT ACCOUNTABILITY
1.6.01 Submit Corrective Action Plan (CAP) letter to Public Health Region Required
Program Manager and DSHS Contract Management Section (CMS) Activity
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 funded or Standard
property provided by grant funds (Universal)
1.7. REQUIRED REPORTING
1.7.01 Complete and submit Immunization Inter -Local Agreement (ILA) Required
Quarterly Report and supplemental documents according to the Activity
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 DSHS Required
immunization contract activities on the quarterly financial status Activity
report (FSR)
1.7.03 Ensure all program income (PI) generated as a result of the DSHS
Standard
immunization contract activities is expended in accordance with the
(Universal)
DSHS Immunization Contractor's Guide for Local Health
Departments
1.7.04 Submit quarterly FSRs to Accounts Payable by the last business
Required
day of the month following the end of each quarter for review and
Activity
financial assessment. Submit the final FSR no later than forty-five
(45) calendar days following the end of the applicable term
2. FACILITY INLMUNIZATION ASSESSMENTS
2.1. CHILDCARE & SCHOOL COMPLIANCE
2.1.01 Assess compliance with vaccine requirements at assigned Standard
schools and childcare facilities (Universal)
2.1.02 Complete 100% of assigned childcare facility Required
audits/assessments. By July 15 of contract year, local health Activity
department staff will complete 100% of assigned childcare
audits and submit into the Children Health Reporting System
(CHRS)
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2.1.03 Complete 100% of assigned public and private school audits, Required
assessments, and/or validation/retrospective surveys in Activity
accordance with the DSHS Immunization Contractor's Guide
for Local Health Departments by June 15 of contract year,
local health department staff will complete 100% of assigned
school audits and submit electronically (probably in Survey
Gizmo, possibly via email)
2.2. CHILDCARE & SCHOOL COMPLIANCE QA
2.2.01 Provide education to school and childcare facilities with high
Required
provisional, delinquency, and/or exemption rates at time of
Activity
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 vaccine requirements in accordance with the
Activity
DSHS Immunization Contractor's Guide for Local Health
Departments
2.2.03 Contact schools/districts to remind them to report during the
Required
Annual School Survey reporting period in accordance with
Activity
the DSHS hmmunization 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 the
Suggested
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
3. MANAGING TVFC AND ASN PROVIDERS
3.1. PROVIDER RECRUITMENT
3.1.01 Recruit additional TVFC providers to administer vaccines to Suggested
program -eligible populations. The goal is to increase each Activity
local health department's provider enrollment by 5%
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3.1.02
Ensure New Enrollment Checklist (11-15016) is completed
for all clinics that join the TVFC/ASN Program
3.1.03 Collaborate with medical societies and/or local health
provider organizations to identify providers to recruit and
enroll
3.2. PROVIDER RETENTION
Required
Activity
Suggested
Activity
3.2.01 Sustain a network (through re -enrollment) of TVFC providers Required Activity
to administer vaccines to program -eligible populations
3.2.02 Promote TVFC and ASN Provider achievements: Suggested Activity
- Implement incentives for provider sites that reach
vaccination coverage rate goals; and
- Implement incentives to recognize sites during national
observances (i.e. NIIW, NIAM, and NIVW)
3.3. PROVIDER EDUCATION
3.3.01 Provide a training for TVFC and ASN providers within the Suggested
LHD 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; and
- meeting the federal requirement that the most current
Vaccine Information Statements (VIS) (available at
(http://www.cdc.gov/vaccines/licp/vis/index.html) must be
distributed to patients prior to patient vaccination
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3.3.02 Notify providers of TVFC and ASN updates and changes to
Standard
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; and
- Vaccine choice
3.3.03 Educate and assist TVFC and ASN providers on a quarterly
Standard
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 offices
(Universal)
3.3.05 Identify TVFC and ASN providers experiencing high volumes Required Activity
of vaccine loss and develop process 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 Activity
Management System (iTEAMS) reports and other provider
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--
- temperature log; 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
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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; and
- 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 stock (Universal)
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 Activity
Grantee's jurisdiction complete the annual influenza pre -book
survey
3.5. PROVIDER QUM.rry ASSURANCE
3.5.01
Utilize the CDC Provider Education Assessment and Reporting
Required Activity
(PEAR) system and CDC Immunization Quality Improvement for
Providers (IQIP) database to document TVFC compliance and
IQIP site visits for all subcontracted clinics and non-LHD
Grantee's clinics (as applicable)
3.5.02
Utilize the CDC PEAR system and directly enter data into PEAR
Required Activity
to document TVFC unannounced storage and handling 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 PEAR
Required Activity
to document TVFC Unannounced Storage and Handling Visits,
Compliance Visits and other visits conducted at TVFC provider
offices
3.5.04
Complete and document 100% of the follow-up activities for
Required Activity
TVFC quality assurance visits within required timeframes
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3.5.05 Utilize Texas hnmunization Registry or DSHS-provided coverage Required Activity
rates to assess immunization practices and coverage rates for all
subcontracted entities and non-LHD Grantee's clinics (as
applicable)
3.5.06 Review 100% of re -enrollment applications from TVFC and ASN Required Activity
providers in your jurisdiction by the DSHS specified deadline
3.5.07 Ensure that expired, wasted, and unaccounted-for vaccines Standard
(excluding flu) do not exceed 5% in TVFC provider clinics within (Universal)
the LHD Grantee's jurisdiction
3.5.08 Review monthly reports to ensure data quality. This includes: Required Activity
Identify sites that have not administered or ordered vaccine in
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;and
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
o
- Quarterly, review 25% of enrolled sites to ensure contacts are Activity
listed correctly in EVI; and
- Quarterly, review 25% of enrolled sites and provide education
for the Vaccine borrowing and Vaccine transfer forins
3.5.10 Review monthly data logger reports for 25% of providers in LHD Suggested
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 providers Suggested
in LHD Grantee's jurisdiction to identify vaccine loss report forms Activity
that were completed in EVI but were not submitted
3.5.13 Conduct a quarterly review of 25% of providers in LHD Grantee's Suggested
jurisdiction to identify those that have adjusted more than 10% of Activity
their vaccine inventory
3.5.14 Conduct a quarterly review of 25% of providers in LHD Grantee's Suggested
jurisdiction to ensure the reported patient population matches the Activity
number of doses ordered
3.5.15 Utilize the CDC IQIP database and directly enter data to document Required
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IQIP follow-ups visits conducted at TVFC provider offices
Activity
3.6. PROVIDER ACCOUNTABILITY
3.6.01
Track, report and follow up on vaccine fraud and abuse cases
Standard
(Universal)
3.6.02
Complete program evaluation activities with TVFC and ASN
Required
providers to address issues identified as noncompliance issues
Activity
For all TVFC providers, document corrective action plans in
the CDC PEAR system as a contact
3.7. RE STAFFEDUCATION
3.7.01
Train LHD Grantee's staff to follow the policies and procedures
Required Activity
outlined in the TVFC & ASN Program Operations 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 Activity
following trainings:
- CDC Immunization Trainings;
- TVFC/ASN Annual Trainings;
- Annual Responsible Entity Training; and
- Public Health Region (PHR) Trainings
3.7.03
Ensure that the TVFC & ASN Coordinator conducts quality
Suggested Activity
assurance on 10% of the temperature recording logs that were
reviewed by their staff each quarter
3.8. RE COMPLIANCE
3.8.01
Comply with the current DSHS Immunization Contractor's
Standard
Guide for Local Health Departments and the TVFC and ASN
(Universal)
'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 transfer (Universal)
occurring
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3.8.03
Address general inquiries by providers about the TVFC/ASN
Standard
Program, and ensure timely follow-up on requests for
(Universal)
information
3.8.04
Ensure that providers within LHD Grantee's jurisdiction are
Required Activity
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
3.9. RE EMERGENCY
RESPONSE
3.9.01
Communicate the importance of an Emergency Vaccine Storage
Standard (Universal).
and Handling Plan to all clinics in 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 from
Standard (Universal)
clinics in the LHD Grantee's jurisdiction if there is a failure in
the clinic's Etnergencv Vaccine Storage and Handling Plan
3.9.03
Be prepared to pack and ship vaccine to other sites, as directed
Required Activity
by the DSHS Immunization Unit
4. EPIDEMIOLOGY & SURVEILLANCE
4.1. PERI NATAL HEPATITIS B CASE IDENTIFICATION
4.1.01
Conduct identification and case management of perinatal
hepatitis B cases
4.1.02 Determine the number of newborns that do not receive 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 Ensure timely follow-up and reporting of case status of
possible moms as reported by DSHS within 2 weeks of
receipt of report
Standard (Universal)
Required Activity
Required Activity
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4.2. PERINATAL HEPATITIS B CASE MANAGEMENT
4.2.01 Contact and provide case management to 100% of hepatitis Required Activity
B surface antigen -positive pregnant women identified, along
with their infants and contacts
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
4.4.
PERINATAL HEPATITIs B EDUCATION
4.4.01
Require Perinatal Hepatitis B Case Manager to attend the
Required Activity
biannual conference
4.4.02
Conduct educational training for hospitals, prenatal care
Required Activity
providers, pediatricians, birthing facilities, and other
healthcare providers/facilities within the Grantee's
jurisdiction, to increase identification, timely reporting, and
appropriate case management of pregnant woman with
hepatitis and their infants and contacts.
4.4.03
Work with partners, as appropriate, to ensure coordination
Standard (Universal)
of activities aimed at preventing 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 (Universal)
Disease Guidelines and current Epi Case Criteria Guide in
conducting all activities
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4.5.03
Ensure all new VPD surveillance staff attend 'Introduction Required Activity
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 Electronic Standard (Universal)
Disease Surveillance System (NEDSS) Base System
(NBS) following the NBS Data Entry Guidelines
4.5.05
Routinely review and follow up on all VPD laboratory Standard (Universal)
reports received, including electronic lab reports (ELRs)
generated through NBS in a timely fashion
4.5.06J
Verify and enter complete vaccination history in NBS on Required Activity
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 (Universal)
identifying population in need of a vaccination response
and requesting vaccination services for that population by
contacting the DSHS Vaccine -Preventable Disease (VPD)
Surveillance Team Lead
4.6. DISEASE SURVEILLANCE EDUCATION
4.6.01 Educate physicians, laboratories, hospitals, schools, child- Suggested Activity
care staff, and other health providers on VPD reporting
requirements
4.7. NEEDS ASSESSMENT
4.7.01 Conduct a community needs assessment to identify gaps Required Activity
in coverage rates or "pockets of need" for immunization
activities.
• Select an area of focus from the list of measurements
provided in the Metrix or obtain approval from
Immunization Unit epis for an alternate area of focus.
• Create an assessment plan, collect data, gather
stakeholder feedback, and analyze the information
4.7.02 Design an intervention to address the need identified in
4.7.01
Suggested 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, children,
(Universal)
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; and
- 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 involved
Activity
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 for
Required
all LHD clinics. Provide training to all staff on appropriate
Activity
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
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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
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 the
Standard
client to a medical home to complete the vaccination series
(Universal)
5.3.06
Maintain a list of current providers within the LHD's
Standard
jurisdiction who accept children on Medicaid or CHIP and
(Universal)
snake this list available to clinic clients and families as needed
5.3.07
Refer uninsured clients to Medicaid or the Children's Health
Standard
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 formulary
Standard
are available and offered to eligible adult patients
(Universal)
5.3.10
Establish "standing orders" for vaccination in LHD Grantee's
Required
clinics that are consistent with legal requirements for standing
Activity
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:
htti)s:Hwww.edc.gov/vaccines/schedules/index.htiiil
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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
lit!p://'www.dshs.texas.gov/iiiimunize/imnitrac/forms.shtm
5.3.14 Report to the Texas Immunization Registry all immunizations Standard
administered to consented children (younger than 18 years of (Universal)
age) and consented adults in LHD 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 parents
Standard
at LHD Grantee's clinics about the Texas Immunization
(Universal)
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 toW5
Required
pin, Monday through Friday, at least once per month
Activity
5.3.20
Institute infection control practices, including effective hand
Standard
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 of
Standard
eligibility for TVFC vaccines. The policy must be consistent
(Universal)
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
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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
5.4.01 Ensure that all expired and spoiled./wasted vaccines are Required Activity
appropriately identified and entered into the Electronic
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 for (Universal)
returns processing
5.5. CLINIC QUALITY ASSURANCE
5.5.01
5.5.02
Ensure that appropriate routine and emergency vaccine
storage and handling plans are in place at each of the LHD
Grantee clinic locations
Ensure that expired, wasted, and unaccounted-for vaccines
(excluding flu) do not exceed 5 percent in LHD Grantee's
clinics
5.6. CLINIC REPORTING
Required Activity
Standard
(Universal)
5.6.01 Conduct timely reporting of monthly clinic activities by Required Activity
recording vaccine inventory, doses administered,
temperature logs and other reportable activities by the 5`h of
each month as described in the TVFC/ASN Provider
Manual
5.6.02 Report all notifiable conditions as specified in the DSHS Standard (Universal)
Immunization Contractor's Guide for Local Health
Departments
5.6.03 Report all vaccine adverse events as specified in the DSHS Standard (Universal)
Immunization Contractor's Guide for Local Health
Departments
3
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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
!L 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 and
Activity
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 for all
Suggested
age groups, including adults and individuals identified as
Activity
recently moved in -state
6.2.02
Conduct at least twelve (12) outreach and educational
Required Activity
activities focused on 18-year-olds in high schools and
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 not
Required Activity
logged into the Registry in the last 90 days
6.3.02
Provide orientation to all new Texas Immunization Registry
Suggested
organizations within the LHD Grantee's jurisdiction at least
Activity
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
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6.4. TEXAS IMMUNIZATION REGISTRY USER EDUCATION
6.4.01
Provide education, training, and technical assistance to Suggested Activity
promote the effective use of the Texas Immunization
Registry by organizations
6.4.02
Identify and assist providers to establish electronic. Required
Activity
affirmation of consent
6.5. TEXAS
IMMUNIZATION REGISTRY PROINIOT1ON
6.5.01
Promote the use of the Texas lnmunization 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 registrars on
Suggested
the effective use of the Texas Immunization Registry
Activity
6.5.03
Collaborate with prenatal healthcare providers, birth registrars,
Suggested
hospital staff, pediatricians, and other entities to educate
Activity
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 IMMUM1IZATION REGISTRY PROGRAM QUALITY IMPROVEMENT
6.6.01
Review the monthly Provider Activity Report (PAR) to
Required Activity
identify organizations who are inactive or not routinely
submitting immunization data or adding consented clients.
Prioritize these organizations for outreach activities
6.6.02
Review the quarterly Consent Accepted Rate Evaluation
Required Activity
(CARE) report to target organizations with largest client
volume and/or lowest consent acceptance rate. Prioritize these
organizations for outreach activities
DSHS Contract No. HHS000109800001 Page 26 of 30
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6.6.03 Conduct a minimum of 60 Texas hmmunization Registry Required Activity
organization quality improvement assessments per FTE 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)
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..Lov/vaceiiies/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
htq):://www.edc.(-Yovi'-,,accines/pubs/Tinkbook/index.htnil
7.2.03
Provide information to community healthcare employers
Suggested
(hospitals, clinics, doctor offices, long-term care facilities) about
Activity
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
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Amendment 3
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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 are Standard
knowledgeable about vaccines and VPDs (Universal)
7.3.02
7.3.03
Develop and implement a written communications and
customer service plan for Grantee's staff to ensure customers
receive consistent, correct immunization information and
services in a courteous and friendly manner on a timely basis
Educate healthcare workers on the importance of keeping
themselves up-to-date with the vaccine schedule
7.4 COALITION BUILDING
Required Activity
xequirea Activity
7.4.01 Appoint an immunization coalition coordinator Required Activity
7.4.02 Attend and participate in required coalition trainings sponsored Required Activity
by DSHS
7.4.03
Develop and maintain a planning group with the goal of
sustaining a coalition
Suggested Activity
7.4.04
Engage and recruit community groups and immunization
Suggested Activity
stakeholders into a coalition
7.4.05
Facilitate and host coalition meetings
Suggested Activity
7.4.06
Participate in monthly calls to provide updates on coalition
Required Activity
collaboration activities
7.4.07
Provide signed letters of agreement and other documentation of
Suggested Activity
commitment to participate in coalition
7.4.08
Document communications, group meetings, and planning of
Required Activity
activities that promote the best practices identified in contract
agreement (documents are to be accessible during site visits)
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Amendment 3
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7.5 COiV MUNITI PARTNERSHIP
7.5.01
Plan and implement community education activities and
Required Activity
partnerships aimed at improving and sustaining immunization
coverage levels
7.5.02
Conduct outreach and collaborative activities with American
Required Activity
Indian tribes, if applicable
7.5.03
Participate in at least one collaborative meeting concerning
Required Activity
tribal health issues, concerns, or needs with American Indian
tribal members, if applicable
7.5.04
Coordinate educational and other activities with local Women,
Suggested Activity
Infants, and Children (WIC) programs to ensure 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 Activity
service area, including information about online and satellite -
broadcast continuing education opportunities from the CDC
Continuing Education website at
htti2s://www.edc.t_)ov/vaccines/edl'ilidex.html
7.5.06
Engage in education and partnerships aimed at reducing or
Required Activity
eliminating coverage disparities by race, ethnicity, and
socioeconomic status
7.5.07
Maintain a contact list of providers, hospitals, schools, child-
Required Activity
care facilities, social service agencies, and community groups
involved in promoting immunizations and reducing vaccine -
preventable diseases
7.5.08
Participate in special initiatives as directed by the .DSHS
Required Activity
Immunization Unit
7.5.09
Implement the DSHS Immunization Ambassador Program
Required Activity
throughout Grantee's jurisdiction
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)
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7.6.02
.. ........... bb
Host at least 1 immunization stakeholder meeting per Suggested Activity
quarter (4 per contract year)
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 by
Required Activity
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.ImniunizeTexas.com, the Immunization Unit's
Required Activity
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
4
DSFIS Contract No. HFIS000109800001 Page 30 of 30
Amendment 3
Docl,v, `
iicunao
Certificate Of Completion
Envelope Id: B06BO17784C547AIA996C36BO4CB5F55 Status: Sent
Subject: Amending $1,042,258; HHS000109800001; City of Lubbock A-3; DSHS/CMS/IMM-LOCALS
Source Envelope:
Document Pages: 40 Signatures: 0 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
3/22/2021 12:24:42 PM Commission
PCS—DocuSign@hhsc.state.tx.us
Signer Events Signature Timestamp
Daniel Pope Sent: 3/22/2021 4:10:40 PM
dpope@mylubbock.us
Mayor
City of Lubbock
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Andy Marker
Edward. Marker@hhsc.state.tx.us
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
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DocuSign Envelope ID: 806B0177-84C5-47A1-A996-C36604CB5F55
toXUALIS-0TEHealth and Human
Services
The Honorable Daniel Pope, Mayor
City of Lubbock
P.O. Box 2000
Lubbock, Texas 79401
Texas Department of State Health Services
)ohn Heuerntedt, M.D.
commisskWW
Subject: IMM/LOCALS
Contract Number: HHS000109800001, Amendment No. 3
Contract Amount: $1,042,258.00
Contract Term: 9/01/2018 — 8/31/2022
Dear Mayor Pope:
Enclosed is the IMM/LOCALS contract between the Department of State
Health Services and City of Lubbock.
The purpose of this contract is to 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).
This amendment increases the contract amount by $88,798.00 for COVID
funding and by $232,115.00 for FY 2022 and extends the end of the contract
term to August 31, 2022.
Please let me know if you have any questions or need additional information.
Sincerely,
Holly Zoerner
Contract Manager
holly. zoerner@dshs.texas. aov
COL Box 149347 - Austinjexas 78714-9347 • Fhone:.888-963.7111 • TTY: 800-735-2889 • wwwdshs.texas.gov